苏州市学龄前儿童超重与肥胖流行现况及影响因素

doi:10.11852/zgetbjzz2023-0632

摘要/Abstract

摘要： 目的了解苏州市学龄前儿童超重与肥胖的流行现况,分析儿童肥胖的影响因素。方法采用分层整群随机抽样的方法,于2021年12月—2022年6月抽取苏州市各区域共24 452名3～6岁儿童进行体格测量,分析超重与肥胖检出率。采用病例对照研究问卷调查3 786例(肥胖组与对照组各1 893例)儿童的基本信息、饮食、运动、睡眠等情况,分析学龄前儿童肥胖的影响因素。结果 1)苏州市学龄前儿童超重总检出率为14.8%(男14.6%、女15.0%);肥胖总检出率为7.9%(男8.7%、女7.1%),男女肥胖检出率差异有统计学意义(χ²=19.828,P<0.01)。2)各年龄组肥胖检出率差异有统计学意义(χ²=98.415,P<0.01),3~<4岁组最低(5.8%),6~<7岁组最高(11.8%)。3)轻度、中度、重度肥胖总检出率分别为4.8%、2.6%、0.5%。在各年龄组中,中重度肥胖构成比随年龄增长而显著增加(χ²=57.275,P<0.05)。4)出生体重>4 000g、剖宫产、父母超重/肥胖、儿童食欲旺盛、吃饭速度快(<10min/正餐)、油炸食物频率高(>1周/次)、看电视就餐、喜好静坐(>2h/d)、运动耐力不足、屏幕暴露时间长(>1h/d)、睡觉时间晚(21∶30后)是学龄前儿童肥胖的危险因素(P<0.05);早餐食量最大、蔬果作为常吃零食、饭后活动是学龄前儿童肥胖的保护因素(P<0.05)。5)学龄前儿童肥胖程度的影响因素:父亲超重(OR=1.33,95%CI:1.06~1.65)、父亲肥胖(OR=1.91,95%CI:1.46~2.49)、母亲超重(OR=1.25,95%CI:1.01~1.54)、母亲肥胖(OR=1.94,95%CI:1.40~2.69)、父亲学历低(初中及以下)(OR=1.57,95%CI:1.25~1.96)、儿童食欲旺盛(OR=1.72,95%CI:1.41~2.11)、吃饭速度快(<10min/正餐)(OR=1.29,95%CI:1.05~1.57)、喜好静坐(静坐>2h/d)(OR=1.51,95%CI:1.24~1.85)、运动耐力不足(OR=1.56,95%CI:1.12~2.19)、屏幕暴露时间长(>1h/d)(OR=1.42,95%CI:1.16~1.75)。结论苏州市学龄前儿童超重与肥胖检出率较高,肥胖检出率与严重程度均随着儿童年龄增长而增加。除了遗传因素外,学龄前儿童肥胖还与孕产史及出生后不良的生活方式相关。

关键词: 学龄前儿童, 超重, 肥胖, 流行病学

Abstract: Objective To investigate the prevalence and influencing factors of overweight and obesity among preschool children in Suzhou. Methods A stratified cluster random sampling method was used to select 24 452 children aged 3 - 6 years in different districts of Suzhou from December 2021 to June 2022. Then the prevalence rate of overweight and obesity was determined by physical measurements. A case-control study was conducted with a questionnaire survey of 3 786 children(1 893 in the obesity group and 1 893 in the control group) to analyze the factors influencing preschool obesity. Results 1) The overall detection rates of overweight among preschool children in Suzhou was 14.8%(boys 14.6%, girls 15.0%). The overall detection rates of obesity was 7.9%(boys 8.7%, girls 7.1%), with a statistically significant difference between boys and girls(χ²=19.828, P<0.01). 2) There was statistically significant difference in the detection rates of obesity among different age groups(χ²=98.415, P<0.01), with the lowest rate in the 3 - 4 years old group(5.8%) and the highest rate in the 6 - 7 years old group(11.8%). 3) The overall detection rates of mild, moderate and severe obesity was 4.8%, 2.6% and 0.5%, respectively. The proportion of moderate and severe obesity significantly increased with age(χ²=57.275,P<0.01). 4) Risk factors for preschool obesity included birth weight >4 000g, cesarean section, parental overweight/obesity, strong appetite of children, eating speed <10min/meal, high frequency of fried food consumption(>1time/week), eating while watching television, sedentary behavior >2h/d, insufficient exercise endurance, screen time >1h/d, and late bedtime(after 21∶30)(P<0.05). Protective factors for preschool obesity included larger breakfast consumption, fruits and vegetables as regular snacks, and physical activity after meals(P<0.05). 5) Factors influencing the degree of preschool obesity included paternal overweight(OR=1.33, 95%CI:1.06 - 1.65), paternal obesity(OR=1.91, 95%CI:1.46 - 2.49), maternal overweight(OR=1.25, 95%CI:1.01 - 1.54), maternal obesity(OR=1.94, 95%CI:1.40 - 2.69), low education level of father(junior high school or below)(OR=1.57, 95%CI:1.25 - 1.96), strong appetite of children(OR=1.72, 95%CI:1.41 - 2.11), eating speed <10min/meal(OR=1.29, 95%CI:1.05 - 1.57), sedentary behavior >2h/d(OR=1.51, 95%CI:1.24 - 1.85), insufficient exercise endurance(OR=1.56, 95%CI:1.12 - 2.19), and screen time>1h/d(OR=1.42, 95%CI:1.16 - 1.75). Conclusions The detection rates of overweight and obesity among preschool children in Suzhou are relatively high, and the detection rate and severity of obesity increase with age. In addition to genetic factors, preschool obesity are also associated with pregnancy and birth history, as well as unhealthy lifestyle after birth.

Key words: preschool children, overweight, obesity, epidemiology

中图分类号:

R723.14

邓莎莎, 孟玉梅, 孙榕伯, 沈玲玲, 孔锐. 苏州市学龄前儿童超重与肥胖流行现况及影响因素[J]. 中国儿童保健杂志, 2024, 32(4): 389-394.

DENG Shasha, MENG Yumei, SUN Rongbo, SHEN Lingling, KONG Rui. Epidemiological survey and influencing factors of overweight and obesity among preschool children in Suzhou[J]. Chinese Journal of Child Health Care, 2024, 32(4): 389-394.

参考文献

[1] World Health Organization. Obesity and overweight [DB/OL]. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight, 2021-06-09.
[2] 首都儿科研究所,九市儿童体格发育调查协作组.2016年中国九城市七岁以下儿童单纯性肥胖流行病学调查[J].中华儿科杂志,2018,56(10):745-752.
Capital Institute of Pediatrics, The Coordinating Study Group of Nine Cities on the Physical Growth and Development of Children. A national epidemiological survey on obesity of children under seven years of age in nine cities of China in 2016[J]. Chin J Pediatr, 2018, 56(10):745-752.(in Chinese)
[3] 国家卫生健康委办公厅,教育部办公厅,市场监管总局办公厅,等.儿童青少年肥胖防控实施方案[EB/OL]. [2020-10-16]. https://www.gov.cn/zhengce/zhengceku/2020-10/24/content_5553848.htm.
[4] 江载芳,申昆玲,沈颖.诸福棠实用儿科学[M].8版.北京:人民卫生出版社,2015:595.
Jiang ZF, Shen KL, Shen Y. ZHUFUTANG practical pediatrics [M]. 8th ed. Beijing: People's Medical Publishing House, 2015:595.(in Chinese)
[5] 李国波. 福建省学龄前儿童超重肥胖流行现状及其与环状RNA的关联研究[D]. 福州:福建医科大学, 2021.
Li GB. The prevalence of overweight and obesity in preschoolers in Fujian province and its association with CircRNAs[D]. Fujian Medical University, 2021.(in Chinese)
[6] 殷刚柱, 李卫东, 郭锋, 等. 合肥市城区学龄前儿童超重和肥胖的流行病学调查及影响因素分析[J]. 安徽医学, 2020,41(8): 960-964.
Yin GZ, Li WD, Guo F, et al. Epidemiological investigation and influencing factors of overweight andobesity among preschool children in Hefei city[J]. Anhui Medical Journal, 2020,41(8): 960-964.(in Chinese)
[7] 黄婉平, 陈甘讷, 韦荣忠, 等. 广州花都3 373名学龄前儿童单纯性肥胖现状及影响因素分析[J]. 中国儿童保健杂志, 2018,26(1): 67-70.
Huang WP, Chen GN, Wei RZ, et al. Prevalence and risk factors of simple obesity in 3 373 preschool children in Huadu District, Guangzho[J]. Chin J Child Health Care, 2018,26(1): 67-70.(in Chinese)
[8] 乔毅娟, 张涛, 刘恩庆, 等. 天津市255 172名3～6岁幼儿园儿童体格发育情况[J]. 中国慢性病预防与控制, 2020,28(6): 423-427.
Qiao YJ, Zhang T, Liu EQ, et al. Analysis on the physical development of 255 172 children(3-6 years old) in kindergartens of Tianjin[J]. Chin J Prev Contr Chron Dis, 2020,28(6): 423-427.(in Chinese)
[9] 戎芬, 黄品贤, 宋花玲, 等. 上海市学龄前儿童超重肥胖现况及影响因素分析[J].数理医药学杂志, 2018,31(1): 51-54.
Rong F, Huang PX, Song HL, et al. Investigation and study on influencingfactors of overweight and obesity in preschool children in Shanghai[J]. Journal of Mathematical Medicine, 2018,31(1): 51-54.(in Chinese)
[10] 李少闻, 王思思, 雷晓梅, 等. 西安市城区2013年0～6岁儿童超重肥胖流行病学调查[J]. 中国学校卫生, 2016,37(9): 1380-1382.
Li SW, Wang SS, Lei XM, et al. Epidemiological study of overweight / obesity among children of 0-6 years old in Xi'an urban area in 2013[J]. Chin J Sch Health, 2016,37(9): 1380-1382.(in Chinese)
[11] 刘彦琦, 赵卫平, 孙艳宏. 呼和浩特地区学龄前儿童肥胖现状及危险因素分析[J]. 中国儿童保健杂志, 2015,23(4): 385-387.
Liu YQ, Zhao WP, Sun YH. Situation and risk factors analysis of preschoolers obesity in Hohhot[J]. Chin J Child Health Care, 2015,23(4): 385-387.(in Chinese)
[12] 秦剑杰, 张璇, 毕鑫, 等. 河北省3～6岁幼儿肥胖流行特征及相关因素分析[J]. 中国学校卫生, 2022,43(12): 1881-1884.
Qin JJ, Zhang X, Bi X, et al. Prevalence and associated factor of obesity in children aged 3-6 years in Hebei Province[J]. Chin J Sch Health, 2022,43(12): 1881-1884.(in Chinese)
[13] 刘艳芳.沈阳市学龄前儿童肥胖情况调查及影响因素分析[J].海峡预防医学杂志,2021,27(4):16-18.
Liu YF. Epidemiological survey and influencing factors analysis of obesity on preschool children in Suzhou[J]. Strai J Prev Med, 2021,27(4):16-18.(in Chinese)
[14] 周萍, 张春梅. 苏州市区学龄前儿童肥胖检出率及原因分析[J]. 护理研究, 2015,29(23): 2868-2869.
Zhou P, Zhang CM. Detection rate and causative analysis of obesity in preschool children in urban in Suzhou[J]. Chinese Nursing Research, 2015,29(23): 2868-2869.(in Chinese)
[15] Geserick M, Vogel M, Gausche R, et al. Acceleration of BMI in early childhood and risk of sustained obesity[J]. New Eng J Med, 2018, 379(14): 1303-1312.
[16] Gato-Moreno M, Martos-Lirio MF, Leiva-Gea I, et al. Early nutritional education in the prevention of childhood obesity[J]. Int J Environ Res Pub Health, 2021, 18(12): 6569.
[17] Novelli G, Cassadonte C, Sbraccia P, et al. Genetics: A starting point for the prevention and the treatment of obesity[J]. Nutrients, 2023, 15(12): 2782.
[18] Silventoinen K, Konttinen H. Obesity and eating behavior from the perspective of twin and genetic research[J]. NeurosciBiobehav R, 2020, 109: 150-165.
[19] Wang Z, Emmerich A, Pillon NJ, et al. Genome-wide association analyses of physical activity and sedentary behavior provide insights into underlying mechanisms and roles in disease prevention[J]. Nat Genet, 2022,54(9): 1332-1344.