Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain.
Department of Psychiatry, Hospital Virgen de La Luz, CIBERSAM, Cuenca, Spain.
JAMA Netw Open. 2022 Apr 1;5(4):e229574. doi: 10.1001/jamanetworkopen.2022.9574.
The role of healthy eating in the association between excess weight and psychosocial health among children is unknown.
To investigate whether a diet based on healthy eating habits moderates the association between excess weight and psychosocial problems in a large sample of children in Spain.
DESIGN, SETTING, AND PARTICIPANTS: This population-based cross-sectional study used data on a representative sample of 3772 children collected in 2017 through the Spanish National Health Survey. Statistical analysis was conducted from September 21 to October 27, 2021.
Body mass index was calculated as weight in kilograms divided by height in meters squared; body mass index z scores were computed following the sex and age criteria of the International Obesity Task Force and were used to determine excess weight. Diet quality was assessed using the Spanish Healthy Eating Index (S-HEI; a higher score denotes greater adherence to the guidelines of the Spanish Society of Community Nutrition and, therefore, a higher quality of diet). Psychosocial problems were assessed with the Strengths and Difficulties Questionnaire completed by parents or guardians. All analyses were adjusted for major confounders.
Among the 3772 participants (1908 boys [50.6%]; mean [SD] age, 9.5 [3.1] years), the prevalence of excess weight (ie, overweight or obesity) was 38.4% (n = 1448). Diet quality moderated the association between excess weight and psychosocial problems (β = -0.06; 95% CI, -0.09 to -0.02). Moderation analysis revealed 2 different regions of significance according to the S-HEI score. First, the association between excess weight and psychosocial problems was greater for children with an S-HEI score lower than 67.5. Second, the association of excess weight with psychosocial problems was lower for children with an S-HEI score higher than 84.9. In addition, a neutral area was found, indicating that the association between excess weight and psychosocial problems neither increased nor decreased in those with an S-HEI score between 67.5 and 84.9.
The results of this study suggest that the association between excess weight and psychosocial problems is moderated by diet quality among children in Spain. These findings are clinically relevant because psychosocial problems are a major concern among children with excess weight. Because obesity is a chronic disease, it requires ongoing counseling and treatment throughout life.
健康饮食在超重儿童和心理社会健康之间的关系中的作用尚不清楚。
本研究旨在调查在西班牙的一个大样本儿童中，基于健康饮食习惯的饮食是否能调节超重与心理社会问题之间的关联。
设计、地点和参与者：这项基于人群的横断面研究使用了 2017 年通过西班牙国家健康调查收集的 3772 名代表性儿童的数据。统计分析于 2021 年 9 月 21 日至 10 月 27 日进行。
体重指数按体重（千克）除以身高（米）的平方计算；体重指数 z 分数根据国际肥胖工作组的性别和年龄标准计算，用于确定超重情况。饮食质量使用西班牙健康饮食指数（S-HEI；得分越高表示对社区营养西班牙学会指南的遵循程度越高，因此饮食质量越高）进行评估。心理社会问题由父母或监护人完成的《长处和困难问卷》进行评估。所有分析均针对主要混杂因素进行了调整。
在 3772 名参与者中（男孩 1908 名[50.6%]；平均[SD]年龄，9.5[3.1]岁），超重（即超重或肥胖）的患病率为 38.4%（n=1448）。饮食质量调节了超重与心理社会问题之间的关联（β=-0.06；95%CI，-0.09 至 -0.02）。调节分析根据 S-HEI 得分揭示了 2 个不同的显著区域。首先，对于 S-HEI 得分低于 67.5 的儿童，超重与心理社会问题之间的关联更强。其次，对于 S-HEI 得分高于 84.9 的儿童，超重与心理社会问题之间的关联较低。此外，还发现了一个中立区域，表明在 S-HEI 得分在 67.5 至 84.9 之间的儿童中，超重与心理社会问题之间的关联既没有增加也没有减少。
本研究结果表明，在西班牙儿童中，饮食质量调节了超重与心理社会问题之间的关联。这些发现具有临床意义，因为心理社会问题是超重儿童的主要关注点。由于肥胖是一种慢性疾病，因此需要在整个生命周期中进行持续的咨询和治疗。
