經濟弱勢兒童之多重飲食行為軌跡：以早餐、蔬果及零食飲料為例

Multiple dietary behavior trajectories among economically disadvantaged children: an example of breakfast, fruits and vegetables, and snacks and beverages

目標：兒童時期的飲食行為對未來健康有著深遠影響。目前多數證據侷限於一般兒童與單一種飲食行為，本研究旨在探討經濟弱勢兒童由吃早餐、蔬果及零食飲料構成的多重飲食行為軌跡及其相關因素。方法：使用「台灣貧窮兒少資料庫：弱勢兒少生活趨勢調查」2009年、2011年與2013年部分資料，樣本共計1,001位國小學童（女生佔50.25%；初始平均年齡為9.07歲）。群體基礎多重軌跡模型和多類別邏輯斯迴歸為主要分析方法。結果：辨識出三種多重飲食行為軌跡，包含「飲食長期規律組」（21.28%），近乎每日吃早餐與蔬果但吃蔬果的頻率從第一時點至第三時點明顯減少；「早餐蔬果長期不規律組」（77.62%），吃早餐的頻率在所有時點皆為最低且有不規律吃蔬果的情況；以及「蔬果長期缺乏組」（1.10%），吃蔬果的頻率在所有時點皆為每週一天或以下。所有組別的零食飲料行為軌跡相似。年齡越大與雙親教育程度越低，不健康飲食行為的可能性越高。結論：吃早餐、蔬果及零食飲料行為之間的關係並非簡單的線性關係，且其發展具有異質性。此次發現的相關因素有限，未來研究應持續探討並剖析不同軌跡之影響機制。

Objectives: Dietary behaviors in childhood have a great influence on future health. Currently, most of the evidence has been focused on non-economically disadvantaged children and single dietary behaviors. The aim of this study was to explore multiple dietary behavior trajectories of breakfast, fruits and vegetables, and snacks and beverages, and associated factors. Methods: The partial data for this study were obtained from the Taiwan Database of Children and Youth in Poverty in 2009, 2011, and 2013, with a total sample size of 1001 elementary school children (50.25% girls and 49.75% boys; mean age at baseline = 9.07 [standard deviation = 1.24] years). Group-based multi-trajectory modeling and multinomial logistic regression were the main analytic methods. Results: Three multiple dietary behavior trajectories were identified, as follows: (1) the “regular eating” group (21.28%) with most children eating breakfast and fruits and vegetables daily, but the frequency of eating fruits and vegetables decreased significantly from time 1 to time 3; (2) the “irregular breakfast and fruits and vegetables eating” group (77.62%) with the lowest frequencies of eating breakfast at all time points and having an irregular pattern of eating fruits and vegetables; and (3) the “lack of fruits and vegetables” group (1.10%), in which children ate fruits and vegetables 1 day or less per week at all time points. There were similar trajectories of eating snacks and consuming beverages in all groups. Older age and parents with lower levels of education were associated with higher probabilities of unhealthy eating behaviors. Conclusions: The associations between eating breakfast, fruit and vegetable intake, and snack and beverage consumption were not as simple as linear relationships, with heterogeneity in the development of these dietary behaviors. Other potential factors were only minimally noted in our study. Future research should explore associated factors and mechanisms of different multiple dietary behavior trajectories.