卫生研究

目的分析学龄前儿童睡眠时间和饮食模式与肥胖的交互作用,探讨影响学龄前儿童肥胖的生命早期因素。方法 2018年9月—2019年3月,采用两阶段整群抽样的方法选取蚌埠市22所幼儿园2129名3～6岁学龄前儿童(男童1148名,女童981名;城镇户口1199名,农村户口930名;独生子女756名,非独生子女1373名)作为研究对象。通过自制"蚌埠市学龄前儿童睡眠及发育问卷"调查学龄前儿童的社会人口学特征(包括性别、年龄、是否独生、是否留守儿童、家庭经济状况、父母文化程度及看护人信息等)、睡眠状况和质量以及膳食摄入情况。采用因子分析法建立膳食模式,采用多因素非条件Logistic回归模型分析儿童睡眠时间和饮食模式与儿童肥胖的关系,并进行交互作用分析。结果主成分分析共获得传统型、动物食物型、高钙型和零食型4种饮食模式,4种饮食模式的因子贡献率分别为16.568%、11.462%、7.317%和4.562%,累积因子贡献率为39.909%。学龄前儿童超重、肥胖率分别为18.0%(383名)和10.5%(223名)。调整年龄、性别、独生子女、留守儿童、城镇户口、父亲文化程度、母亲文化程度、家庭人均月收入、视屏时间、户外活动时间、看护人营养知识-态度-行为得分等因素,睡眠时间较少(OR=1.25,95%CI 1.07～1.72)、动物食物型饮食模式得分偏高(OR=1.32,95%CI 1.15～1.54)、零食型饮食模式得分偏高(OR=1.46,95%CI 1.16～1.78)均增加学龄前儿童超重/肥胖的发生风险。学龄前儿童睡眠时间与动物食物型饮食模式对超重/肥胖症状的发生存在相加交互作用和相乘交互作用(OR=1.23,95%CI 1.16～1.32);儿童睡眠时间短与零食型饮食模式(RERI=0.38,AP=0.20,SI=1.24)未发现相加交互作用,但存在相乘交互作用(OR=1.16,95%CI 1.09～1.24);儿童睡眠时间与传统型饮食模式、高钙型饮食模式对超重/肥胖症状不存在相加、相乘交互作用[(OR=0.76,95%CI 0.51～1.11)vs.(OR=1.04,95%CI 0.65～1.73)]。讨论睡眠时间短是学龄前儿童超重/肥胖症状发生的危险因素,与学龄前儿童的动物食物型饮食模式存在相加和相乘交互作用,与零食型模式存在相乘交互作用。

OBJECTIVE To examine the interaction effect between sleep duration and dietary patterns on obesity, in order to explore the possible risk factors for preschool children's obesity. METHODS During September of 2018 to March of 2019(1148 boys and 981 girls, 1199 living in urban and 930 living in rural, 756 only child and 1373 not only child),a total of 2129 preschool children used two-stage cluster sampling method from 22 kindergartens aged 3-6 years old were investigated. Social-demographic information(included sex, age, only child or not, left-behind children or not, economic status of family, parents ‘cultural level and caregivers' information), sleep duration and dietary intake were collected through "Sleep Duration and Physical Development Questionnaire(SDPDQ) of children aged 3-6 years old in Bengbu city". Factor analysis was applied to determine major dietary patterns, unconditional Logistic regression was used to analyze the multiplication interaction effect between sleep duration and dietary patterns on obesity. RESULTS Four dietary patterns-"traditional", "animal", "calcium" and "snack" were identified in our study by principal component analysis. The factor contribution rate of the four dietary patterns was 16.568%, 11.462%, 7.317% and 4.562%, respectively, the total variance was 39.909%. Among the preschool children, the prevalence of overweight and obesity were 18.0%(n=383) and 10.5%(n=223), respectively. After controlling the confounding factors, the shorter sleep duration(OR=1.25,95%CI 1.07-1.72), scores in the top quintile of "animal" pattern(OR=1.32,95%CI 1.15-1.54) and "snack" pattern(OR=1.46,95%CI 1.16-1.78) showed greater odds with the prevalence of overweight/obesity among preschool children. Both multiplication and additive interactions were observed between levels of low sleep duration and animal dietary pattern with overweight/obesity(OR=1.23, 95%CI 1.16-1.32). Multiplication interaction was observed between lower sleep time and the snack dietary pattern(OR=1.16, 95%CI 1.09-1.24), with RERI, AP and SI was 0.38, 0.20 and 1.24, respectively. However, neither multiplication interaction or additive interaction was noticed between sleep duration and the traditional dietary pattern, the calcium dietary pattern with OR=0.76(95%CI 0.51-1.11) vs. OR=1.04(95%CI 0.65-1.73), respectively. CONCLUSION Levels of low sleep duration presented a risk factor for overweight/obesity in preschool children. Both multiplication and additive interactions were observed between low sleep time and the animal dietary pattern. Multiplication interaction was noticed between children's sleep duration and the snack dietary pattern.