注意缺陷多动障碍儿童的饮食行为和体格生长

Eating behaviors and growth status in children with attention deficit and hyperactivity disorder

目的探讨注意缺陷多动障碍(attention deficit disorder and hyperactivity, ADHD)儿童体格生长和饮食行为的相关性,为ADHD儿童的管理以及给予饮食行为指导提供依据。方法采用方便抽样的方法,抽取2019年6—9月于南京医科大学附属儿童医院儿童保健科门诊就诊的703名4~13岁ADHD儿童进行调查。对所有儿童进行体格测量,按照BMI-Z评分将ADHD组儿童分为消瘦、正常、超重和肥胖4组,同时对ADHD儿童进行饮食行为问卷(Children’s Eating Behavior Questionnaire, CEBQ)评估,分析ADHD患儿的饮食行为情况与体格生长的关系。结果饮食行为评估显示,消瘦组ADHD儿童在过饱响应、进食缓慢、情绪性饮食减少食物逃避维度的得分均高于其他3组(F值分别为17.57,29.32,4.07,P值均<0.01),肥胖组在食物响应、食物喜好、渴望饮料、情绪性过度饮食食物导向维度得分均高于其他3组(F值分别为24.54,47.44,2.96,5.85,P值均<0.05)。多元线性回归校正混杂因素后,过饱响应、进食缓慢与儿童BMI-Z呈负相关(B值分别为-0.05,-0.07,P值均<0.01),食物响应、食物喜好、情绪性过度进食与儿童BMI-Z呈正相关(B值分别为0.04,0.09,0.05,P值均<0.05)。结论 ADHD儿童情绪性进食、对食物喜好及响应程度过高与超重和肥胖相关,进食速度过慢、对饱食信号的高反应则与消瘦相关。临床治疗不仅要重视改善ADHD患儿核心症状,同时需要关注其饮食行为问题对体格生长的影响。

Objective To discuss the correlation between growth status and eating behaviors in children with attention deficit and hyperactivity disorder(ADHD), providing reference data for management and dietary behavior guidance among ADHD children. Methods A total of 703 children aged 4-13 years old were collected from the ADHD patients from Children’s Health Department of Children’s Hospital of Nanjing Medical University from June to September, 2019. The demographic characteristics and information regarding children’s eating behaviors were collected by self-designed questionnaire and Chinese version of the parent-completed Children’s Eating Behavior Questionnaire(CEBQ). The correlation physical growth with dietary behaviors among the ADHD children were analyzed. Results Food avoidant behaviors, including satiety responsiveness, slowness in eating and emotional undereating in ADHD children with thinness scored significantly higher than that of children with short stature, overweight and obesity(F=17.57, 29.32, 4.07, P<0.01), while food approach behaviors, including food responsiveness, enjoyment of food, desire to drink and emotional overeating scored higher in obese children, compared to other three groups(F=24.54, 47.44, 2.96,5.85, P<0.05). Multiple linear regression analysis showed that, after adjusting for the confounders, satiety responsiveness, slowness in eating were still negatively associated with BMI-Z score of the ADHD children(B=-0.05,-0.07, P<0.01). Food responsiveness, enjoyment of food and emotional overeating had a positive association with the BMI-Z score(B=0.04, 0.09, 0.05, P<0.05). Conclusion Emotional eating and high food responsiveness in ADHD children are associated with the overweight and obesity, while long eating time and high satiety responsiveness is associated with underweight among ADHD children. For clinical doctors and parents, problematic eating behaviors among ADHD children should be concerned regarding its negative effects on growth and development, besides core symptoms of ADHD.