目的 分析学龄前儿童肥胖的影响因素及其之间的关系,为早期儿童肥胖防控提供科学依据。方法 采用病例对照研究方法,2024年3―7月在山东省济南市和潍坊市选取94名肥胖和91名正常的学龄前儿童,通过3天24小时膳食调查方法、问卷调查和佩戴加速度计的方式收集肥胖影响因素的信息。计算各食物类别的中国学龄前儿童平衡膳食指数(DBI_C),比较两组儿童在出生及早期喂养、饮食行为及膳食摄入、身体活动及睡眠情况的差异,构建多因素Logistic回归模型,进一步分析交互作用和构建中介模型。结果 多因素分析结果显示,学龄前儿童肥胖与母亲年龄(OR=1.12, 95%CI: 1.02~1.23)、母亲超重/肥胖(OR=3.71, 95%CI: 1.62~8.49)、食物响应得分(OR=2.59, 95%CI: 1.56~4.31)、食物喜好得分(OR=1.79, 95%CI: 1.10~2.91)、谷类DBI_C评分(OR=1.18, 95%CI: 1.06~1.31)和动物性食物DBI_C评分(OR=1.07, 95%CI: 1.00~1.14)呈正相关(P<0.05),与情绪性饮食减少得分(OR=0.56, 95%CI: 0.32~0.98)呈负相关(P<0.05)。未发现儿童出生及早期喂养情况、父亲年龄及父母教育水平、身体活动、睡眠情况与肥胖存在关联。母亲的年龄和体重状态与儿童饮食行为对肥胖的影响存在交互作用。在中介模型中发现,谷类和动物性食物DBI_C评分在食物响应和食物喜好与学龄前儿童肥胖之间关系中起部分中介作用。结论 除母亲因素外,儿童不良饮食行为、谷类和动物性食物摄入过量是学龄前儿童肥胖的主要可干预因素,母亲因素与不良饮食行为存在交互作用,且谷类及动物性食物摄入过量在不良饮食行为与肥胖的关联中起部分中介作用,为制定学龄前儿童肥胖干预措施提供科学依据。
Abstract
Objective To analyze the factors influencing obesity among preschool children and the relationships between these factors, so as to provide scientific evidence for the prevention and control of early childhood obesity. Methods A case-control study was conducted in Jinan and Weifang, Shandong Province from March to July 2024, involving 94 obese and 91 normal preschool children. Data on obesity risk factors were collected using a 3-day 24-hour dietary recall, questionnaires, and accelerometer monitoring.Chinese Diet Balance Index for Preschool Children(DBI_C)of each food was calculated.Differences between the two groups in terms of birth and early feeding practices, dietary behaviors and intake, physical activity, and sleep patterns were compared. Then a multivariate Logistic regression model was constructed. Interaction effects and mediation models were further analyzed. Results Multivariate analysis revealed that preschool children′s obesity was positively associated with maternal age (OR=1.12, 95%CI: 1.02 - 1.23), maternal overweight/obesity (OR=3.71, 95%CI: 1.62 - 8.49), food responsiveness score (OR=2.59, 95%CI: 1.56 - 4.31), food preference score (OR=1.79, 95%CI: 1.10 - 2.91), DBI_C scores for cereals (OR=1.18, 95%CI: 1.06 - 1.31) and animal foods (OR=1.07, 95%CI: 1.00 - 1.14),while it was negatively associated with emotional eating reduction score (OR=0.56, 95%CI: 0.32 - 0.98). Children′s birth, early feeding history, father′s age, parental education level, physical activity, or sleep was found not to be associated with obesity. There was an interaction between maternal age and weight status, and children′s dietary behaviors on their susceptibility to obesity. In the mediation model, it was found that the DBI_C scores for cereal and animal foods partially mediated the relationship between food responsiveness and obesityas well as food preference and obesity among preschool children. Conclusions Besides maternal factors, poor dietary behaviors and excessive intake of cereal and animal foods are the main modifiable factors contributing to preschool children′s obesity. Maternal factors interacted with poor dietary behaviors, and the excessive intake of cereal and animal foods partially mediates the association between poor dietary behaviors and obesity, which provides scientific evidence for the development of intervention measures for preschool children′s obesity.
关键词
平衡膳食指数 /
肥胖 /
饮食行为 /
身体活动 /
交互作用 /
中介作用 /
学龄前儿童
Key words
balanced diet index /
obesity /
dietary behavior /
physical activity /
interaction /
mediation effect /
preschool children
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基金
国家自然科学基金面上项目(82473640);北京大学医学部-潍坊市妇幼健康联合研究中心科研基金(PKUWF-Y08);中国学生营养与健康促进会-美赞臣学优营养科研基金(CASNHP-MJN2023-02)
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