发达地区残疾儿童营养状况研究——以上海市为例

doi:10.3969/j.issn.1006-9771.2021.10.003

《中国康复理论与实践》 ›› 2021, Vol. 27 ›› Issue (10): 1135-1143.doi: 10.3969/j.issn.1006-9771.2021.10.003

• 专题残疾儿童康复与照护研究 • 上一篇下一篇

发达地区残疾儿童营养状况研究——以上海市为例

王晓茜^1,²,吕军^1,^2,³(),孙梅^1,^2,³,邱芬⁴,邱服冰⁵,李安巧^6,⁷,夏聪^1,²

1.复旦大学公共卫生学院,上海市 200032
2.复旦大学中国残疾问题研究中心,上海市 200032
3.国家卫生健康委员会卫生技术评估重点实验室（复旦大学）,上海市 200032
4.武汉理工大学体育部体育科学研究所,湖北武汉市 430070
5.深圳大学体育部体育与健康科学研究中心,广东深圳市 518060
6.中国ICF研究院,山东潍坊市 261000
7.世界卫生组织国际分类家族中国合作中心, 北京市 100068

收稿日期:2021-08-20 修回日期:2021-09-01 出版日期:2021-10-25 发布日期:2021-10-29
通讯作者: 吕军 E-mail:lujun@shmu.edu.cn
作者简介:王晓茜(1997-),女,汉族,河北邢台市人,硕士研究生,主要研究方向：健康服务政策与治理。
基金资助:
国家社会科学基金重大项目(No. 17ZDA078)(17ZDA078);国家自然科学基金面上项目(71774030);上海市哲学社会科学规划一般课题(2018BGL005)

Nutritional Status of Children with Disabilities in Developed Areas in China: a Case of Shanghai

WANG Xiao-qian^1,²,LÜ Jun^1,^2,³(),SUN Mei^1,^2,³,QIU Fen⁴,QIU Fu-bing⁵,LI An-qiao^6,⁷,XIA Cong^1,²

1. School of Public Health, Fudan University, Shanghai 200032, China
2. China Research Center on Disability, Fudan University, Shanghai 200032, China
3. National Health Commission Key Laboratory of Health Technology Assessment (Fudan University), Shanghai 200032, China
4. Institute for Sport Science/Department of Physical Education of Wuhan University of Technology, Wuhan, Hubei 430070, China
5. Research Center of Physical Education, Sport and Health of Department of Physical Education, Shenzhen University, Shenzhen, Guangdong 518060, China
6. China Academy of ICF, Weifang, Shandong 261000, China
7. WHO-FIC Collaborating Center in China, Beijing 100068, China

Received:2021-08-20 Revised:2021-09-01 Published:2021-10-25 Online:2021-10-29
Contact: LÜ Jun E-mail:lujun@shmu.edu.cn
Supported by:
National Social Science Foundation of China (Major)(17ZDA078);National Natural Science Foundation of China (General)(71774030);Shanghai Philosophy and Social Science Project(2018BGL005)

摘要/Abstract

摘要：

目的了解发达地区残疾儿童的营养状况并分析其影响因素。方法 2019年12月至2020年1月以及2020年8月至9月,方便抽样选取上海市2~18岁残疾儿童主要照护者480例。调查残疾儿童的身高和体质量,计算体质量指数(BMI)。基于儿童超重、肥胖预测的生态模型,从儿童个人、家庭及社会特征3个维度分析残疾儿童营养状况的影响因素。采用χ²检验和二分类Logistic回归模型进行分析。结果 480例残疾儿童的消瘦、超重和肥胖检出率分别为23.75%、13.54%、13.33%。多因素Logistic回归分析显示,薯类摄入(OR = 0.420, 95%CI 0.197~0.893, P < 0.05)、照护者对孩子体质量的感知(OR_过轻 = 4.188, 95%CI 1.488~11.787, P < 0.01)对儿童消瘦有影响;残疾类型(OR_孤独症 = 0.142, 95%CI 0.034~0.591, P < 0.01)、家庭角色(OR_父亲 = 5.519, 95%CI 1.110~27.440, P < 0.05)、照护者对孩子体质量的感知(OR_过重 = 5.669, 95%CI 1.112~28.903, P < 0.05)对儿童超重肥胖有影响。结论上海市残疾儿童营养不良问题发生率较高,消瘦和肥胖比例远高于正常儿童。残疾类型、自身膳食摄入及家庭特征对残疾儿童营养状况的影响较大。

关键词: 残疾儿童, 照护者, 营养状况, 影响因素, 上海

Abstract:

Objective To explore the nutritional status and influencing factors among children with disabilities in developed areas.Methods From December, 2019 to January, 2020, and August to September, 2020, a total of 480 caregivers of children with disabilities aged two to 18 years in Shanghai were investigated their heights and weights, and the body mass index (BMI) was calculated. The influencing factors were analyzed from the dimensions of children's personal, family and social characteristics based on the Ecological System Theory. Chi-square test and binary Logistic regression model were used to analyze the influencing factors associated with the nutritional status of children with disabilities.Results The prevalence of thinness, overweight and obesity in 480 children was 23.75%, 13.54% and 13.33%, respectively. Multivariate Logistic regression analysis showed that potato intake (OR = 0.420, 95%CI 0.197 to 0.893, P < 0.05) and caregivers' perception of child's weight (OR _underweight = 4.188, 95%CI 1.488 to 11.787, P < 0.01) were associated with children's thinness. Types of disability (OR _autism= 0.142, 95%CI 0.034 to 0.591, P < 0.01), the role of caregiver (OR _father= 5.519, 95%CI 1.110 to 27.440, P < 0.05), and caregivers' perception of the child's weight (OR _overweight = 5.669, 95%CI 1.112 to 28.903, P < 0.05) were associated with children's overweight/obesity.Conclusion The prevalence of malnutrition among children with disabilities in Shanghai is higher than those typically-developing, especially thinness and obesity. The nutritional status is greatly affected by the type of disability, dietary intake and family characteristics.

Key words: children with disabilities, caregiver, nutritional status, influencing factors, Shanghai

中图分类号:

王晓茜,吕军,孙梅,邱芬,邱服冰,李安巧,夏聪. 发达地区残疾儿童营养状况研究——以上海市为例[J]. 《中国康复理论与实践》, 2021, 27(10): 1135-1143.

WANG Xiao-qian,LÜ Jun,SUN Mei,QIU Fen,QIU Fu-bing,LI An-qiao,XIA Cong. Nutritional Status of Children with Disabilities in Developed Areas in China: a Case of Shanghai[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(10): 1135-1143.

图/表 6

表1

表2

表3

影响残疾儿童营养状况的儿童个人相关因素〔n = 480, n(%)〕"

变量		n	消瘦	正常	超重肥胖	χ²值	P值
性别	男	296	70(23.65)	147(49.66)	79(26.69)	0.026	0.987
性别	女	184	44(23.91)	90(48.91)	50(27.17)
年龄(岁)	2~< 6	262	63(24.05)	137(52.29)	62(23.66)	14.649	0.005
	6~< 12	165	44(26.67)	65(39.39)	56(33.94)
	12~18	53	7(13.21)	35(66.04)	11(20.75)
薯类摄入^a	从不或较少	148	46(31.08)	68(45.95)	34(22.97)	7.139	0.028
薯类摄入^a	较多摄入	172	35(20.35)	78(45.35)	59(34.30)
零食摄入^a	从不或较少	185	54(29.19)	75(40.54)	56(30.27)	5.308	0.070
零食摄入^a	较多摄入	135	27(20.00)	71(52.59)	37(27.41)
饮料摄入^a	从不或较少	285	78(27.37)	128(44.91)	79(27.72)	6.259	0.044
饮料摄入^a	较多摄入	35	3(8.57)	18(51.43)	14(40.00)
体育活动(/月)	0次	233	58(24.89)	116(49.79)	59(25.32)	1.293	0.863
	1~4次	118	29(24.58)	55(46.61)	34(28.81)
	≥ 5次	129	27(20.93)	66(51.16)	36(27.91)
睡眠时间(h/d)	≤ 7	43	6(13.95)	21(48.84)	16(37.21)	13.408	0.009
	8~10	320	72(22.50)	153(47.81)	95(29.69)
	≥ 11	117	36(30.77)	63(53.85)	18(15.38)
屏前时间(h/d)	0~2	369	91(24.66)	185(50.14)	93(25.20)	2.404	0.301
屏前时间(h/d)	> 2	111	23(20.72)	52(46.85)	36(32.43)
并发疾病	有	87	25(28.74)	39(44.83)	23(26.44)	1.565	0.457
	无	393	89(22.65)	198(50.38)	106(26.97)
残疾类型	听力残疾	69	14(20.29)	34(49.28)	21(30.43)	18.153	0.315
	视力残疾	32	7(21.88)	17(53.13)	8(25.00)
	言语残疾	32	9(28.13)	15(46.88)	8(25.00)
	脑瘫以外肢体残疾	48	15(31.25)	21(43.75)	12(25.00)
	脑瘫	71	24(33.80)	33(46.48)	14(19.72)
	智力残疾	53	6(11.32)	32(60.38)	15(28.30)
	孤独症	62	16(25.81)	34(54.84)	12(19.35)
	多重残疾	54	13(24.07)	24(44.44)	17(31.48)
	未定残	59	10(16.95)	27(45.76)	22(37.29)
残疾等级	重度残疾	118	29(24.58)	59(50.00)	30(25.42)	5.025	0.285
	轻度残疾	28	3(10.71)	13(46.43)	12(42.86)
	未定级	334	82(24.55)	165(49.40)	87(26.05)
摄食功能^a	正常	398	85(21.36)	200(50.25)	113(28.39)	3.478	0.176
摄食功能^a	不正常	71	21(29.58)	36(50.70)	14(19.72)
运动功能^a	走动没有困难	198	40(20.20)	96(48.48)	62(31.31)	5.549	0.062
运动功能^a	走动有困难	67	23(34.33)	26(38.81)	18(26.87)

表3

表4

表5

表6

2~18岁残疾儿童营养状况的影响因素"

变量		消瘦对比正常体质量		超重肥胖对比正常体质量
变量		OR(95%CI)	P值	OR(95%CI)	P值
儿童个人特征和危险因素
性别	男	1.000		1.000
	女	0.786(0.373~1.653)	0.525	0.857(0.408~1.798)	0.683
年龄(岁)	2~< 6	1.000		1.000
	6~< 12	1.782(0.763~4.160)	0.182	1.390(0.579~3.335)	0.461
	12~18	1.079(0.215~5.423)	0.926	0.427(0.082~2.219)	0.311
薯类摄入	从不或较少	1.000		1.000
薯类摄入	较多摄入	0.420(0.197~0.893)	0.024	1.279(0.635~2.579)	0.491
饮料摄入	从不或较少	1.000		1.000
饮料摄入	较多摄入	0.290(0.064~1.307)	0.107	1.191(0.405~3.504)	0.752
残疾类型	听力残疾	1.000		1.000
	视力残疾	0.796(0.116~5.477)	0.817	0.599(0.103~3.495)	0.569
	言语残疾	0.649(0.092~4.563)	0.664	0.875(0.149~5.151)	0.883
	脑瘫以外肢体残疾	0.930(0.219~3.951)	0.922	0.779(0.156~3.896)	0.761
	脑瘫	1.718(0.511~5.775)	0.382	1.135(0.293~4.402)	0.854
	智力残疾	0.488(0.077~3.082)	0.445	0.587(0.143~2.420)	0.461
	孤独症	1.943(0.643~5.877)	0.239	0.142(0.034~0.591)	0.007
	多重残疾	1.403(0.361~5.450)	0.625	0.665(0.138~3.212)	0.612
	未定残	0.433(0.132~1.425)	0.168	1.059(0.370~3.032)	0.915
睡眠时间(h/d)	≤ 7	1.000		1.000
	8~10	2.366(0.505~11.086)	0.274	0.591(0.163~2.144)	0.424
	≥ 11	4.644(0.870~24.799)	0.072	0.302(0.072~1.257)	0.100
家庭特征和喂养模式
家庭角色	母亲	1.000		1.000
	父亲	0.257(0.035~1.878)	0.180	5.519(1.110~27.440)	0.037
	祖父母	1.519(0.482~4.787)	0.475	1.823(0.549~6.054)	0.327
	外祖父母	2.794(0.693~11.260)	0.149	1.678(0.485~5.805)	0.414
性别	男性	1.000		1.000
性别	女性	0.694(0.148~3.263)	0.644	1.556(0.401~6.041)	0.523
体质量状态	正常体质量	1.000		1.000
体质量状态	超重肥胖	0.907(0.396~2.078)	0.817	1.145(0.539~2.431)	0.725
对儿童体质量的感知	正常	1.000		1.000
	过轻	4.188(1.488~11.787)	0.007	0.242(0.045~1.300)	0.098
	过重	0.272(0.020~3.718)	0.329	5.669(1.112~28.903)	0.037
对儿童体质量的态度	保持现状	1.000		1.000
	希望减肥	1.559(0.148~16.376)	0.712	2.518(0.440~14.415)	0.300
	希望增重	1.776(0.665~4.745)	0.252	1.353(0.279~6.572)	0.708
喂养注意营养搭配	从来不会	1.000		1.000
喂养注意营养搭配	会	1.147(0.297~4.428)	0.842	0.312(0.093~1.045)	0.059
喂养信息需求	存在需求	1.000		1.000
喂养信息需求	不存在需求	1.702(0.568~5.098)	0.342	1.805(0.676~4.825)	0.239
自身健康管理信息	存在需求	1.000		1.000
自身健康管理信息	不存在需求	0.704(0.315~1.573)	0.392	1.489(0.677~3.271)	0.322

表6

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年龄(岁)	消瘦	正常	超重	肥胖
男童
2~< 6	39(23.49)	89(53.61)	20(12.05)	18(10.84)
6~< 12	27(28.13)	37(38.54)	20(20.83)	12(12.50)
12~18	4(11.76)	21(61.76)	6(17.65)	3(8.82)
女童
2~< 6	24(25.00)	48(50.00)	4(4.17)	20(20.83)
6~< 12	17(24.64)	28(40.58)	13(18.84)	11(15.94)
12~18	3(15.79)	14(73.68)	2(10.53)	0(0.00)
总体
2~< 6	63(24.05)	137(52.29)	24(9.16)	38(14.50)
6~< 12	44(26.67)	65(39.39)	33(20.00)	23(13.94)
12~18	7(13.21)	35(66.04)	8(15.09)	3(5.66)
合计	114(23.75)	237(49.38)	65(13.54)	64(13.33)

变量		n	消瘦	正常	超重肥胖	χ²值	P值
家庭角色^a	母亲	251	62(24.70)	135(53.78)	54(21.51)	14.355	0.026
	父亲	95	15(15.79)	44(46.32)	36(37.89)
	祖父母	72	18(25.00)	30(41.67)	24(33.33)
	外祖父母	55	17(30.91)	24(43.64)	14(25.45)
照护者性别	男	139	26(18.71)	64(46.04)	49(35.25)	7.645	0.022
照护者性别	女	341	88(25.81)	173(50.73)	80(23.46)
照护者体质量状态	正常体质量	308	73(23.70)	166(53.90)	69(22.40)	9.956	0.007
照护者体质量状态	超重/肥胖	172	41(23.84)	71(41.28)	60(34.88)
家庭规模	4人及以下	286	73(25.52)	143(50.00)	70(24.48)	2.510	0.285
	5人及以上	194	41(21.13)	94(48.45)	59(30.41)
与祖辈同住	是	296	68(22.97)	138(46.62)	90(30.41)	4.963	0.084
与祖辈同住	否	184	46(25.00)	99(53.80)	39(21.20)
对儿童体质量的感知^a	正常	179	30(16.76)	100(55.87)	49(27.37)	99.033	< 0.001
	过轻	92	49(53.26)	35(38.04)	8(8.70)
	过重	46	1(2.17)	11(23.91)	34(73.91)
对儿童体质量的态度^a	希望减肥	38	3(7.89)	8(21.05)	27(71.05)	76.034	< 0.001
	希望增重	87	45(51.72)	32(36.78)	10(11.49)
	保持现状	195	33(16.92)	106(54.36)	56(28.72)
喂养注意营养搭配^a	会	287	75(26.13)	135(47.04)	77(26.83)	6.733	0.035
喂养注意营养搭配^a	从来不会	33	6(18.18)	11(33.33)	16(48.48)
喂养信息需求^a	存在需求	403	97(24.07)	207(51.36)	99(24.57)	11.377	0.003
喂养信息需求^a	不存在需求	64	15(23.44)	21(32.81)	28(43.75)
自身健康管理信息需求^a	存在需求	324	77(23.77)	170(52.47)	77(23.77)	6.239	0.044
自身健康管理信息需求^a	不存在需求	137	35(25.55)	56(40.88)	46(33.58)

变量		n	消瘦	正常	超重肥胖	χ²值	P值
儿童户籍	上海	405	95(23.46)	196(48.40)	114(28.15)	2.161	0.339
	其他地区	75	19(25.33)	41(54.67)	15(20.00)
家庭人均月收入(元)^a	< 3000	71	13(18.31)	41(57.75)	17(23.94)	6.431	0.377
	3000~< 5000	115	33(28.70)	49(42.61)	33(28.70)
	5000~< 10000	152	32(21.05)	81(53.29)	39(25.66)
	≥ 10000	139	36(25.90)	63(45.32)	40(28.78)
照护者文化程度	初中及以下	86	20(23.26)	38(44.19)	28(32.56)	3.449	0.751
	高中或中专	108	30(27.78)	51(47.22)	27(25.00)
	大专	88	18(20.45)	46(52.27)	24(27.27)
	本科及以上	198	46(23.23)	102(51.52)	50(25.25)
无障碍坡道^a	有	258	60(23.26)	126(48.84)	72(27.91)	0.288	0.866
无障碍坡道^a	无	221	54(24.43)	110(49.77)	57(25.79)
公交助残设备^a	从未观察到	64	21(32.81)	27(42.19)	16(25.00)	15.330	0.053
	很少观察到	109	32(29.36)	47(43.12)	30(27.52)
	有时观察到	81	15(18.52)	49(60.49)	17(20.99)
	经常观察到	142	29(20.42)	77(54.23)	36(25.35)
	总是观察到	80	16(20.00)	34(42.50)	30(37.50)
伙伴数量	0个	203	52(25.62)	101(49.75)	50(24.63)	2.423	0.658
	1~3个	167	37(22.16)	86(51.50)	44(26.35)
	≥ 4个	110	25(22.73)	50(45.45)	35(31.82)
社会融入^a	存在阻碍	207	45(21.74)	116(56.04)	46(22.22)	8.022	0.091
	没有帮助	70	16(22.86)	30(42.86)	24(34.29)
	有帮助	201	53(26.37)	89(44.28)	59(29.35)

发达地区残疾儿童营养状况研究——以上海市为例

Nutritional Status of Children with Disabilities in Developed Areas in China: a Case of Shanghai

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变量		n	%
性别	男	296	61.67
性别	女	184	38.33
年龄(岁)	2~< 6	262	54.38
	6~< 12	165	34.38
	12~18	53	11.04
户籍	沪籍	405	84.38
户籍	非沪籍	75	15.63
残疾类型	听力残疾	69	14.37
	视力残疾	32	6.67
	言语残疾	32	6.67
	脑瘫以外肢体残疾	48	10.00
	脑瘫	71	14.79
	智力残疾	53	11.04
	孤独症	62	12.92
	多重残疾	54	11.25
	未定残	59	12.29
残疾等级	重度残疾	118	24.58
	轻度残疾	28	5.83
	未定级	334	69.58
家庭角色	父亲	95	19.79
	母亲	251	52.29
	爷爷	25	5.21
	奶奶	47	9.79
	外公	18	3.75
	外婆	37	7.71
	其他	7	1.46

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