Behavioral intervention reduces unhealthy eating behaviors in preschool children via a behavior card approach.

Many eating behaviors form in childhood, and some unhealthy behaviors may persist into adulthood and have potential impacts on people's health. This study evaluated the effectiveness of behavioral intervention in reducing consumption of Western fast food, sweetened beverages, fried food in preschool children, and changing parents' rewarding behaviors that encourage the consumption of the unhealthy foods. The research was a cluster randomized trial of seven kindergartens, involving 1138 children aged 3-6 years and their parents in Beijing, China. Parents and children allocated to the intervention group received two lectures and printed resources, including behavior cards, educational sheets. Children's behavior cards, applied with behavior-changing techniques, were used to intervene, and monitor behavior changes over time. Children in the control group just followed their usual health education curriculum in kindergartens. Intervention effects on food consumption behaviors were assessed by examining pre- and post-questionnaires. Of the 1138 children screened at baseline, 880 (77.3%) were measured at the end of the intervention period. The intervention lasted from March to June in 2010. The results showed that consumption of Western fast food, sweetened beverages, and fried food was decreased among the intervention group (P<0.001). Proportions of parents using Western fast food as rewards for their children were decreased (P=0.002). From March to June 2010, the frequency of each target behavior in children tended to decrease over the intervention period (P<0.001). Most parents favored regularly-delivered behavior cards or materials for behavioral intervention. In conclusion, the behavioral intervention encourages the healthier eating behaviors of children and reduces the parents' practice of using unhealthy foods as reward.

Feeding methods, sleep arrangement, and infant sleep patterns: a Chinese population-based study.

BACKGROUND: Findings from prior research into the effect of feeding methods on infant sleep are inconsistent. The objectives of this study were to examine infants' sleep patterns by feeding methods and sleep arrangement from birth to eight months old. METHODS: This longitudinal cohort study enrolled 524 pregnant women at 34-41 weeks of gestation and their infants after delivery in 2006 and followed up until eight months postpartum. The study subjects were recruited from nine women and children hospitals in nine cities in China (Beijing, Chongqing, Wuhan, Changsha, Nanning, Xiamen, Xi'an, Jinan, and Hailin). Participating infants were followed up weekly during the first month and monthly from the second to the eighth month after birth. Twenty-four hour sleep diaries recording infants' sleeping and feeding methods were administered based on caregiver's self-report. Multivariable mixed growth curve models were fitted to estimate the effects of feeding methods and sleep arrangement on infants' sleep patterns over time, controlling for maternal and paternal age, maternal and paternal education level, household income, supplementation of complementary food, and infant birth weight and length. RESULTS: Exclusively formula fed infants had the greatest sleep percentage/24 h, followed by exclusively breast milk fed infants and partially breast milk fed infants (P<0.01). Night waking followed a similar pattern. However, the differences in sleep percentage and night waking frequency between exclusively formula and exclusively breast milk fed infants weakened over time as infants developed. In addition, compared to infants with bed-sharing sleep arrangement, those with room sharing sleep arrangement had greater daytime and 24-hour infant sleep percentage, whereas those with sleeping alone sleep arrangement had greater nighttime sleep percentage. CONCLUSIONS: Our data based on caregiver's self-report suggested that partial breastfeeding and bed-sharing may be associated with less sleep in infants. Health care professionals need to work with parents of newborns to develop coping strategies that will help prevent early weaning of breastfeeding.

[Waist circumference reference values for screening cardiovascular risk factors in Chinese children and adolescents aged 7 - 18 years].

OBJECTIVE: To explore the optimal threshold values of waist circumference (WC) in detecting the risk on cardiovascular (CV) among the Chinese children and adolescents. METHODS: Association of WC and CV risk factors were studied among 65 898 children and adolescents aged 7 - 18 years whose data were pooled from nine studies carried out in China. Receive-operating characteristic analysis (ROC) and logistic regression were employed to derive optimal age- and sex-specific waist circumference references for predicting the CV risk factors. RESULTS: A slight increasing trend of CV risk factors was observed starting from the 75th percentile of waist circumference in the study population, while a remarkable increasing trend occurred from the 90th percentile. The optimal waist circumference thresholds for predicting high blood pressures were at the 75th percentile for both boys and girls, and at the 90th percentiles it could detect at least two of the above three CV risk factors. In comparison with children whose waist circumference was below the 75th percentile, the odds ratio of two CV risk factors doubled among children with waist circumference between 75th and 90th percentile, and increased by 6 times among children with waist circumference above the 90th percentile. The trend of high blood pressure increasing remained significant with waist circumference after having been stratified by BMI category. CONCLUSION: The 75th and the 90th percentile of WC appeared to be the optimal cut-off points for predicting an increased and a substantially increased risk of CV factors in Chinese children and adolescents.

Waist circumference reference values for screening cardiovascular risk factors in Chinese children and adolescents.

OBJECTIVES: To explore the optimal threshold values of waist circumference (WC) for detecting cardiovascular (CV) risk factors among Chinese children and adolescents. METHODS: Association of WC with CV risk factors was studied among 65,898 children aged 7-18 years whose data were pooled from nine previous studies in China. CV risk factors in this study included hypertension (blood pressure above 95 percentile levels), dyslipidemia (with one or more of the following three indexes: TG > or = 1.7 mmol/L, TC > or = 5.18 mmol/L, and HDL-C < or = 1.04 mmol/L) and elevated glucose level (fasting plasma glucose > or = 5.6 mmol/L). Receive-operating characteristic analysis (ROC) and logistic regression were employed to derive optimal age- and sex-specific waist circumference references for predicting CV risk factors. RESULTS: A slight increasing trend of CV risk factors was observed starting from the 75th percentile of waist circumference in the study population, while a remarkable increasing trend occurred from the 90th percentile. The optimal waist circumference thresholds for predicting high blood pressures were at the 75th percentile for both boys and girls, which was at the 90th percentiles for detecting at least two of the above three CV risk factors. In comparison with children with waist circumference below the 75th percentile, the odds ratio of two CV risk factors doubled among children with waist circumference between the 75th and the 90th percentile, and increased by 6 times among children with waist circumference above the 90th percentile. The trend of high blood pressure increasing with waist circumference remained significant after having been stratified by BMI category. CONCLUSION: The 75th and the 90th percentiles of WC are the optimal cut-off points for predicting an increased and a substantially increased risk of CV factors in Chinese children and adolescents, respectively.

[Development of sleep/wake patterns in infants during the first 12 months of life].

OBJECTIVE: This was a nationwide study of sleep circadian in term infants. The aim was to understand the development characteristics of infants' sleep/wake patterns longitudinally in their own home environments over the first 12 months of life. METHOD: Totally 524 healthy term infants from 9 urban districts took part in this project Their sleep/wake patterns over 24 h were recorded using parental sleep diaries, from the 2nd day to 12 months old. RESULT: The results showed that infant daytime sleep changed significantly at 0-2, 3-4, 5-6, and 8-9 months after birth, and the change was the fastest in the first month, the mean percentage of daytime sleep decreased from 82.4% at Day 2 to 62.8% at 1 month old. Also, the average number of naps reduced from 3.7 to 2 across the infancy. The ability of continuous sleep throughout the night gradually enhanced from 1 month old, and the nocturnal longest sleep time extended to 6.8 h at 4 months of age as well as the nighttime awakening frequency less than 0.5 over 6 months old. Additionally, the nighttime sleep increased significantly at 4 and 9 months after birth, where the proportion of nighttime sleep increased from 55.8% at Day 2 to 64.3% of 4 months and 71.2% of 9 months respectively. In general, the total sleep time over a 24 h period presented a downward trend as the infant aged. CONCLUSION: The periods 0-6 and 8-9 months after birth were the key periods for the development of infant sleep.

Vitamin A deficiency and child feeding in Beijing and Guizhou, China.

BACKGROUND: Vitamin A deficiency (VAD) is one of the three major micronutrient deficiencies in the world. In order to investigate the status of VAD and child feeding in China, we conducted the survey in Beijing city and Guizhou province. METHODS: We included a high socioeconomic area (Beijing) and a low socioeconomic area (Guizhou province) in China in our study. Participants included 1236 randomly selected children aged 0-71 months from stratified clusters (628 in Beijing and 608 in Guizhou), 409 from urban and 827 from rural areas. A food intake frequency questionnaire was used for dietary assessment. Fluorescence microanalysis was carried out to measure serum retinol concentrations. Serum retinol cut-off values of less than 20 microg/dl and 30 microg/dl were defined as sub-clinical VAD and suspected sub-clinical VAD, respectively. RESULTS: No xerophthalmia or night blindness was found. The mean concentration of serum retinol was 31.5 microg/dl in the high socioeconomic group, and 26.5 microg/dl in the low socioeconomic group. Rural infants had lower concentrations of serum retinol compared with the urban ones (26.9+/-8.1 microg/dl vs 31.8+/-7.3 microg/dl). The prevalence of sub-clinical VAD among all the children was 7.8%, and increased to 15.7% in children from the low socioeconomic group. In infants from the high socioeconomic area, the prevalence of suspected subclinical VAD was 38.0%, increasing to 59.5% in infants from the low socioeconomic area. The children from the low socioeconomic area had significantly lower fequency of intake of meat than the children in other groups. The prevalence of suspected sub-clinical VAD was higher in the children with lower consumption frequency of vitamin A rich foods than the children with higher consumption frequency of vitamin A rich foods. CONCLUSIONS: VAD appears to be a moderate public health problem in certain areas of China. In areas with low socioeconomic status, VAD in childrean is more severe, and infants may be the group at the highest risk for VAD. Inadequate intake of vitamin A rich foods may result in VAD. A comprehensive long-term national strategy needs to be fostered in China for the treatment and prevention of the deficiency.

[Study on prevalence and risk factors of sleep disorder among Chinese children aged 0 to 23 months in city].

OBJECTIVE: To investigate the prevalence and main influences on sleep disorder among Chinese children aged 0 to 23 months, as to providing scientific interventions for infant sleep disorder. METHODS: All 7601 children under two years old were selected by stratifying samples from twelve cities in China. The objects' parents were surveyed with questionnaire. All data were analyzed with SPSS statistical software. RESULTS: The total incidence of sleep disorders at 0 to 23 months was 21.94%. The main problems were difficulty falling asleep, nighttime waking and snoring. Feeding manner, sleep environment, sleep-associated habits and medical conditions were all influences on infant's sleep disorder. CONCLUSIONS: Enhancing sleep health education to change parents' nurturing modes should be an important role in preventing infant sleep disorders.

[Family risk factors of overweight and obesity in preschool children].

OBJECTIVE: To explore family risk factors of overweight and obesity focusing on parental characteristics, feeding practice and lifestyle. METHODS: Five kindergartens were selected randomly from two of all the six urban districts in Beijing. The body height and weight of all the children in the 5 kindergartens were measured in light clothing and without shoes. Information on parental characteristics, dietary habits, lifestyle, and feeding practice was collected from 1173 families by parental self-report questionnaires in the 5 kindergartens. Overweight and obesity were defined according to sex- and age-specific body mass index (BMI) cut-points proposed by the International Obesity Task Force. Correlations and multivariate regression analysis was used to explore risk factors of child overweight and obesity. RESULTS: The prevalence of overweight and obesity was 6.9% and 4.1%, respectively, among the sample children. Significantly more overweight and obese children were from obese families (15.2%) than they were from non-obese families (7.5%). Significant associations could be observed between children and parents' characteristics for BMI, frequency of eating in restaurant, television-watching hours, and physical activity hours. Parental obesity, low maternal education level and television watching for > 2 h/d were risk factors of child overweight and obesity after adjusting for sex, age, family income, and kindergarten. CONCLUSIONS: Child overweight and obesity were influenced by family environment. Strategies for prevention should include identified family risk factors.