Table of Content

10 August 2025, Volume 33 Issue 8

Previous Issue   

Professional Forum

Metabolism of lactose in the intestine and lactose intolerance in infants

LI Yu, WU Qingbin

2025, 33(8):  813-816.  DOI: 10.11852/zgetbjzz2025-0676

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The metabolism of lactose primarily relies on the hydrolytic action of lactase, whose activity is regulated by genetic factors and developmental stages.Lactose intolerance can be classified into four types: primary, secondary, congenital, and developmental, with diverse clinical manifestations.Diagnostic methods include hydrogen breath test, lactose tolerance test, and genetic testing, but there is currently no simple and reliable standardized diagnostic approach.Treatment strategies encompass dietary modifications, enzyme replacement therapy, and probiotic supplementation.This article summarizes the metabolic mechanisms of lactose in the intestine, as well as recent advances in the pathophysiology, diagnosis, and treatment of lactose intolerance.A deeper understanding of lactose metabolism is crucial for improving the management of lactose intolerance.

Original Articles

Correlation between serum 25-hydroxyvitamin D and intellectual development in infants of different months

YANG Qian, ZHANG Jingjie, SHI Ying, LIU Yanmin, ZHANG Yonghua

2025, 33(8):  817-822.  DOI: 10.11852/zgetbjzz2024-1318

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Objective To analyze the association between serum 25-hydroxyvitamin D [25-(OH)D] levels and intellectual development in infants, and to evaluate the potential influence of vitamin D on their intellectual development. Methods A total of 205 infants who underwent physical examination at the Lanzhou Maternal and Child Health Care Hospital from November 2023 to September 2024 were selected as the study subjects.Their general information was retrospectively described, and the 25-(OH)D levels and developmental quotients (DQ) were recorded at 3, 6, and 12 months of age.The Spearman correlation coefficient was used to analyze the correlation between 25-(OH)D levels and DQ.Multiple linear stepwise regression analysis was employed to explore the independent correlation of 25-(OH)D levels with DQ and the interaction with other factors.Restricted cubic spline curve fitting was used to analyze the dose-response relationship between 25-(OH)D levels and DQ. Results The 25-(OH)D levels of the infants at 3, 6, and 12 months of age were (29.35±10.21) ng/mL, (29.97±8.21) ng/mL, and (33.04±6.11) ng/mL, respectively.Their DQ scores were (89.72±7.03), (90.16±6.38), and (91.08±6.47), respectively.The 25-(OH)D levels at different ages showed a significant positive correlation with DQ (r＝0.496、0.474、0.437,P<0.05).Multiple linear stepwise regression analysis further confirmed that serum 25-(OH)D is a positive influencing factor for intellectual development.The restricted cubic spline curve fitting revealed a non-linear relationship between 25-(OH)D levels and DQ (P_{for overall}<0.05, P_non-linear<0.05), suggesting that the impact of vitamin D on intellectual development was more pronounced within a certain range. Conclusions The 25-(OH)D levels and intellectual development levels of infants in Lanzhou at different months of age are favorable, and there is a close relationship between the two.Therefore, changes in serum 25-(OH)D levels should be regularly monitored in clinical practice, which is important for predicting and promoting intellectual development in children.

Association of maternal childhood neglect experiences with offspring birth weight

WANG Qiwen, LIU Dan, XIONG Lu, LI Nuo, ZHANG Jinglei, GONG Yujie, ZHU Shaohua, ZHU Yuanzhong, YU Bin, YAN Hong

2025, 33(8):  823-828.  DOI: 10.11852/zgetbjzz2024-1449

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Objective To explore the relationship between maternal childhood neglect experiences and offspring birth weight, and to examine the mediating and moderating roles of prenatal depressive symptoms and family support, so as to provide a basis for reducing the incidence of adverse birth weight. Methods From September to December 2022 (and separately from April to December 2023), late-term pregnant women were recruited with the assistance of obstetricians at a county maternal and child health hospital and a municipal general hospital.Data on maternal adverse childhood experiences, prenatal family support, and offspring birth information were collected.Mediation and moderation analysis were conducted using the SPSS-PROCESS macro program. Results A total of 521 pregnant women and their offspring were included in the study.The median birth weight of newborns was 3 160.0 (2 900.0,3 410.0)g, with 5.6% classified as low birth weight and 2.7% as macrosomia.The mediation-moderation analysis revealed that depressive symptoms partially mediated the relationship between neglect and birth weight (β=-0.051, 95%CI:-0.082 to -0.023).Additionally, family support positively moderated both the effect of neglect on birth weight and the effect of depressive symptoms on birth weight (β=0.189, 95% CI:0.100 to 0.277; β=0.132, 95%CI:0.048 to 0.216). Conclusions Prenatal depressive symptoms and family support play mediating and moderating roles in the relationship between maternal childhood neglect experiences and offspring birth weight.Early identification of pregnant women with childhood neglect histories and targeted interventions addressing prenatal depression and family support may help reduce the occurrence of adverse birth weight.

Application of responsive feeding intervention on infants aged 6 - 12 months and their caregivers based on behaviour change wheel theory

WANG Xue, LI Zhihui, KONG Yan, YU Guiling

2025, 33(8):  829-834.  DOI: 10.11852/zgetbjzz2024-1373

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Objective To evaluate the effectiveness of a responsive feeding intervention program based on the Behaviour Change Wheel (BCW) theory among infants aged 6 - 12 months and their caregivers, in order to provide a reference for enriching specific implementation methods of responsive feeding interventions. Methods A convenience sampling method was used to select 70 infants and their caregivers from the child health clinic of a tertiary hospital in Qingdao between February and March 2024.Participants were sequentially assigned to either the intervention group (n=35) or the control group (n=35) based on enrollment time.The control group received routine feeding guidance from the child health clinic, while the intervention group additionally received a BCW-based responsive feeding intervention.The intervention effects were assessed using the Responsive Feeding Parent Assessment Tool (RFPAT), the Baby Eating Behaviour Questionnaire (BEBQ), and the infant BMI-for-age Z-score (BMI Z). Results Repeated measures ANOVA showed statistically significant differences between the two groups in responsive feeding behavior scores, BEBQ subscale scores (food responsiveness, food fussiness, slowness in eating, and satiety responsiveness), and infant BMI Z-scores across time points, with significant group, time, and interaction effects (P<0.05).At 3 and 6 months post-intervention, the intervention group exhibited higher responsive feeding behavior and food fussiness scores (P<0.05) but lower food responsiveness, slowness in eating, satiety responsiveness scores, and infant BMI Z-scores compared to the control group (P<0.05). Conclusion The BCW-based responsive feeding intervention can significantly improve caregivers' responsive feeding practices, reduce infant feeding behavior problems, and promote healthier physical growth in infants.

Correlation of body mass index with advanced bone age in children from Gansu

DA Zhenqiang, LI Tingting, NAN Nan, WEI Liqiong, CHEN Yiming, ZHU Ying, GAO Yang, AN Dandan, ZHANG Naqi, MA Xin, GUO Jinxian

2025, 33(8):  835-840.  DOI: 10.11852/zgetbjzz2024-1224

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Objective To investigate the correlation of advanced bone age (BA) with overweight/obesity in preschool and school-aged children from Gansu, in order to promote the nutritional intervention and health education in this region. Methods A total of 1 462 children (698 boys, 764 girls) aged 3-12 years who underwent health examinations at the Department of Child Health Care, Gansu Provincial Maternity and Child Health Care Hospital from February 2019 to October 2023 were included.Bone age was assessed using left-hand wrist radiographs, and participants were categorized into underweight, normal weight, overweight, and obese groups based on body mass index (BMI) criteria.Bone age status was analyzed across different sexes, nutritional statuses, and age groups, and the association between overweight/obesity and advanced bone age was further explored. Results In the overall study population, the proportions of underweight, overweight, and obese children were 7.11%, 8.41%, and 13.34%, respectively.The prevalence of advanced bone age and delayed bone age was 7.87% and 35.16%, respectively.Girls had a significantly higher rate of advanced bone age than boys (11.91% vs.3.44%, χ²=71.296, P<0.05).Children aged 9-12 years exhibited a significantly higher rate of advanced bone age (19.40%) compared to those aged 6-8 years (7.62%, P<0.05) and 3 - 5 years (1.01%, χ²=119.802, P<0.05).Compared to normal-weight children (5.77%), the prevalence of advanced bone age was significantly higher in overweight (17.07%) and obese children (16.92%) (χ²=99.176, P<0.05).Both overweight and obesity were identified as risk factors for advanced bone age, with odds ratios (ORs) of 2.488 (95% CI:1.435-4.314, P<0.05) and 2.330 (95% CI:1.463-3.710, P<0.001), respectively.BMI showed a significant positive correlation with bone age difference (r=0.361, P<0.001).Furthermore, the area under the curve (AUC) of BMI in predicting advanced bone age was 0.735 (95%CI:0.684-0.786, P<0.001), with an optimal cutoff value of 16.699 kg/m²(sensitivity was 0.696, specificity was 0.739, Youden index was 0.435). Conclusions Significant differences in bone age are observed among children with varying nutritional status in Gansu, with overweight and obesity strongly associated with advanced bone age.Regular bone age monitoring in overweight and obese children is recommended for early intervention to promote healthy growth and development.

Two-sample Mendelian randomization study on the association between ω-3/6 polyunsaturated fatty acids and childhood obesity

XU Yue, GAO Tongxun, HU Siyuan, LI Meifang, LUAN Yibo, XU Chenxia

2025, 33(8):  841-847.  DOI: 10.11852/zgetbjzz2024-0890

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Objective To investigate the causal relationship between ω-3/6 polyunsaturated fatty acids (PUFAs) and childhood obesity using Mendelian randomization (MR), in order to provide new insights for the health management of childhood obesity. Methods Data from genome-wide association studies (GWAS) were utilized, with seven phenotypes, including ω-3/6 PUFAs, as exposure factors and childhood obesity as the outcome factor. Two-sample MR analysis was conducted using five methods: inverse-variance weighted (IVW), MR-Egger regression, simple mode, weighted median, and weighted mode. The primary conclusions were based on the IVW method, while other methods served as references for robustness. Sensitivity analyses, including heterogeneity, horizontal pleiotropy, MR-PRESSO, leave-one-out, and Steiger tests, were also performed. Results ω-3PUFAs (OR=0.82, 95% CI: 0.71 - 0.96, P=0.012), the ratio of ω-3 PUFAs to total fatty acids (OR=0.83, 95%CI: 0.73 - 0.95, P=0.007), and docosahexaenoic acid (DHA) (OR=0.81, 95%CI: 0.69 - 0.95, P=0.011)were negatively associated with childhood obesity. In contrast, the ω-6/ω-3 PUFA ratio showed a positive association with childhood obesity (OR=1.18, 95%CI: 1.04 - 1.34, P=0.013). No significant causal relationships were observed between ω-6 PUFAs, the ratio of ω-6 PUFAs to total fatty acids, linoleic acid, and childhood obesity (P>0.05). In sensitivity analysis, all six datasets, except for linoleic acid, passed all tests, demonstrating the robustness of the results. Conclusions ω-3 PUFAs, the ratio of ω-3 PUFAs to total fatty acids, and DHA are protective factors against childhood obesity, while the ω-6/ω-3 PUFA ratio is a risk factor. Increasing ω-3 PUFA intake or balancing the intake of ω-3 and ω-6 PUFAs in the diet may help reduce the risk of childhood obesity.

Antibiotics exposure levels and influencing factors in school age children

XU Xian, XUAN Jiale, WANG Bin, LI Juan, LIU Shijian, YU Xiaodan

2025, 33(8):  848-853.  DOI: 10.11852/zgetbjzz2024-1119

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Objective To assess the exposure levels of antibiotics in the urine of school-age children, and to identify influencing factors, in order to provide evidence for the prevention and control of antibiotics exposure in children. Methods A total of 820 children aged 6 - 9 years were recruited from 8 urban and 4 suburban/rural schools in Qufu City and 6 urban and 3 suburban/rural schools in Zhongshan City between October and December 2019. Data on demographic and socioeconomic characteristics, dietary habits, and urinary antibiotic concentrations were collected. The detection of antibiotics in urine was used as the outcome, and binary logistic regression was employed to analyze influencing factors. Results The detection rates of antibiotics in the urine of the 820 school-age children were as follows: human antibiotics (HAs) 63.0%, veterinary antibiotics (VAs) 34.3%, antibiotics primarily used in humans but also shared with animals (PHAs) 46.3%, antibiotics primarily used in animals but also shared with humans (PVAs) 61.3%, combined HAs and PHAs (HAs_PHAs) 76.5%, combined VAs and PVAs (VAs_PVAs) 70.5%, and the total detection rate of 32 antibiotics was 92.9%. Univariate logistic regression revealed that older children had a lower detection rate of HAs (OR=0.744). Children from northern regions had higher detection rates of HAs, PHAs, HAs_PHAs, and total antibiotics compared to those from southern regions (OR=2.494, 6.930, 5.250, 4.757). Urban children had a higher detection rate of VAs than suburban/rural children (OR=1.703). Children with higher parental education levels had lower detection rates of PHAs and HAs_PHAs (OR=0.314, 0.627). Children from households with higher monthly incomes had lower detection rates of PHAs, HAs_PHAs, and total antibiotics (OR=0.386, 0.572, 0.400). Multivariate logistic regression analysis indicated that low fruit consumption frequency (0 - 3 times/week)was a risk factor for HAs and HAs_PHAs exposure (OR=1.384, 1.491), while high fruit consumption frequency (>8 times/week) was a risk factor for VAs exposure (OR=1.784). High poultry consumption frequency (≥4 times/week) was a risk factor for PVAs exposure (OR=1.466), and high soft drink consumption frequency (at least once a week) was a risk factor for VAs_PVAs and total antibiotic exposure (OR=1.394, 1.816). Conclusions School-age children in Zhongshan City, Guangdong Province, and Qufu City, Shandong Province, are widely exposed to antibiotics. Factors such as age, household monthly income, parental education level, urban-rural differences, north-south regional differences, and specific dietary habits influence antibiotic exposure in this population.

Two-sample Mendelian randomization study on the association of gut microbiota and metabolic pathways with short stature

WANG Wen, WANG Zhe, JIANG Xiulei, JIANG Yanlin, HU Yinghua, WANG Mingyue, MU Chunsun, WANG Chunxiang

2025, 33(8):  854-859.  DOI: 10.11852/zgetbjzz2024-0323

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Objective To explore the causal correlation of gut microbiota and their metabolic pathways with short stature using a two-sample Mendelian randomization (MR) approach. Methods Genome-wide association study (GWAS) summary data on gut microbiota from the Dutch Microbiome Project (DMP) and FINRISK 2002 (FR02), as well as genetic data on height from the GIANT Consortium, were utilized. The inverse variance weighted (IVW) method, MR Egger regression, weighted median (WME), simple mode, and weighted mode were employed to investigate the causal relationship between gut microbiota, metabolic pathways, and short stature, with the IVW method serving as the primary approach. Sensitivity analysis, heterogeneity testing, pleiotropy testing, and outlier detection were conducted to validate the stability and reliability of the results. Results The IVW results indicated a causal relationship between five gut microbial taxa, three metabolic pathways, and short stature. Specifically, Bacillales (OR=1.24, 95%CI: 1.11 - 1.38, P_FDR=0.007), GCA-900066755 (OR=1.06, 95%CI: 1.03 - 1.09, P_FDR<0.001), "pyruvate fermentation to acetate and lactate II" (OR=1.04, 95%CI: 1.02 - 1.06, P_FDR<0.001), and "urate biosynthesis/inosine 5'-phosphate degradation" (OR=1.05, 95%CI: 1.02 - 1.08, P_FDR=0.042) were positively associated with height. Conversely, Clostridium E sporosphaeroides (OR=0.93, 95%CI: 0.89 - 0.97, P_FDR=0.023), Escherichia flexneri (OR=0.88, 95%CI: 0.84 - 0.93, P_FDR<0.001), GCA-900199385 sp900320755 (OR=0.96, 95%CI: 0.94 - 0.98, P_FDR<0.001), and "heme B biosynthesis from glutamate" (OR=0.97, 95%CI: 0.96 - 0.98, P_FDR<0.001) were negatively associated with height. No significant pleiotropy or heterogeneity was detected among the instrumental variables (IVs). Conclusions There is a clear causal relationship between gut microbiota, related metabolic pathways, and short stature. The specific biological mechanisms require further investigation, and the identified targets may provide valuable insights for future research.

Development and evaluation of the Family Infant and Toddler Care Quality Assessment Scale

QIN Chengjie, CHEN Yue, YANG Liu, WU Huimin, JIN Shengxian, LIANG Yan, REN yan

2025, 33(8):  860-865.  DOI: 10.11852/zgetbjzz2025-0101

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Objective To develop a culturally appropriate, standardized, and comprehensive assessment tool for evaluating the quality of family-based infant and toddler care (0 - 3 years) in China, and to examine its reliability and validity, in order to provide a scientific foundation for research on family care quality assessment tools. Methods Based on the nurturing care framework and the Guidelines for Healthy Nurturing Care of Children Under 3 Years of Age, an initial assessment tool was constructed through literature review, expert consensus, and consideration of infant and toddler developmental characteristics.The tool was refined through pilot surveys, expert discussions, and internal group revisions.Reliability was assessed using internal consistency, test-retest reliability, and split-half reliability.Validity was examined through content validity and construct validity. Results The final scale consisted of 54 items across five dimensions: safety care, health care, nutrition care, responsive care, and early learning.The questionnaire demonstrated strong reliability, with a Cronbach's α coefficient of 0.931, split-half reliability of 0.848, and test-retest reliability of 0.613.All item factor loadings were >0.4, correlations between subscales and the total scale ranged from 0.604 to 0.751, and inter-subscale correlations mostly fell between 0.501 and 0.715 (all P<0.05).Construct validity indices indicated a good model fit (χ²/df=4.584, CFI=0.901, GFI=0.912, AGFI=0.901, IFI=0.901, RMSEA=0.035). Conclusion The family infant and toddler nurturing care scale developed in this study exhibits good reliability and validity and is suitable for assessing the quality of family-based nurturing care of infants and toddlers.

Original Articles

Status of health literacy among urban adolescents in the Beijing-Tianjin-Hebei region and its association with dietary behaviors

ZHAO Huiru, SONG Lulu, ZHANG Jianfeng

2025, 33(8):  866-870.  DOI: 10.11852/zgetbjzz2025-0007

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Objective To investigate the status of health literacy among urban adolescents in the Beijing-Tianjin-Hebei (BTH) region and its association with dietary behaviors, in order to provide reference for dietary education and interventions targeting adolescents in this region. Methods A stratified cluster sampling method was used to survey 6 484 middle school students in the BTH region from April to May 2023, assessing their health literacy and dietary behaviors.Chi-square tests and logistic regression analyses were employed to examine the association between health literacy and dietary behaviors. Results The proportions of urban adolescents in the Beijing-Tianjin-Hebei region with low, moderate and high health literacy levels were 24.86%, 56.92% and 18.21%, respectively, and the difference was statistically significant (χ²=2 500.332, P<0.01).The proportions of adolescents with irregular breakfast consumption, irregular meal patterns, insufficient intake of fruits and vegetables, inadequate dairy consumption, and frequent sugary drink consumption were 36.26%, 62.49%, 19.65%, 50.57%, and 54.84%, respectively.logistic regression analysis revealed that, compared to those with high health literacy, adolescents with low health literacy were more likely to exhibit poor dietary behaviors, including irregular breakfast consumption (OR=1.24), irregular meal patterns (OR=1.36), insufficient fruit and vegetable intake (OR=1.46), inadequate dairy consumption (OR=1.28), and frequent sugary drink consumption (OR=1.41) (P<0.05). Conclusions Urban adolescents in the BTH region generally have moderate health literacy, which is negatively associated with unhealthy dietary behaviors.Improving health literacy may help reduce the prevalence of poor dietary habits, thereby promoting balanced nutrition and healthy development among adolescents.

Review

Application of family interventions in the management of non-organic feeding difficulties in children

ZHU Yingying, ZHANG Zihao, ZHU Jiayuan, YU Jinzhi, DING Chenli, HUANG Zheng

2025, 33(8):  871-877.  DOI: 10.11852/zgetbjzz2025-0212

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Objective To conduct a scoping review on the application of family interventions in managing children's non-organic feeding difficulties, identify key intervention components, and summarize their effectiveness, so as to provide certain insights and directions for clinical practice and research. Methods Following the scoping review framework, a systematic search was performed across PubMed, Web of Science, Scopus, Embase, Cochrane Library, CINAHL, CNKI, VIP Database, Wanfang Database, and CBM from inception to January 2025.Literature was screened, summarized, extracted, and analyzed based on inclusion and exclusion criteria. Results Eleven studies were included.Family interventions primarily encompassed nutritional education, behavioral modification techniques, psychological support, and mealtime hygiene practices, with durations ranging from 2 weeks to 12 months.Key outcome measures included growth and development, eating behaviors, feeding practices, psychological well-being, and feasibility assessments.The findings indicated that family interventions improved children's dietary behaviors, promoted growth, optimized parental feeding strategies, enhanced caregivers' self-efficacy, and strengthened parent-child interactions.However, heterogeneity was observed in evaluation tools and intervention durations, highlighting the lack of standardized protocols. Conclusions Family-centered interventions demonstrate feasibility and positive effects in managing non-organic feeding difficulties in children.Future efforts should focus on developing standardized intervention systems through multidisciplinary collaboration, incorporating personalized adjustments, and establishing a culturally adapted three-dimensional evaluation model—"objective measures as the core, subjective feedback as supplementary, and biochemical markers for validation"—to enhance intervention precision and efficacy.

Advances in exercise intervention for pediatric obesity

WANG Yeyan, WANG Jinggang, GAO Li, ZHENG Haoxuan, CHEN Yongqiang, CAO Jianguo

2025, 33(8):  878-882.  DOI: 10.11852/zgetbjzz2024-1396

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In recent years, the incidence of childhood obesity has been rising annually, becoming a major public health concern.This condition has numerous adverse effects on children's physical and mental health.Physiologically, it can increase the burden on bones and joints and lead to metabolic disorders; psychologically, it often triggers emotional issues such as low self-esteem and anxiety.Additionally, childhood obesity significantly raises the risk of developing chronic diseases in adulthood, including cardiovascular diseases, diabetes, and hypertension.From the perspective of rehabilitation training, this review comprehensively covers key areas such as exercise assessment, exercise prescription formulation, exercise method selection, precautions, and the treatment of complications.It elaborates in detail on the correct exercise intervention strategies for childhood obesity.The aim is to enhance healthcare professionals' understanding of exercise therapy for childhood obesity, optimize clinical treatment plans, improve therapeutic effectiveness and precision, and provide scientifically sound guidance for the prevention and management of childhood obesity.

Advances in potential mechanisms of non-invasive electrical vagus nerve stimulation in the treatment of attention-deficit/hyperactivity disorder

XU He, ZHI Jincao, CHANG Qing, WANG Yan

2025, 33(8):  883-887.  DOI: 10.11852/zgetbjzz2024-0605

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The vagus nerve (VN) originates from the brainstem, serving as a bidirectional communication bridge between the brain and the body, and is widely distributed throughout the central and peripheral nervous systems. Noninvasive vagus nerve stimulation (nVNS) is a neuromodulation technique with active regulatory functions that has been applied in the treatment of various diseases in recent years, demonstrating significant effects in conditions such as depression and epilepsy. However, there have been relatively few studies on its use in the treatment of attention deficit hyperactivity disorder (ADHD). By summarizing the pathogenesis of ADHD and the mechanism of nVNS, this article identifies associations between the two in terms of neurotransmitters, inflammation, apoptosis, and other aspects, and explore the potential mechanisms that exist between them, so as to provide a theoretical foundation for nVNS treatment of ADHD.

Clinical Research

Assessment of physical activity level in children with Kawasaki disease during early recovery stage

WANG Congying, ZHANG Mengnan, CHENG Tong, ZHANG Mingming, WANG Hongmao, ZHANG Ting, GUAN Hongyan, LI Xiaohui

2025, 33(8):  888-892.  DOI: 10.11852/zgetbjzz2024-1172

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Objective To assess the physical activity (PA) levels in preschool children with Kawasaki disease (KD) during the early stages of the illness,in order to provide reference for making individualized exercise prescriptions. Methods Children hospitalized at the Children's Hospital of Capital Institute of Pediatrics between December 2023 and March 2024 were selected as the KD group. Healthy children matched by gender and age in a 1∶3 ratio served as the control group. The Preschooler Physical Activity Questionnaire (P-PAQ) was used to evaluate the PA levels of the KD group one month after the onset of the disease, focusing on their physical activity over the past week. The clinical data of KD patients were collected through the electronic medical system, including gender, age, height, weight, treatment, laboratory indicators (blood routine, C-reactive protein) and ultrasound results of coronary arteries. Results A total of 112 children were included in the study, comprising 28 KD patients and 84 healthy controls. One month after the onset of KD, the total out-of-school activity time was 99.36 (56.79, 130.18) minutes per day, the outdoor activity time was 12.86 (10.71, 14.29) minutes per day, and the moderate-to-vigorous physical activity (MVPA) time was 26.25 (7.50, 53.32) minutes per day. Compared to the healthy control group, the KD group showed significantly reduced total out-of-school activity time, outdoor activity time, and MVPA time (Z=5.491, 5.072, 3.726, P<0.01). All KD patients were followed up one month after the onset of the disease, and no coronary artery complications or adverse cardiovascular events were observed. Conclusions Preschool children with KD without coronary artery complications exhibit low levels of physical activity during the early stage of the disease. Actively exploring individualized exercise prescriptions based on evidence-based medicine during the recovery phase holds significant clinical importance.

Vitamin D insufficiency and deficiency in children and adolescents with different caregivers in Hainan Province

WANG Chen, WU Weijia, HUANG Chuican, LUO Qing, ZAHNG Chunhui, WANG Ping, WU Shaojing, FAN lichun

2025, 33(8):  893-896.  DOI: 10.11852/zgetbjzz2024-0480

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Objective To analyze the impact of different primary caregivers on vitamin D insufficiency in children aged 0-18 years, and to provide a basis for family-based prevention and control of vitamin D insufficiency in children and adolescents. Methods A total of 12 630 children and adolescents aged 0 - 18 years from 18 regions in Hainan Province were selected as the study population between January 2021 and March 2022. Investigators used a self-designed questionnaire to collect information on caregivers' age, family type, occupation, and educational level. Fasting venous blood samples were collected from the children, and vitamin D levels were measured using electrochemiluminescence immunoassay. Chi-square tests and Fisher's exact tests were used for univariate analysis, and logistic regression was employed for multivariate analysis. Results The detection rate of vitamin D insufficiency and deficiency among children and adolescents aged 0 - 18 years in Hainan Province was 23.42% (2 958/12 630). Significant differences in vitamin D levels were observed based on the child's gender (χ²=215.284),age (χ²=1 484.55), resident area (χ²=180.202), primary caregiver (χ²=229.889), parental occupation (χ²=53.638,51.606), and educational level (χ²=87.965,91.826)and daily outdoor physical activity (χ²=71.844)(P<0.001). After adjusting for confounding factors, multivariate logistic regression analysis revealed thatchildren with grandparents as main caregivers had a higher risk for vitamin D insufficiency and deficiency in children (OR=1.225, 95%CI: 1.009 - 1.487, P<0.05). Conclusions Different primary caregivers have a significant impact on vitamin D levels in children and adolescents. Greater attention should be paid to the family environment to reduce the occurrence of vitamin D insufficiency and deficiency in this population.

Malnutrition ofchildren under 5 years old in the nutrition package used areas of Heilongjiang Province

PAN Xingyue, SUN Yuhua, ZHANG Saisai, SONG Yang, YU Miao, WANG Huiying

2025, 33(8):  897-901.  DOI: 10.11852/zgetbjzz2024-0796

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Objective To analyze the malnutrition status of children under 5 years old in areas covered by the nutrition package program in Heilongjiang Province, so as to provide a scientific basis for further improving child nutrition interventions. Methods The implementation of the program in Heilongjiang Province from 2019 to 2023 was statistically analyzed. Changes and differences in growth and development indicators of children under 5 years old were compared between 34 program counties and 33 non-program counties using statistical tests. Results From 2019 to 2023, the distribution rate (χ²=15 970.500) and effective consumption rate (χ²=1 888.000) of nutrition packages showed an upward trend (P<0.05). In program counties, the rates of underweight, stunting, wasting, overweight, obesity, anemia, and moderate-to-severe anemia among children under 5 years old all demonstrated a declining trend (P<0.05). The average annual reduction rates for these indicators in program counties were -22.1%, -19.7%, -13.6%, -14.8%, -18.8%, -24.7%, and -27.8%, respectively, which were 1.3, 1.3, 1.5, 2.4, 20.9, 1.6, and 0.8 times as high as those of non-program counties. In 2023, the rates of stunting (χ²=871.205), wasting (χ²=884.040), overweight (χ²=6,418.899), and obesity (χ²=3 173.702) in program counties were significantly lower than those in non-program counties (P<0.05). Conclusion The growth and development status of children under 5 years old in areas covered by the nutrition package program in Heilongjiang Province has significantly improved. It is recommended to continue and effectively implement nutrition improvement programs.

Correlation of caregivers' nutrition knowledge, attitudes, and practices with childhood malnutrition among preschool children in rural poverty-alleviated areas of Sichuan Province

CHEN Shiqi, ZHANG Piao, LIANG Xuemei, LUO Liwei, ZHANG Jiawen, YE Yujiao, ZHAO Ziling, LUO Min, ZHU Rui, LIU Weixin

2025, 33(8):  902-906.  DOI: 10.11852/zgetbjzz2024-0313

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Objective To investigate the nutritional status of preschool children in rural poverty-alleviated areas of Sichuan Province, and to explore its correlation with caregivers' nutrition knowledge, attitudes, and practices(KAP). Methods Data from the "Nutrition Improvement Pilot Project for Preschool Children in Sichuan" by the United Nations World Food Programme(WFP) were utilized. From December 2021 to May 2022, a baseline survey was conducted among 180 preschool children and their caregivers from Wangcang County, a poverty-alleviated area in Sichuan Province. The 2006 World Health Organization(WHO) growth and development evaluation criteria were used for assessment. Statistical analysis were performed using t-tests, χ² tests, Pearson correlation analysis, logistic regression analysis, and other methods. Results The prevalence of protein-energy malnutrition among the surveyed children was 20.0%(36/180), with rates of stunting, underweight, and wasting being 15.0%(27/180), 7.8%(14/180) and 4.4%(8/180), respectively. The caregivers scored low on nutrition knowledge, with an average score of 8.95±3.01 and a passing rate of 29.4%(53/180). They scored higher on nutrition attitudes, with an average score of 26.80±4.67, and scored moderately on nutrition practices, with an average score of 5.14±1.36. There was a negative correlation between caregivers' nutrition practice scores and the detection rate of protein-energy malnutrition in children(OR=0.72, 95%CI: 0.53 - 0.97). Conclusions The prevalence of protein-energy malnutrition is high among preschool children in poverty-alleviated areas of Sichuan Province, and their caregivers have low levels of nutrition knowledge. Improving caregivers' nutrition practices can reduce the risk of malnutrition in children. Nutrition and health education tailored to the characteristics of local caregivers is needed to guide and improve their nutrition practices and enhance the nutritional status of preschool children.

Influencing factors for the severity of comorbid intellectual disability in children with cerebral palsy

LIU Yuanyuan, GONG Chao, LIU Juan, LIU Jiahao, LI Jiawei, FANG Liya, LIAN Beibei, ZENG Pei, GUO Jin

2025, 33(8):  907-912.  DOI: 10.11852/zgetbjzz2024-1510

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Objective To analyze the risk factors for comorbid intellectual disability (ID) and its severity in children with cerebral palsy (CP), so as to provide evidence for early clinical intervention and personalized treatment plans. Methods A retrospective study was conducted on 392 children with CP (aged 1 - 16 years, 270 males and 122 females) hospitalized at the Third Affiliated Hospital of Jiamusi University from January 2015 to November 2024.Clinical data and assessment results from the Gesell Developmental Scale (GDS), Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition (WPPSI-IV)/Wechsler Intelligence Scale for Children-Chinese Fourth Edition (WISC-IV), and Gross Motor Function Classification System (GMFCS) were retrospectively collected.Intellectual function was categorized as normal, mild, moderate, or severe based on developmental quotient (DQ)/intelligence quotient (IQ).χ²test was used for univariate analysis to compare intergroup differences and identify significant factors, followed by ordinal logistic regression to determine risk factors influencing ID severity in CP children. Results Univariate analysis revealed significant differences among the four groups in the proportions of preterm birth history (χ²=6.476), hyperbilirubinemia history (χ²=17.248), GMFCS level IV-V (χ²=117.291), spastic quadriplegia (χ²=32.023), and maternal medication use during pregnancy (χ²=36.695) (all P<0.05).Ordinal logistic regression identified hyperbilirubinemia history (OR=2.465, 95% CI: 1.619 - 3.747), preterm birth history (OR=1.478, 95% CI: 1.002 - 2.181), and GMFCS level Ⅳ-Ⅴ (OR=10.166, 95% CI: 6.166 - 16.743) as independent risk factors for increased ID severity in CP children (P<0.05). Conclusions Hyperbilirubinemia history, preterm birth, and severe motor impairment (GMFCS Ⅳ-Ⅴ) exacerbate intellectual disability in children with CP.Strengthened monitoring of high-risk factors, regular assessments, early intervention, and tailored rehabilitation programs are recommended to promote optimal neurodevelopmental outcomes.

Epidemiological investigation on iron deficiency and anemia among preschool children in Shaanxi Province

REN Jiaojiao, LONG Lei, YU Lili, GUO Yongli, LI Xiao, YAN Ping, WANG Zhaohui

2025, 33(8):  913-918.  DOI: 10.11852/zgetbjzz2024-0835

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Objective To investigate the current prevalence rates of iron deficiency (ID), iron deficiency anemia (IDA), and anemia among preschool children in Shaanxi Province. Methods A cross-sectional survey was conducted in Shaanxi Province using stratified sampling to select 15 streets or towns from 5 cities as survey sites.From June 2022 to April 2023, 2 160 children were surveyed and grouped by age into the infants group (0.5 - <1 year), toddlers group (1 - 3 years), and preschool group (3 - 7 years).Questionnaires were used to collect basic information about the children's birth and family conditions, while peripheral blood samples were collected for routine blood tests and serum ferritin measurements.The prevalence rates of ID, IDA, and anemia were statistically analyzed using the χ² test and binary logistic regression was used to explore differences and risk factors associated with these conditions. Results A total of 2 156 valid surveys were completed, including 1 075 boys and 1 081 girls, with 310 in the infant group, 612 in the toddler group, and 1 234 in the preschool group.The prevalence rates of ID, IDA, and anemia among preschool children in Shaanxi Province were 21.8%, 3.4%, and 10.9%, respectively.Among the regions, the prevalence rates in the Guanzhong area (26.9%, 5.2%, 16.6%) were significantly higher than those in northern Shaanxi (15.6%, 1.2%, 1.9%) and southern Shaanxi (13.2%, 0.4%, 3.5%).The infant group (28.7%, 5.5%, 16.8%) had higher rates than the toddler (22.5%, 3.8%, 9.8%) and preschool groups (19.7%, 2.7%, 10.0%).Rural counties (23.0%, 4.1%, 14.4%) had higher rates than urban districts (19.9%, 2.3%, 5.7%).Risk factors for ID, IDA, and anemia included residing in the Guanzhong region (OR=3.150, 17.274, 8.244, P<0.05) and maternal anemia during pregnancy (OR=1.462, 10.013, 3.764, P<0.05).Protective factors for all three conditions included regular health checkups according to national guidelines (OR=0.570, 0.434, 0.455, P<0.05). Conclusions The prevalence rates of ID, IDA, and anemia among preschool children in Shaanxi Province,have improred significantly. However, attention should still be paid to the prevention and treatment of anemia in Guanzhong area, rural areas, and infants.

Influencing factors of ametropia in preschool children in Xiangcheng District, Suzhou

ZHANG Hongbo, WEI Hui, YU Jiajia, ZHANG Xu, GENG Xiaojiao

2025, 33(8):  919-923.  DOI: 10.11852/zgetbjzz2024-1077

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Objective To analyze the current status of refractive errors among preschool children in Xiangcheng District, Suzhou City, and to identify influencing factors, in order to provide a reference for the development of preventive and control measures for refractive errors in children. Methods A cluster sampling method was employed to select 11 698 children aged 4 - 6 years from 63 kindergartens across 10 towns and streets in Xiangcheng District, Suzhou City in June 2023.These children underwent refractive error screening and completed questionnaires.Chi-square tests and binary logistic regression analysis were used to examine the factors influencing refractive errors. Results The detection rate of refractive errors among preschool children was 11.82% (1 310/11 804).Risk factors for refractive errors included being in the middle class (OR=1.205), maternal passive smoking during pregnancy (OR=1.344), preterm birth (OR=1.434), post-term birth (OR=1.491), history of eye diseases in children (OR=1.762), watching TV at a distance less than five times the diagonal length of the screen (OR=1.287), occasionally reading or writing in dim light (OR=1.173), and occasionally or frequently staying up late (OR=1.166, 1.417) (P<0.05).Protective factors included sleeping more than 12 hours per day (OR=0.313) and higher paternal education levels (college: OR=0.716; undergraduate: OR=0.772; master's degree or above: OR=0.647) (P<0.05). Conclusions The risk of refractive errors among preschool children is relatively high.Regular vision screenings should be conducted, and attention should be paid to maternal health during pregnancy.Efforts should be made to control and reduce preventable eye diseases in children, promote healthy eye use and sleep habits, and implement early detection and intervention to support the healthy development of children's vision.

Appropriate Technology

Clinical applicability of artificial intelligence bone age assessment model in children and adolescents

LI Shaowei, HE Jinshui, HAN Meimin, LIU Bowen, ZHANG Dongxu

2025, 33(8):  924-928.  DOI: 10.11852/zgetbjzz2024-0806

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Objective To explore the clinical applicability of a self-developed artificial intelligence bone age assessment model based on a North American dataset for children and adolescents. Methods Based on the Greulich-Pyle (G-P) bone age assessment method, a deep learning-based artificial intelligence bone age assessment model (AIBAA-GP) was constructed using 14 236 left-hand wrist DR images from the 2017 Radiological Society of North America (RSNA) public bone age dataset. Retrospective collection of imaging data from children who underwent left-hand wrist DR imaging at Xiamen Huli District Maternal and Child Health Hospital between September 2018 and September 2022, due to parental requests for bone age assessment, was conducted. A total of 1 709 eligible images were selected, including 867 images of boys and 842 images of girls. The AIBAA-GP model was used to assess bone age. The assessed bone age results were compared with chronological age, and the model's performance across different age groups was evaluated. Results The assessment results of AIBAA-GP model on the 1709 DR images showed statistically significant differences between bone age and chronological age (P<0.05) for boys aged 4, 5, 6, and 7 years and girls aged 3, 4, and 5 years, with mean differences within 1.6 years. By adjusting the mean differences between bone age and chronological age for each age group, the bone age assessment values for the aforementioned groups could be adjusted by -1.16, -1.14, -1.35, -1.29 years for boys and 1.59, -1.52, -1.06 years for girls, respectively. Chronological age was significantly correlated with computer-predicted bone age for boys (r=0.952) and girls (r=0.885). Conclusions The AIBAA-GP algorithm model, based on a North American population dataset, is applicable to a small portion of age groups in Chinese children and adolescents. However, adjustments are required for most age groups before it can be applied in clinical auxiliary diagnosis.