Prevalence of iron deficiency anemia and the association with dietary nutrition factors of preschool children in rural Anhui Province
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摘要:
目的 运用学龄前儿童膳食平衡指数(DBI_C)评价安徽省部分学龄前儿童的膳食质量，为科学指导该人群合理膳食和防治IDA提供实证依据。 方法 2018年9—12月，选择安徽省有完整膳食调查资料的3~6岁留守儿童306名和非留守儿童598名作为研究对象，利用DBI_C的总分(TS)、负端分(LBS)、正端分(HBS)和膳食质量距(DQD)等指标评价膳食质量，运用多因素Logistic回归模型分析膳食平衡指数与缺铁性贫血患病的关联。 结果 安徽省农村地区3~6岁儿童贫血率为13.3%，其中留守儿童为16.7%，非留守儿童为10.9%，差异有统计学意义(χ2=8.87，P=0.00)。贫血组和非贫血组DBI_C分值比较中，TS[-18.3(25.2，-12.7)，-15.2(-19.8，-8.6)]、LBS[25.4(18.3，32.5)，22.7(16.5，30.6)]和DQD[36.8(23.9，43.4)，34.1(27.5，41.0)]差异有统计学意义(Z值分别为-23.07，5.81，4.63，P值均 < 0.05)。贫血组和非贫血组儿童食物摄入评分在奶类豆类[-5.9(-10.7，-0.4)，-5.0(-8.7，0.2)]、动物性食物[-2.4(-5.6，0.8)，-0.6(3.5，1.9)]和食物种类[-7.5(-9.1，-4.8)，-6.3(-8.0，-2.9)]等方面差异均有统计学意义(Z值分别为-5.42，-16.47，-6.83，P值均 < 0.05)。留守儿童(OR=1.27，95%CI=1.15~1.49)贫血发生的比例较高，每周吃肉类食物≥3次(OR=0.81，95%CI=0.68~0.94)、每天吃新鲜蔬菜≥2种(OR=0.84，95%CI=0.73~0.95)贫血发生的比例较低(P值均 < 0.05)。 结论 安徽省农村地区3~6岁儿童贫血率较高，尤其要关注留守儿童; 通过提高看护人的膳食素养、增加膳食中动物性食物和新鲜蔬菜的摄入可以有效减少儿童贫血的发生。 Abstract:Objective To evaluate the dietary quality for preschool children by diet balance index(DBI_C), and to provide an empirical reference for scientific guidance for a reasonable diet and controlling and preventing iron deficiency anemia(IDA). Methods During September to December of 2018, 306 left-behind children and 598 non left-behind children aged 3-6 years old of Anhui Province were selected. Four scoring methods (TS-Total Score, LBS-Low Bound Score, HBS-High Bound Score, DQD-Diet Quality Distance) were used to evaluate the dietary quality by DBI_C, and multivariate Logistic regression was used to assess the relationship between DBI_C and IDA. Results The anemia prevalence (AP) was 13.3% among the 3-6-year-old children in Anhui rural area, whereas the left-behind children (LBC) was 16.7% and the non left-behind children was 10.9%, and there was statistical significance of the differences (χ2=8.8, P < 0.05). There were significant differences of TS[-18.3(25.2, -12.7), -15.2(-19.8, -8.6)], LBS[25.4(18.3, 32.5), 22.7(16.5, 30.6)] and DQD[36.8(23.9, 43.4), 34.1(27.5, 41.0)] in DBI_C scores between anemia group and non-anemia group (P < 0.05). There were significant differences of milk and beans [-5.9(-10.7, -0.4), -5.0(-8.7, 0.2)], animal food [-2.4(-5.6, 0.8), -0.6(3.5, 1.9)], food species [-7.5(-9.1, -4.8), -6.3(-8.0, -2.9)] in food intake scores between anemia group and non-anemia group (P < 0.05). Left behind children (OR=1.27, 95%CI=1.15-1.49) had higher proportions of getting anemia. Meat consumption >3 times per week (OR=0.81, 95%CI=0.68-0.94) and ≥two types of fresh vegetable consumption every day (OR=0.84, 95%CI=0.73-0.95) were associated with lower rate of anemia(P < 0.05). Conclusion The AP was relatively high in 3-6-year-old children in Anhui rural area, especially in those LBC. Anemia should be reduced by improving the caregivers' dietary literacy, increasing intakes of animal foods and fresh vegetables. -
Key words:
- Anemia, iron-deficiency /
- Diet /
- Nutritional status /
- Regression analysis /
- Child, preschool /
- Raral population /
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表 1 不同人口统计学特征学龄前儿童贫血检出率比较
Table 1. Comparison of prevalence of anemia among preschool children with different demographic characteristics
人口统计学指标 选项 统计值 男童 女童 合计 人数 贫血人数 人数 贫血人数 人数 贫血人数 年龄/岁 3~4 279 36(12.9) 255 36(14.1) 534 42(13.5) 5~6 196 28(14.3) 174 20(11.5) 370 48(13.0) χ2值 0.19 0.63 0.05 P值 0.66 0.43 0.82 是否独生子女 是 223 27(12.1) 198 26(13.1) 421 53(12.6) 否 252 37(14.7) 231 30(13.0) 483 67(13.9) χ2值 0.67 0.00 0.32 P值 0.41 0.97 0.57 是否留守儿童 是 157 29(18.5) 149 26(17.4) 306 55(18.0) 否 318 35(11.0) 280 30(10.7) 598 65(10.9) χ2值 5.02 3.89 8.87 P值 0.03 0.05 0.00 看护人身份 父亲/母亲 272 34(12.5) 245 23(9.4) 517 57(11.0) 祖父母/其他亲戚 203 30(14.8) 184 33(17.9) 387 63(16.3) χ2值 0.52 6.76 5.31 P值 0.47 0.01 0.02 注： ()内数字为检出率/%。 
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表 2 不同人口统计学特征学龄前儿童Hb水平比较(x±s，g·L-1)
Table 2. The childrens' Hb levels between different socio-demographic characteristics(x±s, g·L-1)
人口统计学指标 选项 统计值 男童 女童 合计 人数 Hb水平 人数 Hb水平 人数 Hb水平 年龄/岁 3~4 279 127.7±15.6 255 125.3±14.9 534 126.5±15.1 5~6 196 124.9±17.6 174 128.3±16.3 370 127.1±16.4 t值 3.48 -4.97 -3.94 P值 0.02 < 0.01 0.01 是否独生子女 是 223 127.9±18.6 198 127.4±16.8 421 127.5±17.3 否 252 124.2±18.5 231 127.5±17.7 483 125.9±17.8 t值 5.23 -1.09 4.23 P值 < 0.01 0.33 < 0.01 是否留守儿童 是 157 119.4±14.7 149 120.6±15.2 306 119.8±14.9 否 318 128.8±16.9 280 129.3±17.5 598 129.1±17.2 t值 -42.77 -36.78 -40.78 P值 < 0.01 < 0.01 < 0.01 看护人身份 父亲/母亲 272 127.8±17.4 245 130.2±18.5 517 129.2±18.1 祖父母/其他亲戚 203 123.0±19.2 184 120.2±16.7 387 121.4±18.3 t值 2.78 23.08 19.76 P值 0.04 < 0.01 < 0.01
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表 3 不同组别儿童膳食平衡指数比较[M(P25，P75)]
Table 3. The dietary balance indexes between different groups [M(P25, P75)]
组别 选项 人数 统计值 TS LBS HBS DQD 是否贫血 是 120 -18.3(-25.2, -12.7) 25.4(18.3, 32.5) 6.6(1.4, 13.1) 36.8(23.9, 43.4) 否 784 -15.2(-19.8, -8.6) 22.7(16.5, 30.6) 7.8(2.9, 12.7) 34.1(27.5, 41.0) Z值 -23.07 5.81 -0.87 4.63 P值 < 0.01 < 0.05 0.32 < 0.05 是否留守儿童 是 306 -18.2(-25.6, -13.1) 24.8(19.7, 30.5) 7.9(3.2, 13.6) 35.9(24.2, 43.6) 否 598 -16.1(-22.4, -10.7) 23.1(17.2, 30.3) 6.4(2.1, 12.3) 34.4(26.5, 41.4) Z值 -46.02 12.45 3.14 4.78 P值 < 0.01 < 0.01 < 0.05 < 0.05 BMI 超重 104 -16.7(-23.3, -10.8) 23.1(17.1, 28.9) 8.2(3.3, 14.7) 35.7(25.3, 42.7) 非超重 800 -17.8(-24.8, -11.7) 24.5(19.6, 31.5) 6.3(2.4, 13.1) 35.2(27.3, 44.6) Z值 2.05 -3.57 6.24 2.64 P值 0.12 < 0.05 < 0.05 0.07
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表 4 不同组别儿童食物摄入评分比较[M(P25，P75)]
Table 4. The food intake scores between different groups [M(P25, P75)]
组别 选项 人数 统计值 谷薯类 蔬菜水果 奶类豆类 动物性食物 食物种类 饮水 是否贫血 是 120 7.3(4.2, 9.7) -5.4(-12.1, 0.6) -5.9(-10.7, -0.4) -2.4(-5.6, 0.8) -7.5(-9.1, -4.8) -3.6(-6.4, -0.9) 否 784 7.6(4.9, 9.8) -5.7(-11.2, 0.8) -5.0(-8.7, 0.2) -0.6(-3.5, 1.9) -6.3(-8.0, -2.9) -3.8(-6.5, -0.7) Z值 -0.26 2.04 -5.42 -16.47 -6.83 1.47 P值 0.43 0.09 < 0.05 < 0.01 < 0.05 0.11 是否留守儿童 是 306 7.6(4.7, 9.4) -5.9(-11.2, 1.6) -6.1(-10.8, -0.6) -2.2(-5.0, 0.7) -7.4(-9.2, -5.0) -3.7(-6.1, -0.6) 否 598 7.4(5.2, 9.3) -5.2(-9.5, 0.7) -4.8(-8.4, 0.3) -0.8(-3.1, 1.6) -6.2(-8.5, -3.7) -3.9(-6.4, -0.5) Z值 1.04 -1.37 -3.46 -13.02 -8.73 0.46 P值 0.26 0.17 < 0.05 < 0.01 < 0.01 0.39 BMI 超重 104 8.3(5.1, 12.6) -6.0(-12.4, 0.5) -5.2(-11.4, -0.7) -1.0(-4.2, 1.3) -6.9(-10.2, -4.8) -3.5(-7.0, -0.7) 非超重 800 7.1(4.9, 9.8) -5.1(-11.8, 1.2) -5.5(-10.7, 0.1) -2.3(-5.4, 0.9) -7.3(-11.4, -4.6) -3.8(-7.3, -0.6) Z值 7.42 -3.57 0.58 4.01 2.83 1.16 P值 < 0.05 < 0.05 0.31 < 0.05 0.06 0.21
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表 5 学龄前儿童缺铁性贫血多因素Logistic回归分析(n=904)
Table 5. Multivariate Logistic regression for anemia of preschool children (n=904)
自变量 β值 标准误 Wald χ2值 P值 OR值(OR值95%CI) 年龄 -0.21 0.25 3.23 0.08 0.78(0.61~1.09) 性别 -0.18 0.16 2.34 0.12 0.81(0.62~1.09) 母亲文化程度 -0.03 0.24 0.03 0.72 0.93(0.65~1.43) 留守儿童 0.92 0.22 10.78 < 0.01 1.27(1.15~1.49) 肉类食物 -0.86 0.19 6.71 < 0.01 0.81(0.68~0.94) 奶类食物 0.09 0.14 0.44 0.21 1.15(0.94~1.32) 豆类食物 -0.25 0.18 3.78 0.07 0.76(0.57~1.04) 新鲜蔬菜 -0.42 0.20 5.17 0.01 0.84(0.73~0.95) 新鲜水果 0.07 0.19 0.25 0.24 1.06(0.95~1.17)
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