家庭支持在儿童饮食运动行为干预对知识和行为影响中的中介作用

Effect of a dietary and exercise intervention on children’s cognition and behaviors: the mediating role of family support

目的 评估儿童饮食运动行为干预对其认知和行为的影响,并探究家庭支持的中介作用,以期为有效的儿童肥胖干预策略提供科学依据。方法 基于2018—2019年在北京、长治、乌鲁木齐24所小学共1 392名四年级学生及其家长中开展的儿童饮食运动行为干预项目,通过问卷调查收集家长的支持情况以及儿童的认知和行为。在学校—家庭—个人3个层面上对干预组儿童开展饮食运动行为干预,对儿童的饮食运动知识、饮食习惯、运动行为、静坐视屏行为进行评估,采用线性混合效应模型先分析干预对儿童认知和行为评分的作用,再探讨家庭支持的中介作用。结果 干预1年后,相比对照组,干预组饮食运动知识评分高(OR=2.34,95%CI=1.71~3.21)、饮食习惯评分高(OR=2.58,95%CI=1.75~3.82)和静坐视屏评分高(OR=1.91,95%CI=1.35~2.68)的儿童比例明显升高(P值均<0.01),干预组儿童存在家庭支持的比例提高(OR=3.45,95%CI=2.19~5.45),其中父亲(OR=2.70,95%CI=1.68~4.35)、母亲(OR=3.71,95%CI=2.28~6.04)、祖母(OR=1.65,95%CI=1.00~2.70)和外祖母(OR=2.14,95%CI=2.12~2.16)支持儿童控制体重的比例提高(P值均<0.05)。中介作用分析显示,家庭支持在综合干预与儿童饮食习惯和静坐视屏评分的关联中存在中介作用。结论 儿童饮食运动行为干预可促进其认知和行为,家庭支持是重要的中介因素。将家庭干预纳入儿童肥胖综合防控策略可提高儿童饮食运动行为的干预效果。

Objective To evaluate the effect of a dietary and exercise intervention on cognition and behaviors among primary school students, and to further explore the mediating role of family support, in order to provide scientific evidence for future effective intervention strategies. Methods A dietary and exercise intervention program for childhood obesity prevention was carried out in 24 primary schools in Beijing, Changzhi and Urumqi from 2018 to 2019, and 1 392 children in grade four as well as their parents were included. Family support and children’s cognition and behaviors were collected through questionnaire. To carry out diet and exercise behavior intervention on the three levels of school, family and individual in the intervention group, and children’s dietary and exercise knowledge, eating habits, physical activities, as well as sedentary and screen behaviors were evaluated. The linear mixed model was used to analyze the effect of intervention on children’s cognition and behaviors, and the mediation model was used to explore the role of family support. Results The proportion of children with higher score of dietary and exercise knowledge(OR=2.34, 95%CI=1.71-3.21), eating habits(OR=2.58, 95%CI=1.75-3.82), and sedentary and screen behaviors(OR=1.91, 95%CI=1.35-2.68) increased in the intervention group after one-year intervention(P<0.01), compared with the control group, respectively. The intervention also increased the proportion of children’s family support in the intervention group compared with the control group(OR=3.45, 95%CI=2.19-5.45), and the support from children’s fathers(OR=2.70, 95%CI=1.68-4.35), mothers(OR=3.71, 95%CI=2.28-6.04), paternal grandmothers(OR=1.65, 95%CI=1.00-2.70), and maternal grandmothers(OR=2.14, 95%CI=2.12-2.16) increased significantly(P<0.05). The mediation analysis showed that family support played a mediating role in association between comprehensive intervention and children’s eating habits as well as sedentary and screen behaviors. Conclusion The dietary and exercise intervention effectively promoted children’s cognition and behaviors, and family support played an important mediating role.