中国初中生超重与肥胖流行趋势及危险因素研究

高利旺; 赵莉; 孙晓敏; 王友发

doi:10.16462/j.cnki.zhjbkz.2019.09.005

中国初中生超重与肥胖流行趋势及危险因素研究

doi: 10.16462/j.cnki.zhjbkz.2019.09.005

1.
710061 西安, 西安交通大学全球健康研究院、西安交通大学公共卫生学院
2.
610041 成都, 四川大学华西公共卫生学院

基金项目:

联合国儿童基金会 2018-Nutrition-2.1.2.3

美国国立卫生研究院 U54HDO70725

美国中华医学基金会 16-262

详细信息

通讯作者:
王友发. E-mail: youfawang@gmail.com

中图分类号: R153.2;R589.25
计量
- 文章访问数: 506
- HTML全文浏览量: 286
- PDF下载量: 58
- 被引次数: 0
出版历程
- 收稿日期: 2019-05-14
- 修回日期: 2019-07-16
- 刊出日期: 2019-09-10

Trends and risk factors of overweight and obesity among Chinese middle school students

1.
Global Health Institute, School of Public Health, Xi'an Jiaotong University, Xi'an 710061, China
2.
West of China School of Public Health, Sichuan University, Chengdu 610041, China

Funds:

The United Nations International Children 's Emergency Fund 2018-Nutrition-2.1.2.3

The US National Institutes of Health U54HDO70725

China Medical Board 16-262

More Information

Corresponding author: WANG You-fa. E-mail: youfawang@gmail.com

摘要

摘要: 目的分析中国初中学生肥胖患病情况，探讨影响其流行的因素。方法利用中国教育追踪调查2014、2015、2016年三轮数据（分别为8 616、8 762、7 614人，11~18岁），计算中国初中学生超重/肥胖患病率并描述其流行趋势，使用线性回归和Logistic回归分析模型探索初中生体重指数（body mass index，BMI）和肥胖的危险因素。结果 2016年中国初中生超重/肥胖患病率为15.3%（男：17.9%，女：12.6%）。2014-2016年，初中生超重患病率/肥胖患病率表现持续增长趋势。其中男生超重/肥胖患病率表现为先增长后稳定的流行趋势；女生的超重/肥胖患病率表现为持续增长趋势。2016年横断面研究显示，独生子女（β（SE）=0.23（0.10））、自我评价超重/肥胖（β（SE）=2.83（0.14））及户口为非农（β（SE）=0.23（0.11））是初中生BMI增长的独立危险因素；自我评价超重/肥胖（OR=4.20，95%CI：2.97~5.40）与初中生超重肥胖高度相关。结论 2014-2016年中国初中生超重/肥胖患病率持续增加。尤其应当重视对独生子女、城市学生肥胖的预防控制。
- 青少年 /
- 超重 /
- 肥胖 /
- 危险因素
Abstract: Objective To investigate the trends and risk factors of overweight and obesity in Chinese middle school students. Methods Data from the China Education Panel Survey conducted in 2014, 2015 and 2016 were used (8 616, 8 762, 7 614; age range 11-18 years old). Overweight and obesity were defined according to Chinese sex-age-specific body mass index (BMI) cutoffs. Relationships between risk factors and BMI, overweight and obesity were tested, using linear regression and logistic regression models. Results The overall prevalence of overweight and obesity in 2016 was 15.3% (17.9% in boys, 12.6% in girls). From 2014 to 2016, the prevalence of overweight and obesity was increasing steadily. After adjusting for age and sex in 2016, being only-child, self-perceived being overweight or obese, or living in urban area were associated with higher BMI (β(SE)=0.23(0.10), β(SE)=2.83(0.14), β(SE)=0.23(0.11), respectively). Self-perceived being overweight or obese was associated with overweight and obesity (OR=4.20, 95% CI: 2.97-5.40). Conclusions Overweight and obesity rates among Chinese middle school students increased steadily from 2014 to 2016. Efforts should be made on childhood obesity prevention and control, especially target at those being only-child, living in urban areas.
- Adolescent /
- Overweight /
- Obesity /
- Risk factors

HTML全文

图 1 2014 -2016年超重/肥胖趋势变化及城市和性别差异

Figure 1. The trend of overweight and obesityin different areas and gender from 2014 to 2016

下载: 全尺寸图片幻灯片

表 1 2014-2016年中国初中生BMI及超重/肥胖患病趋势变化

Table 1. Trends of BMI and overweight/obesity from 2014 to 2016

年份 (年)	BMI(kg/m²)^a			超重率(%)			肥胖率(%)			超重/肥胖率(%)
年份 (年)	2014	2015	2016	2014	2015	2016	2014	2015	2016	2014	2015	2016
总体(每轮)	18.2±3.0	19.2±3.6	20.1±4.3	8.9	9.2	9.7	3.5	5.1	5.6	12.4	14.3	15.3
性别
男	18.5±3.2	19.4±3.9	20.1±4.0	12.5	12.0	11.5	4.5	6.4	6.4	17.0	18.4	17.9
女	17.9±2.7	19.0±3.3	20.1±4.6	4.9	6.1	7.9	2.5	3.8	4.7	7.4	9.9	12.6
户口类型
农业户口	18.1±2.9	18.9±3.5	19.9±4.1	7.7	7.3	8.0	2.8	4.0	5.1	10.5	11.3	13.1
非农业户口	18.4±3.1	19.5±3.7	20.4±4.6	10.3	11.2	12.1	3.8	5.5	6.1	14.0	16.6	18.2
是否独生
否	17.9±2.9	18.9±3.6	19.9±4.1	6.9	6.9	7.1	2.3	4.0	5.2	9.2	10.9	12.3
是	18.5±3.2	19.5±3.6	20.4±4.5	11.4	12.0	12.7	4.2	5.6	6.1	15.6	17.6	18.8
身材(自我评价)
偏瘦	-	17.2±3.4	17.9±3.2	-	1.3	1.0		3.1	3.3	-	4.4	4.3
中等	-	18.5±2.8	19.4±3.7	-	3.1	2.6		1.8	2.7	-	4.9	5.3
偏胖	-	21.2±3.5	22.0±4.5	-	20.6	21.5		8.7	9.6	-	29.2	31.1
母亲受教育程度
小学及以下	17.9±2.9	19.1±3.6	20.0±5.5	6.4	6.7	7.4	2.5	4.3	4.7	8.9	11.0	12.1
初中	18.1±3.0	19.2±3.7	20.1±4.4	8.0	8.3	9.1	3.0	4.8	5.8	11.0	13.2	14.9
高中/中专	18.4±3.0	19.3±3.5	20.2±3.6	11.8	10.6	10.2	3.3	4.9	6.2	15.1	15.5	16.4
大专/本科及以上	18.6±3.0	19.4±3.4	20.2±3.5	10.8	12.7	13.5	4.1	4.8	5.3	14.9	17.5	18.8
父亲受教育程度
小学及以下	18.0±2.9	19.0±3.8	19.9±3.8	6.2	6.4	7.7	2.4	4.8	4.9	8.6	11.2	12.6
初中	18.1±3.0	19.1±3.7	20.1±4.6	8.2	7.8	8.3	2.7	5.1	5.4	10.9	12.9	13.7
高中/中专	18.3±3.0	19.2±3.4	20.2±4.7	10.1	10.4	10.8	3.4	4.2	6.4	13.5	14.6	17.2
大专/本科及以上	18.6±3.1	19.4±3.5	20.2±3.4	11.1	12.8	13.2	4.3	4.6	5.1	15.4	17.4	18.3
吃快餐膨化食品频率
少或很少	-	19.1±3.6	20.1±4.2	-	9.1	9.3	-	4.6	5.6	-	13.7	14.9
有时	-	19.3±3.6	20.2±4.2	-	9.7	10.2	-	5.0	5.6	-	14.7	15.8
经常或总是	-	19.1±3.7	20.1±4.8	-	7.7	9.2	-	4.6	5.3	-	12.3	14.5
家庭经济条件
中下	17.9±3.0	19.1±3.8	19.9±4.9	6.8	6.1	6.4	2.9	4.7	5.7	9.7	10.8	12.1
中等	18.3±2.9	19.2±3.6	20.1±4.2	9.2	9.8	10.6	3.1	4.7	5.5	12.4	14.5	16.1
中上	18.7±3.2	19.6±3.7	20.1±3.5	12.1	12.3	9.6	4.6	6.4	5.9	16.6	18.8	15.5
零用钱(元/周)
0	18.3±2.9	19.2±3.6	20.1±5.8	9.8	9.8	9.7	3.2	5.0	5.0	13.0	14.9	14.7
1~	17.8±3.0	18.8±3.5	10.0±3.6	6.7	7.9	10.3	3.8	4.0	5.2	10.5	12.0	15.5
10~	18.2±3.0	19.2±3.6	20.2±4.6	8.8	8.6	9.3	3.1	4.6	6.4	11.9	13.2	15.7
≥30	18.3±2.9	19.3±3.6	20.0±3.5	9.3	9.9	9.9	2.9	4.9	5.2	12.2	14.8	15.1
注: ^ax±s; - : 未有数据; 超重, 肥胖定义: 2018年国家卫生标准《学龄儿童青少年超重与肥胖筛查》(WS/T568-2018) ^[9]。

下载: 导出CSV

表 2 影响因素在超重/肥胖组与非超重/肥胖组间比较情况(N=7 614)

Table 2. Comparison on risk factors by weight status (N=7 614)

指标	非超重或肥胖 (n=6 453, %)	超重或肥胖 (n=1 161, %)	χ²值	P值
个人特征
性别39.961			39.961	＜0.001
女	51.3	41.4
男	48.7	58.6
是否独生			60.909	＜0.001
否	56.2	43.7
是	43.8	56.3
身材(自我评价)			957.881	＜0.001
偏瘦	24.8	6.12
中等	42.9	13.4
偏胖	32.3	80.5
家庭环境因素
母亲受教育程度			26.142	＜0.001
小学及以下	20.7	15.6
初中	41.8	40.4
高中/中专	21.0	22.8
大专/本科及以上	16.5	21.1
父亲受教育程度			26.570	＜0.001
小学及以下	13.7	11.0
初中	44.0	38.6
高中/中专	23.9	27.6
大专/本科及以上	18.4	22.8
户口类型			35.467	＜0.001
农业户口	58.8	49.2
非农业户口	41.2	50.7
家庭经济条件			13.373	0.001
中下	19.5	14.9
中等	74.0	78.5
中上	6.5	6.6
零用钱(元/周)			0.848	0.666
0	15.0	14.3
1~10	3.8	3.9
10~30	32.9	34.1
≥30	48.3	47.7
生活行为因素
吃快餐膨化食品频率			1.449	0.330
少或很少	42.2	41.2
有时	45.0	46.8
经常或总是	12.8	12.0

下载: 导出CSV

表 4 BMI和超重/肥胖影响因素的多因素回归分析

Table 4. Multivariate regression analysis on risk factors of BMI and overweight/obesity

	BMI		超重/肥胖
	β(SE)	P值	OR(95% CI)	P值
是否独生(否=0)
是	0.23(0.10)	0.019	1.06(0.84~1.35)	0.615
身材(自我评价)(中等=0)
偏瘦	-1.67(0.10)	＜0.001	0.93(0.66~1.33)	0.711
偏胖	2.83(0.14)	＜0.001	4.20(2.97~5.40)	＜0.001
户口类型(农业户口=0)
非农业户口	0.23(0.11)	0.037	1.21(0.91~1.60)	0.186
注：调整了年龄、性别和表 3中有意义的结果; -：未纳入分析。

下载: 导出CSV

表 3 BMI和超重/肥胖影响因素的单因素回归分析

Table 3. Univariate regression analysis on risk factors of BMI and overweight/obesity

	BMI		超重/肥胖
	β(SE)	P值	OR(95% CI)	P值
是否独生(否=0)
是	0.46(0.12)	＜0.001	1.55(1.32~1.81)	＜0.001
身材(自我评价)(中等=0)
偏瘦	-1.61(0.10)	＜0.001	0.69(0.51~0.94)	0.018
偏胖	2.82(0.14)	＜0.001	10.62(8.35~13.51)	＜0.001
户口类型(农业户口=0)
非农业户口	0.42(0.13)	0.001	1.45(1.22~1.71)	＜0.001
家庭经济条件(中等=0)
中下	-0.17(0.14)	0.250	0.73(0.60~0.90)	0.002
中上	-0.01(0.99)	0.993	0.95(0.75~1.19)	0.640
母亲受教育程度(小学及以下=0)
初中	0.11(0.19)	0.543	1.23(0.98~1.54)	0.070
高中/中专	0.16(0.22)	0.465	1.36(1.05~1.77)	0.022
大专/本科及以上	0.24(0.22)	0.290	1.60(1.21~2.11)	0.001
父亲受教育程度(小学及以下=0)
初中	0.20(0.14)	0.174	1.05(0.85~1.29)	0.653
高中/中专	0.34(0.16)	0.039	1.34(1.07~1.69)	0.012
大专/本科及以上	0.33(0.18)	0.081	1.45(1.12~1.89)	0.005
注：回归分析中调整了年龄、性别2种因素。

下载: 导出CSV

参考文献(17)

[1]	Wang Y, Wang L, Qu W. New national data show alarming increase in obesity and noncommunicable chronic diseases in China[J]. Eur J Clin Nutr, 2017, 71(1): 149-150. DOI: 10.1038/ejcn.2016.
[2]	Jia P, Xue H, Zhang J, et al. Time trend and demographic and geographic disparities in childhood obesity prevalence in China-evidence from twenty years of longitudinal data[J]. Int J Environ Res Public Health, 2017, 14(4). DOI: 10.3390/ijerPh14040369.
[3]	Chen F, Wang Y, Shan X, et al. Association between childhood obesity and metabolic syndrome: evidence from a large sample of Chinese children and adolescents[J]. PloS one, 2012, 7(10): e47380. DOI: 10.1371/journal.Pone.0047380.
[4]	Xi B, Liang Y, Mi J. Hypertension trends in Chinese children in the national surveys, 1993 to 2009[J]. Int J Cardiol, 2013, 165(3): 577-579. DOI: 10.1016/j.ijcard.2012.09.032.
[5]	季成叶. 儿童少年卫生学(第7版)[M]. 北京: 人民卫生出版社, 2012. Ji CY. Hygiene of children and adolescents (7th edition)[M]. Beijing: People's Medical Publishing House, 2012.
[6]	王晓, 罗春燕, 陈毅琼, 等. 上海市静安区初中生超重肥胖知信行现状[J]. 环境与职业医学, 2018, 35(10): 924-928. DOI: 10.13213/j.cnki.jeom.2018.18203. Wang X, Luo CY, Chen YQ, et al. Overweight or obesity relevant knowledge, attitude, and practice among middle school students in Jing'an District, Shanghai[J]. J Environ Occup Med, 2018, 35(10): 924-928. DOI: 10.13213/j.cnki.jeom.2018.18203.
[7]	周潇潇. 台州市初中学生肥胖流行状况及影响因素研究[D]. 杭州: 浙江大学, 2017. Zhou XX. Prevalence and influencing factors of obesity among junior high school students in Taizhou[D]. Hangzhou: Zhejiang University, 2017.
[8]	Tan Z, Min J, Xue H, et al. Parenting practices and overweight status of junior high school students in China: a nationally representative study of 19487 students from 112 schools[J]. Prev Med, 2018, 107: 1-7. DOI: 10.1016/j.yPmed.2017.09.014.
[9]	中华人民共和国国家卫生和计划生育委员会. 学龄儿童青少年超重与肥胖筛查(WS/T 568-2018)[D]. http://www.moh.gov.cn/xxgk/pages/wsbzsearch.jsp. National Health and Family Planning Commission of the people's Republic of China. Screening for overweight and obesity among school-age children and adolescents(WS/T 568-2018)[D]. http://www.moh.gov.cn/xxgk/pages/wsbzsearch.jsp.
[10]	Herman KM, Craig CL, Gauvin L, et al. Tracking of obesity and physical activity from childhood to adulthood: the Physical Activity Longitudinal Study[J]. Int J Pediatr Obes, 2009, 4(4): 281-288. DOI: 10.3109/17477160802596171.
[11]	王烁, 董彦会, 王政和, 等. 1985-2014年中国7~18岁学生超重与肥胖流行趋势[J]. 中华预防医学杂志, 2017, 51(4): 300-305. DOI: 10.3760/cma.j.issn.0253-9624.2017.04.005. Wang S, Dong YH, Wang ZH, et al. Trends in overweight and obesity among Chinese children of 7-18 years old during 1985-2014[J]. Chin J Prev Med, 2017, 51(4): 300-305. DOI: 10.3760/cma.j.issn.0253-9624.2017.04.005.
[12]	Li M, Xue H, Wang W, et al. Increased obesity risks for being an only child in China: findings from a nationally representative study of 19487 children[J]. Public health, 2017, 153: 44-51. DOI: 10.1016/j.Puhe.2017.07.002.
[13]	Min J, Xue H, Wang VHC, et al. Are single children more likely to be overweight or obese than those with siblings? The influence of China's one-child policy on childhood obesity[J]. Prev Med, 2017, 103: 8-13. DOI: 10.1016/j.yPmed.2017.07.018.
[14]	Cheng TO. China's little emperors: medical consequences of China's one-child policy[J]. Int J Cardiol, 2013, 168(6): 5121-5125. DOI: 10.1016/j.ijcard.2013.08.074.
[15]	Min J, Fang YA, Wang Y. Mismatch in children's weight assessment, ideal body image, and rapidly increased obesity prevalence in China: a 10-year, nationwide, longitudinal study[J]. Obesity, 2018, 26(11): 1777-1784. DOI: 10.1002/oby.22310.
[16]	CuyPers K, Kvaloy K, Bratberg G, et al. Being normal weight but feeling overweight in adolescence may affect weight development into young adulthood-an 11-year followup: the hunt study, Norway[J]. J Obes, 2012, 2012: 601872. DOI: 10.1155/2012/601872.
[17]	van den Berg PA, Mond J, Eisenberg M, et al. The link between body dissatisfaction and self-esteem in adolescents: similarities across gender, age, weight status, race/ethnicity, and socioeconomic status[J]. J Adolesc Health, 2010, 47(3): 290-296. DOI: 10.1016/j.jadohealth.2010.02.004.