Beverage intake among preschool children and its effect on weight status
Beverage intake among preschool children and its effect on weight status
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DOI：
10.1542/peds.2005-2348
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发表时间：
2006-10-01
期刊：
影响因子：
8
通讯作者：
Nicklas, Theresa A.
中科院分区：
文献类型：
--
作者：
O'Connor, Teresia M.;Yang, Su-Jau;Nicklas, Theresa A.
目标。在美国，肥胖症的流行持续增加。由于肥胖往往会随着时间的推移而增加，幼儿超重的增加是一个值得关注的问题。许多饮食模式与学龄前儿童的超重有关。最近，100%果汁和加糖果汁饮料受到了相当大的关注，因为它们可能是高能量饮料的潜在来源，可能与幼儿肥胖的流行有关。我们的目的是评估参加1999-2002年全国健康与营养调查的学龄前儿童的饮料摄入量，并调查学龄前儿童饮料消费的种类和数量与体重状况之间的关系。我们对1999-2002年全国健康和营养检查调查的数据进行了二次分析，该调查是对美国非机构人口的全国代表性样本进行的连续横断面调查。它包括收集父母报告的人口统计描述，24小时饮食回忆，身体活动的测量和标准化的身体检查。24小时的饮食回忆是由一位训练有素的采访者亲自获得的，反映了参与者前一天消耗的食物和饮料。国家健康和营养检查调查的食物组是根据美国农业部的饮食研究食品和营养数据库进行分类的。我们回顾了使用的主要食品描述符，并对所列的所有饮料进行了分类。100%果汁被归类为只含有100%果汁，不含甜味剂的饮料。果汁饮料包括任何加糖的果汁、果味饮料（天然的或人造的）或含有部分果汁的饮料。牛奶包括任何种类的牛奶，然后按乳脂的百分比进行细分。任何含咖啡因或不含咖啡因的加糖软饮料都被归类为苏打水。无糖饮料包括任何添加了低热量甜味剂的水果饮料、茶或苏打水。有几种饮料因为样本中饮用频率低而被从分析中剔除。水没有被包括在分析中，因为它不属于美国农业部食品和营养数据库的类别。为了进行这一分析，饮料被转换成盎司，而不是像国家健康和营养检查调查（National Health and Nutrition Examination Survey）那样以克为单位，以使其更具临床相关性。根据疾病控制和预防中心的标准计算儿童年龄和性别的BMI百分位数，并用于确定儿童的体重状况为体重不足（< 5%）、体重正常（5%至< 85%）、有超重风险（85%至< 95%）或超重（>= 95%）。由于体重过轻的儿童人数较少，因此在本次分析中，他们被纳入了正常体重的范畴。数据分析采用SUDAAN 9.0.1统计软件程序。SUDAAN通过计算国家健康和营养检查调查分层、多阶段概率设计的测试统计量，提高了结果的准确性和有效性。样本权重应用于所有分析，以解释从过抽样低收入儿童和黑人和墨西哥裔美国儿童中选择的不平等概率。对年龄、性别、种族、家庭收入、能量摄入、体力活动等因素进行描述性分析、chi(2)分析和协方差分析。所有2至5岁的儿童均被确定（N = 1572）。那些数据缺失的人被从额外的分析中剔除，最终的样本是1160名学龄前儿童。在分析的1160名儿童中，579名（49.9%）为男性。白人儿童占35%，黑人儿童占28.3%，西班牙裔儿童占36.7%。24%的儿童超重或有超重风险（BMI >= 85%）， 10.7%的儿童超重（BMI >= 95%）。在男孩和女孩之间或种族之间，BMI没有统计学上的显著差异。与正常体重儿童（平均年龄3.48岁）相比，超重儿童年龄偏大（平均年龄3.83岁）。83%的孩子喝牛奶，48%的孩子喝纯果汁，44%的孩子喝水果饮料，39%的孩子喝苏打水。46.5%的儿童食用全脂牛奶，3.1%和5.5%的儿童食用脱脂牛奶，1%的儿童食用牛奶。学龄前儿童每天平均消耗26.93盎司的饮料总量，其中包括12.32盎司牛奶，4.70盎司100%果汁，4.98盎司水果饮料和3.25盎司苏打水。儿童的体重状况与饮料、牛奶、100%果汁、水果饮料或苏打水的总摄入量无关。所消耗的牛奶类型（脂肪百分比）与体重状况之间没有临床意义的关联。在协方差分析中，每日总能量摄入量随着牛奶、100%果汁、水果饮料和苏打水的摄入量的增加而增加。然而，在牛奶、100%果汁、水果饮料或苏打水的饮用量的基础上，BMI没有统计学上的显著增加。平均而言，学龄前儿童喝的牛奶少于2005年美国人膳食指南推荐的16盎司/天。只有8.6%的人喝低脂或脱脂牛奶，这是推荐给2岁以上儿童的。学龄前儿童平均每天饮用低于6盎司的100%果汁。饮料消费量的增加与儿童总能量摄入的增加有关，但与他们的体重指数无关。前瞻性研究2 - 5岁以上学龄前儿童，通过其肥胖反弹（类似于5.5-6岁）来确定其BMI是否有增加的轨迹，可能有助于阐明饮料消费在总能量摄入和体重状况中的作用。
OBJECTIVE. The obesity epidemic in the United States continues to increase. Because obesity tends to track over time, the increase in overweight among young children is of significant concern. A number of eating patterns have been associated with overweight among preschool-aged children. Recently, 100% fruit juice and sweetened fruit drinks have received considerable attention as potential sources of high-energy beverages that could be related to the prevalence of obesity among young children. Our aim was to evaluate the beverage intake among preschool children who participated in the National Health and Nutrition Examination Survey 1999-2002 and investigate associations between types and amounts of beverages consumed and weight status in preschool-aged children.METHODS. We performed a secondary analysis of the data from the National Health and Nutrition Examination Survey 1999-2002, which is a continuous, cross-sectional survey of a nationally representative sample of the noninstitutionalized population of the United State. It included the collection of parent reported demographic descriptors, a 24-hour dietary recall, a measure of physical activity, and a standardized physical examination. The 24-hour dietary recall was obtained in person by a trained interviewer and reflected the foods and beverages that were consumed by the participant the previous day. The National Health and Nutrition Examination Survey food groups were classified on the basis of the US Department of Agriculture's Food and Nutrient Database for Dietary Studies. We reviewed the main food descriptors used and classified all beverages listed. One hundred percent fruit juice was classified as only beverages that contained 100% fruit juice, without sweetener. Fruit drinks included any sweetened fruit juice, fruit-flavored drink (natural or artificial), or drink that contained fruit juice in part. Milk included any type of cow milk and then was subcategorized by percentage of milk fat. Any sweetened soft drink, caffeinated or uncaffeinated, was categorized as soda. Diet drinks included any fruit drink, tea, or soda that was sweetened by low-calorie sweetener. Several beverages were removed from the analysis because of low frequency of consumption among the sample. Water was not included in the analysis because it is not part of the US Department of Agriculture's Food and Nutrient Database categories. For the purposes of this analysis, the beverages were converted and reported as ounces, rather than grams, as reported by the National Health and Nutrition Examination Survey, to make it more clinically relevant. The child's BMI percentile for age and gender were calculated on the basis of Centers for Disease Control and Prevention criteria and used to identify children's weight status as underweight (< 5%), normal weight (5% to < 85%), at risk for overweight (85% to < 95%), or overweight (>= 95%). Because of the small number of children in the underweight category, they were included in the normal-weight category for this analysis. Data were analyzed using SUDAAN 9.0.1 statistical software programs. SUDAAN allows for improved accuracy and validity of results by calculating test statistics for the stratified, multistage probability design of the National Health and Nutrition Examination Survey. Sample weights were applied to all analyses to account for unequal probability of selection from oversampling low-income children and black and Mexican American children. Descriptive and chi(2) analyses and analysis of covariance, adjusting for age, gender, ethnicity, household income, energy intake, and physical activity, were conducted.RESULTS. All children who were aged 2 to 5 years were identified (N = 1572). Those with missing data were removed from additional analysis, resulting in a final sample of 1160 preschool children. Of the 1160 children analyzed, 579 (49.9%) were male. White children represented 35%, black children represented 28.3%, and Hispanic children represented 36.7% of the sample. Twenty-four percent of the children were overweight or at risk for overweight (BMI >= 85%), and 10.7% were overweight (BMI >= 95%). There were no statistically significant differences in BMI between boys and girls or among the ethnicities. Overweight children tended to be older (mean age: 3.83 years) compared with the normal-weight children (mean age: 3.48 years). Eighty-three percent of children drank milk, 48% drank 100% fruit juice, 44% drank fruit drink, and 39% drank soda. Whole milk was consumed by 46.5% of the children, and 3.1% and 5.5% of the children consumed skim milk and 1% milk, respectively. Preschool children consumed a mean total beverage volume of 26.93 oz/day, which included 12.32 oz of milk, 4.70 oz of 100% fruit juice, 4.98 oz of fruit drinks, and 3.25 oz of soda. Weight status of the child had no association with the amount of total beverages, milk, 100% fruit juice, fruit drink, or soda consumed. There was no clinically significant association between the types of milk (percentage of fat) consumed and weight status. In analysis of covariance, daily total energy intake increased with increased consumption of milk, 100% fruit juice, fruit drinks, and soda. However, there was not a statistically significant increase in BMI on the basis of quantity of milk, 100% fruit juice, fruit drink, or soda consumed.CONCLUSIONS. On average, preschool children drank less milk than the 2005 Dietary Guidelines for Americans recommendation of 16 oz/day. Only 8.6% drank low-fat or skim milk, as recommended for children who are older than 2 years. On average, preschool children drank < 6 oz/day 100% fruit juice. Increased beverage consumption was associated with an increase in the total energy intake of the children but not with their BMI. Prospectively studying preschool children beyond 2 to 5 years of age, through their adiposity rebound (similar to 5.5-6 years) to determine whether there is a trajectory increase in their BMI, may help to clarify the role of beverage consumption in total energy intake and weight status.