Table of Content

10 October 2023, Volume 31 Issue 10

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Professional Forum

Nutrition intervention for faltering growth in children under 6 years old

YU Xiaodan

2023, 31(10):  1048-1050.  DOI: 10.11852/zgetbjzz2023-0914

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A report published in 2020 on the Nutrition and Chronic Disease Status of Chinese Residents revealed that the rate of faltering growth in Chinese children under 6 years old is 4.8%. This paper focuses primarily on the influence of weight deviation and nutrient deficiency on height (length) in children, and proposes early intervention measures, in order to provide valuable insights for healthcare professionals in the early prevention and treatment of faltering growth in clinical practice.

Dietary diversity, micronutrient supplements and physical growth during childhood

HU Yan

2023, 31(10):  1051-1053.  DOI: 10.11852/zgetbjzz2023-0918



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Dietary diversity can be a valuable indicator to predict nutrition adequacy of children, considering both macro- and micronutrients. Growing evidence suggests an association between dietary diversity and growth outcomes, especially linear growth. Hence, it is crucial for clinicians and parents to understand the importance of dietary diversity and its influence on children's nutrition through educational interventions, which could be effective in avoiding misuse of micronutrient supplements and reducing the development of stunting.

Original Articles

Consistency analysis of fat mass percentage, weight for length and body mass index in evaluating overweight/obesity in infants

ZHANG Ting

2023, 31(10):  1054-1057.  DOI: 10.11852/zgetbjzz2022-1529

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Objective To understand the epidemiological status of overweight/obesity in infants by the latest standards, and to evaluate the consistency of fat mass percentage (FMP) with body mass index for age Z score (BMIZ) andweight for length Z score (WLZ)in diagnosing overweight/obesity, so as to provide basis for accurate evaluation of overweight/obesity in children. Methods From March 2021 to October 2022, a multicenter cross-sectional study on body composition of infants and toddlers was carried out in Shandong Province, infants and toddlers with normal health were recruited as study subjects. An electronic questionnaire on basic information and parents′ characteristics of the tested infants was used in this survey and body composition measurement was conducted. Valid data of 11 472 cases were finally included. Results Taking the 2013 Assessment for growth status of children under 5 years of age as the diagnostic standard, the overall detection rate of overweight/obesity in boys and girls (＜2 years) diagnosed by WLZ were 6.6% and 6.5%, respectively; the total detection rates ofoverweight/obesity in boys and girls (≥2 years) diagnosed by BMIZ was 0.8% and 2.3%, respectively. Taking the Growth Standards for Children under 7 years of age issued in 2022 and implemented in 2023 as the diagnostic standard, the total detection rates of overweight/obesity in boys and girls (＜2 years) diagnosed by WLZ were 23.3% and 23.5%, respectively, and the total detection rates of overweight/obesity in boys and girls diagnosed by BMIZ (≥2 years) were 10.7% and 16.0%, respectively. The implementation of the new diagnostic criteria had significantly increased the detection rate of overweight/obesity. Taking FMP as the evaluation standard, the total detection rates of overweight/obesity in boys and girls were 22.9% and 21.0%, respectively. The new standards had resulted in a significant increase in the consistency between FMP and overweight/obesity assessed by WLZ and BMIZ, and a Kappa value of 0.95 for FMP and BMIZ in girls. Conclusions The new standards have significantly increased in the detection of overweight/obesity in infants and toddlers, which is conducive to early identification and intervention of overweight/obesity. The combination of body composition test with the new diagnostic standard for overweight/obesity in children in 2023 will facilitate the accurate assessment of overweight/obesity in children and the development of appropriate interventions.

Correlation of growth development and nutritional status with socioeconomic status in school-age children from poor areas of western China

LI Chao, GAO Liwang, WU Yan, WEI Wei, ZHANG Jiao, YAN Yating, LIU Min, ZHAO Li, WANG Youfa

2023, 31(10):  1058-1064.  DOI: 10.11852/zgetbjzz2023-0043

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Objective To study growth, development, and nutritional status of school-age children in poor areas of western China, and to analyze their relationship with socioeconomic status (SES), so as to provide recommendations for future work. Methods This study recruited1 059 children and their parents from 3 poverty-stricken counties in Shaanxi and Sichuan provinces, using data collected from the "Study of Nutritional Status and Improvement of School-age Children in Poor Areas of China". Physical measurements were taken, and a questionnaire survey was administered to the children and their parents. Principal component analysis was used to construct SES as explanatory variables, including five indicators of parental education, occupation, and family monthly income. The correaltion of SES and growth (height, weight, waist circumference and BMI) with nutritional status (stunting, wasting, overweight/obesity and central obesity) was analyzed using a mixed-effects model. Results The prevalence of stunting, wasting, overweight/obesity, obesity, and central obesity among school-age children was 2.8%, 7.4%, 26.0%, 14.4%, and 24.5%, respectively. Compared with the low SES group, school-age children with high SES had a higher waist circumference and BMI, increased by 2.50cm (95%CI:1.14 - 3.86) and 0.76kg/m² (95%CI: 0.27 - 1.25) respectively (P < 0.05). They were also more likely to be overweight/obese and have central obesity, with an increased risk of 63% (OR=1.63, 95%CI:1.12 - 2.38) and 62% (OR=1.62,95%CI:1.10 - 2.39) respectively (P<0.05). Conclusions SES is positively correlated with school-age children's growth indices and the prevalence of overweight and obesity in impoverished areas of western China, where children face the double burden of malnutrition. While efforts are made to eliminate wasting, it is necessary to control the rapid increase in obesity prevalence and focus on improving children's family environment and nutritional status.

Isochronous substitution effects of physical activity on obesity and body fat in children

LIU Yan

2023, 31(10):  1065-1069.  DOI: 10.11852/zgetbjzz2022-1410

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Objective To explore the health benefits of high intensity physical activity (MVPA), light intensity physical activity (LPA), and sedentary behavior (SB) substitution for each other in equal time on body mass index (BMI), waist height ratio (WHtR) and body fat percentage (BFP). Methods From November to December 2021, 193 students in a middle school in Tianjin were selected as study subjects. Height, weight, waist circumference, BFP of the participants were measured, BMI and WHtR were calculated. Students were asked to wear Actigraph GT3X acceleration sensor for 7 days, MVPA, LPA and SB were recorded. Multiple linear regression was used to analyze the effects of isochronous substitution of different types of activities on BMI, WHtR and BFP. Results The prevalence of overweight, obesity and abdominal obesity in children was 14.0% (27/193), 17.1% (33/193), and 25.4% (49/193), respectively. Overweight obese children and abdominally obese children showed lower levels of MVPA and LPA, and MVPA and LPA were negatively correlated with BMI, WHtR and BFP (r=-0.416, -0.352, -0.430, -0.358, -0.337, -0.324, P<0.01), while SB was positively correlated with BMI, WHtR and BFP (r=0.456, 0.360, 0.414, P<0.01). Replacing LPA with 15min/d MVPA significantly reduced BMI, WHtR and BFP (P<0.01). BMI, WHtR and BFP were further decreased when SB was replaced by MVPA at 15min/d (P<0.01). Using 15min/d of LPA to replace the equivalent time ofSB also resulted in decrease in BMI, WHtR, and BFP (P< 0.01). Conclusions MVPA isochronous replacement of LPA and SB time can produce good health benefits on BMI, WHtR and BFP, and the same amount of LPA isochronous replacement of SB time can also produce good health benefits.Allocating more SB time to MVPA and LPA can effectively reduce the body fat level of children. In particular, increasing the MVPA time has a better effect on the prevention and treatment of obesity risk in children.

Trends of overweight and obesity among children and adolescents in Baoshan District of Shanghai from 2013 to 2019

XIANG Man, ZHAO Hailei, JI Wei, LUO Ying, LIU Guoping, LI Guangping, RONG Fen

2023, 31(10):  1070-1075.  DOI: 10.11852/zgetbjzz2022-1237

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Objective To investigate the prevalence of overweight and obesity among children and adolescents aged 7 to 18 in Baoshan District of Shanghai from 2013 to 2019, and to explore the variation trend, so as to provide a scientific foundation for effective prevention and control of overweight and obesity. Methods The physical examination census data of primary and middle school students from 2013 to 2019 were used, including a total of 533 419 children and adolescents. The prevalence of overweight and obesity was estimated based on the Screening Standard for Overweight and Obesity of School-age Children and Adolescents (WS/T 586-2018). The variation trends of overweight and obesity among children and adolescents were analyzed. Results The rates of overweight and obesity were 16.37% and 14.26% respectively in 2013, followed by a slight decrease in the next two years and an increase from 2016 to 2019. In 2019, these rates reached to 16.97% for overweight and 16.50% for obesity. There was a significant upward trend in overweight and obesity rates from 2013 to 2019 (χ²_trend = 62.65, 504.82, P<0.001), with the fastest fixed-base ratio of growth rate in 2017 (overweight: 6.18%, obesity: 15.60%). The average growth rate of overweight was 0.66% over the seven-year period, while this rate for obesity was 2.29%. Students in elementary school had a higher tendency to become obese, whereas those in middle school tended to be overweight. Additionally, the overweight and obesity rates increased at a faster pace in high school. Conclusion The increasing trend of overweight and obesity rates among students aged 7 to 18 in Baoshan District of Shanghai from 2013 to 2019 calls for comprehensive prevention and control measures to reduce the risk.

Original Articles

Correlation between infant complementary feeding and family nurturing environment

SUN Jie

2023, 31(10):  1076-1080.  DOI: 10.11852/zgetbjzz2022-1436



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Objective To analyze the relationship between infant complementary feeding and family nurturing environment, in order to provide reference for improving the quality of children's family parenting. Methods The 12-month-old full-term infants who had a physical examination at the community health service center of Jing′an District from January 2021 to November 2022 were collected as the study subjects. Questionnaires on children's basic conditions and complementary food addition and the domestic Questionnaire on Family Parenting Environment for 0 - 1-year-old Children were used to evaluate the infants' family background factors, complementary food addition status and family parenting environment, and the correlation was analyzed. Results Totally 992 infants were enrolled in this study.The differences in the total family nurturing environment scores of the study participants were statistically significant in terms of parents' education level, duration of maternity leave and primary family caregivers(P＜0.05). There was a positive correlation of the frequency of supplementary feeding and meat traits with the total score of family nurturing environment and each dimension (r=0.064 - 0.261, P<0.05). Logistic regression analysis showed that maternal education level (undergraduate and postgraduate degree), duration of maternity leave ≥12 months, parents as main family caregivers, high frequency of coarse grains addition and coarse texture of meat addition were the contributing factors for infants with high total score of family nurturing environment (OR= 2.233, 2.863, 1.465, 1.940, 1.214, 1.133, P＜0.05). Conclusions Family nurturing environment of infants is influenced by family background factors, and there is a correlation between infants' complementary feeding status and family nurturing environment. Various complementary foods should be added in a timely and reasonable manner to improve the quality of family nurturing.

Body composition analysis of preschool children in Nanjing city

FAN Bingjie, WANG Jing, DONG Jing, YANG Lei, HUANG Fangyan, QIAN Jun, ZHANG Min

2023, 31(10):  1081-1084.  DOI: 10.11852/zgetbjzz2022-1359

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Objective To understand the characteristics of body composition of preschool children in Nanjing, in order to provide clues for enriching the content of children's health evaluation. Methods A total of 2 010 children aged 3 to 6 years who took physical examination in Nanjing Maternity and Child Health Care Hospital from January 2020 to January 2022 were enrolled in this study. All participants were measured for height and weight, and bioelectrical impedance analysis (BIA) was used to measure body composition. The test indicators included height, weight, body mass index(BMI), protein, inorganic, total body water(TBW), body moisture, muscle mass, skeletal muscle, body fat mass, etc. Results Body composition was related to gender. The height, weight, BMI, protein percentage, body water percentage, muscle mass percentage, lean body mass, skeletal muscle mass percentage of boys were significantly higher than those of girls, while PBF was significantly lower than that of girls (t=3.50, 3.61, 2.72, 6.97, 7.49, 7.35, 7.06, 8.32, -7.22, P＜0.05). The BMI and body fat percentage of boys and girls significantly differed among the age groups (F_BMI=23.78, 13.66, F_PBF=32.34, 9.82, P＜0.05), and all showed a trend of decreasing and then increasing with age, with the 3- and 4-year-old groups being higher than the 5-year-old group and the 6-year-old group being higher than the 5-year-old group. The height and weight of preschool chidren were positively correlated with the percentage of skeletal muscle(r＝0.663,0.573,0.557,0.304,P<0.05), and BMI was positively correlated with the percentage of body fat (r=0.555, 0.617, P<0.05). Conclusions In addition to height and weight, there are also obvious changes in the body composition of preschool children. It is necessary to understand the growth of body composition of preschool children comprehensively and enrich the assessment content of children's nutritional status.

Application value of allergen component analysis in the diagnosis of food allergy in children

BU Huaqin, SONG Yuxin, ZHOU Xiaoqin, LI Zailing, TAN Qi, YAO Haili, SUN Jinbo, YU Jia, YU Xiaohua, HUANG Zhaoxuan, SHU Junhua, WANG Hua, SUN Jinqiao, WANG Xiaochuan

2023, 31(10):  1085-1090.  DOI: 10.11852/zgetbjzz2022-1524

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Objective To compare allergen specific immunoglobulin E (sIgE) with allergen component test in diagnosing food allergy, in order to explore the application value of allergen component test in diagnosing food allergy. Methods Children with history of allergen sIgE and allergen component test were enrolled in this study, from Children's Hospital of Fudan University, Harbin Children's Hospital, Peking University Third Hospital, Hubei Maternal and Child Health Hospital and Children's Hospital of Chongqing Medical University from October 2017 to March 2019. ImmunoCAP system and enzyme-linked immunoblotting were used to detect eggs, milk, peanuts sIgE and corresponding allergen components respectively. Results 1) Among 242 children with food allergy, 162 had egg allergies, 152 had milk allergies and 72 had peanut allergies, with 50 healthy children as controls. Among children with egg allergy, the highest rate of positive sIgE testing was for ovalbumin (96.3%,156/162), followed by ovotransferrin(92.6%,150/162) and ovomucoid(83.9%, 136/162). Among children with milk allergy, the highest rate of positive sIgE testing was for α-lactalbumin (82.9%, 126/152), followed by β-lactoglobulin (81.6%, 124/152), casein (80.3%, 122/152) and bovine serum albumin (75.0%, 114/152). The sIgE positivity for peanut allergen components in children with peanut allergy ranged from 0% to 13.8%. More than 70% of egg or milk allergies were sensitized to three or more allergen components concomitantly. The higher the level of allergen sIgE in children with egg allergy, the greater the variety of allergen components that cause allergy (r=0.212, P=0.002). 2) The sensitivity of the egg, milk and peanut allergen component test for diagnosing food allergy were 0.975, 0.993 and 0.208, respectively, with specificities of 0.660, 0.920 and 0.980, positive predictive values of 0.903, 0.974 and 0.938 and negative predictive values of 0.892, 0.979 and 0.462, respectively, and the area under the receiver operative characteristic curve were 0.818 (95%CI: 0.735 - 0.900), 0.957 (95%CI: 0.912 - 1.000) and 0.594 (95%CI: 0.494 - 0.694), respectively. Conclusion Food allergen component testing can be used in conjunction with allergen sIgE testing as an adjunct to the diagnosis of IgE-mediated food allergy, to identify the allergenic protein fraction and to better guide the individual clinical management of children with food allergy.

Review

Advances in the application of lipidomics analysis method in children's health and diseases

CHEN Yiren, WU Lijun, CHEN Fangfang

2023, 31(10):  1091-1095.  DOI: 10.11852/zgetbjzz2022-1300

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Lipidomics analysis method is a comprehensive and systematic analysis and identification of lipid metabolites and interacting molecules, which can reveal the relationship between lipid metabolism and physiological or pathological processes of cells, organs and even the body. The development of lipidomics analysis method has not only been limited to the auxiliary verification of pathology in clinically diagnosed patients, but has gradually developed into a means of prospective prediction of disease occurrence and monitoring of disease progression. This article mainly summarizes the application progress of lipidomics analysis method in children's health and disease.

Research progress on the application of motion sensing games in children and adolescents with overweight or obesity

WANG Xiaolong, YANG Tiantian, LIU Zhao, LIU Yanyan

2023, 31(10):  1096-1100.  DOI: 10.11852/zgetbjzz2023-0147

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In the context of the lack of physical activity in overweight and obese children and adolescents, the prolongation of screen-based video games and sedentary behavior, motion sensing games, as a new type of video game, have a positive effect on the improvement of exercise capacity and physical fitness. This review combs the concept of motion sensing game, its advantages and application in the health promotion of children and adolescents with overweight or obesity, aiming to provide references for futher research on motion sensing game, thereby promoting energy consumption, and improving physical activity of children and adolescents.

Research progress in the relationships between sleep problems and metabolic syndrome in children and adolescents

ZHANG Yingxin, TAO Shuman

2023, 31(10):  1101-1105.  DOI: 10.11852/zgetbjzz2023-0021

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The prevalence of metabolic syndrome (MetS) in children and adolescents is increasing, which has been a serious risk to their current health and increased the risk of cardiovascular disease in adulthood. Sleep behaviors are important components of the body's metabolic regulation. There is growing evidence that sleep insufficiency, sleep disorders and circadian rhythm disturbances are associated with an increased risk of MetS in children and adolescents. This paper reviews the associations between sleep problems and MetS in children and adolescents and explores the underlying biological mechanisms, in order to provide a scientific basis for the implementation of public health interventions to reduce metabolic risk in children and adolescents.

Research progress in nutritional components and immunoregulatory factors of breast milk

LI Xiaoxiao, LUO Huipan, LAN Yanping, SU Guoping

2023, 31(10):  1106-1110.  DOI: 10.11852/zgetbjzz2022-1234

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The composition of breast milk is complex, which contains many kinds of substances. The components of breast milk change dynamically with the growth of infants in order to meet the needs of growth and development in different stages. Therefore, breast milk is recognized as the best food for infant nutrition. In addition to comprehensive nutritional functions, a variety of bioactive components and microbiom in breast milk provide direct or indirect antibacterial and antiviral protection for infants, which can effectively reduce the risk of infectious diseases and play an important role in the development and maturation of infants′ immune system. This article briefly reviews the nutritional components of breast milk and its immune regulation process, in order to provide a basis for better understanding of the importance and superiority of breastfeeding, and to provide inspiration for the treatment and nursing of related diseases.

Association of vitamin D and its receptor gene polymorphisms with childhood diseases

CUI Yifan, XIAO Xuwu

2023, 31(10):  1111-1115.  DOI: 10.11852/zgetbjzz2022-1371



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Vitamin D is a fat soluble vitamin, which comes from intestinal absorption and skin synthesis in the human body. It not only participates in the regulation of calcium and phosphorus metabolism, but also is related to the metabolic regulation of endocrine, immune, respiratory and other multiple systems. Vitamin D receptor and its gene polymorphism are important components of the biological effect of vitamin D in human body. This article reviews the researches on serum vitamin D level, vitamin D receptor gene polymorphism and children's respiratory, immune and other systems, as well as children's growth, development, metabolism and other related diseases at home and abroad in recent years, in order to provide reference for further researches on vitamin D and its receptor gene polymorphism in children's diseases, as well as and the prevention and treatment of diseases.

Research progress in nutrition intervention of small for gestational age infants

BAO Shuyun, XING Yan

2023, 31(10):  1116-1120.  DOI: 10.11852/zgetbjzz2022-1062

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Small for gestational age (SGA) infants is a special group of neonates.The occurrence of SGA is mainly related to fetal, placental and maternal factors.SGA infants may have early physical growth retardation, and its long-term risk of metabolic syndrome, cognitive dysfunction and other diseases will also increase.Moderate nutritional intervention on SGA infants can promote its early reasonable growth and good neural development, but excessive nutritional fortification is associated with a series of metabolic diseases, cardiovascular diseases and so on.Therefore, balancing the relationship between nutritional intervention and excessive reinforcement to achieve the optimal catch-up growth of SGA infants is a hot topic in clinical research.This article reviews the nutritional requirements, nutritional support and feeding strategies of SGA infants.

Meta Analysis

Meta-analysis of risk factors for abnormal spinal curvature in adolescents

ZHANG Shuai, ZHAO Li, YANG Yang, WANG Huifang, YUAN Lingyan

2023, 31(10):  1121-1126.  DOI: 10.11852/zgetbjzz2022-1309

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Objective To systematically evaluate the risk factors for abnormal spinal curvature in adolescents, in order to provide reference for its prevention. Methods Related literature published in Web of Science, PubMed, EMbase, The Cochrane Library, VIP, WangFang Data and CNKI databases from inception to August 31st, 2022 was retrieved.Articles were included according to the inclusion and exclusion criteria of the literature. Meta-analysis was performed using RevMan 5.4 software and Stata 16.0 software. Results A total of 29 studies were included, with a cumulative sample size of 272 190 cases. Female (OR=1.87, 95%CI:1.56 - 2.23), age (OR=1.26, 95%CI:1.14 - 1.39), incorrect posture in daily life (OR=1.83, 95%CI:1.45 - 2.31), and physical activity time ＜2h/d(OR=2.08, 95%CI:1.48 - 2.92), low body weight(OR=1.46, 95%CI:1.35 - 1.58), left-sided dominant handedness(OR=2.31, 95%CI:1.04 - 5.13), and sleep time ＜8h/d(OR=2.32, 95%CI:1.82 - 2.96), screen time ＞2h/d (OR=1.36, 95%CI:1.18 - 1.57), engaging in high-risk sports programs (OR=1.37, 95%CI:1.19 - 1.57), family history (OR=1.58, 95%CI:1.15 - 2.16) and higher school grade (OR=3.40, 95%CI:2.63 - 4.40) were risk factors for abnormal spinal curvature in adolescents(P＜0.05), while using desks and chairs consistent with growth and development was a protective factor for abnormal spinal curvature in adolescents (OR=0.21,95%CI:0.06 - 0.78, P=0.02). Conclusion There are many risk factors for the development of spinal curvature abnormalities in adolescents, which should be prevented and controlled in multiple perspectives.

Clinical Research

Application of individualized vitamin D supplementation in very preterm infants

YOU Fang

2023, 31(10):  1127-1131.  DOI: 10.11852/zgetbjzz2022-1397



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Objective To investigate the efficacy of individualized vitamin D supplementation in very preterm infants, in order to provide reference for optimizing the vitamin D supplementation strategy for very preterm infants. Methods A total of 106 very preterm infants hospitalized in NICU from July 2021 to July 2022 were selected into this study, and were randomly divided into observation group (n=47) and control group (n=59). Infants in both groups took vitamin D supplementation from the 7th day after birth. In the observation group, infants received daily vitamin D supplementatation,and the dose was based on their serum 25-hydroxy vitamin D[25-(OH)D] level:800U was taken orally for the infants with sufficient vitamin D; for infants with vitamin D insufficiency, oral vitamin D supplementation was increased to 1 400U; for infants with vitamin D deficiency, oral vitamin D supplementation was increased to 1 800U; for infants with excessive vitamin D, oral vitamin D dose was reduced to 400U; for infants with vitamin D potential poisoning and poisoning, vitamin D supplementation would be discontinued. In the control group, infants were routinely supplemented with 800U vitamin D. Serum levels of 25-(OH)D, the incidence of vitamin D deficiency/insufficiency, and the occurrence of vitamin D overdose or poisoning were compared between the two groups within 48 hours, 4 weeks and 8 weeks after birth. Results The incidence of vitamin D deficiency and insufficiency in 106 very preterm infants within 48 hours after birth was 81.1% and 9.43%, respectively. There was no significant difference in serum 25-(OH)D level and incidence of vitamin D deficiency/insufficiency between the two groups within 48h after birth (P>0.05). The level of serum 25-(OH) D in the observation group was significantly higher than that in the control group at 4 and 8 weeks after birth (t=3.84, 5.94, P<0.05), and the incidence rate of vitamin D deficiency was significantly lower than that in the control group (χ²=11.02, 18.32, P<0.05). Conclusion Compared with the routine supplementation of 800U vitamin D, individualized vitamin D supplementation can significantly increase serum 25-(OH)D level at 4 and 8 weeks after birth and reduce the incidence of vitamin D deficiency in very preterm infants.

Knowledge, attitude and practice regarding milk consumption of 3 364 pupils in some areas of Hainan Province and its influencing factors

GUO Jingyue, LIN Guotian, FENG Qiqin, ZHANG Tao, ZHONG Chengwang, CHENG Qiuyun, ZHANG Fan

2023, 31(10):  1132-1135.  DOI: 10.11852/zgetbjzz2022-1398

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Objective To understand the current situation of knowledge, attitude and practice (KAP) regarding milk consumption among primary school students in Hainan Province, in order to provide reference for promoting nutrition of students. Methods By stratified sampling, one urban and one rural survey sites were selected in Hainan Province, and then a cluster of 10 primary schools were randomly selected from two survey sites in November 3—5,2021. Totally 3 426 primary school students in the third, fourth and fifth grades in the selected sites were surveyed by KAP questionnaire. Results The average score of the respondents on milk drinking related knowledge was 3.44±0.95, and 51.9% had good cognition of milk consumption. The average score of attitude was 4.20±0.98, and 81.2% had a positive attitude towards milk consumption. The average behavior score was 2.55±1.30, and 22.5% had good milk consumption behavior. Significant differences existed in the good behaviors on milk consumption among children with different gender, ethnic groups,grades and children between urban and rural areas (χ²=15.409,4.770,47.892,4.442, P<0.05). There were correlations between milk consumption related knowledge and attitude (r=0.233), between knowledge and behavior (r=0.173), between attitude and behavior (r=0.336) (P<0.001). Binary Logistic analysis showed thatgender was the influencing factor of good milk consumption behavior(OR=1.286,95%CI:1.088 - 1.516,P<0.001).Compared with students in the third grade, students in the fourth and fifth grade were higher likely to have good milk consumption behavior (the fourth grade: OR=1.900, 95%CI:1.544 - 2.338, P<0.001; the fifth grade: OR=1.745, 95%CI:1.436 - 2.122, P<0.001). High cognition (OR=1.357, 95%CI: 1.146 - 1.608, P<0.001) and positive attitude on good milk consumption behavior (OR=3.925, 95%CI:2.877 - 5.355, P<0.001) may significantly promote good milk consumption behavior. Conclusions Knowledge about milk consumption among primary school students in Hainan Province is still inadequate and their milk consumption behavior is poor, but their overall attitude is good. It is important to strengthen the popularization of nutrition among children and adolescents, especially in the upper grades and boys, and to focus on cultivating good milk consumption behavior.

Trend of unintentional injury deaths among children under 5 years old in China during 2009—2019

ZHAO Qian, LI Xiaohong, YAN Ziqi, XIA Jingwei, CHEN Tianyi, GUO Ying, CHEN Kaiyue

2023, 31(10):  1136-1141.  DOI: 10.11852/zgetbjzz2022-1521

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Objective To understand and analyze the trends of unintentional injury deaths of children under 5 years old in different regions during 2009－2019, so as to provide scientific basis for clarifying priorities for reducing the mortality of children under 5 years of age and formulating child unintentional injury prevention strategies. Method Data on childhood deaths due to unintentional injuries from 2009－2019 were collected and analyzed by log-linear regression using the Joinpoint Regression procedure for childhood unintentional injury mortality. Results During 2009－2019, the mortality rate of unintentional injuries among children < 1 year old and aged 1 to ＜5 years in China decreased less than the overall mortality rate. The decrease of unintentional injury mortality among children aged 1 to ＜5 years in urban areas (AAPC= -4.3%, P<0.05) was less than that in rural areas (AAPC=- 7.4%, P<0.001). The proportion of unintentional injury death in the total cause of death of children < 1 year old in urban and rural areas was on the rise, although it was small. The rate of death from unintentional injuries among children aged 1 to <5 years in eastern cities (AAPC=-4.1%, P<0.05) decreased less than that in western cities (AAPC=-5.7%, P<0.05). The composition ratio of unintentional injuries to total causes of death for children in the <1 year old group and children in the 1 to <5 years old group in the eastern cities both tended to increase after 2013. The fall mortality rate among children aged 1 to <5 years in eastern cities increased from 0.200/10⁵ in 2009 to 1.313/10⁵ in 2019 (AAPC = 23.7%, P < 0.001). Conclusions While continuing to do a good job of preventing unintentional injuries among rural children, there is a need to strengthen the prevention of unintentional injuries among urban children. The attention to the prevention of unintentional injuries among children in eastern cities needs to be increased, especially road traffic injuries among children under 1 year old and fall injuries among children aged 1 to <5 years.

Influencing factors of children's non-organic anorexia

XU Deyong, LUO Guangyue, REN Qingyuan, LU Wei

2023, 31(10):  1142-1146.  DOI: 10.11852/zgetbjzz2022-1506

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Objective To analyze the influencing factors for children's non-organic anorexia, so as to provide reference for improving parents′ cognition and reducing the incidence of children's non-organic anorexia. Methods A total of 122 children aged 1 - 6 yearsfromSeptember 2019 to December 2020 were included in the study, of whom 61 children with non-organic anorexia were selected as theanorexia group and 61 children with normal physical examination were selected as the control group. A survey was completed by the families of the children by questionnaire. Univariate analysis was used to collect data, and multivariate Logistic analysis was used for the determinants additionally. Results Non-organic anorexia was influenced by factors such as temperament type (χ²=34.444), feeding patterns(χ²=7.935), age of adding supplementary food(t=7.201),eating duration (χ²=5.638), chase or tease during feeding (χ²=4.753), selective or picky eating (χ²=4.848), snack (χ²=4.560), hemoglobin level (t=4.282), trace elements, feeding caregivers(χ²=8.531), caregiver's education level(χ²=8.531),education mode(χ²=5.025), forced feeding(χ²=8.505) and parenting knowledge (χ²=5.026) (P<0.05). Multivariate Logistic regression analysis showed that the later time for adding complementary food (OR=6.922, 95%CI: 2.757 - 17.379,P＜0.001) and feeding duration≥40min (OR=4.582, 95%CI: 1.041 - 20.161, P=0.044) were independent risk factors for non-organic anorexia. Conclusions Non-organic anorexia in children is influenced by many factors. Timely addition of complementary foods, rational diet, creation of a good eating environment for children and popularization of scientific feeding knowledge can reduce the prevalence of non-organic anorexia nervosa in children.

Clinical Experience

Influencing factors of hospitalization time in premature low birth weight infants

ZENG Xiaoping, CHEN Shunmei, XU Xiaodan, JIANG Bo

2023, 31(10):  1147-1150.  DOI: 10.11852/zgetbjzz2022-0887



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Objective To analyze the factors influencing the hospitalization time of preterm low birth weight infants, in order to provide a basis for shortening their hospital stay. Methods A total of 240 preterm low birth weight infants admitted to Zhongshan Hospital of Xiamen University from January 2019 to December 2020 were selected as study subjects. The hospitalization time was divided into two groups using a cutoff of 28 days, and the influencing factors on hospitalization time were analyzed. Results Univariate analysis showed that there were significant differences in feeding mode (χ²=15.105), dyspnea (χ²=37.604), feeding intolerance (abdominal distension χ²=19.288, vomiting χ²=27.539) between infants with hospitalization time ≥28 days and ＜28 days (P<0.05). Hospitalization time was positively correlated with weight loss (r=0.477), age at the lowest day of weight loss (r=0.390), age at regaining birth weight (r=0.454) and protein intake (r=0.396), and negatively correlated with the rate of weight gain (r=-0.655) and gestational age at birth (r=-0.454,P＜0.001). Multivariate Logistic regression analysis revealed that the rate of weight gain (OR=0.23, 95%CI:0.103 - 0.536), breastfeeding (OR=0.75, 95%CI: 0.596 - 0.954), gestational age at birth (OR=0.23, 95%CI:0.113 - 0.536), and caloric intake (OR=0.85, 95% CI: 0.726 - 0.985) were positively associated with hospitalization time ≥28 days, while dyspnea (OR=2.83, 95%CI: 1.205 - 6.656) was a risk factor for hospitalization time ≥28 days (P<0.001). Conclusions The clinical characteristics of preterm low birth weight infants are distinctive, and attention should be given to changes in dyspnea indicators, daily weight gain rate, feeding mode, gestational age at birth and caloric intake. Relevant treatments should be implemented to reduce the hospitalization time of these infants.

Status quo and risk factors of infant home nurture environment for children aged 5 - 6 and 11 - 12 months in Minhang district, Shanghai

JIANG Chunhua, WEI Muxin, HUANG Jun, LI Yun, ZHANG Ying, JIANG Hong, XU Xiaoxi

2023, 31(10):  1151-1155.  DOI: 10.11852/zgetbjzz2022-1111

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Objective To analyze the status and its influencing factors of home nurture environment (HNE) for children aged 5 - 6 and 11 - 12 months in Minhang district, Shanghai, in order to provide evidence for formulating targeted intervention strategies. Methods From June to October 2021, caregivers of children aged 5 - 6 and 11 - 12 months in the clinic of child health care were asked to conduct a questionnaire survey on their basic social demography and parenting behavior, and the 0 - 6 Years Child Home Nurture Environment Questionnaire(CHNEQ) for children aged 0 - 1 year was used to evaluate the parenting environment. The results of CHNEQ were compared in different age groups. The influencing factors of the CHNEQ were analyzed by ordered Logistic regression. Results A total of 1 152 children were included, including 573 (49.74%) boys and 579 (50.26%) girls, 589 (51.13%) infants aged 5 - 6 months and 563 (48.87%) infants aged 5 - 6 months. The detection rates of poor nurture environment in CHNEQ and its four dimensions, including perception/cognition, emotional warmth, neglect/restriction, interpersonal interaction/feeding were 3.47%, 4.60%, 6.42%, 8.07% and 7.20%, respectively. The detection rate of good nurture environment in neglect/restriction dimension was higher in 5- to 6-month-old infants than that in 11- to 12-month-old infants and moderate detection ratewas lower than that in11- to 12-month-old infants(χ²= 11.17, P=0.004), but the differences in other dimensions between 5- to 6-month-old infants and 11- to 12-month-old infants were not significant(P＞0.05). Children with per capita living area ＜30.58m² (the per capita level of urban households in Shanghai in 2020) and per capita monthly income ＜10 000RMB,poor family relations, screen exposure, parent-child interaction time ＜2h/d and physical activity restriction ＞1h/time in the past month, had a higher risk of poor HNE (OR=1.51, 1.55, 2.68, 1.42, 1.35, 2.25, P＜0.05). Conclusions In Minhang district, the detection rate of poor HNE in children aged 5 - 6 months and 11 - 12 months is generally low. The detection rate of poor nurture environment in infants varies in different age groups, and the home nurture environment in 11- to 12-month-old infants is poor. In a word, HNE is affected by many risk factors, so targeted intervention strategies should be adopted to improve parents′ parenting skills, avoid risk factors, create a good environment, and promote healthy development in early childhood.

Case Report

Coffin-Siris syndrome caused by a de novo mutation in ARID1B: a case report and literature review

TAO Jia-qi, CHEN Ying

2023, 31(10):  1156-1160.  DOI: 10.11852/zgetbjzz2022-1405



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