基于群组轨迹模型的0~3岁婴幼儿体格发育轨迹特征及影响因素研究

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摘要目的探讨婴幼儿体格发育轨迹及其影响因素,为促进婴幼儿生长发育提供科学依据。方法采用前瞻性队列研究设计,基于方便抽样于2015年9月—2019年6月在河北正定县、辽宁立山区、湖南岳阳县、厦门市海沧区和集美区5个区/县构建母婴健康动态监测队列,招募符合要求的孕晚期孕妇并随访其子代至3岁。采用基于群组轨迹模型(GBTM)分析0~3岁婴幼儿体格发育轨迹,应用Group Lasso回归模型进行影响因素的初步筛选,进一步用无序多分类Logistic回归分析体格发育轨迹的影响因素。结果本研究共纳入2 330名婴幼儿。基于贝叶斯信息准则等原则,采用GBTM将婴幼儿体格发育轨迹分为缓慢生长、追赶生长、中速生长和加速生长组(占比分别为25.4%、18.8%、38.4%和17.4%)。以中速生长组作为参考,经无序多分类Logistic回归分析发现:父亲消瘦(OR=1.80,95%CI:1.08~3.01)、母亲孕前消瘦(OR=1.61, 95%CI: 1.23~2.11)、母亲孕晚期户外运动时长小于1 h(OR=1.30,95%CI:1.04~1.63)、孕期未服用铁剂(OR=1.47,95%CI:1.17~1.85)、6月龄室外活动时长＜3 h(OR=1.36,95%CI:1.06~1.75)可显著增加缓慢生长模式发生的风险(P<0.05);1月龄时睡眠质量好(OR=0.74,95%CI:0.58~0.94)可显著降低缓慢生长模式的发生风险(P<0.05);母亲孕前肥胖(OR=1.69,95%CI:1.07~2.66)、分娩方式为剖宫产(OR=1.43,95%CI:1.12~1.83)、纯母乳喂养时长＜6个月(OR=1.39,95%CI:1.07~1.79)可显著增加加速生长模式的发生风险(P<0.05)。结论婴幼儿体格发育轨迹存在异质性。与中速生长组的婴幼儿相比,父亲消瘦、母亲孕前消瘦、母亲孕晚期户外运动时长小于1 h、孕期未补充铁剂、6月龄室外活动时长＜3 h的婴幼儿更易出现缓慢生长;母亲孕前肥胖、剖宫产、纯母乳喂养时长小于6个月婴幼儿更易表现为加速生长。本研究结果为科学、合理指导婴幼儿生长发育提供了科学证据。

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	杨君婷
	黄爱群
	陈大方

关键词 ：婴幼儿, 发育轨迹, 基于群组轨迹模型

Abstract：Objective The purpose of this study was to examine the trajectories of body mass index-for-age z-score (Z-BMI) in 3-year-old infants and their determining factors. Methods In this prospective cohort study, pregnant women were recruited based on convenience sampling method at the third trimester from 5 counties in China and their offspring were followed up to 3-year old during Sept 2015 to June 2019. Group-based trajectory model was used to identify distinct Z-BMI trajectories. Group lasso regression analysis and multinomial logistic regression were utilized identify prenatal and early life determinants of the identified trajectories. Results Among a total of 2330 individuals (1253 males and 1077 females), we identified four distinct Z-BMI trajectories:"low-stable" (25.4%), "catch-up" (18.8%), "intermediate-stable" (38.4%) and "rising" (17.4%) trajectories. Multinomial logistic regression showed that, paternal underweight (OR=1.80, 95%CI:1.08-3.01), maternal underweight before pregnancy(OR=1.30, 95%CI:1.04-1.63), time for outdoor activity in the third trimester < 1h (OR=1.30, 95%CI:1.04-1.63), no iron supplementation during pregnancy (OR=1.47, 95%CI:1.17-1.85), and time for outdoor activity of 6-month-old infants < 3h (OR=1.36, 95%CI:1.06-1.75) were associated with significantly increased risk of being at the "low-stable" group compared with the “intermediate-stable” group, while infants whose sleep quality at 1-month-old was assessed as high-quality (OR=0.74, 95%CI:0.58-0.94) had decreased risk of being at the "low-stable" group. Maternal obesity (OR=1.69, 95%CI:1.07-2.66), cesarean delivery (OR=1.43, 95%CI:1.12-1.83), the duration of exclusive breastfeeding < 6 months (OR=1.39, 95%CI:1.07-1.7) were associated with significantly increased risk of being at the "rising" group compared with the "intermediate-stable" group. Conclusion Distinct BMI trajectories exist during the infancy period. Paternal underweight, maternal underweight, no iron supplementation during pregnancy, and inadequate outdoor activity in the third trimester for pregnant women and at 6 months of age for infants are associated with increased the risk of "low-stable" growth, while high-quality of sleep at 1 month of age is associated with decreased risk of "low-stable" growth. Maternal obesity, cesarean delivery, shorter duration of exclusive breastfeeding are associated with increased risk of "rising” growth.

Key words： infant growth trajectories group-based trajectory model

收稿日期: 2021-04-25

ZTFLH:

R17

通讯作者: 陈大方(dafangchen@bjmu.edu.cn);黄爱群(aqhuang@chinawch.org.cn)

引用本文:

杨君婷, 黄爱群, 陈大方. 基于群组轨迹模型的0~3岁婴幼儿体格发育轨迹特征及影响因素研究[J]. 中国生育健康杂志, 2023, 34(1): 25-34. YANG Junting, HUANG Aiqun, CHEN Dafang. Group-based trajectory modelling for z-scores of body mass index in infants and exploration of determining factors of the trajectories. Chinese Journal of Reproductive Health, 2023, 34(1): 25-34.

链接本文:

http://cjrh.bjmu.edu.cn/CN/ 或 http://cjrh.bjmu.edu.cn/CN/Y2023/V34/I1/25

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