重庆市巴南区学龄前儿童维生素A缺乏膳食筛查模型研究

Study on dietary screening model for preschool children with vitamin A deficiency in Ba'nan District of Chongqing

目的基于营养流行病学调查,建立学龄前儿童维生素A缺乏(VAD)筛査模型,有针对性地筛查学龄前儿童VAD和边缘型维生素A缺乏(MVAD),为进一步VAD膳食干预提供有效的筛查工具。方法采用随机整群抽样方法,随机抽取重庆市巴南区3所幼儿园。调查内容包括膳食调查、体检、最近2周患病情况询问、体格测量和实验室检测;参考儿童健康营养得分(Hu SKY)方法,构建筛查学龄前儿童膳食摄入的健康营养评分模型(HNSP)。结果流行病学调查显示:492名学龄前儿童符合纳入标准,其中男孩229名,女孩263名,平均年龄(4.54±0.87)岁,身高(107.50±7.20)cm,体质量(18.42±3.41)kg。HNSP共建立10个分条目,分别为谷薯类得分、蔬菜类得分、水果类得分、畜禽肉类得分、鱼虾类得分、蛋类得分、豆类和豆制品得分、奶类和奶制品得分、其他食物得分和强化食品以及补充剂得分。有效性分析结果显示:HNSP累积分值与膳食能量或大多数营养素摄入量正相关;除与血浆维生素A有显著相关性外(P<0.01),与体格测量指标(身高、体质量、体质量指数、年龄别体质量Z评分、年龄别身高Z评分和年龄别体质指数Z评分)、其他血生化指标(血红蛋白、红细胞平均血红蛋白浓度、血浆铁和血浆锌)均无相关性(P>0.05)。准确性分析结果显示:以累积分值70分为判断有维生素A营养风险的临界点,HNSP评价和金标准筛检MVAD/VAD和VAD分组差异无统计学意义(P>0.05),筛检的灵敏度为87.98%,特异度为17.95%。可靠性分析结果显示HNSP内在一致性好(Cronbachα系数=0.86)。重复一致性分析结果显示:2次HNSP累积分值差异无统计学意义(P>0.05),2次评价的重复性较好(Kappa值=0.61)。结论构建的HNSP评价膳食整体质量的有效性和可靠性好,重复性和准确性达到一定标准,有望成为今后针对学龄前儿童个体或群体的VAD的膳食筛查工具。建议定期在不同时间、地点和人群进行营养调查,修订和完善该筛查方法。

Objective To establish a screening model for preschool children with vitamin A deficiency （VAD） based on nutrition epidemiological survey, purposely screen preschool children with VAD and marginal VAD （MVAD）, and provide efficient screening tool for further diet intervention of VAD. Methods A random cluster sampling method was adopted and 3 kindergartens in Ba＇nan District of Chongqing were randomly selected. The survey covered dietary survey, ohvsical examination, medical history of last 2 weeks, nhvsical measurement, and laboratory test. The screening model of healthy nutrition score based on food intake for preschoolers （HNSP） was established according to the Healthy Nutrition Score for Kids and Youth （HUSKY） method. Results The epidemiological survey showed that a total of 492 children met the inclusion criteria, including 229 boys and 263 girls. Their mean age, height, and body weight were （4. 54±0.87） years, （107.50±7.20） cm, and （18.42 ±3.41） kg, respectively. HNSP consisted of 10 items, i.e. scores of grains and potatoes, vegetables, fruit, livestock and poultry meat, fish and other animal seafood, eggs, beans and bean products, milk and dairy, and other foods and fortified foods or supplements. The results of effectiveness analysis showed that the accumulative score of HNSP positively correlated with dietary energy and most dietary nutrients and did not correlate with anthropometric indexes （height, weight, body mass index, weight-for-age Z score, height-for-age Z score, and BMI-for-age Z score） and other blood biochemical indexes （Hb, MCHC, serum Ca, serum Fe, and serum Zn） （P〉0.05）, except significant correlation with plasma retinol （P〈0.01） . The results of accuracy analysis indicated that the accumulative score of 70 was the cut-off value for screening VAD or MVAD. The differences of screening MVAD/VAD by HNSP evaluation and gold standard method were not statistically significant （ P 〉 0.05 ）. The sensitivity and specificity of screening were 87.98% and 17.95%, respectively. The results of reliability analysis showed that internal consistency of HNSP was good （Cronbach a coefficient =0.86）. The results of repeated consistency analysis indicated that the difference of accumulative scores of two establishments of HNSP was not statistically significant （ P〉0.05）. The repeatability of two evaluations was good （Kappa value =0.61 ）. Conclusion The HNSP is effective and reliable for evaluating the overall dietary quality with good repeatability and consistency and is an ideal diet screening tool for preschool children. It is recommended to conduct nutrition surveys at different time and places for different people in order to revise and improve the screening method.