饮食节律与青少年抑郁症状的关联

Association between dietary rhythm and depressive symptoms in adolescents

目的描述青少年饮食节律和抑郁症状的流行现状及关联,为改善青少年不健康行为习惯并促进青少年身心健康提供依据。方法于2021年10—12月,采用立意抽样与分层整群随机抽样相结合的方法分别在沈阳市、徐州市、深圳市、太原市、南昌市、郑州市、重庆市、昆明市8个城市的城区和农村分别选取1所初中和1所高中,共22868名在校初中和高中学生为研究对象。采用自编问卷评估青少年饮食节律,用患者健康问卷(PHQ-9)评定抑郁症状。运用二元Logistic回归模型分析青少年饮食节律与抑郁症状之间的关联,并按照性别和体力活动水平进行分层分析青少年饮食节律与抑郁症状的关联性。结果青少年抑郁症状检出率为44.4%。不同性别、体力活动水平、饮食节律紊乱程度青少年抑郁症状检出率差异均有统计学意义(χ^(2)值分别为157.51,105.02,3282.50,P值均<0.01)。二元Logistic回归分析结果显示,调整年龄、性别、家庭所在地、家庭经济情况、是否独生子女、父母文化程度、学习负担、体力活动等混杂因素后,以饮食节律低紊乱组为参照,青少年饮食节律中紊乱组(OR=2.63,95%CI=2.45~2.83)、高紊乱组(OR=6.38,95%CI=5.93~6.86)与抑郁症状均呈正相关;按性别分层后,男生和女生饮食节律中紊乱组(男:OR=2.62,95%CI=2.37~2.89;女:OR=2.67,95%CI=2.40~2.97)、高紊乱组(男:OR=5.74,95%CI=5.19~6.35;女:OR=7.11,95%CI=6.40~7.89)与抑郁症状均呈正相关;按体力活动水平分层后,低、中等及以上体力活动水平青少年饮食节律中紊乱组(低体力活动:OR=2.91,95%CI=2.58~3.29;中等及以上体力活动:OR=2.50,95%CI=2.28~2.74)、高紊乱组(低体力活动:OR=6.51,95%CI=5.94~7.13;中等及以上体力活动:OR=6.18,95%CI=5.47~6.97)与抑郁症状均呈正相关(P值均<0.01)。饮食节律与体力活动水平对青少年抑郁症状的发生存在交互作用,以中等及以上体力活动水平且饮食节律低紊乱组为参照,低体力活动水平且饮食节律中、高紊乱组青少年抑郁症状检出率更高(OR值分别为1.50,3.90,95%CI分别为1.39~1.61,3.63~4.19,P值均<0.01)。结论饮食节律紊乱与青少年抑郁症状检出率呈正向关联。规律性膳食行为、增加体力活动对促进青少年心理健康具有积极意义。

Objective To describe the prevalence and association of dietary rhythm and depressive symptoms among adolescents,so as to provide a basis for improving unhealthy behavioral habits,and to promote adolescent physical and mental health.Methods From October to December 2021,a total of 22868 students were selected from one middle school and high school in urban and rural areas of eight cities,namely,Shenyang,Xuzhou,Shenzhen,Taiyuan,Nanchang,Zhengzhou,Chongqing,and Kunming cities,China,using a combination of purposive sampling and stratified cluster random sampling.A self-administered questionnaire was used to assess adolescents'dietary rhythm,and the Patient Health Questionnaire-9(PHQ-9)was used to assess depressive symptoms.Binary Logistic regression model was employed to analyze the associations between adolescent dietary rhythm and depressive symptoms,while the associations between adolescent dietary rhythm and depressive symptoms across gender and physical activity levels were stratified by gender and physical activity levels.Results The detection rate of depressive symptoms in adolescents was 44.4%.The respective differences in the detection rates of depressive symptoms among adolescents of different genders,physical activity levels,and dietary rhythm disorders were statistically significant(χ^(2)=157.51,105.02,3282.50,P<0.01).Taking the low disordered dietary rhythm group as the reference,binary Logistic regression analyses showed that after adjusting for confounding factors such as age,gender,family location,family economic situation,whether only-child,parental education level,and learning burden,physical activity levels,depressive symptoms were positively correlated with adolescents in the moderate disordered dietary rhythm group(OR=2.63,95%CI=2.45-2.83)and the high disordered dietary rhythm group(OR=6.38,95%CI=5.93-6.86).In addition,after stratifying by gender,dietary rhythm were positively correlated with depressive symptoms.The moderate disordered group(male:OR=2.62,95%CI=2.37-2.89,female:OR=2.67,95%CI=2.40-2.97)and the highly disordered group(male:OR=5.74,95%CI=5.19-6.35,female:OR=7.11,95%CI=6.40-7.89)were positively correlated with depressive symptoms.After stratification by physical activity levels,low,moderate and above physical activity levels among adolescents in the disordered dietary rhythm group(low physical activity:OR=2.91,95%CI=2.58-3.29,moderate and above physical activity:OR=2.50,95%CI=2.28-2.74),high disordered group(low physical activity:OR=6.51,95%CI=5.94-7.13,moderate and higher physical activity:OR=6.18,95%CI=5.47-6.97)were positively associated with depressive symptoms(P<0.01).There was an interaction between dietary rhythm and physical activity levels in regard to the development of depressive symptoms in adolescents,taking the group with moderate and above physical activity levels and low disordered dietary rhythm as the reference,the detection rate of which was higher in adolescents with low levels of physical activity and those in the moderate or high disordered dietary rhythm group(OR=1.50,3.90,95%CI=1.39-1.61,3.63-4.19,P<0.01).Conclusions Dietary rhythm disorders were found to be positively associated with depressive symptoms in adolescents.Regular dietary behaviors and increased physical activity play an important positive role in promoting adolescent mental health.