成都市小学生膳食摄入对肺功能的前瞻性影响

Prospective effects of dietary intake on lung function of pupils in Chengdu City

目的探讨小学生各食物组摄入对肺功能发育的前瞻性影响,为促进中国儿童肺功能的健康发育、预防慢性呼吸系统疾病提供理论依据。方法于2021年11月,采用整群随机抽样法抽取893名成都市二至五年级小学生作为调查对象,通过食物频率法收集调查对象过去1年各类食物摄入情况,并用三分位法将食物组摄入量从低到高分为T1、T2、T3组;2022年对调查对象进行随访获取肺活量等体检数据。采用Logistic回归模型与趋势性检验分析小学生各食物组摄入对肺功能发育的前瞻性影响。结果男生中肺活量评分优良组摄入蔬菜[118.6(50.5,188.2)g/d]和奶及奶制品[200.0(73.3,250.0)g/d]高于肺活量评分非优良组[90.0(37.1,192.9),178.6(35.7,250.0)g/d],差异均有统计学意义(Z值分别为-1.98,-2.24);女生中肺活量评分优良组食用主食[391.1(273.6,511.4)g/d]少于肺活量评分非优良组[407.4(309.5,549.3)g/d],肺活量评分优良组摄入水产品[31.2(14.6,69.8)g/d]和奶及奶制品[215.0(107.1,250.1)g/d]高于肺活量评分非优良组[19.4(10.7,58.3),114.3(35.7,250.0)g/d],差异均有统计学意义(Z值分别为-2.01,-3.33,-5.10)(P值均<0.05)。在调整能量、体质量指数Z评分(BMI-Z)、母亲文化水平、家庭平均月收入、居住环境是否有人吸烟、近1周是否参加体育活动后,男生中蔬菜摄入T3组(OR=0.48,95%CI=0.27~0.86)、豆及豆制品摄入T2组(OR=0.52,95%CI=0.27~0.96)、奶及奶制品摄入T2组与T3组[OR值(95%CI)分别为0.54(0.31~0.93),0.52(0.30~0.90)]与肺活量非优良均呈负相关;女生中水产品摄入T3组(OR=0.52,95%CI=0.28~0.97)、奶及奶制品摄入T2组与T3组[OR值(95%CI)分别为0.44(0.25~0.76),0.33(0.19~0.59)]与肺活量非优良均呈负相关,红肉摄入T2组(OR=2.51,95%CI=1.37~4.67)与肺活量非优良呈正相关(P值均<0.05)。经趋势性检验发现,在男生中随着蔬菜和奶及奶制品摄入的增加,有降低肺活量非优良的可能;在女生中随着奶及奶制品摄入的增加,有降低肺活量非优良的可能,而红肉摄入的增加会增加肺活量非优良的可能(t值分别为-1.13,-0.44;-3.03,1.95,P_(趋势)值均<0.05)。结论奶及奶制品能降低小学生肺活量非优良的风险,蔬菜能降低男生肺活量非优良的风险,红肉会增加女生肺活量非优良的风险。应帮助儿童合理选择食物,以促进儿童肺功能的健康发育。

Objective To investigate the prospective effects of intake of each food group on the development of lung function of pupils,so as to provide theoretical basis for promoting the healthy development of lung function and preventing chronic respiratory diseases in Chinese children.Methods A cluster stratified sampling method was used to select a total of 893 pupils in grades 2-5 from Chengdu in November 2021.Dietary data of respondents were collected using a food frequency questionnaire within the past year,then the food group intake was categorized into T1,T2 and T3 from low to high by the trichotomous method,and anthropometric measurements including lung capacity were obtained in 2022.Logistic regression models and test for trend were used to analyze the prospective effects of intake of each food group on lung function development of pupils.Results Among male students,consumption of vegetables[118.6(50.5,188.2)g/d]and milk and dairy products[200.0(73.3,250.0)g/d]were higher in the excellent lung capacity group than in the non-excellent lung capacity group[90.0(37.1,192.9),and 178.6(35.7,250.0)g/d],with statistically significant differences(Z=-1.98,-2.24);among girls,the group with excellent lung capacity consumed less staple food[391.1(273.6,511.4)g/d]than the group with non-excellent lung capacity[407.4(309.5,594.3)g/d],and the group with excellent lung capacity consumed more aquatic products[31.2(14.6,69.8)g/d]and milk and dairy products[215.0(107.1,250.1)g/d]than that of the non-excellent lung capacity[19.4(10.7,58.3),114.3(35.7,250.0)g/d](Z=-2.01,-3.33,-5.10)(P<0.05).After adjusting for energy,body mass index Z score(BMI-Z),mother's education level,averge family income monthly,whether presence of smokers in the living environment,and whether participation in physical activities during the past week,among male students,T3 group of vegetable intake(OR=0.48,95%CI=0.27-0.86),T2 group of bean and soy product intake(OR=0.52,95%CI=0.27-0.96),T2 and T3 groups of milk and dairy products intake(T2:OR=0.54,95%CI=0.31-0.93;T3:OR=0.52,95%CI=0.30-0.90)were negatively associated with non-excellent lung capacity(P<0.05).Among girls,T3 group of aquatic product intake(OR=0.52,95%CI=0.28-0.97),T2 and T3 groups of milk and dairy product(T2:OR=0.44,95%CI=0.25-0.76;T3:OR=0.33,95%CI=0.19-0.59)were negatively associated with non-excellent lung capacity,whereas the T2 group of red meat intake(OR=2.51,95%CI=1.37-4.67)was positively associated with non-excellent lung capacity.Non-excellent lung capacity was found to be negatively associated with vegetable and milk and dairy product intake in boys by test for trend;in girls,milk and dairy products intake was negatively associated with non-excellent lung capacity,whereas red meat intake was positively associated with non-excellent lung capacity(t=-1.13,-0.44;-3.03,1.95,P_(trend)<0.05).Conclusions Milk and dariy products intakes reduce the risk of non-excellent lung capacity in pupils,vegetables intakes reduce the risk of non-excellent lung capacity in boys,and the intake of red meat increases the risk of non-excellent lung capacity in girls.Promoting rational food choices is necessary for children to improve healthy lung development.