江苏某县农村地区9~10岁儿童膳食模式与生长发育和肥胖的关系

Associations of dietary patterns with physical growth and obesity in school-age children in rural areas of Jiangsu

[背景]学龄期儿童肥胖现状日益严峻,膳食模式作为衡量膳食情况的综合指标,是影响儿童肥胖的重要因素。[目的]总结农村地区学龄期儿童的膳食模式,评价其与儿童生长发育和肥胖的关系。[方法]选取"射阳小型出生队列"中481名9~10岁随访儿童作为研究对象,采用24 h膳食回顾调查法收集膳食资料,使用因子分析法对儿童膳食模式进行分析,并将膳食模式因子得分按三分位数定义为T1、T2、T3三个水平;测量学龄期儿童的体格生长指标,并使用广义线性模型评估膳食模式因子得分与儿童身体质量指数(BMI)-Z评分(经年龄、性别校正的BMI,肥胖评价指标)的关系,利用logistic回归模型评估膳食模式因子得分与儿童肥胖的关系。[结果]本次研究中,学龄期儿童的肥胖检出率为17.26%。因子分析法提取5种膳食模式,累计贡献率为58.46%,分别为蔬菜蛋类、油脂肉类、谷薯油脂类、水果肉类、富含维A蔬果类。5种膳食模式T3组之间的能量及营养素的摄入量差异均具有统计学意义(P<0.05)。广义线性模型显示:与谷薯油脂类因子得分T1组相比,T3组儿童的BMI-Z评分更低(全体,T3:T1,b=-0.44,95%CI:-0.74~-0.15),性别分层分析发现女童中也有此关联(女童,T2:T1,b=-0.41,95%CI:-0.78~-0.04;女童,T3:T1,b=-0.39,95%CI:-0.77~-0.01);水果肉类膳食模式与儿童BMI-Z评分呈正相关(全体,b=0.16,95%CI:0.01~0.31)。logistic回归模型显示:富含维生素A蔬果类膳食模式的因子得分与儿童肥胖发生风险呈负相关(全体,OR=0.46,95%CI:0.27~0.77,P<0.05;女童,T2:T1,OR=0.25,95%CI:0.06~1.00,P<0.05)。[结论]该地学龄期儿童肥胖检出率较高。谷薯油脂类膳食模式不利于儿童体格的健康生长,而水果肉类膳食模式与之相反,富含维生素A蔬果类的膳食模式与低肥胖率有关。

[Background] Obesity among school-age children is an increasingly serious problem. Dietary pattern, as a comprehensive index to measure the dietary intake, is an important factor affecting childhood obesity.[Objective] This study is conducted to analyze dietary patterns and explore the associations of dietary patterns with physical growth and obesity in rural school-age children. [Methods] A total of 481 children aged 9-10 years in Sheyang Mini Birth Cohort were enrolled. Dietary information was collected using 24-h dietary recall survey. A factor analysis was conducted to define dietary patterns, and dietary pattern scores were divided into three groups by tertiles(T1, T2, T3;from low to high levels). Anthropometric indicators were measured and a generalized line model was used to examine the associations between dietary patterns and body mass index(BMI)-Z scores(a measure of obesity defined by sex-and age-standardized according to the World Health Organization criteria). Logistic regression models were performed to evaluate the association between dietary patterns and children obesity. [Results] The prevalence rate of obesity was 17.26% in selected school-age children. Five dietary patterns were identified by the factor analysis, explaining 58.46% of the diet variation, including vegetables and eggs, oil and meat, cereals and oil, fruit and meat, vegetables and fruit rich in vitamin A patterns, respectively. The intakes of energy and nutrients were significantly different among the T3 groups of the five dietary patterns(P< 0.05). The results of generalized line model showed that the children of the cereals and oil pattern T3 group had a lower BMI-Z score compared with the T1 group(total, T3 : T1, b=-0.44, 95% CI:-0.74--0.15), and the associations were also found in girls(T2 : T1, b=-0.41, 95% CI;-0.78--0.04;T3 : T1, b=-0.39, 95% CI:-0.77--0.01);the fruit and meat pattern was significantly positively associated with BMI-Z score(total, b=0.16, 95% CI: 0.01-0.31). The results of logistic regression model showed that the factor score of vegetables and fruit rich in vitamin A pattern negatively correlated with the risk of obesity(total, OR=0.46, 95% CI: 0.27-0.77, P< 0.05;girls, T2 : T1, OR=0.25, 95% CI: 0.06-1.00, P< 0.05).[Conclusion] The prevalence rate of obesity among selected school-age children is high. Contrast to the fruit and meat pattern, the cereals and oil pattern is detrimental to children’s growth. The vegetables and fruit rich in vitamin A pattern is related to a low prevalence rate of obesity.