【目的】探索单次和多次健康教育对肥胖儿童认知,饮食结构、生活方式及体重控制的影响,为儿童肥胖干预的实施提供有效措施。【方法】按照《中国0～18岁儿童青少年体块指数的生长曲线》超重和肥胖诊断标准筛查学龄儿童,对肥胖儿童发放调查问卷,评估肥胖认知、饮食结构及生活方式并分组给予单次或多次健康教育。健康教育的内容包括肥胖的判断和危害,科学的饮食结构、生活方式和心理支持等。6个月后再次进行评估。【结果】共有107名年龄6～13岁的肥胖儿童(男69人,女38人)纳入研究。资料完整90名,其中单次教育组44人,多次教育组46人。1)健康教育后两组儿童和家长对肥胖的认知水平均提高,但多次教育组儿童和家长认知水平显著高于单次教育组(P<0.01);2)干预后,多次教育组总能量及蛋白质、脂肪、碳水化合物摄入量及能量密度均降低(P<0.01),蔬菜份量增加(P<0.05),动物性食物及甜点、薯片的进食份额明显减少(P<0.01);单次教育组脂肪摄入减少(P<0.01),但总能量、食物份额量无明显改变;3)多次教育组在洋快餐、零食、看电视吃零食频率及看电视时间明显减少(P<0.01),但每日运动时间无明显变化;单次教育组生活方式无显著改变(P>0.05);4)干预后单次教育组BMI-SDS(body mass index-standard deviation score)无明显改变,多次教育组BMI-SDS降低(P<0.05)。【结论】对肥胖儿童和家长进行健康教育,尤其是多次教育有助于提高肥胖儿童和家长认知能力,降低儿童总能量摄入,改变饮食结构和生活方式,进而降低BMI。
Background To study the predictive factors of resting energy expenditure(REE)and evaluate the accuracy of predicted equations with indirect calorimeter(IC)in Chinese school-age children,particularly for the obese population.Methods Recruited children were from the department of child healthcare in Nanjing children's hospital during July 2014-September 2015.Anthropometric parameters and body composition were measured by bioelectrical impedance.Measured REE was assessed by IC.Predicted REE was estimated using ten published equations.Results 248 children aged 7-13 years were recruited,including 148 obese[body mass index standard deviation score(BMISDS)=2.48±0.91]and 100 non-obese(BMISDS=-0.96±1.08).The unit mass of REE(REE/kg)in obese group(29.06±5.74)was lower than that in non-obese group(37.51±6.56).The stepwise regression showed that age,BMISDS and fat-free mass(FFM)had a major impact on REE/kg as the regression equation:Y=54.41-1.36×X_(1)-2.25×X_(2)-0.16×X_(3)(Y REE/kg,X_(1)age,X_(2)BMISDS,X_(3)FFM;R=0.633,R^(2)=0.401,P<0.01).The accuracy of predicted REE in obese subjects was 62.16%by the new predictive equations.Conclusions The REE/kg in obese children was lower and closely correlated with age,BMISDS and FFM.It is necessary to validate the new predictive equation in a larger sample to estimate energy requirements,particularly for children with obesity.
Lin ZhangRan ChenRong LiMeng-Ying ChenRong HuangXiao-Nan Li
