Table of Content

20 March 2019, Volume 27 Issue 3

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Feeding disorders and dietary behaviors

XU Hai-qing,DAI Qiong

2019, 27(3):  233-235.  DOI: 10.11852/zgetbjzz2019-0207

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Infant feeding involves the complex interaction between children, feeders and feeding environment. This paper provides a comprehensive basis for the research on feeding disorders and dietary behaviors at home and abroad, and provides a theoretical basis for targeted interventions for maternal and child health care institutions.

Reevaluation of the Preschool Children Eating Behavior Questionnaire based on multidimensional item response theory

ZHANG Hao,YANG Xian-jun,JIANG Xun,YUAN Jing,XU Tong ,SHANG Lei

2019, 27(3):  236-240.  DOI: 10.11852/zgetbjzz2018-0043

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Objective To reevaluate the Preschool Children Eating Behavior Questionnaire by using multidimensional item response theory(MIRT),and to explore the feasibility and effectiveness of MIRT in the development of medical scale,in order to make Preschool Children Eating Behavior Questionnaire more completed and concise,thereby providing basic tools for the assessment of children's eating behavior and related research in China. Methods On the basis of extensive review of relevant literature,data were from the results of the Preschool Children Eating Behavior Questionnaire from children aged 3 to 6 in Xi'an city in June 2017. The MIRT were used to evaluate and select the items,such as degree of differentiation,difficulty and guessing coefficient,etc. Reliability and validity of the questionnaire were evaluated by result of Cronbach's α coefficient,split-half reliability coefficient,retest reliability coefficient and factor analysis. And the results were compared with those of the original scale. Results Three items were deleted according to the differentiation degree and difficulty under MIRT,and the dimension of one item was adjusted. The Cronbach’s α coefficient of revised questionnaire was 0.94,the Guttman split-half reliability was 0.81,and the test-retest reliability was 0.73. Exploratory factor analysis showed that the cumulative variance contribution rate was 59.04%,and confirmatory factor analysis indicated that the values of NFI,NNFI,CFI,RMSR were 0.86,0.92,0.93,and 0.04,respectively. There were significant differences on the scores of satiety responsiveness,food responsiveness,food fussiness,and eating habit dimensions among different weight groups. Finally,the reliability and validity of the revised scale were better than the original one. Conclusions The item screening method based on MIRT could improve the reliability and validity of the scale,making the scale more concise. The newly revised Preschool Children's Eating Behavior Questionnaire is more appropriate for evaluation and study of children's eating behavior problems.

Efficacy evaluation of precise intervention on eating problem of children aged 1-4 years in Wuhan city

XIONG Zhen,WANG Shi-qiong,ZHANG Chuan-jie,LI Rui-zhen

2019, 27(3):  241-243.  DOI: 10.11852/zgetbjzz2018-0838

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Objective To evaluate the effect of precise intervention on children's eating problems,in order to provide theoretical reference for clinical dietary management. Methods Totally 70 children aged 1-4 years with dietary behavior problems fromJanuary to June 2016, were enrolled in this study and were randomly divided into intervention group and control group. The intervention group was given precise intervention,such as etiological treatment,nutrition support,eating skill,behavior therapy and so on. The control group received routine feeding instruction and the dietary behavior of the two groups was evaluated in 3 months. The effects of two groups were compared in the aspects of feeding behavior and physical development index of children. Results The differences on children's dietary behavior problem,feeding behavior problem and the change of children's weight were significant between intervention group and control group(P<0.05). However,the significant difference on the height of the two groups was not found(P>0.05). Conclusion Precision intervention can promote the healthy development of children via improving dietary behavior and feeding behavior,which is worth of clinical application.

Study on the correlation between eating behaviors of preschoolers and feeding behaviors of caregivers

YUAN Jing,YANG Xian-jun,ZHANG Hao,XU Tong,YU Li-li,JIANG Xun,SHANG Lei

2019, 27(3):  244-247.  DOI: 10.11852/zgetbjzz2018-1240

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Objective To explore the relationship between eating behaviors of preschoolers and feeding behaviors of caregivers,so as to put forward references for cultivating children's healthy eating behavior. Methods Totally 912 caregivers of preschool children were enrolled in this study from April to July 2016,and were investigated by Chinese Preschooler's Caregiver Feeding Behavior Scale(CPCFBS) and Chinese Preschooler's Eating Behavior Questionnaire(CPEBQ). The canonical correlation analysis was performed to explore the relationships among family demographic characteristics,feeding behaviors and eating behaviors. Results Two interpretable canonical variables and structures were yielded(CRU₁-V₁=0.703,P<0.001; CRU₂-V₂=0.342,P<0.001),which could explain 16.5%,32.3% and 11.3%,20.0% of CPCFBS and CPEBQ variance respectively. According to the first canonical loadings,responsibility feeding,restricted feeding and monitored feeding showed the positive correlation with children's initiative eating ability,and weight concerns were negatively correlated with children's initiative eating ability in older children's families. According to the second canonical loadings,the positive correlation between forced feeding and children's external eating in the feeding behavior of families with lower education and lower family monthly income were mainly showed. Conclusion After controlling the characteristics of family demography,the caregivers feeding behaviors will have an important effect on children's dietary behaviors.

Correlation analysis of body mass index and dietary behaviors in 486 children aged 3~6 years

LIANG Qiao,XIAO Yan-feng,ZHANG Mei-zhen,LI Ruo-chun,LI Hui

2019, 27(3):  248-250.  DOI: 10.11852/zgetbjzz2018-0923

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Objective To understand current status and the correlation of dietary behavior and body mass index(BMI) in children aged 3-6 years,so as to provide references for the prevention and treatment of malnutrition in children. Methods A stratified cluster sampling method was carried out in 486 main caregivers of children from September 2017 to January 2018.Participants were asked to fill out Preschool Children's Diet Behavior Scale. And data on children's height,weight and body mass index(BMI) were collected. χ² test,independent sample t test and multivariate Logistic regression were used to analyze data. Results Totally 356(73.25%) children with normal BMI,11(2.26%) emaciated children,61(12.55%) overweight children and 58 obese children were detected in 486 children. There was no significant difference on scores of all dimensions of dietary behavior between boys and girls in children aged 3-6 years(P>0.05). And the scores of emotional diet and active eating ability at different age groups were significantly different(F=3.472,3.816,P<0.05). Also,there were statistically significant differences on the scores of picky eating,bad eating habits and satiety response(F=4.804,6.077,4.392,P<0.05) with children different BMI values. Picky eating(OR=-0.367,95%CI:-0.966--0.112,P<0.001) and bad eating habits(OR=-0.097,95%CI:-20.705--0.204,P＝0.045) had impact on children's BMI. Conclusions There are nutritional problems such as obesity,overweight and emaciation in children aged 3-6 years in this district. Picky food,bad eating habits affect children's BMI. Children in different BMI groups have different eating behaviors on the aspects of picky eating,bad eating habits and satiety response.

Study on the correlation between family nurture environment and eating behavior problems of children aged 3-6 years in Urumqi

YANG Jing,WANG Dan,WU Ping-ping,XIAN Ya-jing,LIN Su-lan

2019, 27(3):  251-254.  DOI: 10.11852/zgetbjzz2018-0466

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Objective To understand the status of eating behavior problems of 3 to 6-year-old children in Urumqi,and to explore the relationship between family nurture environment and eating behavior problems,so as to provide reference for the prevention of eating behavior problems of children aged 3-6 years. Methods A stratified random cluster sampling method was used to collect 1 070 children aged 3-6 years from 7 kindergartens in Urumqi from November.2017 to January.2018. Management of Feeding Difficulties(IMFeD) and 3 to 6-year-old Children's Family Nurture Environment Scale were used to assess family nurture environment and eating behavior problems. Results The detection rate of children's eating behavior problem in 3 to 6-year-old children in Urumqi was 55.89%. There were significant differences on the scores of language/cognitive information,emotional warmth/self-expression,social adaptation/self-care,neglect/intervention punishment,activity diversity/game participation and total score of family nurture environment between children with eating behavior problems and children without eating behavior problem(Z=-8.506,-7.395,-9.393,-9.348,-9.773,-12.618,-13.633,P<0.000 1). Multi-factor analysis showed that social adaptation/self-care,neglect/intervention punishment,activity diversity/game participation and environment atmosphere were influencing factors of eating behavior problem of children aged 3-6 years(P<0.01). Conclusions The detection rate of children's eating behavior problems in 3 to 6-year-old children in Urumqi is higher. Family nurture environment is closely related to children's eating behavior problems,and should be actively improved to prevent eating behavior problem.

A prospective cohort study on energy and protein intake of small-for-gestational-age infants under 6 months

ZHOU Ling-lin,YANG Qin,ZHANG Xuan,CHENG Qian

2019, 27(3):  255-257.  DOI: 10.11852/zgetbjzz2018-0373

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Objective To investigate the energy and protein intake of small for gestational age(SGA) infants under 6 months of age, in order to provide basis for early feeding guidance of SGA. Methods Participants were prospectively enrolled from Department of Child Health Care of the Children's Hospital of Chongqing Medical University from September 2013 to May 2015. Totally 146 infants including 63 SGA and 83 appropriate-for-gestational-age(AGA) infants were selected according to the inclusion and exclusion criteria. And their weight,length,head circumference and dietary conditions were evaluated at age of 3 and 6 months(the premature were valuated at adjusted age of 3 and 6 months).Results The energy intake of SGA group in 3-month-old infants [(87.70±15.82)kCal/(kg·d)] was significantly higher than that in 6-month-old infants [(80.40±14.48)kCal/(kg·d)](F=11.260,P=0.001),both of which were lower than the adequate intake of 90 kCal/(kg·d). Compared with AGA group,the energy intake of SGA group was not significantly different in 3 months(LSD-t=0.333, P=0.740),and significantly higher in 6 months(LSD-t=3.672, P＜0.001). The protein intake of SGA group at the age of 3 months old was significantly lower than that of 6-month-old SGA[(10.65±2.94) g/d vs.(12.81±3.15) g/d,F=36.770,P＜0.001)],both of which were higher than the adequate intake of 9 g/d. Compared with AGA group,the protein intake of SGA group was significantly lower in 3-month-old infants(LSD-t=-2.023,P=0.045),and not significantly different in 6-month-old infants(LSD-t=-0.072,P=0.943). Conclusion SGA infants need high intake of protein but no more than adequate intake of energy to keep normal physical growth.

Research on the change of plasma concentrations of kisspeptin,neurokinin B and dynorphin in girls with idiopathic central precocious puberty

GE Wei,WANG Hai-lian,SHAO Hong-jia,XU Rui-ying

2019, 27(3):  258-261.  DOI: 10.11852/zgetbjzz2018-0474

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Objective To investigate the change of plasma concentrations of kisspeptin,neurokinin B(NKB) and dynorphin(Dyn) in girls with idiopathic central precocious puberty(ICPP). Methods Totally 50 girls with ICPP before treatment were enrolled in this study from January 2016 to January 2017 in Qilu hospital, shandong University. The changes of sexual development situation and plasma kisspeptin,NKB and dynorphin concentrations between girls with ICPP and normal healthy girls before and after treatment were analyzed. Results There were significant differences on bone age,bone age/age of child,standard deviation score of height(SDS),basal luteinizing hormone(B-LH),basal follicle stimulating hormone(B-FSH),estradiol(E2),kisspeptin and NKB between ICPP group and healthy control group before treatment(P<0.01). After 6 months treatment,the levels of B-LH,peaking LH(P-LH),B-FSH,peaking FSH(P-FSH),P-LH/ P-FSH,E2,kisspeptin and NKB significantly decreased compared with those before treatment(P<0.01). However,difference on the above indexes were not found significant between 6 months and 12 months after treatment in ICPP girls(P>0.05),and there was no significant difference on the level of Dyn among threee groups(P>0.05). After treatment with gonadotropin releasing hormone analogue(GnRHa),the sexual development of ICPP girls was significantly controlled within 3 months,and the sexual development did not significantly improved at the end of 12 months. Moreover,kisspeptin level was positively correlated with NKB,P-LH,P-LH/P-FSH and E2(P<0.05),and NKB level was also positively correlated with kisspeptin,P-LH,P-LH/P-FSH and E2,too(P<0.05). Conclusion Kisspeptin and NKB play an important role in the pathogenesis of ICPP,and may become an effective indicator for monitoring children'sexual development and evaluating therapeutic effect of ICPP children.

Analysis on the effect of GnRHa on improving final adult height and related factors in girls with idiopathic central precocious puberty

XU Hui-jie,YE Jin,YUAN Xue-jing,CAO Jian-mei,LI Hui,ZHANG Yu

2019, 27(3):  262-264.  DOI: 10.11852/zgetbjzz2018-0585

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Objective To evaluate the effect of gonadotropin-releasing hormone analogues(GnRHa) on improving final adult height(FAH) in girls with idiopathic central precocious puberty(ICPP),and to analyze the related factors. Methods Data of 26 ICPP girls,who had been treated with GnRHa alone and had reached or approached their FAH in the affiliated hospital of Nanjing Unversity of traditonal Chinese medicine from May, 2009 to July,2011,were retrospectively analyzed. Results The 26 girls with ICPP were treated by GnRHa for(22.50±5.48)months,followed up for(58.0±7.44)months,and finally the mean FAH was(161.50±4.41)cm,significantly higher than the prediction of adult height before treatment [(157.23±5.51)cm,P<0.01].The net height gain was(4.27±4.05)cm.The body mass index(BMI) before treatment,at the end of treatment and after reaching FAH was(16.32±1.67)kg/m²,(17.39±2.41)kg/m² and(19.95±2.21)kg/m² respectively,and all remained in the nomal range of age(±1s).The average menstrual age of 26 ICPP girls was(12.5±0.7)years old.The FAH was positively correlated with height when the medication stopped and menarche age(P<0.01 or <0.05),and negatively related to bone age when medication stopped(P<0.01). Conclusion GnRHa can significantly improve the final height in girls with ICPP,and the FAH is correlated with the height,bone age when the medication stopped,and menarche age.Moreover,youth development of children after medication stopped is similar to that of the normal children.

Study on the 0-24 month growth development of 1 143 preterm infants discharged from neonatal intensive care unit

TIAN Yuan,CHEN Fei,ZHANG Yuan-yuan,ZHANG Chun-cao,SHEN Yun-lin,CHEN Hao, CHEN Yi-huan,YU Guang-jun

2019, 27(3):  265-268.  DOI: 10.11852/zgetbjzz2018-0607

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Objective To analyze the growth status of preterm infants discharged from neonatal intensive care unit(NICU) at the age of 0-24 months,in order to provide evidence for growth monitoring and nutrition management of preterm infants. Methods The data of growth development of preterm infants discharged from NICU in Children's Hospital of Shanghai were retrospectively collected from January 2013 to December 2017. The body length and weight of preterm infants aged 0-24 months in different gender and age groups were analyzed. Results A total of 1 143 cases were included, and the extremely early and early term infants account for the largest proportion of premature group, which was 36.8%.Moderately preterm accounted for 29.6% and late preterm accounted for 33.6%.The average gestational age was(32.2±2.4) weeks, and there was no significant difference in the composition of birth age in gender(χ²=2.048,P=0.562).The average height and weight of preterm infants at adjusted age of 0 month exceeded that of the full-term infants.Preterm infants at adjusted age of 1 month achieved catch-up growth, but the height and body weight of preterm infants were still lower than those of full-term infants.Besides, the catch-up growth of preterm male infants was undesirable. Conclusions Appropriate catch-up growth is the goal of nutrition management for preterm infants after discharge,and the preterm male infants should be paid more attention to. Also,systematic nutrition management will facilitate appropriate catch-up growth.

Systematic review on breastfeeding difficulties,reasons of weaning and factors affecting breastfeeding practices

LING Cong,ZHANG Jing

2019, 27(3):  269-272.  DOI: 10.11852/zgetbjzz2018-1678

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Objective To conduct a system review on published literatures related to breastfeeding difficulties,reasons of weaning and factors affecting breastfeeding practices. Methods Databases of CINAHL,PubMed,Embase,Wip and CBM were searched. Relevant studies were enrolled according to definite inclusion and exclusion criteria and were analyzed to summarize interventions supporting breastfeeding. Results Totally 35 studies were included. Most of breastfeeding mothers have experienced a lot of breastfeeding difficulties,especially in the first few weeks after giving birth. Various reasons are reported for stopping(exclusive) breastfeeding. There are many influencing factors for breastfeeding,but remains controversial. Conclusion The mechanism underlying breastfeeding behavior change is not clear,and further study is clearly warranted.

Research advance on feeding difficulties of Prader-Willi syndrome in infants

LIAN Wen-jun,DUAN Pei,LIANG Rui-xing,NIU Dong-he,LU Xiang-peng,ZHENG Hong

2019, 27(3):  273-276.  DOI: 10.11852/zgetbjzz2018-1533

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Objective Prader-Willi syndrome(PWS) is a genetic disease caused by imprinting genetic defects,which is accompanied by problems such as central hypotonia,feeding difficulties and progressive obesity. Nutritional problems caused by feeding difficulties are one of the causes of infant mortality in PWS children. This review summarizes the reasons of feeding difficulties in infants and young children with PWS and the methods of improving feeding. All the evidence that the dysfunction of chromosomal deficiencies in PWS children and the change of the level of hunger hormones in children are the main causes of feeding difficulty. Intranasal infusion of oxytocin,subcutaneous injection of growth hormone,oral exercise and nasogastric feeding tube feeding method can help infants and young children with PWS feeding difficulties,thereby improving nutritional status.

Research progress on feeding difficulty in infants

JI Wen-jing,LIANG Ai-min

2019, 27(3):  277-280.  DOI: 10.11852/zgetbjzz2018-0464

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Feeding difficulty is a common symptom in child care clinic. The etiology of feeding problem is multifactorial,and there is no unified standard diagnostic criterion and intervention processes at present. Intensive multidisciplinary intervention is often needed for severe cases. This review summarizes the definition,epidemiology,etiology and classification of feeding difficulty. Besides,it also illustrates the latest status of diagnosis and management of feeding problems,so as to provide reference for further studies.

Progress on the mechanism of intrauterine growth restriction affecting cognitive development

LIU Wen-jing,YUAN Zhao-hong

2019, 27(3):  281-284.  DOI: 10.11852/zgetbjzz2018-0672

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Intrauterine growth restriction(IUGR) refers to the fact that fetal development in the uterus does not reach its growth potential due to genetic or environmental factors. IUGR is not only associated with peripartum asphyxia,hypothermia,hypoglycemia and other diseases,but also can affect the long-term development of the nervous system,resulting in cognitive developmental disorders,behavioral problems. This article reviews the mechanism that IUGR may impair cognitive development in terms of fetal circulatory redistribution,brain volume and structure,brain metabolism,and epigenetic inheritance,in order to provide basis for revealing and intervening cognitive impairment caused by IUGR.

Research advance on the epidemiological and etiological study of small-for-gestational-age infants

XIE Hua,YANG Fan

2019, 27(3):  285-288.  DOI: 10.11852/zgetbjzz2018-0688

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In recent years,an increasing number of small-for-gestational-age(SGA) infants are seen among live birth. SGA infants,a special group of neonates, have considerable impact on children's health during their development both in the short- and long-term periods. Through the statistical analysis of the birth cohort of the newborns,there is a comprehensively epidemiological document of SGA. At the same time,etiological study on SGA has also reached new depth with focus on the maternal,placenta and fetus. This review mainly introduces the epidemiological features and etiological mechanism of SGA.

Study on the association of chalazia with serum vitamin levels and eating habits in children

ZHANG Zhe-huan,JIA Yan,YANG Chen-hao

2019, 27(3):  289-291.  DOI: 10.11852/zgetbjzz2018-0888

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Objective Toinvestigate the etiology of chalazia in children,in order to provide basis for clinical prevention and treatment of chalazia. Methods Totally 108 preoperative children with chalazia were randomly selected as the case group from 2016 to 2017 in Children's Hospital of Fudan University,and 48 preoperative children with strabismus or trichiasis were as the control group. Serum vitamin A,B1,C,D,E of children were tested and compared in two groups using two independent samples t test. Questionnaires survey was conducted to investigate high-calorie food,snacks and meat consumption and dietary bias in two groups. Chi-square test and Logistic regression were used to analyze the data. Results The average serum vitamin A level of the case group was (0.64±0.14)μmol/L,the control group was (0.70±0.21 )μmol/L,and the difference between the two groups was statistically significant(P=0.014). Serum vitamin A levels in children with multiple cysts were lower than those of children with single cyst(P=0.006). There were no significant differences on serum vitamin B1,C,D and E levels between the two groups(P>0.05). But there were no significant differences on high-calorie food,snacks and meat consumption and dietary bias between case group and control group(P>0.05). Logistic regression analysis showed significant effect of eating habits to chalazia in children was not found(P>0.05). Conclusion Low vitamin A level is associated with chalazia in children,especially in children with multiple cysts.

Study on the correlation of vitamin D levels in infants and their mothers

LIU Ying,SONG Xiao-hong,PAN Jian-ping,SHI Jiao,LI Min,LUO Dan,XIAO Lin

2019, 27(3):  292-295.  DOI: 10.11852/zgetbjzz2018-0357

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Objective Toanalyze the correlation of serum vitamin D level between exclusively breast-fed infants aged 28~42 days with clinical manifestation of rickets and their mothers,in order to provide theoretical foundation for prevention of infant nutritional rickets. Methods A total of 119 exclusively breast-fed infants in Northwest Women and Children Hospital,diagnosed with nutritional rickets at age of 28~42 days,were enrolled in this study from April 2016 to October 2017. Serum 25-hydroxylvitamin D [25-(OH)D] level of both infants and their mothers were tested and the correlation was analyzed. Results Among the 119 mothers,15(12.61%) mothers had serum 25-(OH)D level higher than 30 ng/ml,104(87.39%) mothers were no more than 30 ng/ml. Totally 19 mothers took vitamin D supplementation ≥400 U per day during pregnancy,and the median serum level of 25-(OH)D was 28.8 ng/ml. And 100 mothers took vitamin D supplementation less than 400 U per day during pregnancy,and the median serum level of 25-(OH)D was 16.1 ng/ml. The difference on the median serum level of 25-(OH)D between the two groups was significant(P＜0.05). Also,there was significant difference on the median serum level of 25-(OH)D between infants with and without vitamin D supplementation(20.0 ng/ml vs.9.5 ng/ml,P＜0.05). The serum 25-(OH)D level of infants was positively correlated with theirs mothers' level. No correlation was found between serum 25-(OH)D level(20ng/ml as cutting edge) and the possibility of rickets symptoms and signs. Conclusions The overall vitamin D level of both infants and their mothers is insufficient,and the serum 25-(OH)D level between the infants and their mothers are significantly related. It is suggested to take vitamin D supplementation during pregnancy and to give infants vitamin D supplementation immediately after birth,so as to prevent nutritional rickets in infants.

Study on bone mineral density among children aged 0-5 years in Jiangsu province

ZHAO Yan,HU You-fang,QIN Zhen-ying,YANG Zi,QIN Rui

2019, 27(3):  296-300.  DOI: 10.11852/zgetbjzz2018-0286

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Objective To explore the bone mineral density(BMD) of 0 to 5-year-old children in Jiangsu province monitored by quantitative ultrasound,and to analyze the association among sex,age,births,district,season and BMD,in order to provide reference for making intervention strategies. Methods A stratified cluster random sampling method was used to select children aged 0-5 years in Jiangsu province from April 2014 to March 2015. Totally 5 289 children were investigated,including 2 786 boys and 2 503 girls. A face to face investigation was conducted by the prepared doctors with self-designed questionnaires to collect related details and the bone mineral density was measured. Analysis of covariance variance(ANOVA) was used to describe mean differences of continuous variables after adjusting potential covariates such as age,gender and chi-square test was used to examine differences in categorical variables. Results The overall detection rate of low BMD in 0 to 5-year-old children was 14.6%. And the low BMD rates in children aged 0-6 months,7-12 months,13-24 months,25-36 months,37-48 months,49-60 months and ≥60 months were 44.9%,21.9%,14.3%,10.0%,9.0%,9.1% and 11.6%,respectively,and the difference was significant(P＜0.001). No significant difference on detection rate of low BMD between boys and girls was found(14.8% vs. 14.5%,P=0.887). The detection rate of low BMD in preterm children was significantly higher than that of full-term children(20.9% vs. 14.4%,P=0.018). After adjusting the confounders of gender and age,the speed of sound(SOS) value in preterm infants was significantly lower than that in full-term infants,and SOS value in low birth weight infants was also lower than normal birth weight infants(P＜0.05). After adjusting the confounders of age,gender,gestational age,parity and birth weight,differences on SOS value was significant among different areas and seasons(P＜0.05). Conclusions The BMD level of children in Jiangsu province is generally low. And children under 1 year old are at high risk of low BMD,with the prevalence rate of 44.9% in 0 to 6-month-old infants. The BMD level of children is related to age,preterm,low birth weight,district and season,but is not influenced by gender,parity,delivery mode and dwelling district.

Effect of snacking on dietary nutrition condition of children and adolescents

WANG Mei-chen,ZHU He-nan,WU Wei,REN Zhong-xia,GONG Hui-ting, LI Ting,MENG Li-ping,ZHANG Yu-mei

2019, 27(3):  301-304.  DOI: 10.11852/zgetbjzz2018-0268

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Objective To investigate the situation of snacking intake and nutrients supplementation in Chinese children and adolescents aged 3-17 years,in order to provide scientific guidance for snacking in children and adolescents. Methods Data were extracted from the China Health and Nutrition Study(CHNS) in 2011. The amount of nutrients dietary intake in different snacking groups was described,and was compared with Chinese dietary reference intakes. Results A total of 2 012 valid subjects were included in the study,of whom 68.84% had snacking,and the medium of energy supply ratio was 9%. The participants were divided into snacking 1(S1) group and snacking 2(S2) group according to the energy supply ratio. The energy supply ratio in S2 group was higher,while it was contrast in S1 group. The highest percentage of snacking was fruits(79.28%),and 29.17% of the snacking were dairy in snacking group. The amount of nutrients supplementation was higher in S2 group than that in group without snacking,and the difference was significant in different age groups(P＜0.05) . In this study,the proportion of nutrients meeting estimated average requirement in S2 group was higher than no snacking group. Also,the proportion of vitamin A,Fe and Zn intake more than tolerable upper intake levels in snaking group was much higher. Conclusions Snacking behavior would increase the amount of nutrients intake,and decrease the proportion of insufficient of nutrients intake to a large extent. As a result,scientific and reasonable snacking behavior is suggested to be advocated in children and adolescents.

Clinical analysis of language development retardation in high-risk children at age of 2 years old

LIU Yan-li,HAO Wen-bi,QIAN Yan,JIANG Jin-jin

2019, 27(3):  305-307.  DOI: 10.11852/zgetbjzz2018-0228

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Objective To investigate the language retardation of high-risk infants at the age of 2 years,in order to provide scientific basis for early diagnosis,early intervention and improvement of prognosis. Methods A total of 64 high-risk infants were selected as participants,who received treatment and were followed up to 24 months old in Department of Pediatric in Shanghai Changhai Hospital from June 2014 to July 2015. And 52 healthy children who took physical examination in Department of Health Care were selected as control group. Developmental abilities of children were assessed by Developmental Screening Test(DST) at the age of 12 months,18months and 24 months old in high-risk infants and at the age of 24 months old in healthy children. Results The detection rate of language retardation was about 34.4% in high-risk infants at the age of 24 months old,significantly higher than that in control group(8.0%)(P＜0.05). The detection rate of full-term small-like infants was 63%,followed by 40% of the premature infants,and the ratio of male to female was 3.4∶1. No significant difference was found on the detection of dyskinesia and language retardation in high risk infants at the age of 12 months(P=0.191),and there was significant difference at the age of 18 and 24 months(P<0.05). Conclusions High-risk infants are still at high risk of language retardation,and the detection rate of language retardation caused by different factors is significantly different. Regular follow-up,monitoring and screening of language development are required for the early detection,early intervention in high-risk infants to improve the prognosis.

Analysis of the correlation between visual motor integration ability and visual evoked potentials in children with fine motor skills delay

LIU Li-li,TIE Xiao-ling

2019, 27(3):  308-310.  DOI: 10.11852/zgetbjzz2018-0471

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Objective To investigate the association between visual motor integration(VMI) and flash visual evoked potentials(FVEPs) in children with fine motor skills delay,in order to provide scientific basis for early diagnosis and early intervention of child with fine motor skills delay. Methods Totally 71 children with fine motor skills delay diagnosed by PDMS-Ⅱ and accorded with inclusion criterion in Xi'an Children's Hospital were enrolled in this study from January 2015 to December 2016.FVEPs were performed in all children.Besides,visual motor integration(VMI) and fine motor quotient(FMQ)were assessed by PDMS-Ⅱ.And correlation between LP100 and VMI,LP100 and FMQ were analyzed. Result There were significant correlations among FVEPs,VMI and FMQ,that was higher LP100 indicated lower VMI and FMQ(r=-0.859,-0.844,P<0.001). Conclusions Visual perception has an influence on VMI in children with fine motor skills delay,and FVEPs can provide important clues and electrophysiological basis for early diagnosis and early intervention.

Analysis of the results of auditory brainstem response in 328 normal infants aged 1-6 months

ZHANG Ping,WANG Xiao-yan,WANG Hong,ZHAO Zhi-wei

2019, 27(3):  311-313.  DOI: 10.11852/zgetbjzz2018-0897

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Objective To investigate the characteristics of auditory brainstem response(ABR) in normal infants aged 1~6 months,and to establish a normal range of the peak latencies(PLs) of wave Ⅰ、Ⅲ、Ⅴ and interpeak latencies(IPLs) of Ⅰ-Ⅲ、Ⅲ-Ⅴ、Ⅰ-Ⅴ, in order to provide basis for clinic work. Methods Totally 328 infants with normal hearing and 40 adults were tested by ABR from January 2017 to January 2018. The PLs of wave Ⅰ、Ⅲ、Ⅴ and IPLs of Ⅰ-Ⅲ、Ⅲ-Ⅴ、Ⅰ-Ⅴ from infants of different age groups and ears on different sides were compared. Results The PL of wave I in infants aged 1-6 months was(1.65±0.07),(1.59±0.07),(1.59±0.05),(1.57±0.07),(1.56±0.05) ms and(1.54±0.06) ms,respectively. And the value at the age of 5 months was close to that of adults [(1.53±0.02)ms,P>0.05)]. The PLs of wave Ⅲ、Ⅴ and the IPLs of Ⅰ-Ⅲ、Ⅲ-Ⅴ、Ⅰ-Ⅴ became shorter with the increase of age,which were(4.04±0.12),(6.11±0.13),(2.50±0.11),(2.07±0.13)ms and(4.57±0.12)ms respectively in infants of 6 months old. But these values were still significantly longer than those of adults[(3.90±0.08),(5.77±0.07),(2.37±0.08) ms,(1.87±0.11)ms and(4.24±0.07)ms,P<0.05)]. No significant differences were found between ages or different side of ears(P>0.05). Conclusion The establishment of normalrange of ABR wave for the infants aged 1 to 6 months will provide reliable basis for early diagnosis and follow-up detection of hearing and development disorders.

Analysis of serum amyloid A and human cartilage glycoprotein-39 levels in children with mycoplasmal pneumonia and the correlation with prognosis

ZHANG Hui,CHEN Hao

2019, 27(3):  314-316.  DOI: 10.11852/zgetbjzz2018-1049

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Objective To analyze levels of serum amyloid A(SAA)and human cartilage glycoprotein-39(HC-gp39) in children with mycoplasma pneumonia(MP),as well as the correlation with efficacy,in order to provide reference for predicting the prognosis of MP children. Methods Totally 110 MP children in Shiyan Maternal and Child Health Hospital were enrolled in the observation group and 110 healthy children were included in the control group from February 2015 to February 2017. The observation group was given conventional comprehensive treatment. The levels of serum SAA,HC-gp39,IgA,IgG and IgM of two groups at admission,before and after treatment in observation group were compared. After treatment,the observation group was divided into effective group and invalid group according to the treatment efficacy results. Pearson correlation analysis was used to determine the correlation between serum SSA and HC-gp39 levels before treatment and the efficacy. Results The serum SSA,HC-gp39,and IgG levels at admission in the observation group were significantly higher than those in control group(P<0.05). After treatment,the serum levels of SSA,HC-gp39,and IgG in observation group were lower than those before treatment(P<0.05). The serum SSA,HC-gp39 levels were positively correlated with IgG(r=0.524,0.394,P<0.05) and negatively related to efficacy(r=-0.613,-0.502,P<0.05). Conclusion The levels of serum SSA and HC-gp39 in MP children are significantly higher than those in healthy children,and are positively correlated with IgG and negatively correlated with efficacy.

Investigation on the comprehension and expression of early language in infants in Jü county,Rizhao city

WANG Yong-juan,WANG Chao-xia,MA Xian-sheng

2019, 27(3):  317-319.  DOI: 10.11852/zgetbjzz2018-0768

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Objective To study language comprehension and expression of infants in Jücounty,Rizhao city, in order to provide scientific basis for early intervention Methods Totally 208 infants aged 8-16 months were randomly selected into this study from January to December 2017,and their parents were investigated by Chinese Communicative Development Inventory(CCDI) to report infants' language abilities. The section one of CCDI-Words and Gestures was studied,which includes first signs of understanding(involve three sentences),phrases,starting to talk(imitating and labeling),vocabulary understanding and expression. Results Most 8-month-old infants showed response to phrases like “their name,papa/mama,do not xx” before they starting to speaking. Infants aged 8 months could understand 12 phrases on average,and 26 phrases at 16 months old. Imitating speech ability developed one month earlier than the ability to name the objects. The ability to name the objects of girls developed two months earlier than boys. Conclusions 8 to 16 months is a period of rapid language development time for infants to understand language. Infants aged 8 months start to show response to language,and infants can comprehend quite a few short sentences at 16 months old. The expression ability of girls develops two months earlier than boys.

Status and influencing factors of nutrients package usage among infants and toddlers in poor areas of Ningxia

LI Xiao-qiang,JIANG Tao,LIU Yuan,LI Hong-yan,SUN-Jing,PAN Yu-yang

2019, 27(3):  320-322.  DOI: 10.11852/zgetbjzz2018-0085

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Objective Toinvestigate status and influencing factors of nutrients package usage among infants and toddlers in poor areas of Ningxia from 2017 to 2018. Methods A multi-stage PPS combined with random equipment sampling was used to conduct a questionnaire survey on 2 120 caregivers of 6 to 24-month-old infants in 7 poverty-stricken areas in Ningxia. The contents included infants' basic birth status, nutritional packages, and caregiver' knowledge on nutrition and feeding. Results The rate of effective use of nutritional packages in Ningxia was 80.3%. The rate of effective use of nutritional packages of Han nationality was higher than that of the Hui nationality, and the number of no discomfort reaction was higher than that of the discomfort reaction. With the increasing age of infants and toddlers, the rate of effective taking nutritional packages increased. The higher the mother's and father's degree was, the higher the rate of effective use would be. Differences on the rate of taking nutritional packages in children at different nationality, age, discomfort reaction and mother's educational level groups were statistically significant(P<0.05). Multivariate non-conditional Logistic The Han nationality (OR=0.635,95%CI:0.487-0.827,P=0.001), no discomfort (OR=0.286,95%CI:0.192-0.425,P<0.001) and age of months(OR=0.970,95%CI:0.951-0.990,P=0.003) were the protective factors for Nutrients package compliance. Conclusion The edible compliance of nutritional packages for food consumption in impoverished areas in Ningxia needs to be further improved, and it is suggested to take relevant intervention measures targeting the influencing factors.

Analysis of current status and related factors for obesity and overweight among primary and    secondary school students in the suburb of Beijing

JIANG Chu, SHEN Yuan, MENG Yi, JIANG Xiu-chun, SHEN Yan-hui, YAO Ruo-xue, HUANG Na

2019, 27(3):  323-325.  DOI: 10.11852/zgetbjzz2018-0788

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Objective To analyze the prevalence of obesity, overweight and related nutritional behaviors among primary and secondary school students in the suburb of Beijing in 2015 and 2017, in order to provide evidence for effective intervention measures. Methods A multi-stage stratified cluster sampling method at the proportion of 5% was used to select 3 rural districts in Beijing.And two classes for every grade from grade 3-5 of the primary schools and grade 1-2 for both middle schools and high schools.Totally of 3 833 students were investigated.Information such as weight, height, nutrition and food intake, water intake as well as nutritional knowledge was involved in questionnaires. Results The overall obesity rate of primary and secondary school students was 12.9%, and the overweight rate was 14.2%.And significant difference on obesity rate existed between boys and girls(17.00% vs.8.43%, χ²=57.270, P=0.001).Moreover, obesity rate in 2017 was higher than that in 2015(14.77% vs.11.33%, χ²=10.001, P=0.001).Only 72.89% of the students had breakfast at least six days every week, and 16.54% reported that they did not have enough food for breakfast.31.02% often had sugary drinks,20.90% reported having water less than 1 000 ml of every day.Totally 355(13.05%) primary students,114(20.14%) of middle school students and 128(23.40%)high school students had appropriate attitude for food additives.And students who had wrong attitude for food additives were much more in high grade(χ²=47.622, P=0.001).Also,8.91%(88/988) of the overweight or obese students had ever taken weight-reducing pills and 6.87%(181/2 636) of the normal-weight or underweight students had also ever taken the pills. Conclusion Obesity in suburban students is increasing prevalent, so individualized nutrition intervention should be the priorities of the future work.

Analysis on clinical features of 847 hospitalized infants with medium and severe malnutrition

CHEN Yu-xia,ZHAN Xue

2019, 27(3):  326-329.  DOI: 10.11852/zgetbjzz2018-0176

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Objective To analyze the clinical features and etiology of malnutrition infants, in order to improve clinical diagnosis and treatment, and to reduce the incidence of malnutrition in infants. Methods Clinical data such as basic information, symptoms, complication and auxiliary examination were retrospectively analyzed among 847 infants aged 0 to 3-year-old with medium and severe malnutrition in 2012-2015. Results Totally 395(46.6%) infants were in moderate malnutrition,and 452(53.4%) infants were in severe malnutrition.The birth weights of two groups were(2.95±0.58) kg and(2.64±0.67) kg respectively, both of which were lower than that of normal infants.Breast-feeding rates of two groups were 54.8% and 40.7%, and the complementary feeding was improper in some cases.The chief complaints were cough(46.9％),fever(28.9％),diarrhea(16.4％) and polypnea(15.7％).Children with moderate and severe malnutrition often are more likely to develop respiratory and digestive infection, congenital heart disease(CHD), congenital laryngeal cartilage dysplasia, cerebral palsy and electrolyte disturbance in the same time. Conclusions Malnutrition is a multifaceted disease.Attention should be paid to the prevention and treatment of infection and electrolyte disorders while actively seeking etiological factor for hospitalized children.

Analysis of current level and related factors of vitamin A in 212 cases of hospitalized newborns

CHANG Xiao,WANG Zhe,WU Yun-xia

2019, 27(3):  330-332.  DOI: 10.11852/zgetbjzz2018-0226

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Objective To evaluate the level of plasma vitamin A(VA) and the influencing factors of VA level in 212 hospitalized newborns. Methods The plasma level of VA in newborns was tested by high performance liquid chromatography(HPLC) from June to December 2017.And the general data of children were collected.SPSS 19.0 were used to analyze the influencing factors of VA level. Results There were 189(89.1%) cases were detected with VA deficiency. Gender,age,blood glucose,infection and neonatal respiratory distress syndrome(NRDS) were factors influencing VA concentration,and the difference was statistically significant(P<0.05). The level of VA was negatively correlated with C-reaction protein(CRP)(r=-0.167,P=0.015). The correlation between mother and neonates was not statistically significant(P＞0.05).Gender(OR=0.465,95%CI:0.237-0.913,P=0.026) and infection(OR=2.583,95%CI:1.135-5.876,P=0.024) were the risk factors for clinical VA deficiency. Conclusion Vitamin A deficiency in newborns is severe. Male infants and newborns with infection are prone to developing clinical vitamin A deficiency.

Effects of zinc deficiency on pulmonary function,airway inflammation and clinical efficacy in children with cough variant asthma

HE Qiao-feng,GE Wen-wen,SU Le

2019, 27(3):  333-336.  DOI: 10.11852/zgetbjzz2018-1265

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Objective To discuss the effects of zinc deficiency on pulmonary function,airway inflammation and clinical efficacy in children with cough variant asthma(CVA),so as to provide evidence for clinical assessment and treatment of CVA. Methods A total of 60 CVA children with zinc deficiency admitted to Yulin First Hospital from February 2016 to February 2018 were selected as participants(zinc deficiency group),meanwhile 60 CVA children with similar age and normal zinc level were selected for control study(normal zinc group) during the same period. Both group received conventional treatment of 8 weeks course. Lung function,induced sputum EOS,IL-4 and IL-10 levels were recorded before and after treatment. Clinical efficacy and recurrence of one year follow-up after treatment were recorded. Results FVC,FEV1%,PEF and MMEF after treatment significantly increased in both groups(P<0.05). EOS,IL-4 and IL-10 levels in induced sputum after treatment were significantly improved in both groups(P<0.05),and the improvement of the above indicators after treatment in deficient zinc group was worse than normal zinc group(P<0.05). Clinical efficacy grade of zinc deficiency group was significantly lower than normal zinc group(Z=2.197,P=0.028). Recurrence rate of zinc deficiency group was higher than that of normal zinc group(χ²=3.962,P=0.046). Multiple Logistic regression analysis showed that serum zinc deficiency was risk factor of poor control. Conclusions Serum zinc deficiency is not conducive to improvement of lung function and airway inflammation,and is closely related to recurrence. It may be risk factor for poor control of the disease. Therefore trace elements should be regularly monitored,and zinc supplementation should be given timely and appropriately so as to improve prognosis.

Analysis on the status and influencing factors for height and target height of children in Pudong new area kindergartens

LU Wen-ying,WANG Ting-xue,YANG Hui-lin,YANG Ling-li

2019, 27(3):  337-339.  DOI: 10.11852/zgetbjzz2018-0867

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Objective To understand the height growth and genetic potential of kindergartens children in Pudong new area,and explore the influencing factors of height, in order to provide basis for promoting the growth of preschool chidren's height. Methods Cluster random sampling method was adopted to investigate the height growth of children aged 3-7 years in 10 kindergartens in Pudong new area from January to March in 2018.Data on height and related influencing factors were obtained through physical examination and questionnaire survey. Results A total of 3 785 children(with 1 953 male students and 1 832 female students) were investigated and analyzed,of which 4.7% of the children had stunted growth. And 41.2% of children height for age was under one percentile interval of the target height. 11.8% of the children's height deviated from the normal range. Conclusion It is necessary to strengthen the comprehensive evaluation of children's height and to take corresponding intervention measures in order to promote the growth of children's height.

Trend analysis of physical development and obesity among preschool children in urban areas of Qingdao

ZHANG Meng-han,ZHAO Gui-lan,ZHANG Ting-ting,WANG Wen-yuan

2019, 27(3):  340-342.  DOI: 10.11852/zgetbjzz2018-1537

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Objective To investigate the changes of physical development and obesity of preschool children in urban areas of Qingdao over the past 12 years,in order to provide evidence for the health management of preschool children. Methods Stratified cluster sampling method was used to select 13 kindergartens in Qingdao urban area. The height,weight and nutritional status of children was measured and evaluated in the late March to late April of 2018, the overweight and obesity detection rates were calculated. Data on obesity were compared between 2018 and 2006. Results Compared with 2006,there was no significant difference on the overall height of preschool children in urban areas of Qingdao in 2018(P>0.05),and the body weight decreased except 3-year-old group(P<0.001). In 2018,the detection rates of obesity(7.5%),overweight(15.9%) and growth retardation(0.2%) in preschool children in Qingdao were all significantly lower than those in 2006(P <0.05). Conclusion Under the premise of normal height development in 2018 in Qingdao,the detection rates of obesity and overweight are lower than that in 2006,which proves that the measures from early life,based on community kindergartens and families,and the ongoing prevention and control strategy for comprehensive obesity in children are effective.

Study on the effect of comprehensive intervention on feeding difficulties of infants and young children aged 6-24 months

WANG Xiao-yan, WANG Hong, ZHAO Zhi-wei

2019, 27(3):  343-345.  DOI: 10.11852/zgetbjzz2018-0513

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Objective To explore an effective method for comprehensive intervention of feeding difficulties in infants and young children aged 6 to 24 months,in order to provide operational basis for clinical practice. Methods Totally 170 infants aged 6-24 months with chief complaint of feeding difficulties for the first visit were enrolled in this study to receive clinical intervention for 3 months from January to June in 2017,including 90 males and 80 females. The height,weight,neuropsychological development was collected,and Feeding Difficulty Assessment Scale(MCH-FS) was used to evaluate symptoms before and after intervention. Results After intervention,the percentage of weight within P₂₅-P₇₅ interval increased from 28.2% to 56%,the percentage of mental development index(MDI) >85 increased from 44% to 73%,and the percentage of psychomotor development index(PDI) >85 arose from 39% to 78%.Meantime,the number of infants without feeding disorders increased from 0 to 24.7%,but severe feeding difficulties significantly decreased from 12.4% to 5.4%(P＜0.05). Conclusion The comprehensive intervention,which integrates psychological,physiological and social factors,is effective for feeding difficulties.