喂养方式与儿童体重：这种关联在学龄前儿童中是双向的吗？
Feeding practices and child weight: is the association bidirectional in preschool children?
作者信息
Jansen Pauline W, Tharner Anne, van der Ende Jan, Wake Melissa, Raat Hein, Hofman Albert, Verhulst Frank C, van Ijzendoorn Marinus H, Jaddoe Vincent W V, Tiemeier Henning
机构信息
From the Departments of Child and Adolescent Psychiatry/Psychology (PWJ, JvdE, FCV, and HT) and Pediatrics (VWVJ), Erasmus University Medical Center (Erasmus MC)-Sophia, Rotterdam, Netherlands; The Generation R Study Group (PWJ, AT, and VWVJ) and Departments of Epidemiology (AT, AH, VWVJ, and HT), Public Health (HR), and Psychiatry (HT), Erasmus MC-University Medical Center Rotterdam, Rotterdam, Netherlands; the Institute of Psychology (PWJ) and School of Pedagogical and Educational Sciences (MHvI), Erasmus University Rotterdam, Rotterdam, Netherlands; the Murdoch Childrens Research Institute, Melbourne, Australia (MW); the Department of Pediatrics, University of Melbourne, Melbourne, Australia (MW); and the Centre for Community Child Health, Royal Children's Hospital, Melbourne, Australia (MW).
出版信息
Am J Clin Nutr. 2014 Nov;100(5):1329-36. doi: 10.3945/ajcn.114.088922. Epub 2014 Sep 3.
BACKGROUND
Parental feeding practices are associated with children's body mass index (BMI). It has been generally assumed that parental feeding determines children's eating behaviors and weight gain, but feeding practices could equally be a parent's response to child weight.
OBJECTIVE
In longitudinal analyses, we assessed the directionality in the relation between selected controlling feeding practices and BMI in early childhood.
DESIGN
Participants were 4166 children from the population-based Generation R Study. BMI was measured at ages 2 and 6 y. With the use of the Child Feeding Questionnaire, parents reported on restriction, monitoring, and pressure to eat (child age: 4 y). BMI and feeding-behavior scales were transformed to SD scores.
RESULTS
With the use of linear regression analyses, there was an indication that a higher BMI at age 2 y predicted higher levels of parental restriction (adjusted β = 0.07; 95% CI: 0.04, 0.10) and lower levels of pressure to eat (adjusted β = -0.20; 95% CI: -0.23, -0.17) 2 y later. Restriction at age 4 y positively predicted child BMI at 6 y of age, although this association attenuated to statistical nonsignificance after accounting for BMI at age 4 y (β = 0.01; 95% CI: -0.01, 0.03). Pressure to eat predicted lower BMI independently of BMI at age 4 y (β = -0.02; 95% CI: -0.04, -0.01). For both restriction and pressure to eat, the relation from BMI to parenting was stronger than the reverse (Wald's test for comparison: P = 0.03 and < 0.001, respectively). Monitoring predicted a lower child BMI, but this relation was explained by confounding factors.
CONCLUSIONS
Although the feeding-BMI relation is bidirectional, the main direction of observed effects suggests that parents tend to adapt their controlling feeding practices in response to their child's BMI rather than the reverse. Therefore, some components of current programs aimed at preventing or treating unhealthy child weight may need to be carefully scrutinized, especially those targeting parental food-related restriction and pressure to eat.
背景
父母的喂养方式与儿童的体重指数（BMI）相关。人们普遍认为父母的喂养决定了儿童的饮食行为和体重增加，但喂养方式也可能同样是父母对孩子体重的一种反应。
目的
在纵向分析中，我们评估了幼儿期特定的控制性喂养方式与BMI之间关系的方向性。
设计
参与者为来自基于人群的“R代研究”的4166名儿童。在2岁和6岁时测量BMI。父母使用儿童喂养问卷报告限制、监督和进食压力（儿童年龄：4岁）。BMI和喂养行为量表转换为标准差分数。
结果
通过线性回归分析表明，2岁时较高的BMI预测2年后父母限制水平较高（调整后的β = 0.07；95%置信区间：0.04，0.10），进食压力水平较低（调整后的β = -0.20；95%置信区间：-0.23，-0.17）。4岁时的限制正向预测6岁时儿童的BMI，尽管在考虑4岁时的BMI后这种关联减弱至无统计学意义（β = 0.01；95%置信区间：-0.01，0.03）。进食压力独立于儿童4岁时的BMI预测较低的BMI（β = -0.02；95%置信区间：-0.04，-0.01）。对于限制和进食压力，从BMI到养育方式的关系比反向关系更强（比较的Wald检验：P分别为0.03和<0.001）。监督预测儿童BMI较低，但这种关系由混杂因素解释。
结论
虽然喂养与BMI的关系是双向的，但观察到的主要影响方向表明，父母倾向于根据孩子的BMI调整其控制性喂养方式，而不是相反。因此，当前旨在预防或治疗儿童不健康体重的项目中的一些组成部分可能需要仔细审查，尤其是那些针对父母与食物相关的限制和进食压力的部分。
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