Underestimation of weight status among overweight and obese adults in China in 2013
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摘要:
目的 了解2013年我国超重肥胖成人体重水平低估情况,分析其影响因素。 方法 2013年中国慢性病及其危险因素监测采用多阶段分层整群抽样的方法调查≥ 18岁成人共计179 570人。问卷调查获取人口学特征、体重水平自我评价、慢性病患病知晓情况等信息;体格测量获取个体的身高、体重和血压;采集调查对象静脉血,检测空腹血糖、服糖后2 h血糖和血脂四项。选取收集到的87 552名超重肥胖成人作为研究对象,复杂加权后分析不同特征人群体重水平低估情况及其影响因素。 结果 我国有74.7%(95%CI:73.3%~76.1%)的超重肥胖成人低估自我体重水平,其中轻度低估率为60.7%(59.6%~61.7%),严重低估率为14.0%(13.1%~14.9%)。较高年龄、低文化程度、低收入水平、农村地区和肥胖是低估和严重低估体重水平的危险因素(均有P < 0.05);高血压患者知晓和血脂异常患者知晓是低估和严重低估体重水平的保护因素(均有P < 0.05)。 结论 中国大部分超重肥胖成人低估自身的体重水平,低估受年龄、文化程度、收入水平和慢性病知晓等因素影响,应对不同特征人群开展针对性干预。 Abstract:Objective The aim is to understand the underestimation of body weight status and its associated factors among overweight and obese adults in China. Methods Nationally representative data were collected in 2013 by the China Chronic Disease and Risk Factor Surveillance which used a multistage stratified cluster sampling method. A total of 87 552 overweight and obese adults aged ≥ 18 years old were included. Demographic characteristics, weight perception and disease status were obtained from in-person interviews. Height, weight and blood pressure were measured through physical examination. Venous blood samples were obtained and assayed for fasting plasma glucose, 2-hour oral glucose tolerance test, total cholesterol, triglycerides, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol. Complex sampling was weighted and multiple logistic regression models were used for analyzing. Results Among overweight and obese adults, 74.7% (95% CI: 73.3%-76.1%) underestimated their weight status. The mild underestimation rate was 60.7% (59.6%-61.7%) while the severe was 14.0% (13.1%-14.9%). The aged, low education level, low annual income, rural area and obesity were risk factors for both weight status underestimation and severe underestimation (all P < 0.05). Awareness of having hypertension and dyslipidemia were protective factors (all P < 0.05). Conclusions Most overweight and obese adults in China underestimated their own weight status, which was affected by age, education and income level, awareness of having chronic diseases and other factors. Targeted interventions should be carried out for different characteristic groups. -
Key words:
- Overweight /
- Obesity /
- Adult /
- Body mass index /
- Underestimation
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表 1 2013年中国超重肥胖成人基本特征a[n (%)]
Table 1. Basic characteristics of overweight and obese adults in China in 2013a [n (%)]
特征 合计(n=87 552) 超重者(n=61 362) 肥胖者(n=26 190) 性别 男 36 514(51.9) 26 153(52.6) 10 361(50.5) 女 51 038(48.1) 35 209(47.4) 15 829(49.5) 年龄(岁) 18~ 25 580(52.8) 17 730(52.1) 7 850(54.3) 45~ 37 473(30.4) 26 164(30.7) 11 309(29.8) 60~ 24 499(16.8) 17 468(17.2) 7 031(15.9) 民族 汉族 78 686(92.4) 55 245(92.5) 23 441(92.3) 其他 8 866(7.6) 6 117(7.5) 2 749(7.7) 文化程度 小学及以下 40 361(36.7) 28 266(36.7) 12 095(36.7) 初中 28 701(37.0) 19 967(36.8) 8 734(37.4) 高中/中专/技校 12 739(16.7) 8 983(16.6) 3 756(17.1) 大专及以上 5 696(9.6) 4 108(9.9) 1 588(8.8) 婚姻状况 未婚 2 434(7.7) 1 731(7.7) 703(7.9) 已婚/同居 77 051(87.0) 53 898(86.9) 23 153(87.1) 丧偶/离婚/分居 8 006(5.3) 5 687(5.4) 2 319(5.0) 年收入(万元) <0.7 16 532(24.7) 11 678(25.0) 4 854(24.0) 0.7~ 17 043(26.5) 11 783(26.0) 5 260(27.7) 1.3~ 16 594(25.4) 11 630(25.4) 4 964(25.3) 2.4~ 17 678(23.4) 12 397(23.6) 5 281(23.0) 地区 东部 34 733(43.5) 23 895(42.7) 10 838(45.3) 中部 25 715(33.1) 18 062(33.0) 7 653(33.5) 西部 27 104(23.4) 19 405(24.3) 7 699(21.2) 城乡 城市 43 724(48.2) 30 413(48.1) 13 311(48.5) 农村 43 828(51.8) 30 949(51.9) 12 879(51.5) 高血压 否 47 406(61.9) 35 863(66.0) 11 543(52.4) 是(知晓) 20 364(16.7) 12 420(14.5) 7 944(21.7) 是(不知晓) 19 704(21.4) 13 027(19.5) 6 677(25.9) 糖尿病 否 70 424(85.4) 50 449(87.0) 19 975(81.7) 是(知晓) 6 797(5.6) 4 309(5.0) 2 488(7.1) 是(不知晓) 8 304(9.0) 5 146(8.0) 3 158(11.2) 血脂异常 否 44 703(52.1) 33 555(56.2) 11 148(42.7) 是(知晓) 9 715(8.8) 5 775(7.4) 3 940(12.2) 是(不知晓) 32 606(39.0) 21 645(36.4) 10 961(45.1) 注:a文化程度缺失55例,婚姻状况缺失61例,年收入缺失19 705例,高血压缺失78例,糖尿病缺失2 027例,血脂异常缺失528例。 表 2 2013年中国超重肥胖成人体重水平低估情况a
Table 2. Underestimation of weight status among overweight and obese adults in China in 2013a
特征 体重自评等级[n (%)] 低估人数(人) 体重低估加权率(95% CI) 轻度低估人数(人) 轻度低估加权率(95% CI) 严重低估人数(人) 严重低估加权率(95% CI) 偏瘦 正常 超重 肥胖 合计 3 062(3.1) 52 043(56.4) 28 161(34.7) 4 286(5.8) 67 933 74.7(73.3~76.1) 54 594 60.7(59.6~61.7) 13 339 14.0(13.1~14.9) 肥胖程度 超重 2 530(3.5) 41 766(65.2) 15 333(28.0) 1 733(3.3) 44 296 68.7(67.0~70.4) 41 766 65.2(63.4~67.0) 2 530 3.5(3.0~4.1) 肥胖 532(2.0) 10 277(36.2) 12 828(50.2) 2 553(11.6) 23 637 88.4(87.1~89.7) 12 828 50.2(47.5~52.6) 10 809 38.2(35.4~40.9) χ2值 427.774 63.054 982.907 P值 0.001 0.001 0.001 性别 男 1 169(2.7) 22 880(58.1) 10 925(33.8) 1 540(5.4) 29 242 76.4(74.8~78.0) 24 041 63.6(62.3~65.0) 5 201 12.8(11.9~13.7) 女 1 893(3.5) 29 163(54.6) 17 236(35.7) 2 746(6.3) 38 691 72.9(71.2~74.5) 30 553 57.5(56.3~58.6) 8 138 15.4(14.2~16.6) χ2值 18.008 70.640 26.197 P值 < 0.001 < 0.001 < 0.001 年龄(岁) 18~ 546(2.2) 13 384(50.4) 10 005(40.0) 1 645(7.4) 18 162 69.3(67.4~71.3) 15 072 57.6(56.2~59.1) 3 090 11.7(10.6~12.9) 45~ 1 243(3.2) 22 437(60.3) 12 065(32.0) 1 728(4.5) 29 275 78.3(77.1~79.6) 23 578 63.5(62.4~64.6) 5 697 14.8(13.9~15.7) 60~ 1 273(5.6) 16 222(68.1) 6 091(22.8) 913(3.5) 20 496 85.0(83.7~86.3) 15 944 65.2(63.7~66.6) 4 552 19.8(18.0~21.6) χ2值 427.108 117.067 111.647 P值 < 0.001 < 0.001 < 0.001 民族 汉族 2 616(2.9) 46 293(55.9) 25 961(35.4) 3 816(5.8) 60 658 74.2(72.7~75.7) 49 067 60.6(59.5~61.7) 11 591 13.6(12.6~14.6) 其他 446(5.3) 5 750(62.7) 2 200(26.2) 470(5.8) 7 275 80.3(77.2~83.5) 5 527 61.3(58.3~64.3) 1 748 19.1(15.1~23.0) χ2值 10.369 0.173 7.815 P值 0.001 0.677 0.005 文化程度 小学及以下 1 992(4.8) 26 515(64.7) 10 019(25.5) 1 835(5.0) 33 509 82.1(80.9~83.3) 25 836 63.5(62.2~64.8) 7 673 18.7(17.3~20.0) 初中 781(2.6) 16 410(55.5) 10 081(36.0) 1 429(5.9) 21 781 74.2(72.7~75.8) 17 859 61.2(59.9~62.5) 3 922 13.0(12.0~14.0) 高中/中专/技校 220(1.6) 6 572(48.7) 5 256(43.0) 691(6.7) 8 998 68.1(65.5~70.7) 7 679 58.0(55.9~60.1) 1 319 10.1(8.9~11.2) 大专及以上 68(1.2) 2 507(41.5) 2 791(50.1) 330(7.2) 3 597 59.5(56.0~63.0) 3 181 52.4(49.4~55.4) 416 7.1(5.8~8.3) χ2值 387.072 74.089 269.384 P值 < 0.001 < 0.001 < 0.001 婚姻状况 未婚 71(2.0) 1 361(52.2) 836(36.5) 166(9.3) 1 747 67.2(62.3~72.1) 1 411 54.5(50.5~58.6) 336 12.7(10.3~15.1) 已婚/同居 2 577(3.0) 45 547(56.3) 25 156(35.1) 3 771(5.6) 59 610 75.0(73.6~76.3) 48 044 61.1(60.1~62.2) 11 566 13.8(12.9~14.7) 丧偶/离婚/分居 411(5.3) 5 093(65.0) 2 155(25.3) 347(4.4) 6 525 81.4(79.5~83.2) 5 098 62.4(59.8~65.0) 1 427 19.0(16.5~21.4) χ2值 37.963 17.567 18.636 P值 < 0.001 < 0.001 < 0.001 年收入(万元) <0.7 809(4.6) 10 836(63.6) 4 118(26.7) 769(5.1) 13 595 80.0(78.1~81.8) 10 490 61.8(59.8~63.7) 3 105 18.2(16.1~20.2) 0.7~ 597(2.8) 10 168(56.8) 5 452(34.5) 826(5.9) 13 319 75.1(73.4~76.9) 10 593 60.0(58.4~61.6) 2 726 15.2(13.6~16.8) 1.3~ 516(2.7) 9 298(53.4) 5 980(38.9) 800(5.0) 12 488 73.7(72.1~75.4) 10 228 61.6(60.0~63.2) 2 260 12.1(11.1~13.1) 2.4~ 401(2.0) 9 361(49.5) 7 014(41.7) 902(6.8) 12 792 68.4(65.9~70.9) 10 773 58.2(56.3~60.1) 2 019 10.2(9.2~11.2) χ2值 104.460 12.127 122.145 P值 <0.001 0.007 < 0.001 地区 东部 1 158(3.3) 20 434(56.6) 11 531(34.5) 1 610(5.6) 27 044 75.7(73.3~78.2) 21 686 60.9(59.3~62.4) 5 358 14.8(13.2~16.5) 中部 807(2.8) 14 922(53.5) 8 554(37.2) 1 432(6.5) 19 528 72.3(69.9~74.6) 15 874 59.3(57.2~61.3) 3 654 13.0(11.4~14.6) 西部 1 097(3.1) 16 687(60.1) 8 076(31.6) 1 244(5.2) 21 361 76.2(74.1~78.4) 17 034 62.3(60.6~64.0) 4 327 14.0(12.7~15.2) χ2值 6.623 4.926 3.338 P值 0.037 0.085 0.188 城乡 城市 1 199(2.2) 24 056(51.7) 16 282(39.9) 2 187(6.2) 32 433 70.9(69.0~72.9) 26 620 59.4(58.0~60.8) 5 813 11.5(10.6~12.5) 农村 1 863(3.9) 27 987(60.7) 11 879(29.9) 2 099(5.5) 35 500 78.2(76.5~79.9) 27 974 61.9(60.4~63.3) 7 526 16.3(15.1~17.6) χ2值 38.985 6.719 55.791 P值 < 0.001 0.010 < 0.001 高血压 否 1 584(2.8) 28 809(56.5) 14 867(35.0) 2 146(5.7) 35 974 72.3(70.6~74.0) 29 780 60.5(59.1~61.9) 6 194 11.8(11.0~12.6) 是(知晓) 757(3.5) 10 940(53.0) 7 471(37.3) 1 196(6.2) 15 896 77.3(75.9~78.7) 12 364 60.3(59.1~61.6) 3 532 17.0(15.7~18.2) 是(不知晓) 718(3.5) 12 252(58.9) 5 798(31.8) 936(5.8) 16 000 79.6(77.8~81.3) 12 394 61.5(60.0~63.0) 3 606 18.1(16.2~19.9) χ2值 101.971 1.684 146.508 P值 < 0.001 0.431 < 0.001 糖尿病 否 2 286(2.9) 42 180(56.2) 22 628(35.1) 3 330(5.8) 54 296 73.8(72.3~75.4) 44 146 60.6(59.4~61.8) 10 150 13.2(12.3~14.2) 是(知晓) 421(5.5) 3 781(54.8) 2 233(33.4) 362(6.3) 5 405 78.1(76.2~80.1) 4 039 57.9(55.5~60.2) 1 366 20.3(17.9~22.7) 是(不知晓) 268(2.9) 4 787(58.4) 2 737(32.5) 512(6.2) 6 593 79.7(77.8~81.5) 5 113 62.4(60.1~64.7) 1 480 17.3(15.5~19.1) χ2值 45.733 6.139 70.272 P值 < 0.001 0.047 < 0.001 血脂异常 否 1 657(3.4) 28 347(60.3) 12 880(31.6) 1 819(4.7) 35 086 75.6(74.2~77.0) 28 588 62.5(61.3~63.6) 6 498 13.2(12.3~14.0) 是(知晓) 323(2.7) 4 269(40.2) 4 456(48.4) 667(8.7) 6 941 68.1(65.0~71.1) 5 554 55.1(52.8~57.4) 1 387 12.9(11.4~14.5) 是(不知晓) 1 062(2.7) 19 080(54.8) 10 690(35.9) 1 774(6.6) 25 483 74.9(73.4~76.5) 20 116 59.5(58.3~60.8) 5 367 15.4(14.1~16.7) χ2值 49.205 52.196 27.844 P值 < 0.001 < 0.001 < 0.001 注:a文化程度缺失55例,婚姻状况缺失61例,收入缺失19 705例,高血压缺失78例,糖尿病缺失2 027例,血脂异常缺失528例。 表 3 超重肥胖成人体重水平低估的多因素分析
Table 3. Multiple Logistic regression analysis of weight status underestimation among overweight and obese adults
变量 低估 轻度低估 严重低估 OR(95% CI)值 P值 OR(95% CI)值 P值 OR(95% CI)值 P值 性别 男 1.68(1.55~1.83) < 0.001 1.48(1.40~1.58) < 0.001 1.08(0.98~1.19) 0.106 女 1.00 1.00 1.00 年龄(岁) 18~ 1.00 1.00 1.00 45~ 1.67(1.54~1.81) < 0.001 1.25(1.17~1.34) < 0.001 1.51(1.31~1.76) < 0.001 60~ 2.45(2.17~2.77) < 0.001 1.31(1.19~1.44) < 0.001 2.26(1.88~2.71) < 0.001 民族 汉族 1.00 1.00 1.00 其他 1.23(0.97~1.55) 0.094 0.97(0.83~1.14) 0.738 1.48(1.10~1.98) 0.009 文化程度 小学及以下 2.23(1.89~2.63) < 0.001 1.55(1.36~1.77) < 0.001 1.98(1.56~2.52) < 0.001 初中 1.52(1.29~1.80) < 0.001 1.33(1.16~1.52) < 0.001 1.50(1.19~1.90) < 0.001 高中/中专/技校 1.21(1.01~1.44) 0.042 1.21(1.04~1.40) 0.012 1.15(0.89~1.49) 0.277 大专及以上 1.00 1.00 1.00 婚姻状况 未婚 1.00 1.00 1.00 已婚/同居 1.07(0.86~1.33) 0.576 1.19(0.98~1.44) 0.088 0.73(0.55~0.96) 0.026 丧偶/离婚/分居 1.14(0.87~1.50) 0.335 1.13(0.89~1.44) 0.324 0.92(0.67~1.26) 0.587 年收入(万元) <0.7 1.42(1.22~1.67) < 0.001 1.05(0.94~1.17) 0.399 1.73(1.43~2.11) < 0.001 0.7~ 1.19(1.05~1.36) 0.009 1.03(0.93~1.13) 0.611 1.37(1.18~1.58) < 0.001 1.3~ 1.21(1.07~1.37) 0.002 1.13(1.02~1.25) 0.022 1.13(0.99~1.29) 0.069 2.4~ 1.00 1.00 1.00 地区 东部 1.00 1.00 1.00 中部 0.79(0.67~0.94) 0.007 0.92(0.83~1.02) 0.120 0.80(0.64~1.00) 0.053 西部 0.91(0.75~1.10) 0.312 1.00(0.91~1.11) 0.983 0.85(0.69~1.05) 0.131 城乡 城市 1.00 1.00 1.00 农村 1.15(1.02~1.30) 0.020 1.02(0.94~1.11) 0.605 1.26(1.09~1.45) 0.002 肥胖程度 超重 1.00 1.00 1.00 肥胖 4.18(3.62~4.84) < 0.001 0.58(0.49~0.68) < 0.001 20.60(16.96~25.0) < 0.001 高血压 否 0.99(0.89~1.09) 0.796 1.01(0.93~1.09) 0.842 0.95(0.83~1.08) 0.428 是(知晓) 0.77(0.68~0.88) < 0.001 0.97(0.88~1.07) 0.571 0.71(0.60~0.84) < 0.001 是(不知晓) 1.00 1.00 1.00 糖尿病 否 0.86(0.75~0.99) 0.032 0.92(0.83~1.02) 0.110 0.95(0.83~1.08) 0.585 是(知晓) 0.96(0.79~1.15) 0.622 0.85(0.73~0.99) 0.039 1.36(1.11~1.67) 0.003 是(不知晓) 1.00 1.00 1.00 1.00 血脂异常 否 1.24(1.14~1.34) < 0.001 1.13(1.11~1.19) < 0.001 1.11(1.01~1.21) 0.030 是(知晓) 0.67(0.59~0.76) < 0.001 0.92(0.82~1.02) 0.103 0.63(0.55~0.72) < 0.001 是(不知晓) 1.00 1.00 1.00 -
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