兒童多重飲食行為軌跡與其睡眠時數之關係

Abstract

背景：充足的睡眠對兒童身體發育、認知功能和心理健康至關重要。然而，臺灣兒童及青少年在課業壓力、生活環境與心理健康等多重因素交互作用下，睡眠不足的情況日益嚴重。雖然部分研究指出，飲食調整可能有助於改善睡眠情形，但目前多數仍為橫斷性研究，較無法反映其長期影響。 目的：本研究參考國民健康署公布之每日飲食指南食物類別，探討五穀根莖類、蔬果類、乳品類及高熱量加工食品類（漢堡/披薩/炸雞、糖果/餅乾/蛋糕）等四類食物於兒童五至十二歲期間攝取頻率的聯合軌跡變化，並分析不同多重飲食行為軌跡和其十二歲時睡眠時數的相關性。 研究方法：本研究使用「臺灣出生世代研究」的長期追蹤調查資料進行分析。資料涵蓋第四波（2010年，樣本個案五歲）、第六波（2013年，樣本個案八歲）、第八波（2017年，樣本個案十二歲）健康照護需求調查中的主要照顧者問卷資料，以及第八波（2017年，十二歲）兒童自填問卷資料。首先，採用群體基礎多重軌跡模型（Group-based multi-trajectory modeling，簡稱 GBMTM）分析飲食行為的聯合軌跡。後續透過多元線性迴歸（Multiple linear regression）檢驗不同軌跡類別與睡眠時數的關聯。 結果：兒童的多重飲食行為軌跡可區分為三類，分別是飲食均衡組 (36.61%)、不健康飲食組 (33.16%) 及蔬果乳品缺乏組 (30.23%)。多元線性迴歸結果顯示，控制其他相關因素後，相較於不健康飲食組，飲食均衡組（參數估計值= 0.05，95%信賴區間= 0.03, 0.07）與蔬果乳品缺乏組（參數估計值= 0.03，95%信賴區間= 0.01, 0.05）的兒童睡眠時數均較長。 結論：兒童長期的飲食行為與其日後的睡眠時數存在顯著關聯，其中健康飲食（即較高頻率的蔬果與乳品攝取，搭配較低頻率的高熱量加工食品攝取），最有益睡眠時數的延長；相反地，不健康飲食對睡眠時數可能產生較多的負面影響。

Background: Adequate sleep is crucial for the physical development, cognitive functioning, and psychological health of children and adolescents. However, due to the combined influence of multiple factors such as academic pressure, living environment, and mental health, insufficient sleep among children and adolescents in Taiwan has become increasingly prevalent. Although some studies have suggested that dietary adjustments may contribute to improved sleep, most existing research remains cross-sectional and limited in its ability to capture long-term effects. Aim: This study drawn on the six major food groups outlined in the Dietary Guidelines published by the Health Promotion Administration and focuses on four specific categories: grains and root crops, vegetables, fruits, and dairy products, along with high-calorie processed foods (e.g., hamburgers, pizza, fried chicken, candies, cookies, and cakes). It examines the joint developmental trajectories of eating behaviors across these four food categories among children from ages 5 to 12 years and analyzes their associations with sleep duration at age 12. Method: This study utilized longitudinal data from the Taiwan Birth Cohort Study (TBCS), specifically from the fourth wave (2010, when participants were 5 years old), the sixth wave (2013, 8 years old), and the eighth wave (2017, 12 years old) health care needs surveys, which were completed by the primary caregivers. In addition, self-reported questionnaire data collected from children at age 12 (eighth wave) were included. Based on these data, Group-Based Multi-Trajectory Modeling (GBMTM) was first used to analyze the joint trajectories of eating behaviors, followed by multiple linear regression analysis to examine associations between trajectory group membership and sleep duration at age 12. Result: Three joint eating behavior trajectories were identified: the balanced diet group (36.61%), the unhealthy diet group (33.16%), and the low fruit, vegetable, and dairy intake group (30.23%). Results from the multiple linear regression analysis showed that, after controlling for covariates, children in the “balanced diet group” (β = 0.05, 95% CI = 0.03, 0.07) and the “low fruit, vegetable, and dairy intake group” (β = 0.03, 95% CI = 0.01, 0.05) had longer sleep duration compared to those in the “unhealthy diet group.” Conclusion: These findings suggest that children’s developmental trajectories of eating behaviors are significantly associated with their subsequent sleep duration. A healthy dietary pattern, characterized by frequent consumption of fruits, vegetables, and dairy products and limited intake of high-calorie processed foods, appears most beneficial for promoting adequate sleep. In contrast, unhealthy dietary patterns may have more detrimental effects on sleep duration.