含糖饮料摄入模式与儿童肥胖关联的纵向研究

A cohort study on the association between sugar-sweetened beverage intake and childhood obesity using a group-based trajectory model

目的探讨童年期不同含糖饮料(sugar-sweetened beverages,SSBs)摄入模式对儿童肥胖的影响,旨在为预防和控制儿童超重或肥胖提供新的流行病学证据。方法采用方便抽样方法,于2016年在安徽省蚌埠市2所小学建立儿童随访队列,每年随访1次,共随访3次。基线有1263名儿童参加调查,3次随访后最终有997名儿童纳入分析。通过自编父母问卷和学生问卷获得儿童基本信息及每日SSBs消费情况,应用群组轨迹模型(group-based trajectory modelling,GBTM)拟合童年期SSBs摄入模式发展轨迹,采用多元线性回归模型分析不同SSBs摄入模式与儿童肥胖的关联。结果GBTM拟合4种童年期SSBs摄入模式发展轨迹,分别命名为SSBs摄入持续较低组(822名)、先升后降组(20名)、渐降组(106名)和渐增组(49名)。SSBs摄入先升后降组和渐增组儿童基线及3次随访时的体质量指数(BMI)均高于持续较低组(F值分别为6.26,5.90,5.99和5.87,P值均<0.01)。SSBs摄入模式与儿童BMI的关联存在性别差异。调整儿童基线BMI、父母BMI、肥胖遗传风险评分和体力活动等混杂因素后,在女童中,相比于SSBs摄入持续较低组,SSBs摄入渐增组女童第3次随访时BMI增加(B=1.20,95%CI=0.25~2.15,P=0.01);在男童中,未发现4组SSBs摄入模式与BMI关联存在统计学意义(P值均>0.05)。结论儿童SSBs摄入模式与肥胖关联存在性别差异,SSBs摄入水平较高的女童肥胖风险显著增加。未来需更多研究探讨性别差异的生理机制,为儿童肥胖预防及干预措施的制定提供理论依据。

Objective To evaluate the development trajectory of sugar-sweetened beverage(SSB)intake in childhood,and to explore the influence of different SSB intake patterns on childhood obesity.Methods In 2016,a follow-up cohort study was carried out in two primary schools in Bengbu,Anhui Province.Three annual follow-ups were conducted in 1263 children at baseline,and 997 children were included in the final analysis.Parental and student questionnaires were used to obtain basic information related to the children’s consumption of SSBs.A group-based trajectory model(GBTM)was applied to classify the development trajectory of SSB intake patterns in childhood.Multiple linear regression analyses were performed to assess the correlation between different SSB intake patterns and childhood obesity.Results GBTM identified four childhood SSB intake patterns,namely,the"persistently-low group(n=822),"decreasing-after-increasing"group(n=20),"gradually-decreasing"group(n=106),and"increasing"group(n=49).In the decreasing-after-increasing group and the gradually-decreasing group,baseline BMI levels and BMI levels obtained at the three follow-ups were significantly higher than those observed in the persistently-low group(F=6.26,5.90,5.99,5.87,P<0.01).There were sex differences in the association between SSB intake patterns and the children’s BMI levels.Among girls,after adjusting for confounding factors,the gradually-decreasing group increased by 1.20 kg/m2(B=1.20,95%CI=0.25-2.15,P=0.01)when compared with the persistently low group at the third follow-up.Among boys,no statistically significant association was found between SSB intake patterns and BMI levels(P>0.05).Conclusion Sex differences were observed with respect to the association between SSB intake patterns and obesity in children.Girls with a higher SSB intake had a significantly increased risk of obesity.Further studies are needed to explore the physiological mechanisms underlying sex differences,to provide the theoretical basis for developing intervention programs to prevent childhood obesity.