健康教育对肥胖儿童认知、饮食结构及生活方式的影响

【目的】 探索单次和多次健康教育对肥胖儿童认知,饮食结构、生活方式及体重控制的影响,为儿童肥胖干预的实施提供有效措施。 【方法】 按照《中国0~18岁儿童青少年体块指数的生长曲线》超重和肥胖诊断标准筛查学龄儿童,对肥胖儿童发放调查问卷,评估肥胖认知、饮食结构及生活方式并分组给予单次或多次健康教育。健康教育的内容包括肥胖的判断和危害,科学的饮食结构、生活方式和心理支持等。6个月后再次进行评估。 【结果】 共有107名年龄6~13岁的肥胖儿童(男69人,女38人)纳入研究。资料完整90名,其中单次教育组44人,多次教育组46人。1)健康教育后两组儿童和家长对肥胖的认知水平均提高,但多次教育组儿童和家长认知水平显著高于单次教育组(P<0.01);2)干预后,多次教育组总能量及蛋白质、脂肪、碳水化合物摄入量及能量密度均降低(P<0.01),蔬菜份量增加(P<0.05),动物性食物及甜点、薯片的进食份额明显减少(P<0.01);单次教育组脂肪摄入减少(P<0.01),但总能量、食物份额量无明显改变;3)多次教育组在洋快餐、零食、看电视吃零食频率及看电视时间明显减少(P<0.01),但每日运动时间无明显变化;单次教育组生活方式无显著改变(P>0.05);4)干预后单次教育组BMI-SDS(body mass index-standard deviation score )无明显改变,多次教育组BMI-SDS降低(P<0.05)。 【结论】 对肥胖儿童和家长进行健康教育,尤其是多次教育有助于提高肥胖儿童和家长认知能力,降低儿童总能量摄入,改变饮食结构和生活方式,进而降低BMI。     

学龄儿童单纯性肥胖影响因素Logistic回归分析

目的研究学龄儿童单纯性肥胖（CSO）的影响因素，为探讨干预对策提供依据。方法采用多阶段分层整群抽样，对徐州市8所小学1～5年级学生进行问卷调查与体检，所得资料采用SPSS 11．5软件进行单因素与多因素非条件Logistic回归分析。结果经单因素和多因素Logistic回归分析，有8个暴露因素为危险因素。可归结为父、母亲肥胖、儿童出生与周岁体重过大和不良饮食方式等；有4个因素具有保护作用，主要为儿童的合理喂养和适当的运动；儿童的出生体重、周岁体重、进食速度、喜食肥肉、主食量大和适量运动的等级间OR值较大。结论徐州市学龄儿童单纯性肥胖的影响因素以营养过度和饮食行为偏差更为突出，家长、学校以及社区应创造一个综合防治的社会环境，才能有利于儿童肥胖的群体干预。     

北京市通州区学龄儿童主观体型认知与减重行为分析

目的了解学龄儿童及其家长对学生体型认知和体质指数(BMI)评价结果的相关性,为预防和控制儿童青少年肥胖提供参考。方法2018-04/05采用方便抽样和分层整群抽样相结合的方法,选择北京市通州区城镇、农村中小学校各4所,调查对象为6~13岁学龄儿童及其家长,通过调查问卷收集对学龄儿童体型的评价,体格检查测量身高、体重。采用SPSS 21.0软件进行χ²检验,分析体型认知与BMI评价指标的相关率。检验准为α=0.05。结果2411名中小学生肥胖检出率为36.42%。自我评价为肥胖的占25.88%,家长评价为肥胖的为26.61%。不同性别之间BMI评价(χ²=46.004,P<0.001)、自我评价(χ²=26.621,P<0.001)及家长评价(χ²=38.787,P<0.001)差异有统计学意义。自我评价和家长评价与BMI指标相关率分别为44.46%、44.71%。肥胖儿童被自我及家长低估的比例分别为36.56%、34.74%。肥胖人群控制体重的比例为68.68%,不同性别、年龄之间控制体重比例差异有统计学意义(性别:χ²=4.724,P=0.031;年龄:χ²=9.632,P=0.022)。结论学龄儿童体体型自我评价、家长评价与BMI评价结果相关性较差,肥胖低估是体型认知的主要问题。应积极改善学生和家长对体型认知偏倚,促进儿童青少年身心健康。     

肥胖儿童生活方式的研究

目的 研究我国学龄儿童中肥胖的发病率以及相关生活方式对肥胖发病的影响。方法 数据来源于2005年11-12月在我国进行的一项学龄儿童睡眠相关问题的普查。选取与生活方式相关因素,主要包括:饮食方面,屏幕暴露,生活质量以及体育活动四大方面,并进行多因素Logistic回归。结果 我国儿童肥胖的发病率大约为10.2%,经过单因素分析得出学龄儿童与肥胖有关的生活方式包括社交少,长期屏幕暴露,经常被师长责骂,运动少,咖啡因摄入过多。最终模型中,各方面的OR值(95%CI)分别为:长时间电视屏幕暴露1.104(1.035～1.178),经常被老师责骂1.099(1.036～1.166),较少的体育运动1.096(1.050～1.143)和朋友很少1.091(1.044～1.141)。结论 在我国部分肥胖学龄儿童中存在不良的生活方式,家长应予以足够的重视。对未患肥胖的儿童也应避免出现这些情况。     

家长对儿童肥胖认知行为的健康教育效果评价

目的探讨健康教育对家长关于儿童肥胖认知行为及儿童肥胖率的影响。方法采用整群抽样法随机抽取郑州郊区4所幼儿园,通过营养讲座的方式对家长进行健康教育,并采用问卷调查比较干预1年前后家长对儿童肥胖相关知信行变化;比较健康教育前后儿童肥胖率。结果健康教育前后家长关于儿童肥胖相关知识、态度和行为的条目回答结果差异均有统计学意义(P0.05)。健康教育前男童肥胖率为9.17%、女童为6.25%,健康教育后男童肥胖率为8.13%、女童为5.23%,比较差异均无统计学意义(P0.05)。结论健康教育对家长关于儿童肥胖的认知行为有明显影响,但儿童肥胖率下降不明显,应加强对肥胖儿童及家长的健康教育。     

学龄前儿童家长体重认知现状及影响因素分析

目的调查学龄前儿童家长体重认知情况,分析儿童家长体重认识偏差的影响因素。方法分层整群随机抽样法,选取扬州市共562名学龄前儿童及家长进行营养知识、肥胖态度及喂养方式等问卷调查。结果学龄前儿童家长对儿童体重的认知与儿童实际BMI等级的一致性极低(Kappa=0.182)。多因素logistic回归分析显示:营养知识得分达标(OR=0.361)和鼓励多样化型喂养方式明显(OR=0.449)是儿童家长体重认知偏差的保护因素,肥胖态度消极(OR=2.493)和促进型喂养方式明显(OR=2.853)是家长体重认知偏差的危险因素。结论学龄前儿童家长对儿童的体重认知存在明显偏差,家长的营养知识、肥胖态度以及喂养方式影响其儿童体重认知,是开展学龄前儿童超重和肥胖预防保健工作的潜在干预靶点。     

家长对肥胖儿童营养认知影响因素结构方程模型研究

目的构建家长对肥胖儿童营养认知影响因素的结构方程模型,并探讨其直接效应与间接效应。方法于2014年5至7月采用随机方式选取泉州地区3家医院门诊就医肥胖儿童（4~6岁）的家长共258名进行营养认知问卷调查,对调查数据进行结构方程模型的估计及结构方程模型拟合。结果结构方程模型的拟合较好;家长的营养知识对肥胖儿童饮食行为的直接效应为0.2278,间接效应为0.1287,总效应为0.3065;而家长的营养态度对肥胖儿童饮食行为改变的效果为0.2719。结论结构方程模型能较好评价家长的营养知识、营养态度及对肥胖儿童饮食行为的影响情况,可作为评估家长掌握肥胖儿童营养认知状况的理论依据。     

北京市中学生营养状况及其与家长营养认知的关联分析

了解北京市中学生家长对子女营养状况的认知现状及其与学生营养状况的关联,为有效预防儿童青少年肥胖提供科学依据.方法 采用分层随机整群抽取北京8所初中、8所高中学生共2 308名进行体格测量(身高、体重),根据中国肥胖问题工作组2004年制订的“中国学龄儿童青少年超重、肥胖筛查体重指数分类标准”及“中国6~19岁学龄儿童青少年分年龄BMI筛查消瘦界值”进行营养状况评价,并通过问卷调查了解家长对儿童营养状况的认知情况.结果 家长对子女主观营养评价与BMI评价结果总符合率为57.8%,33.4%的家长出现低估偏倚,8.8%的家长出现高估偏倚,一致程度不够理想(Kappa=0.32,u=26.80,P<0.01).认知正确组家长了解孩子偏食挑食的比例、鼓励孩子闲暇时间进行体育运动的比例、了解孩子身高体重变化情况的比例、选择最科学减肥途径的比例均高于认知错误组家长(x2值分别为6.06,13.02,11.94,6.15,P值均<0.05).结论 家长对子女的营养状况存在认知偏差,应进一步加强宣传教育,使家长能够正确评估儿童的营养状况,并在日常生活中培养孩子健康的生活行为.     

喂养与生活方式对儿童单纯性肥胖影响的研究

目的:探讨喂养与生活方式对儿童单纯性肥胖的影响,为预防和控制儿童单纯性肥胖的发生提供理论依据。方法:在现况研究的基础上,采用病例对照研究方法,对筛查出的肥胖儿童和正常儿童进行现场问卷调查,分析对儿童单纯性肥胖的影响因素。结果:15所学校共计调查学龄儿童(6～9岁)6288名,儿童单纯性肥胖的检出率为3.59%。Logistic回归分析结果表明,肥胖的发生与0.5～1岁以前添加辅食(OR=2.84)、6个月以后添加肉食(OR=0.82)、油腻食品食用频率高(OR=1.83)、每餐用餐时间长(OR=0.63)和户外活动时间(OR=0.77)等生活方式有关。结论:儿童单纯性肥胖的发生与早期喂养方式及饮食和运动习惯等多种生活方式相关。     

超重、肥胖对潍坊市学龄儿童生活质量的影响

目的 探讨超重、肥胖对潍坊市学龄儿童生活质量的影响. 方法 采用儿童少年生活质量问卷对儿童生活质量进行测评,利用体重指数对儿童进行分组,利用协方差分析比较正常、超重和肥胖儿童的生活质量状况. 结果 正常体重和超重体重儿童活动能力优于肥胖儿童(P<0.01);正常体重和超重体重儿童生理健康方面优于肥胖儿童(P<0.01). 结论 肥胖对潍坊市学龄儿童生活质量有影响,学生保健部门、学校和家庭三方加强干预,预防儿童期肥胖的发生.     

北京市小学生及其家长的肥胖相关知识·态度·行为

目的了解北京市小学生的营养状况及肥胖相关知识、态度、行为现状,并研究其与家长相关知识、态度、行为间的关系,为防制青少年学生肥胖健康教育提供依据.方法整群抽取北京市4所小学三、四年级全体学生,采用问卷调查法调查学生及其家长各2 020名.结果北京市小学生肥胖相关知识掌握较好的学生占0.73%,正确态度持有率为56.75%,良好行为形成率为11.27%.家长的态度与学生的态度及行为之间存在一定的关联性.结论通过健康教育,向学生及其家长传授正确的与肥胖相关的知识及控制肥胖的技能,转变他们错误态度和不良行为习惯,以促进学生营养状况的改善.     

Children and Adolescents Dietary Habits and Lifestyle Changes during COVID-19 Lockdown in Italy

Background: We evaluated the changes in lifestyle during the COVID-19 pandemic lockdown in a sample of children and adolescents in order to assess any increase in risk factors for the onset of cardiovascular diseases in later ages. Methods: We conducted a cross-sectional study involving 965 parents who completed an online survey about dietary habits and lifestyle during the first lockdown in Italy (from 9 March 2020 to 18 May 2020) and compared their findings with the period before the pandemic. The inclusion criteria were parents (or caregivers) with Italian residency and with children aged between 5 and 18 years. Results: We identified 563 adolescents and 402 children. The mean age was 12.28 years (SD 3.754). The pandemic was associated with an increase in the consumption of high-calorie snack foods. The total amount of food in homes during lockdown compared with before the pandemic increased 50%. Relating to the parent-perceived child weight status, more parents reported obesity in their children after lockdown (+0.6% in the 5–11 age group and +0.2% in the 12–18 age group). We reported a reduction of physical activity, an increase of sedentary lifestyle and sleep habits changes. Conclusion: The COVID-19 pandemic was associated with changes in the lifestyles of children and adolescents; this could cause an increase in the incidence of obesity and of cardiovascular and metabolic diseases in adulthood.     

Impact of Lifestyle Disruption on Parent and Child Coping, Knowledge, and Parental Discipline in Children With Sickle Cell Anemia

We compared the knowledge of sickle cell disease, child and parent coping strategies, and parent discipline methods/knowledge in three groups of children and their parents. The groups were composed of: (a) children with sickle cell anemia who experienced disease-related significant lifestyle disruption, (b) children with sickle cell anemia who experienced disease-related minimal lifestyle disruption, and (c) non-ill Black children. The groups were matched for age, sex, and ethnicity. No differences were found among the groups on measures of child coping. Children with sickle cell anemia, regardless of level of disruption, reported more knowledge about sickle cell disease than did healthy peers. Parents of children in the significant lifestyle disruption groups scored lower on the Engagement, Emotional Engagement, and Problem-Focused Disengagement, and higher on the Medical Coping scales of the Coping Strategies Inventory than parents of healthy children and children in the minimal lifestyle disruption group. Surprisingly, the groups did not differ in discipline knowledge; however, parents of children in the minimal lifestyle disruption group reported significantly greater use of effective discipline methods than parents of healthy children. Further research on the relations among coping, discipline, and lifestyle disruption due to SCA in children is suggested.     

Psychological Abuse of Children in Health Care (Book)

We compared the knowledge of sickle cell disease, child and parent coping strategies, and parent discipline methods/knowledge in three groups of children and their parents. The groups were composed of: (a) children with sickle cell anemia who experienced disease-related significant lifestyle disruption, (b) children with sickle cell anemia who experienced disease-related minimal lifestyle disruption, and (c) non-ill Black children. The groups were matched for age, sex, and ethnicity. No differences were found among the groups on measures of child coping. Children with sickle cell anemia, regardless of level of disruption, reported more knowledge about sickle cell disease than did healthy peers. Parents of children in the significant lifestyle disruption groups scored lower on the Engagement, Emotional Engagement, and Problem-Focused Disengagement, and higher on the Medical Coping scales of the Coping Strategies Inventory than parents of healthy children and children in the minimal lifestyle disruption group. Surprisingly, the groups did not differ in discipline knowledge; however, parents of children in the minimal lifestyle disruption group reported significantly greater use of effective discipline methods than parents of healthy children. Further research on the relations among coping, discipline, and lifestyle disruption due to SCA in children is suggested.     

珠海市学龄前儿童单纯性肥胖流行现况及相关因素研究

目的 了解珠海市学龄前儿童单纯性肥胖的流行现况,初步探讨学龄前儿童单纯性肥胖的相关因素,为干预学龄前儿童单纯性肥胖提供依据。方法 调查资料来源于2011-2016年的托幼机构体检数据,使用1∶1病例对照方法筛查学龄前儿童单纯性肥胖危险因素,143名病例来自于3个区的10所托幼机构,对照为同性别、年龄、身高相近健康儿童。采用问卷调查收集病例和对照儿童的家庭、社会学因素以及可能与肥胖相关的因素。结果 珠海市2011-2016年学龄前儿童单纯性肥胖发生率为6.12%,并呈现上升趋势(P<0.01),男童组发生率高于女童组,且随着年龄增长肥胖发生率越高,均具有统计学意义(P<0.01)。学龄前儿童出生体重≥4 000 g,吃饭速度快,父母亲超重或/和肥胖是学龄前儿童肥胖的危险因素,放学后户外活动超过2 h、家长正确填报儿童体重是其保护因素。结论 珠海市学龄前儿童单纯性肥胖发生率呈现上升趋势,其相关因素复杂多样,家长应注意自身体重管理,培养儿童良好生活习惯,降低儿童单纯肥胖发生率。     

The Outcome of COVID-19 Lockdown on Changes in Body Mass Index and Lifestyle among Croatian Schoolchildren: A Cross-Sectional Study

Globally, the COVID-19 pandemic altered adults’ and children’s lifestyles and habits, causing an increase in body weight. Adolescents are sensitive to habit changes and, because of their insufficient capacity to deal with the unexpected COVID-19 changes, were at greater risk of noncommunicable disease development due to the consequences of adopting unhealthy habits. The survey aimed to reveal the changes in nutritional status and lifestyle habits of school children in Croatia and to assess their nutrition knowledge and emotional state and feelings about COVID-19 lockdown. Self-reported data from 1370 school children aged 10 to 15 years were obtained to examine the influence of the lockdown on their nutritional status, lifestyle and emotional status, and to assess their nutrition knowledge. The study revealed that the COVID-19 lockdown has caused an increase in the proportion of overweight and obesity among Croatian school children who changed their lifestyle habits towards being less physically active, spending more time using screen-based media and revealing potential psychological distress. However, the schoolchildren had a high adherence to the Mediterranean diet assessed with the Mediterranean Diet Quality Index for children and adolescents (KIDMED) index and had good nutrition knowledge. Public health programs promoting a healthy lifestyle and involving the whole family, in a school environment, could provide children with a healthy adulthood.     

Health and social situation of adolescents in Hanoi,Vietnam

Abstract

Primary education in Vietnam is free and compulsory for five years. The majority of school-aged children continue into lower secondary school, but significant numbers drop out. This study investigated the health and social situation of adolescents aged 11–16 years (between primary education and legal employment age) to compare the situation of adolescents in school with those working, including possible gender differences. The data were collected by questionnaire on a randomly selected sample of adolescents, aged 11–16 years, living in Hanoi. A total of 1547 adolescents were interviewed. Adolescents from Hanoi were healthy, continuing their education, lived with parents, and only a few reported behaviour detrimental to their health. They knew about HIV, but their knowledge about prevention was poor. The working adolescents had moved to Hanoi to earn an income. The girls were staying mainly with relatives, while the boys lived with employers or in rented rooms. Very few were homeless and these were exposed to more risks to their health due to a more risky lifestyle and less knowledge about HIV prevention. For urban adolescents, their right to education, basic health and to be cared for by their parents was fulfilled. More of the rural adolescents had left school early, were responsible for their own daily life and were exposed to greater risks and a more risky lifestyle. The living and working conditions of these rural adolescents need further investigation and action to ensure their rights to welfare, development and health are met.     

上海市核心家庭中学生生殖健康知识及影响因素分析

目的：了解上海市核心家庭中初中、高中孩子生殖健康知识状况及影响因素，为有效开展家庭生殖健康教育提供依据。方法：通过流行病学横断面调查，对符合入选标准的核心家庭初中、高中孩子进行问卷调查，对他们的生殖健康知识及可能的影响因素进行分析。结果：调查对象生殖健康知识不高，相关问题的正确回答率较低（〈70％）。知识得分仅为40．69±27．13分（满分100分）。同父母谈论生殖健康问题可以提高孩子的生殖健康知识水平，OR值为2．466（95％CI：1．523—3．993）。多因素分析发现孩子的年龄以及同父母谈论生殖健康问题对他们的生殖健康知识有影响。结论：上海市核心家庭初中和高中孩子的生殖健康知识总体较差，而同父母交流可以提高他们的生殖健康知识。提示家庭教育对孩子生殖健康知识的获得有促进作用。     

上海部分初中生家长对干预子女肥胖相关行为的意愿和影响因素分析

[目的]了解初中学生家长对干预子女肥胖相关行为的意愿,并通过对家长意愿的影响因素分析,为随后开展的学生肥胖相关行为干预提供依据。[方法]从上海市的徐汇区和长宁区的初中学校中各随机抽取2所,对其中的初中预备班和初一的所有学生家长和学生进行问卷调查。经逻辑纠错后分析有效问卷,对数据进行卡方检验、相关分析和逐步Logistic多因素分析。[结果]90％学生家长认为自己的孩子存在与肥胖相关的不良行为;有77．2％的家长希望在未来的6个月中孩子能够改变这些与肥胖相关的行为。家长的知识得分,家长在调查前1周内是否陪伴孩子锻炼、是否给孩子买零食与改变孩子的行为意愿有关。家长的意愿与孩子的意愿不一致。[结论]对干中学生行为的干预不能仅仅局限于家庭的范围,而应该扩展到学校、社区和社会。增加家长的知识和促进家长采取积极的行动,可以帮助学生减少与肥胖相关的行为。