中国9个城市学龄前儿童单纯性肥胖的影响因素研究

宗心南; 李辉; 张亚钦; 九市儿童体格发育调查协作组

Abstract

宗心南,李辉,张亚钦,九市儿童体格发育调查协作组.中国9个城市学龄前儿童单纯性肥胖的影响因素研究[J].Chinese journal of Epidemiology,2022,43(1):50-57

中国9个城市学龄前儿童单纯性肥胖的影响因素研究

Risk factors of simple obesity in preschool children in nine cities of China

Received:April 07, 2021

DOI：10.3760/cma.j.cn112338-20210407-00284

KeyWord: 肥胖儿童危险因素流行病学研究

English Key Word: Obesity Child Risk factor Epidemiologic study

FundProject:国家卫生健康委员会委托项目（2015-42）

Author Name	Affiliation	E-mail
Zong Xinnan	Department of Growth and Development, Capital Institute of Pediatrics, Beijing 100020, China
Li Hui	Department of Growth and Development, Capital Institute of Pediatrics, Beijing 100020, China	huiligrowth@163.com
Zhang Yaqin	Department of Growth and Development, Capital Institute of Pediatrics, Beijing 100020, China
The Coordinating Study Group on the Physical Growth and Development of Children of Nine Cities	Department of Growth and Development, Capital Institute of Pediatrics, Beijing 100020, China

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Abstract:

目的分析我国学龄前儿童单纯性肥胖的影响因素及其交互作用。方法采用整群随机抽样方法，于2016年6-11月调查北京、哈尔滨、西安、上海、南京、武汉、广州、福州、昆明9个城市3~7岁儿童63 292名。基于中国2~18岁儿童青少年超重和肥胖筛查BMI界值点筛检出肥胖儿童1 522名（男童1 006名、女童516名），采用病例对照研究方法，按“同性别、年龄相差≤6个月、身高相差≤5 cm”随机选择同一调查区域内体重正常儿童与肥胖儿童进行配对。影响因素及交互作用分析采用条件logistic回归模型。结果 ① 单因素条件logistic回归模型筛选出17个肥胖影响因素有统计学意义（P < 0.001），包括出生体重≥4.0 kg、剖宫产、妊娠期糖尿病、妊娠期高血压、出生后前6个月人工喂养、食欲强、进食速度快或慢、户外活动强度较低、每日户外活动时间 < 1 h、每日视屏时间 < 1 h或≥2 h、每日夜间睡眠时间 < 9 h、母亲超重、父亲超重、母亲文化程度高中及以下、父亲文化程度高中及以下、非核心家庭、孩子日常生活主要照护人为（外）祖父母和/或保姆。②多因素条件logistic回归模型筛选出12个影响因素有统计学意义，包括出生体重≥4.0 kg（OR=1.83，95%CI：1.29~2.61，P < 0.001）、剖宫产（OR=1.22，95%CI：1.07~1.39，P=0.003）、妊娠期糖尿病（OR=4.57，95%CI：2.13~9.79，P < 0.001）、母亲文化程度高中及以下（OR=1.52，95%CI：1.11~2.07，P=0.008）、单亲家庭（OR=4.79，95%CI：1.44~15.88，P=0.010）、母亲超重（OR=2.58，95%CI：1.93~3.46，P < 0.001）、父亲超重（OR=2.40，95%CI：1.86~3.10，P < 0.001）、食欲强（OR=7.78，95%CI：5.38~11.27，P < 0.001）、进食速度快（OR=6.59，95%CI：4.86~8.94，P < 0.001）、每日户外活动时间 < 1 h（OR=1.42，95%CI：1.09~1.85，P=0.009）、每日夜间睡眠时间 < 9 h（OR=1.59，95%CI：1.13~2.23，P=0.007）、每日视屏时间≥2 h（OR=1.69，95%CI：1.27~2.24，P < 0.001）。③交互作用分析显示4组影响因素之间存在较强交互作用，包括母亲超重和父亲超重（OR=5.53，95%CI：3.76~8.13，P < 0.001）、食欲强和进食速度快（OR=54.48，95%CI：32.95~90.06，P < 0.001）、户外活动强度较低和每日户外活动时间 < 1 h（OR=2.12，95%CI：1.29~3.48，P=0.002）、每日夜间睡眠时间 < 9 h和每日视屏时间≥2 h（OR=2.83，95%CI：1.71~4.68，P < 0.001）。结论筛选出12个肥胖影响因素，包括高出生体重、剖宫产、妊娠期糖尿病、母亲文化程度较低、单亲家庭、母亲超重、父亲超重、食欲强、进食速度快、每日户外活动时间较短、每日夜间睡眠时间较短、每日视屏时间过长，其中母亲超重与父亲超重、食欲强与进食速度快、户外活动强度较低与每日户外活动时间较短、每日夜间睡眠时间较短与每日视屏时间过长存在交互作用。

English Abstract:

Objective To examine risk factors of simple obesity and their interaction in preschool children in China.Methods A total of 63 292 preschool children aged 3-7 years selected by cluster random sampling in 9 cities of China, including Beijing, Harbin, Xi'an, Shanghai, Nanjing, Wuhan, Guangzhou, Fuzhou and Kunming, were investigated from June to November in 2016. Based on the BMI-for-age cut off points of overweight and obesity for Chinese children aged 2-18 years, a total of 1 522 obese children (1 006 boys and 516 girls) were screened. By population-based matched case-control design, a normal weight child was randomly selected to match with an obese child by sex, age (difference ≤6 months) and body height (difference ≤5 cm) from the survey area. Conditional logistic regression model was used to analyze association of risk factors with obesity and the interaction of risk factors.Results ① Univariate conditional logistic regression model showed that 17 risk factors of simple obesity had statistical significance (P < 0.001), including high birth weight, cesarean section, gestational diabetes, gestational hypertension, formula feeding in the first 6 months after birth, strong appetite, fast or slow eating speed, low intensity of outdoor activities, daily outdoor activity time < 1 hour, daily screen viewing time < 1 hour or ≥2 hours, daily night sleep time < 9 hours, mother overweight, father overweight, mother's low educational level, father's low educational level, non-nuclear family structure, and parents not being the primary caregivers of children. ②Multivariate conditional logistic regression model showed that 12 risk factors had statistical significance, including high birth weight (OR=1.83, 95%CI: 1.29-2.61, P < 0.001), cesarean section (OR=1.22, 95%CI: 1.07-1.39, P=0.003), gestational diabetes (OR=4.57, 95%CI: 2.13-9.79, P < 0.001), mother's low educational level (OR=1.52, 95%CI: 1.11-2.07, P=0.008), single parent family (OR=4.79, 95%CI: 1.44-15.88, P=0.010), mother overweight (OR=2.58, 95%CI: 1.93-3.46, P < 0.001), father overweight (OR=2.40, 95%CI: 1.86-3.10, P < 0.001), strong appetite (OR=7.78, 95%CI: 5.38-11.27, P < 0.001), fast eating speed (OR=6.59, 95%CI: 4.86-8.94, P < 0.001), daily outdoor activity time < 1 hour (OR=1.42, 95%CI: 1.09-1.85, P=0.009), daily night sleep time < 9 hours (OR=1.59, 95%CI: 1.13-2.23, P=0.007), daily screen viewing time ≥2 hours (OR=1.69, 95%CI: 1.27-2.24, P < 0.001). ③ Interaction of the four groups of risk factors had statistical significance, including interaction between mother overweight and father overweight (OR=5.53, 95%CI: 3.76-8.13, P < 0.001), interaction between strong appetite and fast eating speed (OR=54.48, 95%CI: 32.95-90.06, P < 0.001), interaction between low intensity of outdoor activity and daily outdoor activity time < 1 hour (OR=2.12, 95%CI: 1.29-3.48, P=0.002), interaction between daily night sleep time < 9 hours and daily screen viewing time ≥2 hours (OR=2.83, 95%CI: 1.71-4.68, P < 0.001).Conclusions This study identified 12 risk factors of childhood obesity, including high birth weight, cesarean section, gestational diabetes, mother's low educational level, single parent family, mother overweight, father overweight, strong appetite, fast eating speed, daily short outdoor activity time, daily short night sleep time, daily long screen viewing time, and interaction of the four groups of risk factors had statistical significance, including strong interaction between mother overweight and father overweight, interaction between strong appetite and fast eating speed, interaction between low intensity of outdoor activity and daily short outdoor activity time, interaction between daily short night sleep time and daily long screen viewing time.

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