氣喘兒童身體質量指數及其相關因素之研究

Abstract

研究背景：氣喘是兒童全球性最常見的慢性疾病，過去30年來發生率逐年攀升，依據調查資料顯示台北市國小學童氣喘盛行率已高達20.34%，氣喘已成為慢性兒童疾病照護的重點。近年研究發現肥胖與氣喘間存在關聯性，許多研究者試圖探討兩者間是否有共同的基因、共同的胎內環境或共同生活環境，若氣喘合併肥胖，除影響原本疾病的控制外，對兒童整體的健康亦有負面影響。 研究目的：本研究在瞭解氣喘兒童身體質量指數的表現，比較其與正常學童身體質量指數的差異，探討家庭學校環境、能量平衡行為與健康狀況等潛在相關因素，對於氣喘兒童身體質量指數的影響。 研究方法：本研究為量性研究設計，採橫斷性調查方法，自2014年9月1日至2014年12月27日期間，以立意取樣方式，於北部某醫學中心小兒過敏免疫風濕科門診進行資料收集。兒童研究對象納入條件為：年齡6至12歲學童、確診為氣喘之兒童、患病達一年以上、其父母或法定代理人同意接受研究者。同意兒童參與研究的父母，有識讀中文能力、有能力及意願完成本研究者，也一併邀請加入研究。研究工具參考使用高碧霞等人2014年發展的結構式問卷，收集資料內容包括：兒童及其父母親的基本資料、家庭學校環境資料、兒童的能量平衡行為及兒童的健康狀況。另外，實地測量與記錄兒童及其父母親的身高與體重，計算出身體質量指數(BMI)。本研究參考陳偉德及張美惠2010年發表之台灣兒童及青少年新生長曲線圖，以50th百分位值做為基準點，將測得之BMI值以中位數調整後兒童身體質量指數做為連續型變項，並區分自變項於中位數以上(含中位數)以及中位數以下兩組的差異。研究資料分析方法乃利用SPSS 17.0 及 R3.1.3版統計套裝軟體，進行次數分配表、百分比、平均值、標準差、中位數等描述性統計外，也進行獨立樣本T檢定、Wilcoxon等級和檢定、Fisher精確性檢定單變項檢定，以及進一步進行變異數分析、線性迴歸模式、廣義加性模式等多變量分析。 研究結果：本研究共收集118對兒童及父母，最後納入統計分析的有效樣本數為113對。其中男童67人(59.3%)，女童46人(40.7%)，平均年齡8.98歲(標準差 ± 1.84)，平均罹患氣喘年數3.94年(標準差 ± 2.43)，結果發現體重過重有15人(13.27%)，肥胖者有10人(8.85%)，再依年齡區分，兒童體重過重於8歲時為最多佔31.25%，肥胖於10歲時達20.00%。父母親平均年齡41.03歲(標準差 ± 5.36)，體重過重有59人(26.11%)，輕度肥胖有23人(10.18%)，中度肥胖有17人(17.52%)，重度肥胖有2人(.88%)。本研究運用廣義加性模式分析三個模式，以第三模式為最佳，其解釋變異量為78.36%。茲將顯著影響兒童BMI的自變項因素描述如下：(一)、人口學變項因素：兒童性別男生、年齡大於8.18歲、有過動或注意力不集中、母親妊娠週數大於39.52週皆與兒童BMI顯著正相關，而異位性皮膚炎兒童與其BMI呈顯著負相關。(二)、家庭學校環境因素：父母年齡介於31.02至42.21歲之間、父母親BMI、中餐由家人準備、走路放學.304至11.011分鐘與兒童BMI達到顯著正相關，而高教育程度父親、低教育程度母親、走路及搭車或家人開車兒童BMI呈顯著負相關。(三)、兒童能量平衡行為因素：兒童攝取高油高糖頻率小於1.59天/週、肉類頻率介於0.43至2.25天/週、奶蛋頻率介於1.72至3.62天/週、蔬果頻率介於3.97至6.15天/週、益生菌小於.112天/週及介於1.121至2.752天/週、冰品飲料頻率大於.284天/週、假日睡眠時間介於8.217至10.696小時，均與兒童BMI呈顯著正相關。(四)、兒童健康狀態因素：孩子運動或活動過度會有喘鳴或咳嗽、一年內因氣喘至急診2次以上及一年內氣喘曾住院的兒童與其BMI呈負相關。 結論與建議：本研究結果發現氣喘兒童的身體質量指數，在體重過重與肥胖比例相較於國內健康學童比例稍低，但以陳偉德及張美惠於2010年發表台灣兒童及青少年新生長曲線研究之中位數分組做比較，不管男童或女童，其身體質量指數的平均值皆高於中位數，氣喘兒童體重問題仍須我們注意。本研究分析所證實之氣喘兒童身體質量指數的重要影響因素，有助於了解與預防氣喘兒童潛在的健康危害風險。希望藉由影響因素的分析探討，提供臨床照護者、學校教育人員及衛教工作者在疾病控制與體重管理時之重要參考，教導兒童與家長重視家庭學校環境的影響因素，協助建立氣喘兒童健康生活型態，幫助兒童有效控制疾病並能促進健康。

Background: Asthma is the most common chronic diseases among children world in the past 30 years. The incidence has increased steadily. According to the survey data showed that the prevalence of asthma in Taipei elementary school children has reached 20.34%. Therefore, asthma has become a chronic childhood illness care focus. Recent researches indicate relationship between obesity and asthma. Many researchers are trying to explore whether is common gene between the two, in a common environment fetal environment or living together. When asthma combined with obesity, they will in addition to the impact of disease control, but overall health of children negative impact also. Aim: This study is aimed to understand body mass index of asthma children, and then to compared with the normal students. The potential related factors of home-school environments, energy balance-related behaviors and health status are explored to understand how they affect body mass index of asthma children. Methods: This quantitative study adopted a cross-sectional survey method by means of a purposive sampling method to recruit subjects in the allergy and rheumatic clinic of a northern medical center during September 1, 2014 to December 27, 2014,. The inclusion criteria was children aged 6-12 years, diagnosed with asthma for children, the asthma persisted more than a year, their parents or legal representatives agree to participate the researchers. The parents of recruited children who were able to read Chinese and agree to complete this researcher were also invited to join the study. Research instrument of a structured questionnaire developed by Gau et al. (2014) was used to collect the data. The contents included demographic data of children and their parents, home-school environmental data, the energy balance–related behaviors of children and health status of children. In addition, field measurement and recording of height and weight of children and their parents, to calculate the body mass index. The median value (50th percentile BMI) was the baseline by taking the reference of new growth curve of Taiwan children and adolescents from Chen & Chang (2010). The adjusted median of BMI of the body mass index was a continuous variables to compare differences of independent variables between groups of above (including the median) and below the median. Research data analysis was using SPSS statistical software package version 17. R3.1.3 carried frequency allocation table, percentage, mean, standard deviation, median and other descriptive statistics, but also for independent samples t test, Wilcoxon rank-sum test, Fisher Exact test univariate test, and further analysis of variance, linear regression models, generalized additive model of multivariate analysis. Results: Effective sample size in this study were collected 118 pairs of children and parents, and finally into the statistical analysis of 113 pairs. Where 67 boys (59.3%) and 46 girls (40.7%), with an average age of 8.98 years (SD ± 1.84), the average number of years of suffering from asthma 3.94 years (SD ± 2.43), and found that 15 people were overweight (13.27%), and 10 people were obese (8.85%). Then follow the age division, child overweight at the age of 8 was the most (31.25%), obese at the age of 10 up to 20.00%. The average age of parents 41.03years (SD ± 5.36), 59 were overweight (26.11%), 23 were mildly obese (10.18%), 17 were moderately obese (17.52%), and 2 were severe obesity (.88%). In this study, three generalized additive three models were explored, the third model explained total variance of 78.36%. The independent variables significantly affect the child BMI were: (A), demographic variables: boy, age older than 8.18, were hyperactive disorder or attention-deficit, mother’s gestation more 39.52 weeks are significant positive correlated with children's BMI, but atopic dermatitis and BMI was significantly negatively correlated. (B), home-school environmental factors: parents aged between 31.02 to 42.21, parents BMI, lunch prepared by their families, walking school spending .304 to 11.011 minutes with the children significant positive correlation between BMI, but the highly educated father, low levels of education mother, walking and riding for children or family car was significantly negatively correlated with BMI. (C), children's energy balance-related behavioral factors: high oil and high sugar intake less than 1.59 days/week, meat intake ranged from 0.43 to 2.25 days/week, milk and egg intake ranged from 1.72 to 3.62 days/week, fruits and vegetables intake between 3.97 to 6.15 days/week, probiotics less than .112 days/week and ranged from 1.121 to 2.752 days/week, ice cream drinks greater than .284 day/week, and holiday sleep time between 8.217 to 10.696 hours, were significantly positively e related to children BMI. (D), children's health status factors: wheezing or coughing caused by overactive exercise, visits to emergency department more than 2 times a year, and asthma related hospitalization during past one year was negatively correlated with BMI. Conclusion: This study indicates the proportion of overweight and obese asthma children is lower than the domestic health children, but according to the growth curve study among children and adolescents in Taiwan of Chen & Chang (2010), regardless of gender, the average BMI of asthma children are higher than the median. Asthma child weight problems still need our attention. The significant affecting factors to asthma children's body mass index confirmed in this study, will give reference to understand and prevent the asthma potential health risk for children. It is hoped to provide the valuable references of disease control and weight management for clinical health providers, school educators and health educators to help children and parents get insights of home-school environmental factors, to build a healthy lifestyle for children with asthma to effectively control their disease and to promote health status.