| Background : Overweight and obesity among preschoolers have gradually become serious public health problem in China.Excessive dietary energy intake and insufficient physical activity energy consumption are the main reasons for obesity.Preschoolers have poor autonomy but strong plasticity in dietary intake and physical activity,and parents play a vital role in the preschoolers’ dietary intake and physical activity.Objective: The purpose of this study is to acknowledge the status of parents’ diet and exercise related knowledge,attitudes and behaviors and its influence on preschoolers’ overweight and obesity in Chongqing.Methods: This study was a cross-sectional survey.An online survey was carried out in September 2020 through the “Questionnaire Star”network platform.The electronic questionnaire link was sent step by step through school health working groups by related Chongqing educational departments to the parents’ groups of kindergartens,and caregivers of preschoolers were invited to fill out this questionnaire,finally,17342 valid questionnaires of preschoolers’ parents were included for analysis.The self-designed questionnaire was developed after literature search and expert consultation,including basic information of preschoolers and their caregivers,dietary intake and physical activity of preschoolers,and parents’ knowledge,attitudes and practices associated with preschoolers’ diet and physical activity with a total of 92 questions.A total of 14single-choice questions were used to measure knowledge(0=not true or do not know,1=true),and the higher score indicated the better knowledge mastery;the attitude items were measured by the Likert five-point scale with a total score of 9-45,the higher score indicated the better attitude;The fostering behaviors included feeding related behaviors and exercise related behaviors,the items were measured by the Likert five-point scale,feeding behaviors included seven dimensions,which were responsible feeding,content-restricted feeding,behavior-restricted feeding,encourage healthy eating,forced feeding,supervised feeding and emotional regulation,exercise related behaviors included two dimensions,which were encouraging children’s physical activity and hindering children’s physical activity,and the average score of each dimension is calculated.The higher score indicated more tendency to this kind of fostering behavior.In univariate analysis,the chi-square test was used to compare categorical variables between groups;the continuous variables did not conform to the normal distribution,so Mann-Whitney U test was used to compare among two groups,and Kruskal-Wallis H test was used among three groups and above.In the multivariate analysis,the logistic regression models were used to explore the influence of diet and exercise related knowledge,attitudes and behaviors of parents on children’s overweight and obesity.All statistical analyses in this study were performed using STATA 15.0 software package.Results:1.Basic characteristics of preschoolers and their parentsPreschoolers: ages between 2-6 years old,boys accounted for50.98%,31.10% of preschoolers were the only-child,64.77% of preschoolers lived with parents,48.63% of preschoolers lived with two or more grandparents,and 19.06% of preschoolers were overweight or obesity.Parents: mothers accounted for 81.72%,parents aged 30-40 accounted for the largest proportion(54.56%),the education background is mainly junior high school,high school or technical secondary school(62.80%),24.01% of parents are overweight and obese.54.95% of parents’ assessment of the child’s weight is consistent with its BMI classification,25.90% of parents underestimated the preschoolers’ weight,and 19.14% of parents overestimated the preschoolers’ weight.22.23% of parents often or always worry about children getting fat,and 27.30% of parents often or always worry about children not getting enough food.2.Dietary intake and physical activity of preschoolersIn the past seven days,22.98%,23.62%,and 23.49% of children consumed vegetables,fruits and milk for less than 4 days,respectively;and 19.32% of preschoolers ate sweets foods more than three days.37.86% and 28.96% of preschoolers’ average daily cumulative time of various types of physical activities have not reached 180 minutes or more on weekdays and weekends,respectively.In addition,25.63% and10.29% of children’s outdoor activities did not reach 120 minutes or more.3.Parents’ knowledge,attitudes and practices related to diet and physical activity of preschoolersThe parents’ average score of knowledge was 10.34,the passing rate was 84.00%,and the mastery rate was 30.12%.The parents’ average score of attitudes was 33.29.only 35.28% and 36.86% of parents strongly agree or agree that they have enough nutritional knowledge and experience to raise their children healthy,respectively;besides,72.98%and 76.84% of parents strongly agree or agree that they play an important role in the preschoolers’ daily diet and exercise,respectively.The average scores of each dimension of parents’ feeding behavior from high to low were: responsible feeding(3.96±0.61),behavior-restricted feeding(3.92±0.65),supervise feeding(3.82±0.91),encourage healthy eating(3.31±0.73),content-restricted feeding(3.10±0.97),forced feeding(2.61±0.72),emotional regulation(2.21±0.83).The average scores on the dimensions of encouraging preschoolers’ physical activity and hindering preschoolers’ physical activity were 3.18±0.75 and 2.38±0.66,respectively.4.Logistic regression analysis of the influence of parents’ diet and exercise related knowledge,attitudes and behaviors on overweight and obesity in preschool childrenAfter adjusting children’s gender,age,only child status,screen-time,living with their parents,living with their grandparents,the caregivers who spends the most time with the child,children’s dietary intake,physical activity and outdoor activities on weekdays and weekends,and parents’ age,educational level,overweight and obesity status,concerns about children’s weight and diet in the multivariate logistic regression analysis model,we found that the parents’ diet and exercise-related knowledge are negatively correlated with the incidence of children’s overweight and obesity,(OR=0.95,95%CI [0.92-0.97]);Parents’ diet and exercise-related attitude are negatively correlated with the incidence of children’s overweight and obesity(OR=0.98,95%CI [0.97-0.99]);Parents’ content-restricted feeding are positively correlated with the incidence of children’s overweight and obesity(OR=1.07,95%CI[1.01-1.13]);Parents’ forced feeding is negatively correlated with the incidence of children’s overweight and obesity(OR=0.89,95%CI [0.83-0.96]);Parent’s supervised feeding is negatively correlated with the incidence of children’s overweight and obesity(OR=0.94,95%CI[0.89-0.99]);Parent’s hindering children’s physical activity is positively correlated with the incidence of children’s overweight and obesity(OR=1.10,95%CI [1.02-1.19]).Conclusion: The overweight and obesity of preschool children in Chongqing is severe,and there are unreasonable dietary intake and insufficient physical activity.The mastery level of parents’ knowledge related diet and physical activity of preschoolers is not high.And most parents have a sense of responsibility for children’s diet and exercise,but a few parents believed that they have enough knowledge and practice.Responsible feeding is the most inclined way to adopt,while,the emotional feeding is the least inclined way to adopt;and the tendency of adopting encouraging physical activity is higher than hindering physical activity.In addition,the knowledge,attitudes and behaviors related to diet and exercise of parents may have an impact on the occurrence of overweight and obesity in preschool children.Under the background that the overweight and obesity situation of preschool children in the post-epidemic era may be more severe,this study would provide some references for relevant departments and staff related child health to carry out health education on obesity prevention and control targeted preschoolers’ parents. |
PDF Full Text Request