MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
Int J Obes (Lond). 2020 Apr;44(4):790-802. doi: 10.1038/s41366-019-0502-1. Epub 2019 Dec 11.
To investigate how mealtime setting, mealtime interaction and bedroom screens are associated with different trajectories of child overweight and obesity, using a population sample.
Growth mixture modelling used data from children in the Growing Up in Scotland Study born in 2004/5 (boys n = 2085, girls n = 1991) to identify trajectories of overweight or obesity across four time points, from 46 to 122 months. Using data from children present at all sweeps, and combining sexes (n = 2810), mutually adjusted associations between primary exposures (mealtime setting, mealtime interaction and bedroom screens) and trajectory class were explored in multinomial models; controlling for early life factors, household organisation and routines, and children's diet patterns, overall screen use, physical activity and sleep.
Five trajectories were identified in both sexes: Low Risk (68% of sample), Decreasing Overweight (9%), Increasing Overweight (12%), High/Stable Overweight (6%) and High/Increasing Obesity (5%). Compared with the Low Risk trajectory, High/Increasing Obesity and High/Stable Overweight trajectories were characterised by early increases in bedroom screen access (respective relative risk ratios (RRR) and 95% confidence intervals: 2.55 [1.30-5.00]; 1.62 [1.01-2.57]). An informal meal setting (involving mealtime screen use, not eating in a dining area and not sitting at a table) characterised the High/Increasing Obesity and Increasing Overweight trajectories (respective RRRs compared with Low Risk trajectory: 3.67 [1.99-6.77]; 1.75 [1.17-2.62]). Positive mealtime interaction was associated with membership of the Increasing Overweight trajectory (RRR 1.64 [1.13-2.36]).
Bedroom screen access and informal mealtime environments were associated with higher-risk overweight and obesity trajectories in a representative sample of Scottish children, after adjusting for a wide range of confounders. Findings may challenge the notion that positive mealtime interaction is protective. Promoting mealtimes in a screen-free dining area and removing screens from bedrooms may help combat childhood obesity.
利用人群样本研究就餐时间设定、就餐互动和卧室屏幕与儿童超重和肥胖不同轨迹之间的关系。
使用 2004/5 年出生于苏格兰成长研究（男孩 n=2085，女孩 n=1991）的儿童数据，通过增长混合模型，从 46 至 122 个月四个时间点识别超重或肥胖的轨迹。利用所有阶段均存在的儿童数据（n=2810），并结合性别，在多项模型中探索主要暴露因素（就餐时间设定、就餐互动和卧室屏幕）与轨迹类别的相互调整关联；通过控制早期生活因素、家庭组织和日常生活、儿童饮食模式、总体屏幕使用、身体活动和睡眠进行调整。
在两性中均确定了 5 种轨迹：低风险（样本的 68%）、逐渐超重（9%）、逐渐超重（12%）、高/稳定超重（6%）和高/持续肥胖（5%）。与低风险轨迹相比，高/持续肥胖和高/稳定超重轨迹的特征是早期卧室屏幕使用增加（各自的相对风险比（RRR）和 95%置信区间：2.55 [1.30-5.00]；1.62 [1.01-2.57]）。非正式的就餐时间设定（涉及就餐时使用屏幕、不在就餐区就餐和不坐在餐桌旁）描述了高/持续肥胖和逐渐超重轨迹（与低风险轨迹相比的各自 RRR：3.67 [1.99-6.77]；1.75 [1.17-2.62]）。积极的就餐互动与逐渐超重轨迹的成员身份相关（RRR 1.64 [1.13-2.36]）。
在苏格兰代表性儿童样本中，调整了一系列混杂因素后，卧室屏幕使用和非正式的就餐环境与更高风险的超重和肥胖轨迹相关。这些发现可能对积极的就餐互动具有保护作用的观点提出了挑战。促进在无屏幕的就餐区就餐，并将屏幕从卧室中移除，可能有助于防治儿童肥胖。
