1] Murdoch Childrens Research Institute, Melbourne, Victoria, Australia [2] Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands.
Int J Obes (Lond). 2013 Oct;37(10):1307-13. doi: 10.1038/ijo.2013.71. Epub 2013 May 14.
Temporal pathways of known associations between overweight and poor health-related quality of life (HRQoL) in adolescents remain poorly documented. This study aims to (1) examine timing and strength of the association between HRQoL and body mass index (BMI) in childhood, and (2) investigate directionality and impact of cumulative burden in any observed HRQoL-BMI associations.
DESIGN, SETTING AND PARTICIPANTS: Participants were 3898 children in the population-based Longitudinal Study of Australian Children (LSAC) assessed at four biennial waves from ages 4-5 (2004) to 10-11 years (2010).
At every wave, parents completed the Pediatric Quality of Life Inventory, and measured BMI (kg m(-2)) was converted into BMIz and overweight using international norms.
Linear and logistic regressions.
Overweight first became cross-sectionally associated with HRQoL at 6-7 years of age, with linear associations between poorer HRQoL (physical and psychosocial health) and higher BMI developing by 8-9 years and strengthening by 10-11 years. Longitudinal analyses revealed cumulative relationships such that the number of times a child was overweight between the ages 4 and 11 years predicted progressively poorer scores on both physical and psychosocial health at 10-11 years (P-values for trend <0.001). In the weaker reverse associations, children with poor (vs persistently good) physical health at any wave had slightly higher mean BMIz at age 10-11 years, but this difference was small (0.14, 95% confidence interval (CI): 0.04, 0.24) and not cumulative; results for psychosocial health were even weaker, with mixed subscale findings.
Middle childhood appears to be the critical period in which HRQoL-BMI comorbidities emerge and strengthen, first among children with clinically relevant conditions, that is, overweight or poor HRQoL, and then more generally across the whole range of BMI. Poorer HRQoL seemed predominantly a consequence of higher BMI, rather than a cause, suggesting that effective promotion of healthy weight could benefit multiple aspects of children's well-being.
超重与青少年健康相关生活质量（HRQoL）之间的已知关联的时间途径仍记录不佳。本研究旨在：（1）检查 HRQoL 与儿童时期 BMI 之间关联的时间和强度，以及（2）调查任何观察到的 HRQoL-BMI 关联中累积负担的方向和影响。
设计、地点和参与者：参与者是来自基于人群的澳大利亚儿童纵向研究（LSAC）的 3898 名儿童，他们在 4-5 岁（2004 年）至 10-11 岁（2010 年）的四个两年一次的波次中进行了评估。
在每个波次中，父母都完成了儿科生活质量问卷，并用国际标准将 BMI（kg/m²）转换为 BMIz 和超重。
线性和逻辑回归。
超重首先在 6-7 岁时与 HRQoL 呈现出横断面关联，HRQoL（身体和心理社会健康）较差与更高的 BMI 之间的线性关联在 8-9 岁时发展，并在 10-11 岁时加强。纵向分析显示出累积关系，即儿童在 4 至 11 岁之间超重的次数预测了 10-11 岁时身体和心理社会健康的得分逐渐变差（趋势 P 值<0.001）。在较弱的反向关联中，任何波次中身体状况较差（而非持续良好）的儿童在 10-11 岁时 BMIz 略高，但差异很小（0.14，95%置信区间（CI）：0.04，0.24）且不累积；心理社会健康的结果更弱，各子量表的发现结果不一。
儿童中期似乎是 HRQoL-BMI 共病出现和加强的关键时期，首先是在超重或 HRQoL 较差的儿童中，然后是在 BMI 整个范围内更为普遍。较差的 HRQoL 似乎主要是 BMI 较高的结果，而不是原因，这表明有效促进健康体重可能有益于儿童福祉的多个方面。
