学龄儿童家庭食物环境潜在类别及其与体重状况的关联

Latent profile analysis of family food environment types and their associations with weight status in school-aged children

摘要

目的 探讨学龄儿童家庭食物环境的潜在类别及其与儿童体重状况的关联,为精准家庭干预提供依据。方法 采用横断面设计,于2022年8月—2023年2月多阶段整群抽取南京市2所小学的学龄儿童及其主要照顾者,使用一般资料调查表、家庭食物环境调查表、儿童喂养问卷及儿童版荷兰饮食行为量表进行调查。对家庭食物环境进行潜在剖面分析,采用多项logistic回归分析不同家庭食物环境类别与儿童体重状况的关联。结果 共纳入1 015份有效问卷,有效回收率为88.11%。学龄儿童家庭食物环境可分为4种类型:规则引导型(30.15%)、强制担忧型(9.16%)、丰富放任型(37.34%)和匮乏管控型(23.35%)。多项logistic回归分析显示,在控制儿童年龄、性别、父母文化程度等混杂因素后,以正常体重为结局参照、匮乏管控型为暴露参照,规则引导型和强制担忧型家庭食物环境与学龄儿童超重(OR=0.383、0.418)、肥胖(OR=0.198、0.147)呈负向关联(P<0.001),而丰富放任型与超重及肥胖的关联均无统计学意义(P>0.05)。结论 学龄儿童不同家庭食物环境与体重状况的关联存在差异,儿童肥胖家庭干预应针对不同环境类型采取差异化策略。

Abstract

Objective To identify latent profiles of the family food environment among school-aged children, and to examine their associations with children's weight status, in order to provide evidence for targeted family-based interventions. Methods A cross-sectional study was conducted between August 2022 and February 2023. School-aged children and their primary caregivers were recruited from two primary schools in Nanjing using multistage cluster sampling. Data were collected using a general information questionnaire, the Family Food Environment Questionnaire, the Child Feeding Questionnaire, and the Dutch Eating Behavior Questionnaire for Children. Latent profile analysis was performed to identify distinct profiles of the family food environment. Multinomial logistic regression was used to examine the associations between family food environment profiles and children's weight status. Results A total of 1 015 valid questionnaires were included, with a valid response rate of 88.11%. Four family food environment profiles were identified: rule-guided (30.15%), coercion-and-concern (9.16%), abundance-and-permissiveness (37.34%), and scarcity-and-control (23.35%). After adjustment for potential confounders, including the children's age and sex and parental educational attainment, and using normal weight as the outcome reference and the scarcity-and-control profile as the exposure reference, the rule-guided and coercion-and-concern profiles were negatively associated with overweight (OR=0.383,0.418) and obesity (OR=0.198, 0.147, P<0.001). No statistically significant associations were observed between the abundance-and-permissiveness profile and either overweight or obesity (P>0.05). Conclusions The associations between the family food environment and weight status vary across different family food environment profiles among school-aged children. Family-based interventions for childhood obesity should adopt tailored strategies according to specific family food environment profiles.

关键词

家庭食物环境 / 学龄儿童 / 超重肥胖 / 潜在剖面分析

Key words

family food environment / school-aged children / overweight and obesity / latent profile analysis

[1] 洪平, 马玉国, 陶芳标, 等. 基于健康生活方式的超重肥胖儿童青少年体重管理多学科专家共识(2025)[J]. 中国运动医学杂志, 2025, 44(12): 943-951.
Hong P, Ma YG, Tao FB, et al. Multidisciplinary expert consensus on weight management for overweight and obese children and adolescents based on healthy lifestyle[J]. Chin J Sports Med, 2025, 44(12): 943-951. (in Chinese)
[2] 董彦会, 陈力, 刘婕妤, 等. 1985—2019年中国7~18岁儿童青少年超重与肥胖的流行趋势及预测研究[J]. 中华预防医学杂志, 2023, 57(4): 461-469.
Dong YH, Chen L, Liu JY, et al. Epidemiology and prediction of overweight and obesity among children and adolescents aged 7-18 years in China from 1985 to 2019[J]. Chin J Prev Med, 2023, 57(4): 461-469. (in Chinese)
[3] Yuan C, Dong Y, Chen H, et al. Determinants of childhood obesity in China[J]. Lancet Public Health, 2024, 9(12): e1105-e1114.
[4] Han JC, Yu S, Lee M, et al. The global burden of childhood obesity and its association with adult chronic diseases and economic costs: A comprehensive review[J]. Annual Review of Public Health, 2023, 44: 237-257.
[5] 洪烨, 傅君芬. 中国儿童肥胖健康报告与防控策略[J]. 中国儿童保健杂志, 2025, 33(2): 117-126.
Hong Y, Fu JF. Health report, prevention and control strategies for childhood obesity in China[J]. Chin J Child Health Care, 2025, 33(2): 117-126. (in Chinese)
[6] 马冠生, 张帆. 培养健康饮食行为远离儿童肥胖[J]. 中国儿童保健杂志, 2023, 31(1): 10-14.
Ma GS, Zhang F. Cultivate healthy dietary behavior and keep away from childhood obesity[J]. Chin J Child Health Care, 2023, 31(1): 10-14. (in Chinese)
[7] Rosado CL, Díez J, Valiente R, et al. Home and school urban food environments in relation to childhood overweight and obesity in Madrid[J]. Health Place, 2026, 100: 103698.
[8] Liu Y, Yang Z, Deng T, et al. Food environment and childhood overweight/obesity: A systematic review[J]. Adv Nutr, 2026, 17(1): 100564.
[9] Yang S, Zhang X, Feng P, et al. Access to fruit and vegetable markets and childhood obesity: A systematic review[J]. Obes Rev, 2021, 22(Suppl 1): e12980.
[10] 朱瑜朝.家庭食物环境对重庆市小学生超重肥胖的影响研究[D].重庆:重庆医科大学,2023.
Zhu YZ. Study on the influence of family food environment on overweight and obesity among primary school students in Chongqing[D]. Chongqing: Chongqing Medical University, 2023. (in Chinese)
[11] 王伊敏.家庭致肥胖环境与学龄前儿童肥胖的关联及健康行为的中介作用研究[D].武汉:华中科技大学, 2024.
Wang YM. Association between family obesogenic environment and obesity in preschool children and the mediating role of health behaviors[D]. Wuhan: Huazhong University of Science and Technology, 2024. (in Chinese)
[12] 王志芳, 张倩, 杨媞媞, 等. 家庭食物环境与儿童青少年超重肥胖关系研究进展[J]. 中国学校卫生, 2023, 44(9): 1436-1440.
Wang ZF, Zhang Q, Yang TT, et al. Research progress on the relationship between home food environment and overweight and obesity in children and adolescents[J]. Chin J Sch Health, 2023, 44(9): 1436-1440. (in Chinese)
[13] Mathew A, Doorenbos AZ. Latent profile analysis-An emerging advanced statistical approach to subgroup identification[J]. Indian J Continuing Nurs Educ, 2022, 23(2): 127-133.
[14] Tein JY, Coxe S, Cham H. Statistical power to detect the correct number of classes in latent profile analysis[J].Structural Equation Modeling: A Multidisciplinary Journal, 2013, 20(4): 640-657.
[15] 国家卫生和计划生育委员会. 学龄儿童青少年超重与肥胖筛查: WS/T 586—2018[S]. 北京: 中国标准出版社,2018.
[16] 苏笑, 刘坦, 李妞妞, 等. 学龄儿童家庭食物环境评价工具构建及信效度分析[J]. 中国食物与营养, 2020, 26(6): 74-79.
Su X, Liu T, Li NN, et al. Development and assessment of home food environment measurement questionnaire for school-aged children[J]. Food Nutr China, 2020, 26(6): 74-79. (in Chinese)
[17] Birch LL, Fisher JO, Grimm-Thomas K, et al. Confirmatory factor analysis of the Child Feeding Questionnaire: A measure of parental attitudes, beliefs and practices about child feeding and obesity proneness[J]. Appetite, 2001, 36(3): 201-210.
[18] 郑丽霞, 宋道平, 陈楚琳, 等. 中文版儿童喂养问卷在学龄前儿童家长中的信效度分析[J]. 中国儿童保健杂志, 2016, 24(10): 1019-1023.
Zheng LX, Song DP, Chen CL, et al. Reliability and validity of a Chinese version of Child Feeding Questionnaire among parents of preschoolers[J]. Chin J Child Health Care, 2016, 24(10): 1019-1023. (in Chinese)
[19] van Strien T, Oosterveld P. The children's DEBQ for assessment of restrained, emotional, and external eating in 7-to 12-year-old children[J]. Int J Eat Disord, 2008, 41(1): 72-81.
[20] 赵艳.儿童版荷兰饮食行为量表的修订[D].武汉:武汉体育学院,2018.
Zhao Y. Revision of the Dutch Eating Behavior Questionnaire for Children[D]. Wuhan: Wuhan Sports University, 2018. (in Chinese)
[21] Schisterman EF, Cole SR, Platt RW. Overadjustment bias and unnecessary adjustment in epidemiologic studies[J]. Epidemiology, 2009, 20(4): 488-495.
[22] Janicke DM, Mitchell TB, Pinto S, et al. Latent profiles of the feeding practices of caregivers of rural children with overweight and obesity and associations with child eating behaviors[J]. Appetite, 2022, 171: 105911.
[23] Pickard A, Farrow C, Haycraft E, et al. Associations between parent and child latent eating profiles and the role of parental feeding practices[J]. Appetite, 2024, 201: 107589.
[24] 周琼, 刘海波, 胡必梅, 等. 母亲喂养方式、婴幼儿饮食行为及气质对儿童超重肥胖的影响[J]. 中国儿童保健杂志, 2024, 32(8): 850-855.
Zhou Q, Liu HB, Hu BM, et al. Influence of maternal feeding practice, eating behaviors and temperament of infants and toddlers on childhood overweight and obesity[J]. Chin J Child Health Care, 2024, 32(8): 850-855. (in Chinese)
[25] Loth KA, Huang Z, Wolfson J, et al. Variability in feeding practices by parent and eating occasion: A cluster analysis approach[J]. Appetite, 2026, 217: 108318.
[26] 王文娴, 王海宁, 高晶晶, 等. 养育者喂养照护风格与营养问题儿童晚餐质量的相关性[J]. 中国儿童保健杂志, 2024, 32(4): 460-464.
Wang WX, Wang HN, Gao JJ, et al. Association between caregiver feeding style and dinner diet quality in children with nutritional problems[J]. Chin J Child Health Care, 2024, 32(4): 460-464. (in Chinese)

基金资助

江苏高校优势学科建设工程四期项目“护理学”(苏教研函〔2023〕11 号);江苏省大学生创新训练计划(S202510312037, S202510312119S);2025年南京医科大学大学生创新创业训练计划项目;南京医科大学“天元护理”科研项目