College of Nursing, Florida State University, Tallahassee, FL, USA.
College of Nursing, University of Illinois at Chicago, Chicago, IL, USA.
Int Nurs Rev. 2019 Sep;66(3):346-355. doi: 10.1111/inr.12513. Epub 2019 Apr 23.
Childhood obesity is a complex and multifaceted problem involving interactions among child, family and community environment.
The purpose of this study was to examine the contributing factors to early childhood obesity within a multilevel context, including child and family, childcare setting and community.
A cross-sectional, quantitative research design was employed. A total of 129 preschoolers and their parents in northwest Florida participated in this study. Child height and weight were measured, and body mass index (BMI) was calculated. Parents and directors of preschools completed survey questionnaires to assess child/family, childcare setting and community factors, respectively. Hierarchical multiple regression was used to evaluate the association of each level of factors with child BMI z-score.
Twenty-one per cent of children were overweight or obese (≥85th BMI percentile). In hierarchical multiple regression, household income, parent beliefs, attitudes and practices for child feeding, family obesogenic environment, child routines (screen time on weekends, sleep hours, bedtime) and physical activity environment were significantly related to child BMI z-score.
The findings of this study provide a broader understanding of factors that influence child BMI z-score. Shaping a non-obesogenic environment by establishing healthy routines for children in the home, childcare setting and community is essential in childhood obesity prevention.
Paediatric nurses should routinely assess accurate parental perception of child weight, feeding style and child routines in well-child care visits. Healthcare professionals and health policymakers should enact policies that build a healthy environment for preschoolers in their childcare setting and community.
儿童肥胖是一个复杂且多方面的问题，涉及儿童、家庭和社区环境之间的相互作用。
本研究旨在从多层次的角度探讨儿童肥胖的促成因素，包括儿童和家庭、儿童保育环境和社区。
采用横断面、定量研究设计。在佛罗里达州西北部，共有 129 名学龄前儿童及其家长参与了这项研究。测量了儿童的身高和体重，并计算了体重指数（BMI）。家长和幼儿园园长分别填写了调查问卷，以评估儿童/家庭、儿童保育环境和社区因素。采用分层多元回归分析评估各层次因素与儿童 BMI z 评分的关联。
21%的儿童超重或肥胖（≥85%BMI 百分位）。在分层多元回归中，家庭收入、父母对儿童喂养的信念、态度和实践、家庭肥胖环境、儿童日常生活（周末的屏幕时间、睡眠时间、就寝时间）和身体活动环境与儿童 BMI z 评分显著相关。
本研究结果提供了对影响儿童 BMI z 评分因素的更全面理解。通过在家中、儿童保育环境和社区为儿童建立健康的日常生活习惯来塑造非肥胖环境，对于预防儿童肥胖至关重要。
儿科护士应在常规儿童保健就诊中评估父母对儿童体重、喂养方式和儿童日常生活习惯的准确认知。医疗保健专业人员和卫生政策制定者应制定政策，在儿童保育环境和社区中为学龄前儿童营造健康的环境。
