Study On The Factors Of Obesity Related Behaviors In Preschool Children

ObjectiveUnderstanding the current status of obesity prevalence and the distribution of 5 obesity-related behaviors and their aggregation among preschool children in Yangzhou.To study the effects of parenting styles and children’s emotional and behavioral problems in families on obesity-related behaviors and their aggregation,and the mediating effect of sleep status in between to provide a scientific basis for early family intervention for children with psycho-behavioral problems.MethodsAll of 2431 preschool children were selected in Yangzhou using the cluster sampling method,and their parents were surveyed by questionnaire,collected and classified according to relevant criteria.The survey included general demographic characteristics,family characteristics,parenting styles,child obesity-related behaviors,and emotional behavior problems.Obesity-related behaviors in preschoolers include physical inactivity(<1 h/d),longer video screen time(>2 h/d),frequent take-out/fast food intake(≥3 times/week),frequent intake of sugary drinks(≥3 times/week),insufficient sleep time(<10 h/d)in a total of five categories.The presence of three or more "obesity-related behaviors" at the same time was defined as having "obesity-related behavioral aggregation".The questionnaire also included information on the child’s age,gender,and place of residence,as well as the parents’ education level and the family’s economic status.Parental parenting behavior was evaluated by the Parental Bonding Instrument(PBI),which is divided into supportive/engage and hostile/coercive.The total scores of fathers and mothers in the two dimensions were calculated separately,and then parenting styles were classified into 3 levels according to their P25 and P75.Children’s emotional behavior problems was evaluated by the Strength and Difficulty Questionnaire(SDQ),which were divided into five dimensions:emotional symptoms,conduct,hyperactivity attention deficit,peer interaction,and pro-social behavior.Calculate the total score,each dimension and the total score can be divided into three levels:"normal","suspicious" and "abnormal".Statistical analysis was performed using SPSS 26.0 with ANOVA,correlation analysis,and logistic regression,and mediating effects were analyzed using Amos 24.0.Results1.Current situation of overweight and obesity among survey respondentsThe current status of overweight and obesity of survey respondents:a total of 2431 preschool children aged 3～6 years were included in this study,including 1291 boys and 1140 girls,and the mean age of the survey respondents is 4.40±0.90.Screened 321 overweight children and 167 obese children.The overweight rate was 13.20%,the obesity rate was 6.90%,and the total detection rate of overweight and obesity was 20.10%.The detection rate of overweight and obesity among boys was 22.80%,and the detection rate of overweight and obesity among girls was 16.90%,and the total detection rate of overweight and obesity among boys was higher than that of girls(P<0.001).The detection rates of obesity-related behaviors among preschoolers with longer video screen time,insufficient physical activity,frequent take-out/fast food intake,frequent intake of sugary drinks,and insufficient sleep were 26.10%,30.50%,25.30%,18.90%,and 46.50%,and 16.30%of children with aggregates of three or more behavioral.The results of Single-factor analysis:gender,age,parental education,and obesity-related behaviors were associated with the detection rate of overweight and obesity in preschool children.2.Parenting styleParenting style studies show:the score of paternal supportive/engage is 36.48±7.71,the score of paternal hostile/coercive is 16.95±5.97;the score of maternal supportive/engage is 40.47±6.87,the score of maternal hostile/coercive is 17.39±6.32.The score of maternal supportive/engage is higher than paternal score(P<0.05)Girls scored higher on the paternal supportive/engage than boys(35.39±8.60 vs 34.65±8.73,P<0.05),while boys scored higher on the paternal hostile/coercive than girls(18.04±6.49 vs 17.32±6.32,P<0.05).3.Emotional behavior problems in childrenResearch on children’s emotional behavior problems shows:the score of SDQ is 9.45±4.24,with the total score was suspicious or abnormal for 303 people,accounting for 8.5 percent.Among all the dimensions,the highest rate of detectable or abnormal hyperactive attention deficits was found(21.80%),followed by pro-social behavior(21.70%)and peer interaction problems(20.10%).With the exception of emotional symptoms,the differences in scores on all dimensions between boys and girls were statistically significant.4.Multivariate analysis of obesity-related behaviorsThe results of the multifactorial analysis showed that after controlling for the confounding factors of child age,gender,and family residence,high levels of parental supportive/engage were protective factors for children’s video time compared to low levels of parental hostile/coercive(Paternal:OR=0.70,95%CI:0.50～0.81;Maternal:OR=0.67,95%CI:0.49～0.92),it were protective factors for insufficient physical activity in children(Paternal:OR=0.71,95%CI:0.55～0.91;Maternal:OR=0.69,95%CI:0.51～0.86),it were protective factors for sleep duration in children(Paternal:OR=0.70,95%CI:0.49～0.87;Maternal:OR=0.69,95%CI:0.51～0.86),and it were protective factors for childhood obesity aggregation behavior(Paternal:OR=0.61,95%CI:0.50～0.89;Maternal:OR=0.64,95%CI:0.55～0.73).Compared to low levels of maternal hostility/coercion,high levels of maternal hostility/coercion were risk factors for child video time(OR=1.86,95%CI:1.50～1.94);child physical activity time(OR=1.71,95%CI:1.55～2.31).Children with normal scores were at higher risk for longer video time compared to children with normal scores for hyperactive attention deficit and abnormal peer interaction scores(hyperactive attention deficit:OR=1.10,95%CI:1.08～1.36,peer interaction:OR=1.37,95%CI:1.19～1.73);children with suspicious or abnormal peer interaction scores were at higher risk for physical activity(OR=1.86,95%CI:1.21～2.84);higher risk of sleep duration in children with suspected or abnormal emotional symptoms,hyperactive attention deficit scores(emotional symptoms:OR=2.12,95%CI:1.13～3.99,hyperactive attention deficit:OR=1.86,95%CI:1.21～2.84);higher risk of sleep duration in children with suspected or abnormal emotional symptoms,conduct problems,hyperactive attention,peer children with suspicious or abnormal interaction scores were at higher risk for childhood obesity-related behavioral clusters(emotional symptoms:OR=1.76,95%CI:1.32～2.77,conduct problems:OR=1.82,95%CI:1.45～3.32,hyperactive attention deficits OR=1.90,95%CI:1.51～2.84,peer interaction:OR=1.58,95%CI:1.13～2.22).5.Pathways of parenting style,child obesity-related behavior,and the role of child emotional behavior.Parental supportive/engage-SDQ score-obesity behavior structural equation model modified to fit well:χ2/df=3.833,NFI=0.997,IFI=0.998,GFI=0.999,CFI=0.999,RMSEA=0.034.The direct effect of parental support involvement on the degree of obesity behavior was significant,accounting for 72.76%of the total effect;SDQ score played a partially mediating role,accounting for 27.24%of the total effect.Parental hostile/coercive-SDQ score-obesity behavior structural equation model modified to fit well:χ2/df=0.914,NFI=0.999,IFI=1.000,GFI=1.000,CFI=1.000,RMSEA=0.000.The direct effect of parental support involvement on the degree of obesity behavior was significant,accounting for 72.22%of the total effect;SDQ score played a partially mediating role,accounting for 27.78%of the total effect.Conclusion1.The prevalence of obesity in preschool children in Yangzhou is like that reported in China,and the detection rate of obesity-related behaviors and their aggregation is high,and public health interventions are urgently needed.2.Mothers of preschoolers score higher in the support/engage dimension than fathers.Fathers are less supportive/engage and more hostile/coercive to boys than girls.3.The rate of abnormal emotional behavior problems in preschool children is low compared to the abnormal rates reported in all regions of the country.The abnormality rates of each dimension from highest to lowest were hyperactive attention deficit,peer interaction,pro-social behavior,conduct and emotional symptoms,and the detection rate of abnormal emotional behavior problems is higher in boys than in girls.4.Parental supportive/engage parenting style was negatively associated with obesity-related behaviors and emotional behavior problems in children,and hostile/coercive parenting style was positively associated with obesity-related behaviors and emotional behavior problems in children.Childhood emotional behavior problems were positively associated with childhood obesity-related behaviors,and there was a mediating effect between parenting style and childhood obesity-related behaviors.