Durão Catarina, Andreozzi Valeska, Oliveira Andreia, Moreira Pedro, Guerra António, Barros Henrique, Lopes Carla
EPIUnit - Institute of Public Health, University of Porto, Rua das Taipas 135, 4050-600 Porto, Portugal.
Center of Statistics and Applications of the University of Lisbon, Faculdade de Ciências da Universidade de Lisboa, Campo Grande, Bloco C6-Piso 4, 1749-016 Lisbon, Portugal.
Appetite. 2015 Sep;92:15-23. doi: 10.1016/j.appet.2015.04.067. Epub 2015 Apr 29.
This study aimed to evaluate the association between maternal perceived responsibility and child-feeding practices and dietary inadequacy of 4-year-old children. We studied 4122 mothers and children enrolled in the population-based birth cohort - Generation XXI (Porto, Portugal). Mothers self-completed the Child Feeding Questionnaire and a scale on covert and overt control, and answered to a food frequency questionnaire in face-to-face interviews. Using dietary guidelines for preschool children, adequacy intervals were defined: fruit and vegetables (F&V) 4-7 times/day; dairy 3-5 times/day; meat and eggs 5-10 times/week; fish 2-4 times/week. Inadequacy was considered as below or above these cut-points. For energy-dense micronutrient-poor foods and beverages (EDF), a tolerable limit was defined (<6 times/week). Associations between maternal perceived responsibility and child-feeding practices (restriction, monitoring, pressure to eat, overt and covert control) and children's diet were examined by logistic regression models. After adjustment for maternal BMI, education, and diet, and children's characteristics (sex, BMI z-scores), restriction, monitoring, overt and covert control were associated with 11-18% lower odds of F&V consumption below the interval defined as adequate. Overt control was also associated with 24% higher odds of their consumption above it. Higher perceived responsibility was associated with higher odds of children consuming F&V and dairy above recommendations. Pressure to eat was positively associated with consumption of dairy above the adequate interval. Except for pressure to eat, maternal practices were associated with 14-27% lower odds of inadequate consumption of EDF. In conclusion, children whose mothers had higher levels of covert control, monitoring, and restriction were less likely to consume F&V below recommendations and EDF above tolerable limits. Higher overt control and pressure to eat were associated, respectively, with higher possibility of children consuming F&V and dairy above recommendations.
本研究旨在评估母亲感知到的责任与儿童喂养方式以及4岁儿童饮食不足之间的关联。我们对参与基于人群的出生队列研究——二十一世纪世代研究（葡萄牙波尔图）的4122对母婴进行了研究。母亲们自行填写了儿童喂养问卷以及一份关于隐蔽和公开控制的量表，并在面对面访谈中回答了食物频率问卷。根据学龄前儿童的饮食指南，确定了充足摄入量区间：水果和蔬菜每天4 - 7次；乳制品每天3 - 5次；肉类和蛋类每周5 - 10次；鱼类每周2 - 4次。摄入量低于或高于这些切点则被视为不足。对于能量密集型、微量营养素含量低的食物和饮料（EDF），定义了一个可耐受限度（每周<6次）。通过逻辑回归模型研究了母亲感知到的责任与儿童喂养方式（限制、监督、进食压力、公开和隐蔽控制）以及儿童饮食之间的关联。在对母亲的体重指数、教育程度、饮食以及儿童特征（性别、体重指数z评分）进行调整后，限制、监督、公开和隐蔽控制与水果和蔬菜摄入量低于充足区间的几率降低11% - 18%相关。公开控制还与水果和蔬菜摄入量高于充足区间的几率增加24%相关。更高的感知责任与儿童水果和蔬菜以及乳制品摄入量高于推荐量的几率增加相关。进食压力与乳制品摄入量高于充足区间呈正相关。除进食压力外，母亲的行为与能量密集型、微量营养素含量低的食物和饮料摄入不足的几率降低14% - 27%相关。总之，母亲具有较高隐蔽控制、监督和限制水平的儿童，其水果和蔬菜摄入量低于推荐量以及能量密集型、微量营养素含量低的食物和饮料摄入量高于可耐受限度的可能性较小。较高的公开控制和进食压力分别与儿童水果和蔬菜以及乳制品摄入量高于推荐量的可能性增加相关。
