环境影响因素及血清瘦素、脂联素水平与3-6岁儿童单纯性肥胖的关联性研究

发布时间：2018-06-21 09:08

本文选题：单纯性肥胖 + 儿童　；参考：《华中科技大学》2013年博士论文

【摘要】：目的：旨在了解学龄前单纯性肥胖和正常体重儿童的体格差异，探讨肥胖对3-6岁儿童健康的危害；明确导致儿童肥胖的环境影响因素并观察单纯性肥胖儿童血清瘦素及脂联素水平，探讨两者与儿童肥胖之间的关系。为从各个层面建立针对儿童早期肥胖的综合干预策略和措施提供理论基础；为以后建立长期的、有效的、科学的儿童肥胖健康促进与健康教育模式提供参考依据，更好的促进儿童的健康发育。方法：于2011年8月-10月间，选取湖北省荆州市沙市区、武汉市武昌区、汉口、江夏、蔡甸、东西湖6个市区。以调查日期作为标准，以现场流行病学方法为基础，用世界卫生组织2006年颁布儿童生长标准为标准（身高别体重+2SD及以上判断为肥胖），采取整群抽样的方法，以湖北省内6个市区所属当地幼儿园为单位（共计36所幼儿园），对3-6岁单纯性肥胖儿童进行流行病学调查，同时对每一个肥胖儿童选取一名对照儿童，对照儿童入选标准为居住在与肥胖儿童同一社区、性别相同、年龄相同（±3个月）、身高相同（±3厘米）、身高别体重在正常范围的健康儿童。采用自编问卷，由经过专业培训的调查员用统一的调查表对3-6岁儿童的家长或抚养人进行面对面询问。对所有儿童进行人体测量并采集外周静脉血3ml，用ELISA法测定血清瘦素及脂联素水平。利用卡方检验、t检验、1:1配对条件logistic回归、协方差分析对数据进行分析。结果：6个区县共调查467对肥胖-对照儿童。 1.儿童各测量指标分析：肥胖儿童组及对照儿童组的胸围分别为58.68±5.10cm和49.93±3.50cm，腰围分别为60.61±6.85cm和50.78±3.12cm，臀围分别为66.06±5.12cm和55.60±3.50cm，收缩压分别为95.39±9.22mmHg和87.76±6.72mmHg，舒张压分别为62.06±6.25mmHg和58.49±6.13mmHg；肥胖儿童组和对照儿童组各皮褶厚度分别为：8.64±3.06mm和6.19±1.26mm（肱二头肌）、13.27±3.76mm和8.14±1.89mm（腹部）、19.41±3.46mm和11.12±2.95mm（大腿）、10.03±2.85mm和6.66±1.45mm（肩胛下）、12.11±3.58mm和7.58±2.28mm（腰部），各测量值在两组间均存在显著差异（P0.001）。肥胖儿童组和对照儿童组的血红蛋白值分别为126.07±9.21g/L和123.12±8.89g/L、脂联素水平分别为8.93±5.11mg/L和13.60±5.81mg/L、瘦素水平分别为11.65±4.98μg/L和3.89±2.33μg/L，两组间差异亦具有统计学意义（P0.05）。 2.家庭基本特征：467对儿童中，肥胖儿童组母亲的生育年龄为27.02±3.85岁，稍高于对照组26.41±3.80岁，两组差异有统计学意义（t=2.453，P0.05）。父亲的生育年龄分别为28.92±4.88岁和29.34±4.47岁，差异无统计学意义，P0.05。肥胖儿童组和对照儿童组母亲文化程度主要是大专及以上，所占比例分别为49.5%和50.1%；其父亲的文化程度也主要集中分布在大专及以上，所占比例分别为54.6%和55.2%；两组儿童母亲的职业主要为商业或服务类人员，所占比例分别为35.8%和34.0%，父亲的职业则主要为技术人员，所占比例分别为35.8%和33.4%，差异均无统计学意义，P0.05。肥胖儿童组和对照儿童组的家庭人均月收入分别集中在2000-2500元和2500-3000元（25.9%和28.9%），差异有统计学意义，P0.05。 3.儿童性格特点和生活习惯：对肥胖组儿童及对照组儿童的性格特点、饮食行为（早餐情况、食物偏好、宵夜习惯、进餐次数、洋快餐频率、零食摄入情况和进餐速度等）、体力活动情况（久坐静态行为、活动时间等）和睡眠时间进行分析。发现两组儿童在偏爱甜食（P=0.048）、肉类（P=0.000）、每日进餐次数（P=0.000）、进餐速度（P=0.000）、每日看电视时间（P=0.000）和运动时间（P=0.001）上的存在显著差异。 4.母亲孕期情况分析：对肥胖儿童组及对照儿童组父母BMI、吸烟/饮酒情况、异常孕产史、孕早期阴道出血或损伤情况、妊娠期疾病、孕期母亲体重变化、孕期母亲生活习惯（各类食物摄入情况、情绪状态、活动情况、睡眠时间等）等方面进行分析。发现肥胖儿童组和对照儿童组母亲BMI分别为22.29±2.89和21.23±2.53（t=5.908，P0.001）、父亲BMI分别为24.29±3.17和23.20±2.79（t=5.386，P0.001）、母亲孕期增加的体重分别为17.26±6.34Kg和14.93±5.98Kg（t=5.658，P0.001）、摄入豆类及其制品（P0.001）和甜食（P0.05）的频率、睡眠时间（P0.05）和情绪状态（P0.05）的差异具有统计学意义。 5.儿童的出生史：对儿童出生时的体重、身长、分娩方式以及分娩时的胎龄情况做比较，发现肥胖组儿童出生时的体重高于对照组（3514.52±524.01g vs3263.90±446.77g，P0.001），肥胖儿童组中巨大儿所占比例明显高于对照组（15.0%vs8.8%，P0.05），出生时身长亦大于对照组儿童（50.84±1.81cm vs50.24±1.45cm，P0.05）。肥胖儿童组中剖宫产比例明显高于对照儿童组（72.8%vs64.2%，P0.05）。两组在分娩时胎龄上的差异不具有统计学意义（P0.05）。 6.儿童喂养史：肥胖组中纯母乳喂养的儿童有282例，占60.4%，混合喂养的儿童有107例，占22.9%，人工喂养的儿童有78例，占16.7%；对照组中母乳喂养的儿童有315例，占67.5%，混合喂养的儿童有97例，占20.8%，人工喂养的儿童有55例，占11.8%。肥胖儿童组中纯母乳喂养的比例明显低于对照组（60.4%vs67.5%，P0.05）、母乳喂养时间≥6个月的比例明显低于对照组（43.7%vs51.9%，P0.05）。两组在初次添加辅食时间（P=0.046）和初次添加固体辅食时间（P=0.010）上的差异亦具有统计学意义。 7.家长对儿童肥胖相关知识的认识程度：两组家长在是否知晓体质指数（BMI）（P=0.040）以及对儿童肥胖所持态度（P=0.019）上的差异有统计学意义。 8.肥胖影响因素分析结果：多因素条件logistic回归分析结果显示，儿童偏食肉类（OR=1.713）、每日看电视时间3h（OR=7.820）、母亲BMI≥24（OR=3.884）、父亲BMI≥24（OR=3.905）、出生体重≥4000g（OR=2.108）、孕期增加体重在13-20kg（OR=1.960），孕期增加体重20kg（OR=5.147）、血清瘦素水平10.45μg/L（OR=2.697）均为儿童肥胖的危险因素。家庭人均月收入在2500-3000元（OR=0.183）、家庭人均月收入≥3000元（OR=0.135）、儿童进餐速度较慢（OR=0.471）、孕期经常摄入豆类及其制品（OR=0.406）、母乳喂养时间≥6个月（OR=0.486）、初次添加辅食时间在4-6个月（OR=0.383）、初次添加辅食时间6个月（OR=0.355）、血清瘦素水平4.40μg/L（OR=0.516）、家长知晓儿童肥胖原因3点（OR=0.222）均为儿童肥胖的保护因素。 9.母乳喂养时间与儿童血清瘦素及脂联素水平：母乳喂养时间在4-6个月和≥6个月者，其血清瘦素水平均低于无母乳喂养者，差异具统计学意义（P0.05）。脂联素水平的差异则不具统计学意义（P0.05）。结论：环境因素及血清瘦素水平对3-6岁儿童单纯性肥胖有影响作用。 1.儿童肥胖不仅仅体现在高体重，过量的脂肪也在身体各不同部位聚积，在3-6岁的年龄段，，肥胖已表现出了对儿童心血管的危害。 2.影响学龄前儿童肥胖发生的因素是多方面的。儿童不良的饮食和生活方式是导致肥胖的主要原因。同时，儿童肥胖与父母体重密切相关，父母超重的儿童易患肥胖。孕期母亲的膳食习惯、体重增加、母乳喂养方式、辅食添加时间、家长对儿童肥胖知识的知晓情况、家庭经济情况均是影响儿童肥胖发生的因素。 3.肥胖儿童存在血清脂联素水平偏低、瘦素水平偏高（瘦素抵抗）的现象，母乳喂养时间的延长可以降低儿童血清瘦素水平。 4.儿童单纯性肥胖的发生应重在预防并且尽早预防，儿童的父母应接受健康科学的家庭喂养知识教育，同时帮助孩子在早期建立健康的饮食习惯和生活方式并长期保持下去，才能从根本上杜绝肥胖的发生。
[Abstract]:Objective: to understand the physical differences between preschool simple obesity and normal weight children, to explore the health hazards of obesity to 3-6 year old children, to clarify the environmental factors that lead to obesity in children and to observe the level of serum leptin and adiponectin in children with simple obesity, and to explore the relationship between obesity and obesity in children. Provide theoretical basis for early childhood obesity intervention strategies and measures for the future; to establish long-term, effective, and provide reference for health education of childhood obesity promoting scientific health, promote the healthy development of children better.
Methods: during the -10 month of August 2011, 6 cities in Jingzhou, Hubei, Jingzhou, Wuhan, Wuchang, Hankou, Jiangxia, Caidian and Dongxihu were selected as the standard, based on the field epidemiological method, and the standard of child growth was issued by WHO in 2006. A cluster sampling method was adopted to investigate the epidemiological investigation of children with simple obesity at the age of 3-6 (36 kindergartens) in 6 urban areas in Hubei province. At the same time, a control child was selected for each obese child. The standard for the control of children was to live in the same community as obese children, with the same sex and age. The same (3 months), the height of the same height (3 cm), the height of the normal range of healthy children. A self-made questionnaire was used by a trained investigator to conduct face-to-face inquiries on parents or dependants of 3-6 year old children with a unified questionnaire. All children were measured in human body and collected peripheral venous blood 3ml, measured by ELISA method. Serum leptin and adiponectin levels were analyzed by chi square test, t test, 1:1 paired conditional logistic regression and covariance analysis.
Results: 467 obesity control children were investigated in 6 districts and counties.
1. analysis of the measurement indexes of children: the chest circumference of the obese children and the control children was 58.68 + 5.10cm and 49.93 + 3.50cm respectively, the waist circumference was 60.61 + 6.85cm and 50.78 + 3.12cm respectively, the hip circumference was 66.06 + 5.12cm and 55.60 + 3.50cm respectively, and the systolic pressure was 95.39 + 9.22mmHg and 87.76 + 6.72mmHg respectively, and the diastolic pressure was 62.06 + 6.25mmHg and 58.49 + 6, respectively. .13mmHg, the thickness of skin pleats in obese children and control children were 8.64 + 3.06mm and 6.19 + 1.26mm (biceps brachii), 13.27 + 3.76mm and 8.14 + 1.89mm (abdomen), 19.41 + 3.46mm and 11.12 + 2.95mm (thigh), 10.03 + 2.85mm and 6.66 + 1.45MM (under scapula), 12.11 + 3.58mm and 7.58 + 2.28mm (waist), and the measured values were all in the two groups. Significant difference (P0.001). The hemoglobin values of obese children and control children were 126.07 + 9.21g/L and 123.12 + 8.89g/L respectively. Adiponectin levels were 8.93 + 5.11mg/L and 13.60 + 5.81mg/L respectively, and leptin levels were 11.65 + 4.98 g/L and 3.89 + 2.33 g/L respectively. The difference between the two groups was also statistically significant (P0.05).
2. the basic characteristics of the family: in 467 pairs of children, the birth age of the obese children was 27.02 + 3.85 years old, which was slightly higher than the control group of 26.41 + 3.80 years old. The two groups were statistically significant (t=2.453, P0.05). The age of the father was 28.92 + 4.88 and 29.34 + 4.47 years, respectively, with no statistical significance, P0.05. obese children group and control children group. The majority of mothers' education level is junior college and above, the proportion of which is 49.5% and 50.1% respectively. Their father's educational level is mainly concentrated in college and above, and the proportion is 54.6% and 55.2% respectively. The two groups of children's mothers are mainly commercial or service personnel, accounting for 35.8% and 34%, and the father's occupation is the principal. For the technical personnel, the proportion was 35.8% and 33.4%, there were no significant differences in P0.05., obese children group and control group of children's family income per month were concentrated in 2000-2500 yuan and 2500-3000 yuan (25.9% and 28.9%), the difference was statistically significant, P0.05.
3. children's personality characteristics and living habits: the personality characteristics of children in the obese group and the control group, diet behavior (breakfast, food preference, night habit, meal times, foreign fast food frequency, snack intake and meal speed, etc.), physical activity (sedentary static behavior, activity time, etc.) and sleep time were analyzed. Two groups of children in preference for sweets (P=0.048), meat (P=0.000), the number of meals per day (P=0.000), eating speed (P=0.000), daily TV time (P=0.000) and movement time (P=0.001) on the existence of significant differences.
4. maternal pregnancy analysis: BMI, smoking / drinking, abnormal pregnancy history, vaginal bleeding or injury in the early pregnancy, pregnancy disease, maternal weight change during pregnancy, mother's living habits (all kinds of food intake, emotional state, activity, sleep time, etc.) in the obese children group and the control children group. The mother BMI of the obese children group and the control child group was 22.29 + 2.89 and 21.23 + 2.53 (t=5.908, P0.001) respectively. The father BMI was 24.29 + 3.17 and 23.20 + 2.79 (t=5.386, P0.001) respectively. The maternal weight of mother's pregnancy was 17.26 + 6.34Kg and 14.93 + 5.98Kg (t=5.658, P0.001) respectively, and the frequency of legumes and their products (P0.001) and sweet food (P0.05) were consumed. There was a statistically significant difference in rates of sleep time (P0.05) and emotional state (P0.05).
5. birth history of children: the weight, length, mode of childbirth and gestational age of childbirth were compared. It was found that the weight of children at birth in obese group was higher than that of the control group (3514.52 + 524.01g vs3263.90 + 446.77g, P0.001). The proportion of giant children in obese children group was significantly higher than that of the control group (15.0%vs8.8%, P0.05), and the birth time was higher than that of the control group. The length is larger than that of the control group children (50.84 + 1.81cm vs50.24 + 1.45cm, P0.05). The obese group in cesarean section were significantly higher than the control group of children (72.8%vs64.2%, P0.05). The differences between the two groups in the gestational age at delivery was not statistically significant (P0.05).
6. children feeding history: there were 282 cases of pure breast-feeding children in the obese group, accounting for 60.4%, 107 children in mixed feeding, 22.9% and 16.7% in artificial feeding children, 315 in the control group, 67.5% in 315, 97 in mixed children, 20.8% in children, and 6. children in artificial feeding, accounting for 11.8%. obese children. The proportion of pure breastfeeding in the group was significantly lower than that in the control group (60.4%vs67.5%, P0.05), and the proportion of breastfeeding time for more than 6 months was significantly lower than that of the control group (43.7%vs51.9%, P0.05). The difference between the two groups at first addition of supplementary feeding time (P=0.046) and the initial addition of solid food time (P=0.010) was also statistically significant.
7. parents awareness of knowledge related to childhood obesity: two groups of parents are aware of the body mass index (BMI) (P=0.040) as well as on childhood obesity attitudes (P=0.019) there were significant differences.
8. analysis of influencing factors of obesity: the results of multiple factor Logistic regression analysis showed that children's meat (OR=1.713), TV time 3H (OR=7.820), mother BMI > 24 (OR=3.884), father BMI > 24 (OR=3.905), birth weight more than 4000g (OR=2.108), 13-20kg (OR=1.960) during pregnancy, and weight gain during pregnancy, The serum leptin level 10.45 g/L (OR=2.697) is a risk factor for children's obesity. The monthly income of the family is 2500-3000 yuan (OR=0.183), the per capita monthly income of the family is more than 3000 yuan (OR=0.135), the speed of children's meal is slower (OR=0.471), the regular intake of beans and their products (OR=0.406) during pregnancy (OR=0.406), and breast feeding time more than 6 months (OR=0.486), the first supplemented supplemented Feeding time at 4-6 months (OR=0.383), the first feeding time of 6 months (OR=0.355), serum leptin levels of 4.40 g/L (OR=0.516), 3 children parents know the causes of obesity (OR=0.222) were protective factors of children obesity.
9. children with breast feeding time of serum leptin and adiponectin levels: Breastfeeding time in 4-6 months and over 6 months, the serum leptin level was lower than that in non breastfeeding, the difference was statistically significant (P0.05). The difference in adiponectin levels is not statistically significant (P0.05).
Conclusion: environmental factors and serum leptin levels have an effect on simple obesity in children aged 3-6 years.
1. childhood obesity is not only reflected in the high weight, excessive fat accumulation in different parts of the body, at the age of 3-6 years old, obesity has shown cardiovascular harm to children.
2. the factors affecting the obesity of preschool children are multifaceted. Poor children's diet and lifestyle are the main causes of obesity. At the same time, children's obesity is closely related to the weight of parents, and the overweight children of the parents are prone to obesity. Knowledge of childhood obesity and family economic situation are all factors that influence obesity in children.
3. obese children have low levels of serum adiponectin, leptin levels (leptin resistance) phenomenon, prolonged breastfeeding can reduce the serum leptin levels in children.
4. the occurrence of simple obesity in children should be seriously prevented and prevented as soon as possible. The parents of children should accept the knowledge education of family feeding in the health science, and help the children to establish healthy eating habits and lifestyle in the early stage and keep it for a long time, in order to eradicate the occurrence of fat fat.
【学位授予单位】：华中科技大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R723.14

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