注意缺陷多动障碍儿童的饮食行为和体格生长

陈书进; 吴丹丹; 黄荣; 李荣; 陈梦莹; 黄懿钖; 林霜; 李晓南

doi:10.16835/j.cnki.1000-9817.2021.03.032

注意缺陷多动障碍儿童的饮食行为和体格生长

doi: 10.16835/j.cnki.1000-9817.2021.03.032

南京医科大学附属儿童医院儿童保健科，江苏 210008

基金项目:

江苏社会发展重点项目 BE2015607

南京医科大学科技发展基金一般项目 NMUB2018074

江苏省人口学会开放基金项目 JSPA2019019

详细信息

作者简介:
陈书进(1996-)，女，江苏南京人，在读硕士，主要研究方向为儿童保健

通讯作者:
李晓南，E-mail：xiaonan6189@163.com

中图分类号: R 151 R 153.2 R 748
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- 被引次数: 0
出版历程
- 收稿日期: 2020-10-12
- 修回日期: 2021-02-03
- 网络出版日期: 2021-04-20
- 刊出日期: 2021-03-25

Eating behaviors and growth status in children with attention deficit and hyperactivity disorder

Department of Children Health Care, Children's Hospital of Nanjing Medical University, Nanjing (210008), China

摘要

摘要: 目的探讨注意缺陷多动障碍(attention deficit disorder and hyperactivity, ADHD)儿童体格生长和饮食行为的相关性，为ADHD儿童的管理以及给予饮食行为指导提供依据。方法采用方便抽样的方法，抽取2019年6—9月于南京医科大学附属儿童医院儿童保健科门诊就诊的703名4~13岁ADHD儿童进行调查。对所有儿童进行体格测量，按照BMI-Z评分将ADHD组儿童分为消瘦、正常、超重和肥胖4组，同时对ADHD儿童进行饮食行为问卷(Children’s Eating Behavior Questionnaire, CEBQ)评估，分析ADHD患儿的饮食行为情况与体格生长的关系。结果饮食行为评估显示，消瘦组ADHD儿童在过饱响应、进食缓慢、情绪性饮食减少食物逃避维度的得分均高于其他3组(F值分别为17.57，29.32，4.07，P值均 < 0.01)，肥胖组在食物响应、食物喜好、渴望饮料、情绪性过度饮食食物导向维度得分均高于其他3组(F值分别为24.54，47.44，2.96，5.85，P值均 < 0.05)。多元线性回归校正混杂因素后，过饱响应、进食缓慢与儿童BMI-Z呈负相关(B值分别为-0.05，-0.07，P值均 < 0.01)，食物响应、食物喜好、情绪性过度进食与儿童BMI-Z呈正相关(B值分别为0.04，0.09，0.05，P值均 < 0.05)。结论 ADHD儿童情绪性进食、对食物喜好及响应程度过高与超重和肥胖相关，进食速度过慢、对饱食信号的高反应则与消瘦相关。临床治疗不仅要重视改善ADHD患儿核心症状，同时需要关注其饮食行为问题对体格生长的影响。
- 注意缺陷障碍伴多动 /
- 饮食习惯 /
- 生长和发育 /
- 回归分析 /
- 儿童
Abstract: Objective To discuss the correlation between growth status and eating behaviors in children with attention deficit and hyperactivity disorder (ADHD), providing reference data for management and dietary behavior guidance among ADHD children. Methods A total of 703 children aged 4-13 years old were collected from the ADHD patients from Children's Health Department of Children's Hospital of Nanjing Medical University from June to September, 2019. The demographic characteristics and information regarding children's eating behaviors were collected by self-designed questionnaire and Chinese version of the parent-completed Children's Eating Behavior Questionnaire(CEBQ). The correlation physical growth with dietary behaviors among the ADHD children were analyzed. Results Food avoidant behaviors, including satiety responsiveness, slowness in eating and emotional undereating in ADHD children with thinness scored significantly higher than that of children with short stature, overweight and obesity(F=17.57, 29.32, 4.07, P < 0.01), while food approach behaviors, including food responsiveness, enjoyment of food, desire to drink and emotional overeating scored higher in obese children, compared to other three groups(F=24.54, 47.44, 2.96, 5.85, P < 0.05). Multiple linear regression analysis showed that, after adjusting for the confounders, satiety responsiveness, slowness in eating were still negatively associated with BMI-Z score of the ADHD children(B=-0.05, -0.07, P < 0.01). Food responsiveness, enjoyment of food and emotional overeating had a positive association with the BMI-Z score(B=0.04, 0.09, 0.05, P < 0.05). Conclusion Emotional eating and high food responsiveness in ADHD children are associated with the overweight and obesity, while long eating time and high satiety responsiveness is associated with underweight among ADHD children. For clinical doctors and parents, problematic eating behaviors among ADHD children should be concerned regarding its negative effects on growth and development, besides core symptoms of ADHD.
- Attention deficit disorder with hyperactivity /
- Food habits /
- Growth and development /
- Regression analysis /
- Child

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表 1 不同组别ADHD儿童体质量构成比较

Table 1. Comparisson of body mass component ratio of ADHD children in different groups

组别	选项	人数	消瘦	正常	超重	肥胖	χ²值	P值
父亲学历	初中及以下	265	12(4.5)	181(68.3)	46(17.4)	26(9.8)	12.75	0.17
	中专及高中	183	5(2.7)	128(69.9)	34(18.6)	16(8.7)
	大专及本科	221	12(5.4)	136(61.5)	37(16.7)	36(16.3)
	硕士及以上	20	0	17(85.0)	2(10.0)	1(5.0)
母亲学历	初中及以下	301	12(4.0)	201(66.8)	58(19.3)	30(10.0)	5.44	0.79
	中专及高中	150	4(2.7)	101(67.3)	27(18.0)	18(12.0)
	大专及本科	215	13(6.0)	145(67.4)	32(14.9)	25(11.6)
	硕士及以上	11	0	7(63.6)	2(18.2)	2(18.2)
家庭年收入/万元	< 1	39	0	31(79.5)	3(7.7)	5(12.8)	10.61	0.30
	1~ < 15	460	23(5.0)	300(65.2)	84(18.3)	53(11.5)
	15~ < 100	177	6(3.4)	123(69.5)	31(17.5)	17(9.6)
	≥100	6	0	4(66.7)	0	2(33.3)
父亲BMI	消瘦	16	0	15(93.8)	1(6.3)	0	58.88	0.00
	正常	273	14(51.9)	204(46.4)	43(38.4)	12(16.2)
	超重	269	13(4.8)	175(65.1)	47(17.5)	34(12.6)
	肥胖	95	0	46(48.4)	21(22.1)	28(29.5)
母亲BMI	消瘦	49	5(10.2)	35(71.4)	6(12.2)	3(6.1)	29.12	< 0.01
	正常	419	20(4.8)	299(71.4)	63(15.0)	37(8.8)
	超重	136	2(1.5)	76(55.9)	34(25.0)	24(17.6)
	肥胖	42	1(2.4)	24(57.1)	9(21.4)	8(19.0)
每日儿童电子屏幕时间/h	≥3	195	6(3.1)	130(66.7)	29(14.9)	30(15.4)	12.64	0.05
	1~2	305	17(5.6)	195(63.9)	58(19.0)	35(11.5)
	< 1	127	4(3.1)	98(77.2)	17(13.4)	8(6.3)
注：()内数字为构成比/%；部分问卷有信息缺失。

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表 2 不同营养状况ADHD儿童饮食行为量表得分比较(x±s)

Table 2. CEBQ scores for four groups of children(x±s)

组别	人数	食物逃避				食物趋向
组别	人数	过饱响应	进食缓慢	挑食	情绪性饮食减少	食物响应	食物喜好	渴望饮料	情绪性过度饮食
消瘦	29	15.8±2.8	12.6±3.3	16.3±2.9	10.9±2.9	8.9±3.4	10.1±3.0	8.2±3.4	5.3±1.9
正常	474	14.4±3.4	11.5±3.3	15.8±3.4	11.2±3.4	11.1±4.4	11.3±3.5	8.2±3.3	6.4±2.6
超重	120	12.9±2.9	9.4±2.9	15.1±3.5	10.1±3.6	13.1±4.9	14.1±4.0	8.2±3.4	6.8±3.0
肥胖	80	12.2±3.0	8.8±2.5	15.3±3.8	10.5±3.6	15.1±5.9	15.6±3.5	9.4±3.5	7.5±3.9
F值		17.57	29.32	1.85	4.07	24.54	47.44	2.96	5.85
P值		0.00	0.00	0.14	0.01	0.00	0.00	0.03	0.00

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表 3 儿童饮食行为问卷得分与BMI-Z值多元线性回归分析

Table 3. Multiple linear regression between CEBQ score and BMI-Z value

饮食行为	模型0	模型1	模型2
过饱响应	-0.05(-0.08~-0.02)^**	-0.05(-0.08~-0.02)^**	-0.05(-0.09~-0.02)^**
进食缓慢	-0.09(-0.12~-0.05)^**	-0.08(-0.12~-0.05)^**	-0.07(-0.11~-0.04)^**
挑食	-0.03(-0.06~0.00)^*	-0.03(-0.06~0.01)	-0.03(-0.06~0.01)
情绪性饮食减少	-0.01(-0.04~0.02)	-0.02(-0.05~0.01)	-0.02(-0.05~0.01)
食物响应	0.05(0.02~0.07)^**	0.04 (0.01~0.06)^**	0.04(0.01~0.06)^**
食物喜好	0.09(0.06~0.12)^**	0.08(0.05~0.11)^**	0.09(0.06~0.12)^**
渴望饮料	0.02(-0.01~0.05)	0.03(0.00~0.06)	0.02(-0.01~0.06)
情绪性过度饮食	0.05(0.01~0.08)^**	0.05(0.01~0.08)^*	0.05(0.01~0.08)^*
注：* P < 0.05，** P < 0.01。模型0仅纳入了CEBQ各项得分；模型1在模型0的基础上，校正ADHD儿童出生体重和父母BMI；模型2在模型1的基础上校正了儿童电子屏幕使用时间。上述方程模型方差膨胀因子VIF < 3。

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