出生体重与环境因素对儿童青少年超重肥胖影响的队列研究

发布时间：2018-06-20 22:19

本文选题：高出生体重 + 环境因素　；参考：《复旦大学》2012年博士论文

【摘要】：[研究背景] 肥胖己成为21世纪全球公共卫生的严重问题之一,中国儿童青少年肥胖也正进入高发期。经济增长和都市化进程,引起生活环境的改变,如过度能量摄入、低体力活动、静坐生活方式增多等,肥胖患病率也随之呈现明显增加趋势。儿童青少年肥胖危害深远,不仅导致身心疾患和生理功能障碍,影响学习能力,更为严重的是儿童青少年肥胖可发展为成人肥胖,引起高血压、心脏病、糖尿病等慢性疾病,从而导致长期病态和早期死亡。超重、肥胖是多种慢性病的主要危险因素之一,而儿童青少年肥胖已经成为这些疾病的隐患。因此对儿童青少年肥胖问题必须加以重视。肥胖是遗传和环境因素综合作用的结果。大量研究表明,引起儿童青少年肥胖的危险因素多种多样且相互关联,主要包括遗传、出生体重、饮食、体育锻炼、父母行为意识、社会经济、精神心理等因素。肥胖是多因素、长期作用的结果,原因错综复杂。遗传因素决定个体肥胖发生的易感性,而各种环境因素则促进肥胖的发生。研究证实,从胎儿到成年期的各年龄阶段中,肥胖的发生和发展有鲜明的生长发育轨迹现象,探讨这些现象及其影响因素,不仅有助于为儿童青少年肥胖的预防提供理论依据,有效开展早期干预,而且对减少成年期肥胖相关疾病、保障终身健康都具有重要意义。 [研究目的] 本研究拟了解巨大儿和正常出生体重儿队列在儿童期和青少年期超重、肥胖发生的现况和相关危险因素：分析从出生到儿童期再到青少年期,儿童青少年体重变化趋势；探讨出生体重与生活行为因素之间的交互作用、父母超重肥胖对子代超重肥胖的影响以及超重肥胖和相关生活行为因素的家庭聚集性。 [研究方法] 本研究选择江苏省无锡市的一个县级市(江阴市)和两个中心行政区(惠山区和锡山区)出生于1993-1995年的活产婴儿作为研究对象,其中出生体重大于等于4000克者作为暴露组,小于4000克同时大于等于2500克者作为对照组。采用历史性队列研究设计,基线数据来源于这三个地区在90年代初建立的妇女围产保健数据库,包括母亲的一般人口学特征、健康状况、初次孕产期检查、产前复查、产时及围产期检查等。2005年10月至2006年10月期间进行儿童期随访,随访所用调查表的内容主要包括研究对象的个人生长发育情况、生活方式、饮食运动习惯及其家庭特征和父母生活方式等,同时进行体格检查(身高、体重、血压等)。在此基础上,于2010年10月至2011年10月期间再次对已进入青春期的研究对象进行第二次随访,除收集与上次随访类似的信息外,本次随访信息更具体化和详细化,增加收集父母的相关信息,仍然进行体格检查(身高、体重及血压等)。采用体质指数(BMI)作为结局变量,并以中国肥胖工作组(WGOC)发表的中国儿童青少年性别年龄别BMI参考值作为判定超重与肥胖的标准。以超重肥胖者作为病例,按同性别、同年龄配以对照,进行病例对照研究。应用Epidata3.1软件建立数据库和设置核查程序,双遍录入所有数据。运用SPSS16.0和SAS9.2等软件进行统计分析,主要方法包括t检验、方差分析、χ2检验、秩和检验、非条件Logistic回归分析、因子分析、相关分析、广义线性混合效应模型等。 [研究结果] 1.队列概况本次队列研究起点为研究对象出生时,经过儿童期和青少年期两次随访,最终进入分析的合格对象为2236人,其中出生时1108人为巨大儿,1128人为正常出生体重儿；男生1488名,占66.55%(暴露组737名,对照组751名),女生748名,占33.45%(暴露组371名,对照组377名)。 2.基线调查结果过期妊娠、母亲孕前BMI较高和母亲孕期增加体重较多均是婴儿高出生体重的危险因素,OR值分别为2.31(95%CI：1.48,3.63)、1.17(95%CI：1.07,1.27)、1.11(95%CI：1.08,1.14)。 3.儿童期随访调查结果儿童期实际随访到2870人,年龄在10-13岁之间。本人群儿童期超重检出率为12.03%(男生15.66%,女生4.81%),肥胖检出率为2.15%(男生2.42%,女生1.61%),超重肥胖检出率为14.18%(男生18.08%,女生6.42%)；暴露组中超重检出率为13.45%,肥胖检出率为2.80%,对照组中超重检出率为10.64%,肥胖检出率为1.51%。暴露组的超重肥胖检出率(16.25%)高于对照组的超重肥胖检出率(12.15%),差别有统计学意义(P=0.003)；暴露组与对照组相比,发生超重和肥胖的RR分别为1.26(95%CI：1.01,1.58)和1.86(95%CI：1.03,3.33),AR分别为2.81%和1.29%。不同出生体重组之间儿童BMI均值不同,超重率和肥胖率有明显的随出生体重增加而增高的趋势(P0.01)。儿童期超重肥胖的影响因素分析：多因素非条件Logistic回归分析表明,男性(OR=2.06)、高出生体重(OR=1.48)、母亲超重肥胖(OR=2.22)、婴儿期人工喂养(OR=2.80)和混合喂养(OR=2.70)、经常吃油炸食品(OR=1.41)、经常吃夜宵(OR=4.59)、看电视时间较长(OR=1.37)、收入较高(OR=1.47)、父亲饮酒(OR=1.34)均为儿童超重肥胖的危险因素。牛奶食用次数较多(OR=0.66)为保护因素。 4.青少年期随访调查结果青少年期实际随访到2236人,随访率为77.91%,年龄在15-18岁之间。青少年期超重检出率为9.35%(男生10.28%,女生7.49%),肥胖检出率为1.83%(男生2.09%,女生1.34%),超重肥胖检出率为11.18%(男生12.37%,女生8.83%)；暴露组超重检出率为11.73%,肥胖检出率为2.44%,对照组超重检出率为7.00%,肥胖检出率为1.24%。暴露组的超重肥胖检出率(14.17%)高于对照组的超重肥胖检出率(8.24%),差别有统计学意义(P0.001)。暴露组与对照组相比,发生超重和肥胖的RR分别为1.68(95%CI：1.28,2.19)和1.96(95%CI：1.04,3.72),AR分别为4.73%和1.20%。不同出生体重组之间青少年BMI均值不同,超重率和肥胖率有明显的随出生体重增加而增高的趋势(P0.05)。青少年期超重肥胖的影响因素分析：多因素非条件Logistic回归分析表明,男性(OR=1.43)、高出生体重(OR=1.62)、双亲均超重肥胖(OR=2.56)、母亲超重肥胖(OR=1.87),父亲超重肥胖(OR=1.85)、经常每顿吃得很饱(OR=1.45)、进餐速度偏快(OR=1.34)、使用电脑时间较长(OR=1.40)、母亲中等文化程度(OR=1.46)和较高文化程度(OR=2.01)均为青少年超重肥胖的危险因素,校内活动时间较多(OR=0.69)、母亲对肥胖持反对态度(OR=0.65)为保护因素。出生体重与生活行为因素的交互作用分析：采用因子分析方法,共提取蛋白类食物、静坐生活方式、果蔬类食物、体育活动、饮食习惯和饮食偏好6个公因子。二分类Logistic回归分析显示,出生体重分别与蛋白类食物、果蔬类食物对超重肥胖的发生有相乘交互作用；出生体重与蛋白类食物、果蔬类食物、饮食偏好的交互作用相对超额危险度分别为-1.65(95%CI：-3.29,-0.01)、1.36(95%CI：0.37,2.36)和1.19(95%CI：0.14,2.23),均具有统计学意义,表明两者之间存在相加交互作用。交互作用归因比分别为76.74%、55.06%、48.29%。 5.儿童青少年超重肥胖的队列分析在所有研究对象2236人中,出生时1108人为巨大儿,进入儿童期有317(14.18%)名儿童超重或肥胖,进入青少年期有250(11.18%)名青少年超重或肥胖。按照性别分组,男生出生时49.53%为巨大儿,儿童期18.08%超重肥胖,青少年期12.37%超重肥胖；女生出生时49.60%为巨大儿,儿童期6.42%超重肥胖,青少年期8.82%超重肥胖。由此可见从儿童期到青少年期,男生的超重肥胖检出率降低,而女生的超重肥胖检出率升高。研究对象在不同时间体重变化趋势分析：性别与时间有交互作用,即男生和女生的体重异常率随时间的变化趋势不同。出生体重与时间没有交互作用,说明两因素的作用效果相互独立。从儿童期至青少年期,从总体来看,BMI分级转好率大于转差率,差别有统计学意义(P=0.003)；分性别来看,男生BMI分级转好率大于转差率,差别有统计学意义(P=0.004),女生BMI分级虽转好率大于转差率,但差别无统计学意义(P=0.286)。 6.父母超重肥胖对子女超重肥胖影响的分析父母超重肥胖状况为双亲均正常、父亲超重肥胖、母亲超重肥胖、双亲均超重肥胖,其子女超重肥胖检出率依次为：12.01%、14.20%、15.94%、29.09%(儿童期)和7.52%、13.34%、13.43%、16.67%(青少年期),总体均呈现增加趋势(P0.01)。青少年BMI与其父母超重肥胖状况关系的多元线性回归分析结果显示,青少年BMI与其父母超重肥胖状况呈显著正相关,偏回归系数为0.54(95%CI：0.37,0.71)；青少年超重肥胖与其父母超重肥胖状况关系的多因素Logistic回归分析结果显示,父亲超重肥胖、母亲超重肥胖、双亲均超重肥胖的家庭与双亲均正常的家庭相比,其子女超重肥胖的危险性(OR值)分别为1.73(95%CI：1.23,2.42)、1.89(95%CI：1.18,3.02)和2.36(95%CI：1.49,3.73)。进一步分析不同性别青少年超重肥胖与其父母超重肥胖状况的关系,结果显示,在男生组,父亲超重肥胖和双亲均超重肥胖与双亲均正常相比,其子女超重肥胖的危险性(OR值)分别为1.83(95%CI：1.24,2.71)和2.05(95%CI：1.17,3.61),但在母亲超重肥胖者中,未观察到此效应；在女生组,母亲超重肥胖和双亲均超重肥胖与双亲均正常相比,其子女超重肥胖的危险性(OR值)分别为2.49(95%CI：1.09,5.68)和3.07(95%CI：1.36,6.92),但在父亲超重肥胖者中,未观察到此效应；由此推测母亲超重肥胖可能对其女儿超重肥胖的影响较大,而父亲超重肥胖可能对其儿子超重肥胖的影响较大；与双亲体重均正常相比,双亲同时超重肥胖对女儿(OR=3.07)超重肥胖产生的影响可能大于对儿子(OR=2.05)的影响。青少年与其父(母)亲在超重肥胖和生活行为因素等方面的相关关系：父(母)亲和子女在BMI、BMI分级、饮酒、饮茶、吃油炸食品、每顿吃得很饱、进餐速度、对肥胖的态度、对体型的评价、是否需减肥方面有正相关关系。 [结论] 1.该队列超重率较高,儿童期超重肥胖率均高于青少年期。控制超重向肥胖发展是一个重要的预防措施,儿童期是超重肥胖的高发阶段,应引起高度重视。 2.高出生体重是影响儿童、青少年超重肥胖的独立危险因素,肥胖的一级预防应从胎儿期抓起；生活行为因素可能修饰出生体重与肥胖的关系,高出生体重的儿童青少年应作为高危人群进行重点干预,通过改变其不良的生活行为习惯,来降低肥胖发生的危险性。 3.父母超重肥胖是儿童、青少年超重肥胖的独立危险因素,且关联存在性别差异；父母与子女超重肥胖及其生活行为因素存在相关性。对儿童青少年肥胖的预防和干预,应重视家庭环境因素。
[Abstract]:[research background]
Obesity has become one of the serious problems of public health in the world in the twenty-first Century. The obesity of children and adolescents in China is also entering a period of high incidence. The economic growth and urbanization have caused changes in the living environment, such as excessive energy intake, low physical activity, and more sedentary lifestyles. The prevalence of obesity is also obviously increasing. Obesity is far-reaching, not only causes physical and mental disorders and physical dysfunction, but also affects learning ability. More serious is that obesity in children and adolescents can develop into adult obesity, cause chronic diseases such as hypertension, heart disease, diabetes and so on, which lead to long-term morbid and early death. Overweight and obesity are the main risk factors for many chronic diseases. First, obesity of children and adolescents has become a hidden danger of these diseases. Therefore, attention should be paid to obesity in children and adolescents.
Obesity is the result of the combination of genetic and environmental factors. A large number of studies have shown that the risk factors for obesity in children and adolescents are varied and interrelated, mainly including heredity, birth weight, diet, physical exercise, parents' behavior consciousness, social economy, mental psychology and other factors. Obesity is the result of multiple factors, the result of long-term effect, and the wrong reason. The genetic factors determine the susceptibility of individual obesity, and the various environmental factors promote the occurrence of obesity. The study confirms that the occurrence and development of obesity have a distinct growth and development trajectory from the fetal to adult stages. The study of these phenomena and its influencing factors will not only contribute to obesity for children and adolescents. To provide theoretical basis for prevention, effective early intervention, and to reduce obesity related diseases in adulthood and ensure lifelong health.
[research purposes]
The present study is to understand the prevalence and risk factors of overweight and obesity in childhood and adolescence, the analysis of the trend of weight change from birth to childhood to adolescence, the trend of weight change in children and adolescents, the interaction between birth weight and life behavior factors, and the overweight and obesity of parents. The impact of overweight and obesity on offspring and family aggregation of overweight, obesity and related life behavior factors.
[research methods]
In this study, a county-level city (Jiangyin city) in Wuxi, Jiangsu, and two central administrative regions (Huishan and Xishan districts) were selected as the subjects of 1993-1995 years of live birth. The birth weight is more than 4000 grams as exposure group, less than 4000 grams and equal to 2500 grams as the control group. A historical cohort is used. Research design, baseline data derived from the women's perinatal health care database established in the three regions in the early 90s, including the general demographic characteristics of the mother, health status, initial pregnancy examination, prenatal review, delivery and perinatal examination, between October and October 2006.2005 years for childhood follow-up, and the contents of the follow-up questionnaire. It mainly includes the individual growth and development of the subjects, lifestyle, eating habits, family characteristics and parents' lifestyle, and physical examination (height, weight, blood pressure, etc.). On this basis, second follow-up studies on the subjects that have entered puberty from October 2010 to October 2011 are followed up. In the last follow-up with similar information, the follow-up information more specific and detailed, increase collect information of parents, still physical examination (body weight and blood pressure height, etc.).
The body mass index (BMI) was used as the outcome variable and the standard of gender and age BMI of Chinese children and adolescents published by the Chinese obesity working group (WGOC) was used as the criterion to determine overweight and obesity. The cases of overweight and obesity were compared with the same sex and age, and a case-control study was performed.
Using Epidata3.1 software to set up a database and set up a verification program, double entry of all data. Using SPSS16.0 and SAS9.2 software for statistical analysis, the main methods include t test, variance analysis, chi 2 test, rank sum test, unconditional Logistic regression analysis, factor analysis, correlation analysis, and generalized linear mixed effect model.
[results]
1. queue profile
The starting point of this cohort study was two times of childhood and adolescence, and 2236 of them were qualified, of which 1108 were large, 1128 were normal birth weight, 1488 were boys, 66.55% (737 in exposure group, 751 in control group), 748 in girls, and 33.45% (371 in exposure group). The name, the control group 377).
2. baseline survey results
Prolonged pregnancy, pre pregnancy BMI increased higher and more body weight during pregnancy were risk factors of high birth weight infants, OR values were 2.31 (95%CI:1.48,3.63), 1.17 (95%CI:1.07,1.27), 1.11 (95%CI:1.08,1.14).
3. childhood follow-up survey results
In childhood, 2870 people were followed up to 10-13 years of age. The prevalence rate of overweight in children was 12.03% (boys 15.66%, girls 4.81%), obesity detection rate was 2.15% (boys 2.42%, girls 1.61%), overweight and obesity detection rate was 14.18% (boys 18.08%, female 6.42%), the exposure group was 13.45%, obesity detection rate was 2.80%. The detection rate of overweight was 10.64%, and the detection rate of obesity was 1.51%.
The prevalence rate of overweight and obesity in the exposure group (16.25%) was higher than that of the control group (12.15%), and the difference was statistically significant (P=0.003). Compared with the control group, the RR of overweight and obesity was 1.26 (95%CI:1.01,1.58) and 1.86 (95%CI:1.03,3.33) respectively, and AR was 2.81% and 1.29%. in different birth weight groups, respectively, BMI. The mean rate of overweight and obesity increased significantly with the increase of birth weight (P0.01).
Analysis of influencing factors of overweight and obesity in childhood: multiple factors unconditional Logistic regression analysis showed that male (OR=2.06), high birth weight (OR=1.48), mother overweight and obesity (OR=2.22), infant artificial feeding (OR=2.80) and mixed feeding (OR=2.70), often eating fried foods (OR=1.41), frequent snack (OR=4.59), and longer television time (OR=1.37) Higher income (OR=1.47). Father drinking (OR=1.34) is a risk factor for overweight and obesity in children. Milk consumption is more frequent (OR=0.66) as a protective factor.
4. adolescent follow-up survey results
In adolescence, 2236 people were followed up, the rate of follow-up was 77.91%, the age was 15-18 years old. The prevalence rate of overweight was 9.35% (boys 10.28%, girls 7.49%), the obesity detection rate was 1.83% (boys 2.09%, girls 1.34%), the prevalence rate of overweight and obesity was 11.18% (boys 12.37%, girls 8.83%); the prevalence rate of overweight in the exposure group was 11.73% and obesity detection rate. For 2.44%, the overweight group had a detection rate of 7%, and the detection rate of obesity was 1.24%.
The prevalence rate of overweight and obesity in the exposure group (14.17%) was higher than that of the control group (8.24%), and the difference was statistically significant (P0.001). Compared with the control group, the RR of overweight and obesity was 1.68 (95%CI:1.28,2.19) and 1.96 (95%CI:1.04,3.72), respectively, and AR was 4.73% and 1.20%. in different birth weight groups, BMI, respectively. The mean rate of overweight and obesity increased significantly with the increase of birth weight (P0.05).
Analysis of the influencing factors of overweight and obesity in adolescence: multiple factors unconditional Logistic regression analysis showed that male (OR=1.43), high birth weight (OR=1.62), both parents were overweight and obese (OR=2.56), mother overweight and obesity (OR=1.87), father overweight and obesity (OR=1.85), often eat very full (OR=1.45), eat faster (OR=1.34), when using a computer, and use a computer. Between long (OR=1.40), mother of secondary education (OR=1.46) and higher education (OR=2.01) were risk factors of overweight and obese adolescents, school activities more time (OR=0.69), the mother is opposed to obesity (OR=0.65) was a protective factor.
Analysis of the interaction between birth weight and life behavior factors: using factor analysis, 6 common factors were extracted from protein food, sedentary lifestyle, fruit and vegetable food, physical activity, diet habit and diet preference. Two classification Logistic regression analysis showed that the weight of birth weight was respectively with protein food and fruit and vegetable food to overweight and obesity. The interaction of birth weight and protein food, fruit and vegetable food and diet preference were -1.65 (95%CI:-3.29, -0.01), 1.36 (95%CI:0.37,2.36) and 1.19 (95%CI:0.14,2.23), respectively, which showed that there was an additive interaction between them. The ratio is 76.74%, 55.06%, 48.29%., respectively.
Cohort analysis of overweight and obesity in 5. children and adolescents
Among all 2236 subjects, 1108 were born at birth, 317 (14.18%) children were overweight or obese in childhood, 250 (11.18%) were overweight or obese in adolescence. According to the sex group, boys were 49.53% at birth, 18.08% overweight in childhood, 12.37% overweight and obesity in adolescence; girls were 12.37%. When 49.60% for macrosomia, 6.42% childhood overweight and obesity, adolescent overweight and obesity 8.82%. Thus from childhood to adolescence, overweight and obese boys rate decreased, and the overweight and obese girls higher detection rates.
The analysis of the trend of body weight change at different time: gender and time have interaction, that is, the change trend of body weight abnormality rate of boys and girls is different with time. There is no interaction between birth weight and time. It shows that the effect of the two factors is independent. From childhood to adolescence, the overall rate of BMI grading turns better. Greater than the slip, the difference was statistically significant (P=0.003); sex, male BMI grade better rate than the slip, the difference was statistically significant (P=0.004), BMI has better classification rate than girls slip, but the difference was not statistically significant (P=0.286).
6. the influence of overweight and obesity on overweight and obesity of children
Parents were overweight and obese, father overweight and obesity, mother overweight and obesity, both parents were overweight and obese, the rate of overweight and obesity in their children were 12.01%, 14.20%, 15.94%, 29.09% (childhood) and 7.52%, 13.34%, 13.43%, 16.67% (Adolescence), and the overall trend was increased (P0.01).
The multivariate linear regression analysis of the relationship between adolescent BMI and their parents' overweight and obesity showed that adolescent BMI and their parents were positively correlated with overweight and obesity, and the partial regression coefficient was 0.54 (95%CI:0.37,0.71), and the multiple factor Logistic regression analysis of overweight and obesity in adolescents and their parents' overweight and obesity showed that the father was the father. The risk of overweight and obesity in their children (OR value) was 1.73 (95%CI:1.23,2.42), 1.89 (95%CI:1.18,3.02) and 2.36 (95%CI:1.49,3.73), respectively, compared with the normal families of both parents and parents. Further analysis was made of overweight and obesity in different sex adolescents and their parents. The results showed that in boys, the risk of overweight and obesity (OR) was 1.83 (95%CI:1.24,2.71) and 2.05 (95%CI:1.17,3.61) for overweight and obesity and 2.05 (95%CI:1.17,3.61) in the father's overweight and obese parents, but in the mothers of overweight and obese mothers, the effect was not observed; in the female group, the mother was overweight and obese and double. The risk of overweight and obesity in their children (OR) was 2.49 (95%CI:1.09,5.68) and 3.07 (95%CI:1.36,6.92), but the effect was not observed in the father's overweight and obese children, and the mother overweight and obesity may have a greater impact on the overweight and obesity of her daughter, and the father was overweight and obese. The son can have great effect on overweight and obesity; and their weight were compared to normal, overweight and obesity of parents and daughter (OR=3.07) effect of overweight and obesity may produce greater than that of the son (OR=2.05) effect.
Youth with his father (mother) related pro in overweight and obesity and lifestyle factors such as: the father (mother) children in BMI BMI affinity, grading, drinking, drinking tea, eating fried food, every meal to eat very full, eat
【学位授予单位】：复旦大学
【学位级别】：博士
【学位授予年份】：2012
【分类号】：R589.2

【引证文献】