学龄前儿童含糖饮料摄入与情绪行为问题的关联

Associations between sugar-sweetened beverage intake and emotional and behavioral problems in preschoolers

目的探讨学龄前儿童含糖饮料(sugar-sweetened beverages,SSBs)摄入情况及其与行为问题的关联,为儿童行为问题预防提供参考依据。方法于2017年10—11月选择长江中下游流域的扬州、徐州、镇江3座城市,采取随机整群抽样的方法选取7634名3~6岁学龄前儿童为研究对象,通过对父母或监护人进行问卷调查获得儿童SSBs消费情况,采用《长处与困难问卷》(SDQ)评估儿童情绪和行为问题,采用多元Logistics回归模型分析不同SSBs摄入频率与儿童行为问题的关联。结果调查的学龄前儿童中,SSBs摄入<1、1和≥2次/d分别为5509(72.2%)、830(10.9%)和1295名(16.9%)。调整年龄、性别、体质量指数(BMI)、家庭经济状况、父母受教育程度、视屏时间、睡眠时长和体力活动时间等混杂因素后,SSBs摄入1次/d与男童多动障碍(OR=1.26,95%CI=1.01~1.57)、SDQ困难(OR=1.44,95%CI=1.14~1.82)风险增加有关,与女童情绪症状(OR=1.34,95%CI=1.02~1.76)、品行问题(OR=1.53,95%CI=1.18~2.00)、多动障碍(OR=1.79,95%CI=1.42~2.27)和亲社会行为(OR=1.48,95%CI=1.14~1.91)风险增加均有关。SSBs摄入≥2次/d仅与男童情绪症状(OR=1.28,95%CI=1.02~1.59)和SDQ困难(OR=1.30,95%CI=1.07~1.58)风险增加有关(P值均<0.05)。结论SSBs摄入与学龄前儿童行为问题风险增加有关且存在性别差异,但未见显著剂量—反应关系。未来需更多纵向研究深入探讨SSBs摄入与学龄前儿童行为问题的关联及其潜在生理机制。

Objective To explore the consumption of sugar-sweetened beverages(SSBs)and its association with behavioral problems in Chinese preschool children,and to provide a scientific basis for the prevention of behavioral problems of children.Methods A total of 7634 children aged 3-6 years were chosen from kindergartens in 3 cities(Yangzhou,Xuzhou,Zhenjiang)in the lower reaches of Yangtze River using method of cluster sampling during October to November in 2017.Parental or guardian questionnaires were used to obtain information regarding child consumption of SSBs.The Strengths and Difficulties Questionnaire(SDQ)was used to assess children’s emotional and behavioral problems.Multivariate Logistic regression model was used to explore the association between different SSBs intake frequency and children’s behavioral problems.Results A total of 5509(72.2%)consumed SSBs less than once a day,830(10.9%)reported SSBs consumption once a day,and 1295(16.9%)had 2 times or more intake of sugar-sweetened beverages per day.After adjusting for confounding factors including age,sex,BMI,family financial status,parental education,screen time,sleep duration,and physical activities duration,multiple Logistic regression model revealed that intake of SSBs once a day was associated with an increased risk of hyperactivity disorder(OR=1.26,95%CI=1.01-1.57)and SDQ total difficulties(OR=1.44,95%CI=1.14-1.82)in boys and with an increased risk of emotional symptoms(OR=1.34,95%CI=1.02-1.76),conduct problems(OR=1.53,95%CI=1.18-2.00),hyperactivity disorder(OR=1.79,95%CI=1.42-2.27)and prosocial behavior(OR=1.48,95%CI=1.14-1.91)in girls.Intake of SSBs≥2 times per day was associated with an increased risk of emotional symptoms(OR=1.28,95%CI=1.02-1.59)and SDQ difficulties(OR=1.30,95%CI=1.07-1.58)in boys and not with behavioral problems in girls.Conclusion Sex differences are observed with respect to the association between SSBs intake and behavioral problems in preschoolers,but no significant dose-response relationship was observed.More longitudinal studies are needed to further explore the association between SSBs intake and behavioral problems in preschool children as well as the underlying physiological mechanisms in future.