儿童早期体重指数增长与入学准备：一项纵向队列研究。

Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.

Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.

Paediatr Perinat Epidemiol. 2024 Nov;38(8):733-744. doi: 10.1111/ppe.13114.

BACKGROUND

Child growth influences future health and learning. School readiness refers to a child's ability to meet developmental expectations at school entry. The association of early growth rate and patterns with school readiness remains unknown.

OBJECTIVE

To determine the association of child body mass index (BMI) growth with school readiness in a cohort of young children.

METHODS

A prospective cohort study (2015-2022) was conducted in children 0-6 years enrolled in the TARGet Kids! research network in Toronto, Canada. Two analytical approaches were used to measure growth using child weight and height/length data between 0 and 4 years: (i) age- and sex-standardised BMI (zBMI) growth rate per year using a piecewise linear model; and (ii) distinct zBMI trajectories using latent class mixed models. School readiness (4-6 years) was measured using teacher-completed Early Development Instrument (EDI). Robust Poisson models and marginal linear models using generalised estimating equations were used adjusting for confounders identified a priori.

RESULTS

In this study of 1077 children (mean age at EDI completion: 4.8 years; 52.6% male) with 6415 zBMI measurements, mean growth rate was 0.65 zBMI units/year (0-2 years) and -0.11 zBMI units/year (2-4 years). Two distinct zBMI trajectories were identified: the stable trajectory and the catch-up trajectory. There was insufficient evidence that zBMI growth rates (risk ratio 1.10, 95% confidence interval 0.78, 1.55 for 0-2 years; risk ratio 0.71, 95% confidence interval 0.32, 1.57 for 2-4 years) or trajectories (risk ratio 1.05, 95% confidence interval 0.82, 1.35, catch-up trajectory vs. stable trajectory) were associated with school readiness.

CONCLUSIONS

No association was found between BMI growth and school readiness. School readiness may be more impacted by factors directly related to obesity or adiposity at the time of EDI measurement rather than growth.

背景

儿童的生长发育会影响其未来的健康和学习状况。入学准备是指儿童在入学时具备满足发展期望的能力。早期生长速度和模式与入学准备之间的关系尚不清楚。

目的

在多伦多儿童 TARGet 研究网络中，对 0-6 岁的幼儿队列进行研究，以确定儿童体重指数（BMI）增长与入学准备之间的关系。

方法

这是一项前瞻性队列研究（2015-2022 年），研究对象为加拿大多伦多儿童 TARGet 研究网络中 0-6 岁的入组儿童。使用两种分析方法来测量 0-4 岁期间使用儿童体重和身高/长度数据的儿童 BMI 增长：（i）使用分段线性模型计算每年的年龄和性别标准化 BMI（zBMI）增长率；（ii）使用潜在类别混合模型确定不同的 zBMI 轨迹。入学准备（4-6 岁）通过教师完成的早期发展工具（EDI）进行测量。使用广义估计方程的稳健泊松模型和边际线性模型进行调整，以预先确定混杂因素。

结果

本研究纳入了 1077 名儿童（完成 EDI 时的平均年龄：4.8 岁；52.6%为男性），共进行了 6415 次 zBMI 测量，平均增长率为 0.65 zBMI 单位/年（0-2 岁）和-0.11 zBMI 单位/年（2-4 岁）。确定了两种不同的 zBMI 轨迹：稳定轨迹和追赶轨迹。zBMI 增长率（0-2 岁的风险比为 1.10，95%置信区间为 0.78，1.55；2-4 岁的风险比为 0.71，95%置信区间为 0.32，1.57）或轨迹（追赶轨迹与稳定轨迹相比的风险比为 1.05，95%置信区间为 0.82，1.35）均无足够证据表明与入学准备相关。