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Title: [Survey on the influential factors of stunting among children under seven years of age in nine cities of China].
Author: Zhang YQ, Wu HH, Zong XN, Li H.
Journal: Zhonghua Er Ke Za Zhi; 2021 Sep 02; 59(9):743-751. PubMed ID: 34645214.
Abstract:
Objective: To analyze the influential factors of stunting among children under 7 years of age in nine cities of China in order to provide empirical data for early prevention and intervention for stunting. Methods: The survey was carried out with 1∶1 case-control study design in the communities and kindergartens of nine cities (Beijing, Harbin, Xi'an, Shanghai, Nanjing, Wuhan, Guangzhou, Fuzhou, and Kunming) from June to November in 2016. Children of heights lower than the 3^rd percentile according to the 2009 children's height standard in China were included as the stunting case group (n=1 281), and those with normal height matched for geolocation, gender, and age were recruited as the control group (n=1 281). The height and weight were measured on site, and the information related to family, perinatal status, diet and feeding, lifestyle, and medical history was collected by questionnaire. Continuous variables were compared by paired samples t test and Wilcoxon matched-pair signed ranks test, and proportions were compared by paired Chi square test. Multivariate analysis were carried out using conditional Logistic regression model. Results: Among 1 281 pairs of stunting and control group, there were 677 pairs of boys and 604 pairs of girls, with 238 pairs of children under age 3 years and 1 043 pairs of children aged 3 to 7 years. The Z scores for height and weight of stunting group were lower than that of control group (-2.27 (-2.54, -2.08) vs. -0.59 (-1.04, -0.10), -1.85 (-2.35, -1.38) vs. -0.69 (-1.20, -0.21), Z=30.982, 25.580, both P<0.01). Among family related factors, parental education level, height, weight, and height of grandparents in stunting children were all lower than those in control group (all P<0.05). Among individual related factors, proportion of preterm birth, low birth weight, shorter birth length, mother's pregnancy complications, difficulties adding milk or complementary feeding, poor appetite, slow eating, picky and partial eating, passive eating, more snack intake, shorter sleep duration, difficulty falling asleep, disturbed sleep, and recurrent infectious diseases in infant in stunting children were all higher than those in control group (all P<0.05). Multivariate Logistic regression analysis results illustrate that the lower the parental education level and the parental height, the higher the risk of stunting. For example, the risk of stunting in children whose fathers had short stature was 6.46 times (95%CI: 2.73-15.30) of those children whose fathers' height were medium and the risk of stunting in children whose mothers were short stature was 10.56 times (95%CI: 4.92-22.69) of those children whose mothers' height were medium. The risks of stunting increase significantly among preterm children or those with low birth weight (OR=2.27, 95%CI: 1.33-3.88), birth length<45 cm (OR=3.56, 95%CI: 1.41-8.98), difficulties adding milk or complementary feeding (OR=2.04, 95%CI: 1.32-3.15), poor appetite (OR=3.20, 95%CI: 1.74-5.89), slow eating (OR=1.85, 95%CI: 1.31-2.63), and food allergy (OR=1.80, 95%CI: 1.02-3.16). Conclusion: Parental short stature, preterm birth or low birth weight, shorter birth length, feeding difficulty in infant, poor appetite, slow eating, and food allergy are the main risk factors for stunting in infants and children. 目的： 分析中国九城市7岁以下儿童生长迟缓的影响因素，为早期预防和干预提供科学依据。 方法： 采用1∶1病例对照研究设计，于2016年6—11月在北京、哈尔滨、西安、上海、南京、武汉、广州、福州和昆明9个城市，以社区和幼儿园为调查点，身高低于2009年中国儿童身高标准的第3百分位的7岁以下生长迟缓儿童作为病例组，同地区、同性别、同年龄身高正常儿童作为对照组，共调查2 562名儿童（病例、对照各为1 281名）。现场测量获得身高、体重，问卷方式收集家庭情况、围生期信息、饮食喂养、生活习惯及患病史等信息。采用配对t检验或Wilcoxon配对秩和检验或配对χ²检验进行组间比较，应用条件Logistic回归方法进行多因素分析。 结果： 1 281对生长迟缓和对照儿童中男677对，女604对，3岁以下238对，3~<7岁1 043对。生长迟缓组身高、体重Z分值均明显低于对照组［-2.27（-2.54，-2.08）比-0.59（-1.04，-0.10）、-1.85（-2.35，-1.38）比-0.69（-1.20，-0.21），Z=30.982、25.580，均P<0.01］。家庭相关因素中，生长迟缓组父母受教育程度、身高、体重及祖辈身高均低于对照组（均P<0.05）。个体相关因素中，生长迟缓组早产、低出生体重、出生身长短、母孕期合并疾病、婴儿期乳类或辅食添加困难、食欲差、进食速度慢、挑食偏食、非主动进食、经常吃零食、睡眠时间短、入睡困难、睡眠不安、婴儿期经常感染疾病的比例均高于对照组（均P<0.05）。条件Logistic多因素回归分析父亲受教育程度和父母身高越低生长迟缓风险越高，如父、母亲矮身材子女生长迟缓发生风险是中等身高的6.46倍（95%CI：2.73~15.30）和10.56倍（95%CI：4.92~22.69）。早产或低出生体重（OR=2.27，95%CI：1.33~3.88）、出生身长<45 cm（OR=3.56，95%CI：1.41~8.98）、婴儿期乳类或辅食添加困难（OR=2.04，95%CI：1.32~3.15）、食欲差（OR=3.20，95%CI：1.74~5.89）、进食速度慢（OR=1.85，95%CI：1.31~2.63）、食物过敏（OR=1.80，95%CI：1.02~3.16）儿童的生长迟缓发生风险明显增加。 结论： 父母身高矮、早产或低出生体重、出生身长短、早期喂养困难、食欲差、进食速度慢、食物过敏是影响婴幼儿及儿童期生长迟缓的主要危险因素。.

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