出生体重与抑郁-肥胖共病风险的关联研究

doi:10.11852/zgetbjzz2025-0388

摘要/Abstract

摘要： 目的分析出生体重与抑郁-肥胖共病风险的关联,为针对不同风险人群开展精准共病干预提供科学依据。方法基于中国家庭追踪调查,纳入2012年(本研究基线调查)和2016—2022年(随访调查)有抑郁肥胖数据、出生体重数据完整者,共纳入2 628名10~19岁的儿童青少年。抑郁症状定义为流调中心用抑郁量表评分≥17分。儿童青少年肥胖根据BMI Z评分标准判断;成年人肥胖根据BMI≥28.0kg/m²判定。抑郁症状和肥胖共病定义为有抑郁症状且肥胖。非共病进一步分为健康(无抑郁症状且不肥胖)、仅有抑郁症状(有抑郁症状但不肥胖)以及仅肥胖(肥胖但无抑郁症状)。采用多分类logistic回归模型分别分析出生体重作为连续变量和分类变量时与抑郁症状和肥胖共病风险的关联。根据年龄和性别进行分层分析。结果在出生体重<3kg的人群中,随着出生体重增加,仅有抑郁症状的风险降低(OR＝0.561, 95%CI: 0.356~0.885)。相比于正常出生体重,低出生体重人群仅有抑郁症状的风险增加(OR＝1.489, 95%CI: 1.068~2.075),巨大儿人群仅肥胖的风险增加(OR＝1.823, 95%CI: 1.122~2.963)。结论异常出生体重可能与儿童青少年抑郁、肥胖或抑郁-肥胖共病风险增加相关,提示将生命早期因素纳入共病风险干预有一定意义。

关键词: 出生体重, 抑郁症状, 肥胖, 共病, 关联

Abstract: Objective To analyze the association between birth weight and the comorbidity of depressive symptoms and obesity, so as to provide scientific evidence for future personalized interventions targeting different risk groups. Methods Based on the China Family Panel Studies, 2 628 children and adolescents aged 10 - 17 years with complete data on depressive symptom, obesity, and birth weight in both the baseline survey (2012) and follow-up surveys (2016-2022) were included.Depressive symptoms were defined as a score of ≥17 on the Center for Epidemiological Studies Depression Scale.Obesity in children and adolescents was determined by BMI Z-score criteria, while adult obesity was defined as BMI ≥ 28.0 kg/m².Comorbid depressive symptoms and obesity were defined as the presence of both depressive symptoms and obesity.Non-comorbid cases were further categorized into healthy (no depressive symptoms and not obese), depressive symptoms dominant (had depressive symptoms but not obese), and obesity dominant (obese but no depressive symptoms).Multinomial logistic regression models were used to analyze the associations between birth weight (both as a continuous and categorical variable) and the risk of comorbid depressive symptoms and obesity.Stratified analysis were conducted by age and gender. Results Among individuals with birth weight <3 kg, each 1-kg increase in birth weight was associated with a decreased risk of depressive symptoms dominant (OR＝0.561, 95%CI: 0.356 - 0.885).Compared with individuals with normal birth weight, individuals with low birth weight had an increased risk of depressive symptoms dominant (OR＝1.489, 95%CI: 1.068 - 2.075), while those with macrosomia had an increased risk of obesity dominant (OR＝1.823, 95%CI: 1.122 - 2.963). Conclusion Abnormal birth weight may be associated with an increased risk of depressive symptoms, obesity, or comorbid depressive symptoms and obesity in children and adolescents, highlighting the potential significance of incorporating early-life factors into future interventions for comorbidity risk.

Key words: birth weight, depressive symptoms, obesity, comorbidity, association

中图分类号:

R179

刘婧瑶, 陈敬, 杨洋, 杨奕航, 单蕊, 张晓蕊, 刘峥. 出生体重与抑郁-肥胖共病风险的关联研究[J]. 中国儿童保健杂志, 2025, 33(10): 1108-1113.

LIU Jingyao, CHEN Jing, YANG Yang, YANG Yihang, SHAN Rui, ZHANG Xiaorui, LIU Zheng. Association between birth weight and the comorbidity of depressive symptoms and obesity[J]. Chinese Journal of Child Health Care, 2025, 33(10): 1108-1113.

参考文献

[1] Dębski J, Przybyłowski J, Skibiak K, et al.Depression and obesity-do we know everything about it? A narrative review [J].Nutrients, 2024, 16(19).
[2] Chae WR, Schienkiewitz A, Du Y, et al.Comorbid depression and obesity among adults in Germany: Effects of age, sex, and socioeconomic status [J].J Affect Disord, 2022, 299: 383-392.
[3] Were JM, Hunter S, Patte KA, et al.Income inequality and comorbid overweight/obesity and depression among a large sample of Canadian secondary school students: The mediator effect of social cohesion [J].SSM Popul Health, 2024, 28: 101710.
[4] Khanolkar AR, Patalay P.Socioeconomic inequalities in co-morbidity of overweight, obesity and mental ill-health from adolescence to mid-adulthood in two national birth cohort studies [J].Lancet Reg Health Eur, 2021, 6: 100106.
[5] Gerardo G, Peterson N, Goodpaster K, et al.Depression and obesity [J].Curr Obes Rep, 2025, 14(1): 5.
[6] Cao B, Xu J, Li R, et al.Interventions targeting comorbid depression and overweight/obesity: A systematic review [J].J Affect Disord, 2022, 314: 222-232.
[7] Fu X, Wang Y, Zhao F, et al.Shared biological mechanisms of depression and obesity: Focus on adipokines and lipokines [J].Aging (Albany NY), 2023, 15(12): 5917-5950.
[8] Rao WW, Zong QQ, Zhang JW, et al.Obesity increases the risk of depression in children and adolescents: Results from a systematic review and meta-analysis [J].J Affect Disord, 2020, 267: 78-85.
[9] McLachlan C, Shelton R, Li L.Obesity, inflammation, and depression in adolescents [J].Front Psychiatry, 2023, 14: 1221709.
[10] Wadhwa PD, Buss C, Entringer S, et al.Developmental origins of health and disease: Brief history of the approach and current focus on epigenetic mechanisms [J].Semin Reprod Med, 2009, 27(5): 358-368.
[11] Shi J, Guo Q, Fang H, et al.The relationship between birth weight and the risk of overweight and obesity among Chinese children and adolescents aged 7-17 years [J].Nutrients, 2024, 16(5).
[12] Kumar D, Sharma S, Raina SK.Risk of childhood obesity in children with high birth weight in a rural cohort of northern India [J].Indian Pediatr, 2023, 60(1): 103-107.
[13] Xie Y, Hu J.An introduction to the china family panel studies (CFPS) [J].Chinese Sociological Review, 2014, 47(1): 3-29.
[14] 章婕, 吴振云, 方格, 等.流调中心抑郁量表全国城市常模的建立 [J].中国心理卫生杂志, 2010, 24(2): 139-143.
Zhang J, Wu ZY, Fang G, et al.Development of the national urban norm for the Center for Epidemiological Studies Depression Scale in China [J].Chin J Ment Health, 2010, 24(2): 139-143.(in Chinese)
[15] World Health Organization. Growth reference data for 5 - 19 years[EB/OL].[2024-01-15].http://www.who.in/growthref/en/.
[16] 中华人民共和国国家卫生和计划生育委员会.WS/T 586 —— 2018学龄儿童青少年超重与肥胖筛查[S].北京:中国标准出版社,2018.
National Health and Family Planning Commission of the People's Republic of China.WS/T 586—2018 Screening for overweight and obesity among school-age children and adolescents [S].Beijing: China Standards Press, 2018.(in Chinese)
[17] World Health Organization. WHO global nutrition targets 2025: Low birth weight policy brief [EB/0L].[2014-12-30].https://www.who.int/publications/i/item/WHO-NMH-NHD-14.5
[18] Dennedy MC, Dunne F.Macrosomia: Defining the problem worldwide [J].Lancet, 2013, 381(9865): 435-436.
[19] Walsh Ó, Nicholson AJ.Adolescent health [J].Clinics in Integrated Care, 2022, 14: 100123.
[20] Zou Z, Yang Z, Yang Z, et al.Association of high birth weight with overweight and obesity in Chinese students aged 6-18 years: A national, cross-sectional study in China [J].BMJ Open, 2019, 9(5): e024532.
[21] He X, Shao Z, Jing J, et al.Secular trends of birth weight and its associations with obesity and hypertension among Southern Chinese children and adolescents [J].J Pediatr Endocrinol Metab, 2022, 35(12): 1487-1496.
[22] Wojcik W, Lee W, Colman I, et al.Foetal origins of depression? A systematic review and meta-analysis of low birth weight and later depression [J].Psychol Med, 2013, 43(1): 1-12.
[23] Gale CR, Martyn CN.Birth weight and later risk of depression in a national birth cohort [J].Br J Psychiatry, 2004, 184: 28-33.
[24] Mathewson KJ, Brook CA, Saigal S, et al.Dynamic changes in postnatal growth predict adolescent mental health problems in survivors of extremely low birth weight (ELBW) [J].Dev Psychopathol, 2023: 1-17.
[25] Nakano Y.Adult-onset diseases in low birth weight infants: Association with adipose tissue maldevelopment [J].J Atheroscler Thromb, 2020, 27(5): 397-405.
[26] Ge MW, Shen LT, Attiq UR, et al.Internalizing and externalizing symptoms in children and adolescents born preterm or low birth weight: A meta-analysis [J].J Youth Adolesce, 2025.doi: 10.1007/s10964-025-02229-1.
[27] Yang Z, Dong B, Song Y, et al.Association between birth weight and risk of abdominal obesity in children and adolescents: A school-based epidemiology survey in China [J].BMC Public Health, 2020, 20(1): 1686.
[28] Jelenkovic A, Yokoyama Y, Sund R, et al.Association between birthweight and later body mass index: An individual-based pooled analysis of 27 twin cohorts participating in the CODATwins project [J].Int J Epidemiol, 2017, 46(5): 1488-1498.
[29] Amadou C, Ancel PY, Zeitlin J, et al.Long-term health in individuals born preterm or with low birth weight: A cohort study [J].Pediatr Res, 2025, 97(2): 577-585.
[30] Puhl RM, Lessard LM, Pearl RL, et al.International comparisons of weight stigma: Addressing a void in the field [J].Int J Obes, 2021, 45(9): 1976-1985.
[31] Warnick JL, Darling KE, West CE, et al.Weight stigma and mental health in youth: A systematic review and meta-analysis [J].J Pediatr Psychol, 2021, 47(3): 237-255.
[32] Warnick JL, Darling KE, West CE, et al.Weight stigma and mental health in youth: A systematic review and meta-analysis [J].J Psychiatry Psychol, 2022, 47(3): 237-255.
[33] Glover V, O'Connor TG, O'Donnell K.Prenatal stress and the programming of the HPA axis [J].Neurosci Biobehav Rev, 2010, 35(1): 17-22.
[34] Nist MD, Shoben AB, Pickler RH.Early inflammatory measures and neurodevelopmental outcomes in preterm infants [J].Nurs Res, 2020, 69(5S Suppl 1): 11-20.
[35] Moreno-Galarraga L, Álvarez-Zallo N, Oliver-Olid A, et al.Parent-reported birth information: birth weight, birth length and gestational age.Validation study in the SENDO project [J].Gac Sanit, 2021, 35(3): 224-229.
[36] Roystonn K, Abdin E, Sambasivam R, et al.Accuracy of self-reported height, weight and BMI in a multiethnic Asian population [J].Ann Acad Med Singap, 2021, 50(4): 306-314.
[37] Park SH, Yu HY.How useful is the center for epidemiologic studies depression scale in screening for depression in adults? An updated systematic review and meta-analysis [J].Psych Res, 2021, 302: 114037.
[38] Park SH, Kwon YM.Can the Center for Epidemiologic Studies Depression Scale be used to screen for depression in children and adolescents? An updated systematic review [J].Child Psychiatry Hum Dev, 2025, 56(2): 277-287.