上海市3城区1～6岁儿童饮食行为问题交互式干预的随机对照研究

Randomized controlled trial of intervention effects on 1 to 6 years age children with dietary behavior problems from 3 urban districts of Shanghai

目的对存在不良饮食行为问题儿童行交互式干预,观察饮食行为的改善情况。方法选择上海市3个城区(长宁区、卢湾区和虹口区)1～6岁常住户籍儿童。编制《上海市儿童饮食行为调查和干预随访问卷》基线版和随访版,经专业培训合格的社区儿保医生确定研究起点(T0)存在饮食行为问题的儿童入组,以密封信封的方式将入组儿童随机分为干预组和对照组。两组根据年龄分为1、2、3、4、5和6岁亚组;根据营养状况分为营养正常、中度营养不良和重度营养不良亚组。干预组在T0时首次干预,并于干预后1(T1)、3(T2)、6(T3)和9个月(T4)分别以随访版内容评估和干预。对照组于T0、T4时点分别行基线版和随访版评估,不行交互式干预。比较干预组和对照组的饮食行为状况,并计算得到1例有益结果需干预的人数(NNT)和不良行为保持率。结果 2009年1～10月共纳入有不良饮食行为问题的儿童490例,至T4时点,随访完全不依从2例,部分不依从26例,失访率为5.7%(28/490例)。462例有效数据纳入分析,干预组245例,对照组217例。①干预组T0时点儿童的饮食行为问题综合评分为(19.7±0.0)分,T4时点为(14.2±0.3)分,呈显著下降(P<0.01);对照组T0时点为(19.7±0.5)分,T4时点为(19.6±0.1)分,无显著改变(P>0.05)。②干预组T0～T4不同时点各年龄亚组饮食行为问题综合评分随交互式干预的介入均呈下降趋势,各年龄亚组儿童饮食行为综合评分T4较T0时点均显著降低(P<0.01),其中3岁亚组△(T0～T4)减分最多,6岁亚组△(T0～T4)减分最少,3和6岁亚组间△(T0-T4)差异有统计学意义(P<0.05)。462例存在不良饮食行为问题的儿童干预效果NNT为2.5(95%CI:2.1～3.0),总的不良饮食行为保持率干预组与对照组差异有统计学意义(P<0.001)。③干预组营养正常与重度营养不良亚组饮食行为问题综合评分T4较T0显著降低(P<0.05)。对照组营养正常和重度营养不良亚组饮食行为问题综合评分T4较T0时点差异无统计学意义(P>0.05)。④干预组干预前后各单项饮食行为问题评分T4较T0时点均有显著降低(P<0.01);但干预后各项饮食行为问题的△(T0-T4)差异无统计学意义(P>0.05)。对照组各项饮食行为问题评分T4较T0时点无显著降低(P>0.05)。各单项饮食行为NNT为1.4～2.5。各单项不良饮食行为保持率干预组与对照组差异均有统计学意义(P<0.05)。结论合理的饮食行为干预可改善儿童的不良饮食行为,交互式干预模式是适合中国国情的有效干预方法。

Objective To evaluate the intervention effects on children with dietary behavior problems in Shanghai through a comprehensive intervention （at multiple time points） follow-up study. Methods Children aged 1 -6-years with dietary behavior problems were selected from three districts of Shanghai （Changning, Luwan and Hongkou）. Shanghai Children＇s Dietary Behavior Questionnaire and Follow-up Intervention Questionnaire was prepared. Children were recruited into the study by professionally trained pediatricians, and randomly divided into intervention and control groups by using sealed envelops. Both the intervention group and control group were divided into 5 subgroups according to age, and 3 subgroups according to nutritional status. The intervention group received interactive interventions and respective assessments at T0 （baseline）, T1 （end of the 1 st month ） , T2 （end of the 3rd month） , T3 （end of the 6th month） and T4（ end of the 9th month）. The control group were evaluated at TO and followed up at T4. Comparisons of dietary behavior were made before and after the interventions between intervention and control groups. Results From January to October 2009, 462 children with dietary bebaviour problems were recruited, including 245 in intervention group and 217 in the control group. （1）The comprehensive dietary behaviour problem scores of the intervention group were 19.7 ± 0.0 at TO and 14.2 ± 0.3 at T4, decreased dramatically （ P 〈 0.01 ） , while the scores of the control group were 19.7 ±0.5 at T0 and 19.6 ±0. 1 at T4, showing no significant change （P 〉0.05）. （2）The scores of all age subgroups in the intervention group decreased with more interventions made （P 〈 0.01 ）. Among all the age subgroups, the 3-year-old group had the largest△（ T0 -T4 ） , while the 6-year-old group had the smallest △ （T0 -T4）. There was significant difference between 3-year-old and 6-year-old groups （P 〈 0. 01 ）. The average number to treat （NNT） of the intervention group was 2.5 （95% CI：2.1 - 3.0）. There was significant difference of the overall retention rate of dietary behaviour between intervention and control group （ P 〈 0. 001 ）. （3）The dietary behaviour problem scores of both severe malnutrition and normal nutrition subgroups of intervention group decreased （P 〈0.01 ）. In the control group, the difference of the scores △（T0 -T4） was not statistically significant for either nutrition subgroup （P 〉 0.05 ）. （4）Controlling for the natural improvement of dietary behaviour with time passed, all the dietary behaviour problems of the intervention group children were eventually improved （ P 〈 0.05 ）. While ＂no fixed eating location＂ , ＂ eating and playing toys＂ changed less, the rest of the dietary behaviour problems all improved by a large margin. However, the effects of intervention on different dietary behaviour problems occurred at different time points. ＂Eating slow＂ , ＂ strong preference to some food＂ , ＂eating and doing other things＂ were improved earlier; ＂eating less＂ , ＂no fixed eating location＂ , ＂no interest in food＂ were improved later. The NNT of nine dietary behaviours was 1.4- 2.5. The difference of misconduct retention rate between intervention and control groups was statistically signifieant（ P 〈 0.05 ）. Conclusion Reasonable dietary behavior intervention could improve children＇s unhealthy eating behaviors. The interactive intervention strategy proposed here could markedly improve the dietary behavior of children in Shanghai.