婴幼儿食欲特征及气质在积极喂养行为和体质指数间的中介调节作用

Mediating and moderating effects of appetite traits and temperament of infants and young children on the association between positive feeding behaviors and body mass index

目的分析婴幼儿食欲特征(食物接触、食物回避)在照护者积极喂养行为(鼓励健康膳食、监督、自主支持)与婴幼儿体重指数(BMI)间的中介作用,以及婴幼儿气质在前半路径中的调节作用,为制定改善婴幼儿食欲特征和BMI状况的干预策略提供参考。方法2021年5月采用综合性喂养实践问卷、婴幼儿喂养行为问卷、喂养策略问卷、婴儿和儿童饮食行为问卷、婴儿和幼儿行为问卷对青岛市某三甲医院儿童保健科322名婴幼儿照护者进行调查。结果仅有食物接触、自主支持、婴幼儿BMI两两变量相关,即食物接触与自主支持呈负相关(r=-0.769,P<0.01),与婴幼儿BMI呈正相关(r=0.680,P<0.01),自主支持与婴幼儿BMI呈负相关(r=-0.548,P<0.01)。自主支持直接预测婴幼儿BMI的效应不显著(β=-0.082,P>0.05),主要经食物接触间接预测婴幼儿BMI,中介效应值为-0.412。在婴幼儿不同气质类型中,仅有努力控制在自主支持与食物接触间发挥调节作用(△R^(2)=0.031,P<0.01),即自主支持对食物接触的影响在努力控制水平高的个体相对努力控制水平低者要小。结论食物接触在自主支持与婴幼儿BMI间发挥完全中介作用,努力控制在自主支持与食物接触间发挥调节作用。若要改善婴幼儿BMI状况,应从培养婴幼儿良好的食欲特征入手,医护人员应结合婴幼儿努力控制水平为照护者提供喂养行为指导,改善婴幼儿食欲特征和BMI状况。

Objective To explore the mediating effect of infants and young children′s appetite traits(food approach,food avoidance)between caregivers′positive feeding behavior(encouraging healthy diet,monitoring and autonomy support)and body mass index(BMI)of infants and young children,as well as the moderating effect of infants and young children′s temperament in the first of the pathway,and to provide reference for the development of intervention strategies to improve appetite characteristics and BMI of infants.Method A total of 322caregivers were selected from the Child Health Care Department of a grade A tertiary hospital in Qingdao city in May 2021,and were surveyed by Comprehensive Feeding Practice Questionnaire,Infants and Young Children′s Feeding Behavior Questionnaire,Feeding Strategy Questionnaire,Baby Eating Behavior Questionnaire,Children′s Eating Behavior Questionnaire,Infant Behavior Questionnaire and Children′s Behavior Questionnaire.Results Only the correlations of food approach,autonomy support and infant and young children′s BMI were significant.Detailed,food approach was negatively correlated with autonomy support(r=-0.769,P<0.01),positively correlated with infant and young children′s BMI(r=0.680,P<0.01),and autonomy support was negatively correlated with infant and young children′s BMI(r=-0.548,P<0.01).The direct effect of autonomy support on infant and young children′s BMI was not significant(β=-0.082,P>0.05),but the indirect effect of autonomy support on infant and young children′s BMI was-0.416mainly through food approach.Among the different temperament types of infants and young children,only effortful control moderated the relationship between autonomy support and food approach(△R^(2)=0.031,P<0.01).Specifically,compared with individual with low effortful control,the influence of autonomy support on food approach was less in those with high effortful control autonomy support.Conclusions Food approach plays a complete mediating role between autonomy support and BMI of infants and young children,and effort control plays a moderating role in the relationship between autonomy support and food approach.Therefore,in order to improve BMI of infants and young children,appetite traits of infants and young children should be cultivated at beginning.Medical staff are suggested to provide feeding behavior guidance for caregivers based on effortful control level of infants and young children to improve the appetite traits and BMI of infants and young children.