Wang Liang, Dalton William T, Schetzina Karen E, Fulton-Robinson Hazel, Holt Nicole, Ho Ai-leng, Tudiver Fred, Wu Tiejian
From the Departments of Biostatistics and Epidemiology, Psychology, Pediatrics, and Family Medicine, James H. Quillen College of Medicine, East Tennessee State University, Johnson City.
South Med J. 2013 Oct;106(10):550-7. doi: 10.1097/SMJ.0000000000000008.
This study examined the relation of multiple aspects of the home food environment to dietary intake and body weight among overweight and obese children in southern Appalachia.
The study used baseline data from a cluster-randomized controlled trial, Parent-Led Activity and Nutrition for Healthy Living, evaluating a parent-mediated approach to treating child overweight and obesity in the primary care setting in southern Appalachia. Sixty-seven children ages 5 to 11 years were recruited from four primary care clinics. Multiple linear regression was used to estimate the relation between multiple aspects of the home food environment to dietary intake (fruit and vegetable intake, fat and sweets intake), and standardized body mass index (zBMI), adjusted for baseline family characteristics (education, smoking status during the past month, BMI) and child characteristics (sex, age, Medicaid/TennCare).
Findings showed greater parental restriction and pressure in feeding were associated with greater fruit and vegetable intake in children (β = 0.33, β = 0.30, respectively; both P < 0.05). The availability of chips and sweets in a child's home and parental inappropriate modeling of eating were associated with an increased risk for consumption of fats and sweets by children (β = 0.47, β = 0.54, respectively; both P < 0.01). Parental monitoring of the child's eating was associated with a reduced risk for fat and sweets intake (β = -0.24; P < 0.01). Finally, parental responsibility for feeding the child was associated with lower zBMI (β = -0.20; P < 0.05).
The home food environment, including food availability and parenting behaviors, was associated with overweight and obese children's dietary intake and weight. This study adds to evidence suggesting that programs aimed at improving overweight and obese children's eating patterns may target both aspects of the physical home environment and parental behaviors surrounding eating.
本研究探讨了美国阿巴拉契亚山脉南部超重和肥胖儿童家庭食物环境的多个方面与饮食摄入及体重之间的关系。
本研究使用了一项整群随机对照试验的基线数据，即“家长主导的健康生活活动与营养”试验，该试验评估了在阿巴拉契亚山脉南部初级保健机构中，一种由家长介导的治疗儿童超重和肥胖的方法。从四个初级保健诊所招募了67名5至11岁的儿童。采用多元线性回归来估计家庭食物环境的多个方面与饮食摄入（水果和蔬菜摄入量、脂肪和甜食摄入量）以及标准化体重指数（zBMI）之间的关系，并对基线家庭特征（教育程度、过去一个月的吸烟状况、BMI）和儿童特征（性别、年龄、医疗补助/田纳西医疗保健计划）进行了调整。
研究结果显示，父母在喂养时更多的限制和压力与儿童更多的水果和蔬菜摄入量相关（β分别为0.33和0.30；P均<0.05）。儿童家中薯片和甜食的可得性以及父母不恰当的饮食示范与儿童食用脂肪和甜食的风险增加相关（β分别为0.47和0.54；P均<0.01）。父母对孩子饮食的监督与脂肪和甜食摄入量的风险降低相关（β = -0.24；P < 0.01）。最后，父母对孩子喂养的责任感与较低的zBMI相关（β = -0.20；P < 0.05）。
家庭食物环境，包括食物可得性和养育行为，与超重和肥胖儿童的饮食摄入及体重相关。本研究进一步证明，旨在改善超重和肥胖儿童饮食模式的项目可能需要针对家庭物质环境和围绕饮食的父母行为这两个方面。
