Prospective association between peripubertal diet quality and puberty timing
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摘要:
目的 探讨围青春期膳食质量对青春期发育的前瞻性影响，为预防中国儿童青春期发育提前提供理论依据。 方法 利用西南地区儿童营养与生长发育队列数据，以1 588名6~8岁儿童(女童976名，男童612名)为研究对象，通过食物频率问卷收集儿童的膳食摄入信息，采用修订版中国儿童膳食指数(Chinese Children Dietary Index, CCDI)评价儿童围青春期(初潮/变声发生前2~4年)的膳食质量。以女童初潮年龄和男童变声年龄作为青春期发育观测指标，通过多元线性回归模型分析膳食质量对青春期发育的前瞻性影响。 结果 女童和男童的围青春期CCDI得分分别为(58.0~132.5)和(48.3~129.9)分。调整父亲文化程度、能量摄入、体脂百分比后，围青春期膳食质量较高的儿童与膳食质量较低的女童/男童相比，女童初潮发生时间晚0.6年[膳食质量较高组的初潮年龄为13.1(11.2~13.3)岁，较低组为12.5(12.0~13.9)岁，P=0.01]；男童变声发生时间晚0.4年[膳食质量较高组的变声年龄为13.8(12.1~14.8)岁，较低组为13.4(12.5~15.1)岁，P=0.03]。 结论 围青春期较高的膳食质量可使儿童青春期发育延迟，应积极开展膳食指导和干预，提升围青春期儿童膳食质量水平。 Abstract:Objective To examine the prospective association between peripubertal diet quality and pubertal timing. Methods Multivariate regression analyses were performed using data obtained from 1 588 SCCNG (Southwest China Childhood Nutrition and Growth) study participants, which included dietary data, anthropometric parameters, and information about potential confounders during peri-puberty, two and four years before the onset of menarche or voice break. Dietary intake in peri-puberty was assessed using a validated food frequency questionnaire. Diet quality was determined using the Chinese Children Dietary Index (CCDI), which measures adherence to current dietary recommendations. Age at menarche or voice break (M/VB) were used as pubertal markers. Results The CCDI score ranged from 58.0 to 132.5 for girls and from 48.3 to 129.9 for boys. The pubertal markers consistently indicated that girls and boys with a higher peripubertal diet quality entered puberty later than their counterparts with lower CCDI scores (higher vs. lower CCDI tertiles: age at M was 13.1 years (11.2-13.3) and 12.5 years (12.0-13.9)(P < 0.01); VB was 13.8 years (12.1-14.8) and 13.4 years (12.5-15.1)(P=0.03), after adjusting for paternal education level, energy intake, and pre-pubertal body fat. Conclusion Children with a higher diet quality during peri-puberty entered puberty at a later age. Dietary guidance and intervention are needed for better dietary quality among children during pubertal transition. -
Key words:
- Diet surveys /
- Nutritional status /
- Prospective studies /
- Puberty /
- Child
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表 1 不同膳食质量水平调查对象的基本情况(x±s)
Table 1. General characteristics of the study participants(x±s)
性别 膳食质量 人数 统计值 出生体重/kg* 基线年龄/岁 初潮或变声
年龄/岁BMI SDS 体脂百分比* 能量摄入/
(kcal·d-1)碳水化合物供能比/% 脂肪供能比/% 蛋白质供能比/% 女 低 325 3.3(2.9, 3.8) 7.7±0.8 12.6±0.8 0.4±0.9 17.1(15.1, 19.8) 1 432±231 53.6±5.5 32.1±4.7 14.3±2.2 中 326 3.2(2.8, 3.6) 7.8±0.7 12.8±0.9 0.3±0.8 16.4(15.2, 18.0) 1 658±245 59.3±4.6 25.9±4.0 14.8±2.0 高 325 3.2(2.9, 3.7) 8.0±0.9 13.2±1.0 0.2±0.8 15.9(13.7, 19.1) 1 579±227 57.3±4.2 28.8±4.3 13.9±1.8 F/H值 3.13 2.31 3.93 1.61 6.58 2.82 3.52 3.93 3.23 P值 0.20 0.10 0.02 0.20 0.04 0.06 0.03 0.02 0.04 男 低 204 3.5(3.0, 3.8) 7.9±0.7 13.5±1.2 0.4±0.9 14.1(11.8, 17.6) 1 908±232 58.9±6.2 26.2±4.7 14.9±2.2 中 204 3.3(2.9, 3.8) 8.1±0.9 13.8±1.3 0.3±0.7 13.8(10.3, 17.1) 1 824±213 61.0±5.4 26.3±4.0 12.7±2.0 高 204 3.3(2.8, 3.7) 8.2±0.8 14.1±1.1 0.4±0.8 13.7(11.2, 17.9) 1 768±221 61.4±4.9 26.4±4.3 12.2±1.8 F/H值 2.84 1.61 3.53 1.61 6.95 2.67 3.01 2.83 3.24 P值 0.20 0.20 0.03 0.20 0.03 0.07 0.05 0.06 0.04 注： *为M(P25，P75)；1 kcal=4.18 kJ。 
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表 2 男女童围青春期膳食摄入情况[M(P25, P75)]
Table 2. Dietary intakes by groups of peripubertal diet quality[M(P25, P75)]
性别 膳食质量 人数 谷类/(g·d-1) 蔬菜/(g·d-1) 水果/(g·d-1) 奶类及其制品/
(g·d-1)豆类及其制品/
(g·d-1)肉类/(g·d-1) 水产品/(g·d-1) 蛋类/(g·d-1) 女 低 325 498(436, 551) 104(93, 113) 44(31, 58) 78(60, 91) 3.1(0, 6.7) 76(13, 131) 0(0, 0) 0(0, 0) 中 326 332(278, 387) 157(143, 169) 123(105, 149) 231(205, 247) 11(9.3, 14) 62(36, 105) 7(5, 16) 18(12, 26) 高 325 185(123, 251) 273(261, 285) 170(157, 201) 302(287, 337) 53(42, 82) 43(37, 75) 27(21, 37) 61(47, 83) 男 低 204 525(503, 541) 91(79, 103) 29(24, 36) 74(65, 82) 0(0, 0) 91(62, 176) 0(0, 0) 0(0, 0) 中 204 456(328, 501) 142(126, 157) 134(109, 168) 287(238, 306) 8.2(6.4, 18.7) 79(45, 125) 3(1, 17) 21(15, 36) 高 204 202(156, 345) 255(246, 263) 189(173, 211) 351(327, 378) 69(43, 92) 43(37, 74) 29(22, 40) 69(55, 102) 性别 膳食质量 人数 饮水量/
(mL·d-1)含糖饮料/
(mL·d-1)维生素A/
(μgRE·d-1)脂肪酸比值 膳食纤维/
(g·d-1)食物多样性/份 早餐与晚餐/次 能量摄入/
能量支出女 低 325 375(250, 400) 148(119, 172) 189(168, 203) 1.8(1.5, 2.0) 5.4(4.6, 6.2) 7(5, 9) 8(7, 9) 0.7(0.5, 2.3) 中 326 600(525, 800) 72(27, 96) 311(286, 337) 2.6(2.3, 3.1) 8.7(7.8, 9.9) 9(7, 11) 9(8, 10) 0.8(0.6, 1.7) 高 325 1 000(925, 1 100) 0(0, 0) 469(436, 487) 3.7(3.3, 3.9) 12(10, 13) 11(9, 13) 10(9, 11) 1.0(0.8, 1.2) 男 低 204 400(325, 450) 171(126, 203) 175(162, 197) 1.6(1.4, 1.9) 4.5(3.1, 5.2) 6(4, 9) 6(4, 8) 1.3(0.5, 2.5) 中 204 650(550, 800) 82(51, 105) 289(264, 332) 2.5(2.2, 3.0) 7.1(6.2, 8.4) 9(7, 12) 7(6, 9) 0.7(0.6, 1.3) 高 204 1 100(900, 1 200) 0(0, 0) 457(421, 491) 3.6(3.4, 3.8) 11(9.2, 12) 10(8, 13) 9(7, 10) 1.0(0.8, 1.2)
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表 3 男女童围青春期CCDI各指标得分情况[M(P25，P75)]
Table 3. Dietary intakes by groups of the sub-scores of CCDI[M(P25, P75)]
性别 人数 谷类 蔬菜 水果 奶类及其制品 豆类及其制品 肉类 水产品 蛋类 女 976 5.8(3.6, 7.7) 4.9(3.1, 7.2) 7.1(3.8, 10.0) 8.2(3.6, 10.0) 4.1(2.3, 10.0) 3.2(0, 6.8) 0(0, 5.5) 2.9(0, 8.1) 男 612 2.9(0, 5.8) 4.6(2.7, 6.8) 6.7(1.1, 10.0) 8.5(5.3, 10.0) 3.7(0, 10.0) 1.3(0, 6.1) 0(0, 7.1) 3.5(0, 10) 性别 人数 饮水量 含糖饮料 维生素A 脂肪酸比值 膳食纤维 食物多样性/份 早餐与晚餐 能量摄入/
能量支出女 976 5.1(3.4, 8.1) 4.9(2.9, 10.0) 5.7(3.3, 8.6) 10.0(4.1, 10.0) 4.1(2.7, 4.6) 6.0(4.0, 8.0) 9.0(8.0, 10.0) 8.5(3.7, 9.9) 男 612 5.8(4.1, 8.7) 4.1(2.5, 10.0) 5.3(3.1, 8.5) 10.0(4.0, 10.0) 3.4(2.0, 4.3) 6.0(4.0, 7.0) 7.0(6.0, 10.0) 8.2(2.9, 9.8)
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表 4 男女童围青春期膳食质量与青春期发育年龄的多重线性回归分析/[x (95%CI)，岁]
Table 4. Association between peripubertal diet quality and timing of puberty by multivariate regression models/[x (95%CI), year]
性别 模型 低 中 高 P值 女 1 12.6 (11.4~13.4) 12.9(11.7~13.5) 13.3(12.2~13.6) 0.03 (n=976) 2 12.5(11.3~13.4) 12.7(11.5~13.5) 13.2(12.0~13.8) 0.01 3 12.5(11.2~13.3) 12.7(11.5~13.6) 13.1(12.0~13.9) 0.01 男 1 13.2(12.0~14.7) 13.6(12.3~14.9) 13.8(12.4~14.9) 0.04 (n=612) 2 13.2(12.1~14.7) 13.7(12.3~15.0) 13.9(12.4~15.0) 0.02 3 13.4(12.1~14.8) 13.7(12.4~15.0) 13.8(12.5~15.1) 0.03 注：模型1为未调整模型，模型2调整了父亲受教育水平、膳食能量摄入，模型3在模型2的基础上进一步调整了体脂百分比。
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