中国成人肥胖十年变化及对死亡影响的研究

发布时间：2018-01-13 20:25

本文关键词：中国成人肥胖十年变化及对死亡影响的研究　出处：《中国疾病预防控制中心》2017年博士论文　论文类型：学位论文

【摘要】：研究背景与目的2013全球疾病负担研究表明高BMI造成了440万人死亡。肥胖不仅是一种独立的疾病和多种慢性病的重要危险因素,还会引发健康不公平,已成为世界各国最为关切的综合性社会问题之一。本研究采用系统和综合评价指标,全面分析2002～2012年我国人群肥胖流行状况、肥胖不平等程度及变化趋势;探讨肥胖与死亡的关系;为我国制订肥胖防控策略,有的放矢地开展人群肥胖干预,提高人群期望寿命与促进健康公平提供理论依据和支撑。研究内容与方法利用最具国家代表性、人群及地区特征的2002和2012年中国居民营养与健康状况调查数据,对141141和119694名18岁及以上调查对象的信息进行分析,内容包括问卷调查法收集的人口学基本特征、吸烟、饮酒等信息;采用标准方法和统一型号的器材测量的身高、体重、腰围,并计算体质指数(BMI)、腰围身高比(WHtR);空腹静脉血检测得到的血清甘油三酯等生化指标。依据中华人民共和国卫生行业标准《成人体重判定》判断全身性肥胖(24kg/m2≤BMI≤28kg/m2为超重,BMI≥28kg/m2为肥胖)和中心型肥胖(男性腰围≥90cm;女性≥85cm);以WHtR≥0.50判定腰围身高比超标;依据美国国家胆固醇教育计划ATPIII亚洲人标准判定高甘油三酯腰围表型(HTGW)。计算不同亚组中国成人体重、腰围和BMI均值和标准误;全身性肥胖、中心型肥胖、WHtR≥0.50、HTGW流行率和95%置信区间,及其绝对和相对变化。采用国际公认的方法,计算率比和不平等相对指数评价社会经济地位相关的肥胖不平等程度。对2012年数据采用复杂抽样加权处理,所有数据采用2009年国家统计局公布的人口数据进行标化。两个年代数据的绝对变化比较采用合并t检验。以2002年中国居民营养与健康状况调查山西省数据为基线,于2015年12月至2016年3月对研究对象进行死因回顾调查及随访,其中年龄、性别、身高、体重、腰围等基线信息完整者7007人,随访到5360人,随访率为76.5%。将研究对象按BMI、腰围和WHtR分别分为8组,计算分组死亡率,以最低组作为参照,采用Cox比例风险回归模型估计全人群、分性别、年龄(≥60岁、60岁)的各组死亡相对风险及95%置信区间,模型调整基线年龄、性别、吸烟、饮酒、文化程度等因素。通过剔除现在吸烟者、意外原因死亡者、随访第一年内死亡者,随访时间不满3年者进行敏感性分析。所有数据采用SAS 9.3软件进行清理与统计分析,双侧检验,显著性水平为P0.05。研究结果1.2002～2012年,我国成年男性体重、腰围和BMI均值分别增长2.1 kg、2.7 cm和0.6 kg/m2;成年女性分别增长1.1 kg、2.1 cm和0.3 kg/m2。发现60岁以上的城市男性和50岁以上的城市女性三项指标有不同程度的下降。农村居民三项指标的增幅是城市居民的3倍以上,三项指标的增幅为腰围体重BMI。2.2012年,中国成人超重率、肥胖率、中心型肥胖率、WHtR≥0.5流行率和HTGW流行率分别为30.0%、11.8%、25.7%、48.4%和13.1%。与2002年相比,各型肥胖呈明显上升趋势,中心型肥胖增长快于全身性肥胖。农村居民各型肥胖增速高于城市;18～49岁人群各型肥胖增长高于其他年龄组,60岁及以上老年人的全身性肥胖率基本稳定,城市女性的全身性肥胖率出现下降。3.社会经济地位与肥胖的关系存在明显性别差异。男性社会经济地位越高,体重、腰围和BMI均值及各型肥胖率越高;女性则相反。十年间,低文化、低收入和以体力劳动为主的人群中各型肥胖率上升幅度最大;社会经济地位相关的肥胖不平等程度在男性有所缩小,女性则在扩大,低文化和低收入女性更容易受到肥胖危害。4.研究共随访94606.4人年,平均随访12.7年,死亡615人,队列总死亡率为650.0/10万人年。以BMI 26.0-27.9 kg/m2组为参照,调整多因素后,BMI18.5、18.5-19.9、22.0-23.9 和≥30.0kg/m2组的死亡风险明显升高,RR值和95%CI分别为1.90(1.26-2.86)、1.68(1.15-2.45)、1.49(1.08-2.06)和 1.72(1.07-2.76)。以 90 cm≤男性腰围95 cm,85 cm≤女性90 cm为参照,多因素(包括BMI)调整后,男性腰围≥100 cm和女性≥95 cm组的死亡风险明显升高,为1.85(1.11-3.08)。WHtR各组的死亡风险与参照组(0.47-0.49)相比,差异无统计学意义。对于60岁及以上老年人,低体重(BMI18.5kg/m2)和高腰围(男性≥100cm和女性≥95 cm)组的死亡风险明显升高,分别为1.94(1.20-3.15)和 2.07(1.08-3.96)。结论2002～2012年,我国人群各型肥胖率持续增长,不同亚组人群的流行特征存在明显差异。农村人群,特别是农村男性,以及低社会经济地位人群应作为肥胖防控的重点人群;同时应重视老年人低体重营养不良造成的高死亡风险。我国人群中心型肥胖增长更为显著,腰围具有独立于BMI的死亡预测作用,应将腰围作为与BMI同等重要的肥胖简易快速筛查指标和死亡风险预测指标,在人群中推广应用。应将人人保持健康体重作为重要的公共卫生策略,并实施多层次的健康体重及社会决定因素干预活动,以防控慢性病、降低早死,促进健康公平。
[Abstract]:Background and objective 2013 of the global burden of disease study showed that high BMI caused 4 million 400 thousand deaths. Obesity is not only an important risk independent of disease and chronic disease factors, but also lead to the inequity of health, has become the world's most comprehensive social concern one. This study used and the comprehensive evaluation index system from 2002 to 2012, a comprehensive analysis of China's population prevalence of obesity, obesity and inequality trends; on obesity and mortality; obesity prevention and control strategy of making our country, to carry out targeted obesity intervention, improve life expectancy and promote health equity and provide a theoretical basis and support. The research contents and methods using the most on behalf of the state, characteristics of population and regions in 2002 and 2012 Chinese nutrition and health survey data of 141141 and 119694 subjects aged 18 years and above The analysis of information, including the basic demographic characteristics, collect the questionnaire on smoking, drinking and other information; using standard method and unified model of the equipment measured height, weight, waist circumference, and body mass index (BMI), waist to height ratio (WHtR); serum biochemical indicators such as blood get empty stomach.. on the basis of the People's Republic of China health industry standard adult weight determination > < judgment of systemic obesity (24kg/m2 = BMI = 28kg/m2 BMI = 28kg/m2 for overweight, obesity and central obesity (male) waist is larger than 90cm; women aged 85CM; WHtR = 0.50) to determine the waist height ratio exceed the standard; according to the National Cholesterol Education Program ATPIII Asian standard high triglyceride waist phenotype (HTGW). Calculation of different subgroups Chinese adult body weight, waist circumference and BMI mean and standard error; general obesity, central obesity, WHtR = 0.50, HTGW The rate and the 95% confidence interval, and the absolute and relative changes. Using internationally accepted methods of calculating rate and relative index of inequity evaluation of socioeconomic status related to obesity inequality. On the 2012 data using complex sample weighting, all data were standardized using the population data of National Bureau of Statistics announced in 2009 two years. The data were compared using t test with absolute change in 2002. Chinese nutrition and health survey data of Shanxi Province as the baseline, from December 2015 to March 2016 retrospective survey and follow-up, the object of study including age, gender, height, weight, waist circumference and other baseline information to complete the 7007 people, up to 5360 people, the rate of follow-up the study by 76.5%. BMI, waist circumference and WHtR were divided into 8 groups, with the lowest mortality rate calculation group, as the reference group, using Cox proportional hazards regression model to estimate the total Population, gender, age (over 60 years old, 60 years old) were the relative risk of death and 95% confidence interval, the models adjusted for baseline age, sex, smoking, alcohol consumption, factors of education. By eliminating the current smokers, accidental causes of death, death within the first year of follow-up, follow-up time of less than 3 years. Sensitivity analysis. All the data cleaning and statistical analysis using SAS 9.3 software, two-sided test, significant level P0.05. results from 1.2002 to 2012, China's adult male body weight, waist circumference and average BMI growth of 2.1 kg respectively, 2.7 cm and 0.6 kg/m2; the adult female growth of 1.1 kg respectively, 2.1 cm and 0.3 kg/m2. three indicators over the age of 60 men over the age of 50 city and city women have different degrees of decline. The three indicators of rural residents in city residents is more than 3 times, the three indicators of growth for waist weight BMI.2.2012, in The rate of adult overweight, obesity, central obesity rate, WHtR more than 0.5 prevalence rate and HTGW prevalence rates were 30%, 11.8%, 25.7%, 48.4% and 13.1%. compared with 2002, the obesity was significantly increased, central obesity is growing faster than overall obesity. Rural residents of various types of fat growth rate is higher than the City 18 to 49 year olds; the obesity growth higher than other age groups, the body fat of people aged 60 years and over rate basically stable, city women's obesity rate declined.3. relationship between socioeconomic status and obesity obvious gender differences. The higher socioeconomic status of male body weight, waist circumference and BMI the mean and the obesity rate is high; women are the opposite. In ten years, low culture, low income and with physical labor among the obesity rate of the largest increase; socioeconomic status is related to obesity inequality has narrowed in men, Women in the expansion, low culture and low income women are more susceptible to obesity hazards.4. study were followed up for 94606.4 years. The average follow-up of 12.7 years, 615 people died, the total mortality rate was 650.0/10 million years. The queue in BMI 26.0-27.9 kg/m2 group, after adjusting, BMI18.5,18.5-19.9,22.0-23.9 and more than 30.0kg/m2 group obviously the risk of death increased value of RR and 95%CI were 1.90 (1.26-2.86), 1.68 (1.15-2.45), 1.49 (1.08-2.06) and 1.72 (1.07-2.76). In 90 cm male waistline 95 cm, 85 cm less than 90 female cm as reference, many factors (including BMI) after adjustment, the risk of death for male and female waist circumference greater than 100 cm more than 95 cm was significantly elevated in group 1.85 (1.11-3.08).WHtR was the risk of death (0.47-0.49) compared with the reference group, the difference was not statistically significant. For the elderly aged 60 and above, low birth weight (BMI18.5kg/m2) and high waist circumference (male and female was 100cm = 95 cm) The risk of death was significantly elevated in group were 1.94 (1.20-3.15) and 2.07 (1.08-3.96). Conclusion: 2002 ~ 2012, the obesity rate of the population of our country continues to grow, there exist obvious differences in the epidemic characteristics of different subgroups. The rural population, especially the rural male, and low socioeconomic status groups should be the focus of obese people at the same time, should pay attention to prevention and control; elderly low weight malnutrition caused by high risk of death. China's population growth is more significant in central obesity, waist circumference is independent of the death of the BMI predictor should be equally important as waist circumference and BMI index and simple obesity screening death risk prediction index, application in the crowd we should all keep a healthy weight as an important public health strategy, and the implementation of a healthy weight and the multi-level social determinants of interventions to prevent chronic disease, reduce premature death, promote health Kang fair.

【学位授予单位】：中国疾病预防控制中心
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R589.2

【相似文献】