目的 分析婴幼儿食欲特征(食物接触、食物回避)在照护者积极喂养行为(鼓励健康膳食、监督、自主支持)与婴幼儿体重指数(BMI)间的中介作用,以及婴幼儿气质在前半路径中的调节作用,为制定改善婴幼儿食欲特征和BMI状况的干预策略提供参考。方法 2021年5月采用综合性喂养实践问卷、婴幼儿喂养行为问卷、喂养策略问卷、婴儿和儿童饮食行为问卷、婴儿和幼儿行为问卷对青岛市某三甲医院儿童保健科322名婴幼儿照护者进行调查。结果 仅有食物接触、自主支持、婴幼儿BMI两两变量相关,即食物接触与自主支持呈负相关(r=-0.769, P<0.01),与婴幼儿BMI呈正相关(r=0.680, P<0.01),自主支持与婴幼儿BMI呈负相关(r=-0.548, P<0.01)。自主支持直接预测婴幼儿BMI的效应不显著(β=-0.082, P>0.05),主要经食物接触间接预测婴幼儿BMI,中介效应值为-0.412。在婴幼儿不同气质类型中,仅有努力控制在自主支持与食物接触间发挥调节作用(△R2=0.031, P<0.01),即自主支持对食物接触的影响在努力控制水平高的个体相对努力控制水平低者要小。结论 食物接触在自主支持与婴幼儿BMI间发挥完全中介作用,努力控制在自主支持与食物接触间发挥调节作用。若要改善婴幼儿BMI状况,应从培养婴幼儿良好的食欲特征入手,医护人员应结合婴幼儿努力控制水平为照护者提供喂养行为指导,改善婴幼儿食欲特征和BMI状况。
Abstract
Objective To explore the mediating effect of infants and young children's appetite traits (food approach, food avoidance) between caregivers' positive feeding behavior (encouraging healthy diet, monitoring and autonomy support) and body mass index(BMI) of infants and young children, as well as the moderating effect of infants and young children's temperament in the first of the pathway, and to provide reference for the development of intervention strategies to improve appetite characteristics and BMI of infants. Method A total of 322 caregivers were selected from the Child Health Care Department of a grade A tertiary hospital in Qingdao city in May 2021, and were surveyed by Comprehensive Feeding Practice Questionnaire, Infants and Young Children's Feeding Behavior Questionnaire, Feeding Strategy Questionnaire, Baby Eating Behavior Questionnaire, Children's Eating Behavior Questionnaire, Infant Behavior Questionnaire and Children's Behavior Questionnaire. Results Only the correlations of food approach, autonomy support and infant and young children's BMI were significant. Detailed, food approach was negatively correlated with autonomy support(r=-0.769, P<0.01), positively correlated with infant and young children's BMI(r=0.680, P<0.01), and autonomy support was negatively correlated with infant and young children's BMI(r=-0.548, P<0.01). The direct effect of autonomy support on infant and young children's BMI was not significant (β=-0.082, P>0.05), but the indirect effect of autonomy support on infant and young children's BMI was -0.416 mainly through food approach. Among the different temperament types of infants and young children, only effortful control moderated the relationship between autonomy support and food approach (△R2=0.031,P<0.01). Specifically, compared with individual with low effortful control, the influence of autonomy support on food approach was less in those with high effortful control autonomy support. Conclusions Food approach plays a complete mediating role between autonomy support and BMI of infants and young children, and effort control plays a moderating role in the relationship between autonomy support and food approach. Therefore, in order to improve BMI of infants and young children, appetite traits of infants and young children should be cultivated at beginning. Medical staff are suggested to provide feeding behavior guidance for caregivers based on effortful control level of infants and young children to improve the appetite traits and BMI of infants and young children.
关键词
婴幼儿 /
积极喂养行为 /
食欲特征 /
气质 /
体质指数
Key words
infants and young children /
positive feeding behavior /
appetite traits /
temperament /
body mass index
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参考文献
[1] 心洁, 壹图.《中国居民营养与慢性病状况报告(2020年)》国务院新闻办公室2020年12月23日新闻发布会(摘要)[J]. 中老年保健, 2021,36(2):14-21.
[2] Bell KA, Wagner CL, Feldman HA, et al. Associations of infant feeding with trajectories of body composition and growth[J]. Am J Clin Nutr, 2017,106(2):491-498.
[3] Abdella HM, Broom DR, Hadden DA, et al. Eatingbehaviours and food cravings; influence of age, sex, BMI and FTO genotype[J]. Nutrients, 2019,11(2):377-393.
[4] Zhou Z, Liew J, Yeh YC, et al. Appetitive traits and weight in children:Evidence for parents' controlling feeding practices as mediating mechanisms[J]. J Genet Psychol, 2020,181(1):1-13.
[5] Liew J, Zhou Z, Perez M, et al. Parentalchild-feeding in the context of child temperament and appetitive traits:Evidence for a biopsychosocial process model of appetite self-regulation and weight status[J]. Nutrients, 2020,12(11):3353.
[6] Russell CG, Russell A. Biological and psychosocial processes in the development of children's appetitive traits:Insights from developmental theory and research[J]. Nutrients, 2018,10(6):692.
[7] Taylor MB, Emley E, Pratt M, et al. Structure-based feeding strategies:A key component of child nutrition[J]. Appetite, 2017,114:47-54.
[8] Ruggiero CF, Hohman EE, Birch LL, et al. INSIGHT responsive parenting intervention effects on child appetite and maternal feeding practices through age 3 years[J]. Appetite, 2021,159:105060.
[9] Russell CG, Worsley A, Campbell KJ. Strategies used by parents to influence their children's food preferences[J]. Appetite, 2015,90:123-130.
[10] Rollins BY, Loken E, Savage JS, et al. Maternal controlling feeding practices and girls' inhibitory control interact to predict changes in BMI and eating in the absence of hunger from 5 to 7 y[J]. Am J Clin Nutr, 2014,99(2):249-257.
[11] De Onis M, Garza C, Onyango AW, et al. WHO growth standards for infants and young children[J]. Arch Pediatr, 2009,16(1):47-53.
[12] Musher-Eizenman DR, de Lauzon-Guillain B, Holub SC, et al. Child and parent characteristics related to parental feeding practices:Across-cultural examination in the US and France[J]. Appetite, 2009,52:89-95.
[13] 谢丽惠,陈藜,张延峰.婴幼儿饮食行为及家长喂养方式量表的研究现状[J].中国妇幼保健, 2016,31(19):4089-4093.
[14] Berlin KS, Davies WH, Silverman AH, et al. Assessing family-based feeding strategies, strengths, and mealtime structure with the Feeding Strategies Questionnaire[J]. J Pediatr Psychol, 2011,36(5):586-595.
[15] Zhang H, Yang X, Xu T, et al. Preliminary evaluation of the Chinese version of the Baby Eating Behaviour Questionnaire[J]. Child Care Health Dev, 2021,47(5):627-634.
[16] 薛琨.儿童肥胖与食欲及其影响因素研究[D].上海:复旦大学,2012.
[17] Putnam SP. Cultural influences on temperament development:Findings from the Global Temperament Project[C]. Biennial Meeting of the Society for Research in Child Development, 2019.
[18] McNally J, Hugh-Jones S, Caton S, et al. Communicating hunger and satiation in the first 2 years of life:A systematic review[J]. Matern Child Nutr, 2016,12(2):205-228.
[19] 熊祯,张传杰,王仕琼,等.儿童饮食行为问题与家庭饮食环境的相关性研究[J].中国儿童保健杂志,2017,25(12):1259-1262.
[20] 谢小敏,梁亚红,冯蓓,等. 240名学龄前儿童饮食行为现状及影响因素分析[J].护理学报, 2020,27(9):33-37.
[21] 刘薇,何首杰,杨银梅,等.出生因素和早期喂养方式对6~23月龄婴幼儿超重肥胖的影响[J]. 中国儿童保健杂志, 2018,26(2):215-217.
[22] 陈敏,康淑蓉,李云.基于广义估计方程分析婴幼儿超重肥胖的影响因素[J]. 上海预防医学, 2020,32(12):1029-1034.
[23] Di Pasquale R, Rivolta A. A conceptual analysis of food parenting practices in the light of self-determination theory:Relatedness-enhancing, competence-enhancing and autonomy-enhancing food parenting practices[J]. Front Psychol, 2018,9:2373.
[24] 王健,伍茹星,程旭文,等.气质对学龄前儿童家长喂养行为与其子女挑食关系的调节作用[J]. 中国儿童保健杂志, 2021,29(6):600-604.
[25] Russell CG, Worsley T. Associations between appetitive traits and food preferences in preschool children[J]. Food Qual Prefer, 2016,52:172-178.
[26] Fuglestad AJ, Demerath EW, Finsaas MC, et al. Maternal executive function,infant feeding responsiveness and infant growth during the first 3 months[J]. Pediatr Obes, 2017,12(Suppl 1):102-110.
[27] Lin B, Liew J, Perez M. Measurement of self-regulation in early childhood:Relations between laboratory and performance-based measures of effortful control and executive functioning[J]. Early Child Res Q, 2019,47:1-8.
[28] van den Heuvel M, Chen Y, Abdullah K, et al. The concurrent and longitudinal associations of temperament and nutritional risk factors in early childhood[J]. Pediatr Obes, 2017,12(6):431-438.