Quah Phaik Ling, Ng Jing Chun, Fries Lisa R, Chan Mei Jun, Aris Izzuddin M, Lee Yung Seng, Yap Fabian, Godfrey Keith M, Chong Yap-Seng, Shek Lynette P, Tan Kok Hian, Forde Ciaran G, Chong Mary F F
Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore, Singapore.
Nestlé Research, Vers-chez-les-Blanc, Lausanne, Switzerland.
Front Nutr. 2019 Apr 2;6:32. doi: 10.3389/fnut.2019.00032. eCollection 2019.
Bidirectional studies between maternal feeding practices with subsequent child weight are limited, with no studies in Asian populations. In longitudinal analyses, we assessed the directionality of the associations between maternal feeding practices and body mass index (BMI) in preschoolers. Participants were 428 mother child dyads from the GUSTO (Growing Up in Singapore Toward healthy Outcomes) cohort. Feeding practices were assessed using the Comprehensive Feeding Practices Questionnaire (CFPQ) at age 5 y. Child BMI was measured at ages 4 and 6 y. BMI and maternal feeding practices subscales were transformed to SD scores and both directions of their associations examined with multivariable linear regression and pathway modeling. Higher BMI at age 4 was associated with lower encouragement of balance and variety (β = -0.33; 95%CI: -0.53, -0.13), lower pressure to eat (β = -0.49; -0.68, -0.29) and higher restriction (β = 1.10; 0.67, 1.52) at age 5, adjusting for confounders and baseline feeding practices at 3 years. In the reverse direction, only pressure and restriction at age 5 were associated with lower and higher child BMI at age 6 years, respectively. After the adjustment for baseline BMI at age 5, the association with pressure was attenuated to non-significance (β = 0.01 (-0.01, 0.03), while the association with restriction remained significant (β = 0.02; 0.002, 0.03). Overall, associations from child BMI to maternal restriction for weight control and pressure feeding practices was stronger than the association from these maternal feeding practices to child BMI (Wald's statistics = 24.3 and 19.5, respectively; < 0.001). The strength and directionality suggests that the mothers in the Asian population were likely to adopt these feeding practices in response to their child's BMI, rather than the converse. This study was registered at clinicaltrials.gov as NCT01174875 (www.clinicaltrials.gov, NCT01174875).
关于母亲喂养方式与孩子后续体重之间的双向研究有限，且尚无针对亚洲人群的研究。在纵向分析中，我们评估了母亲喂养方式与学龄前儿童体重指数（BMI）之间关联的方向性。研究对象为来自GUSTO（在新加坡健康成长）队列的428对母婴。在孩子5岁时，使用综合喂养方式问卷（CFPQ）评估喂养方式。在孩子4岁和6岁时测量其BMI。将BMI和母亲喂养方式子量表转换为标准差分数，并通过多变量线性回归和路径模型分析它们之间的双向关联。调整混杂因素和3岁时的基线喂养方式后，4岁时较高的BMI与5岁时较低的平衡和多样化鼓励得分（β = -0.33；95%置信区间：-0.53，-0.13）、较低的进食压力得分（β = -0.49；-0.68，-0.29）以及较高的限制得分（β = 1.10；0.67，1.52）相关。在相反方向上，只有5岁时母亲的进食压力和限制分别与孩子6岁时较低和较高的BMI相关。在调整5岁时的基线BMI后，与进食压力的关联减弱至无统计学意义（β = 0.01（-0.01，0.03）），而与限制的关联仍然显著（β = 0.02；0.002，0.03）。总体而言，从孩子BMI到母亲为控制体重而进行的限制和强迫喂养方式的关联，强于从这些母亲喂养方式到孩子BMI的关联（Wald统计量分别为24.3和19.5；P < 0.（此处原文有误，推测应为P < 0.001））。这种关联的强度和方向性表明，亚洲人群中的母亲可能是根据孩子的BMI来采取这些喂养方式，而非相反。 本研究已在clinicaltrials.gov上注册，注册号为NCT01174875（www.clinicaltrials.gov，NCT01174875）。
