The association of sedentary lifestyles with cardiometabolic risk factors in children in Guangzhou
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摘要:
目的 了解广州市儿童课外静态生活方式情况，探究课外静态生活方式与心血管代谢危险因素的关系。 方法 本研究采用分层整群随机抽样的方法，于2017年抽取广州市7~12岁儿童4 294名，采用体格检查、问卷调查等方法，收集儿童课外静态生活方式及心血管代谢危险因素状况，分析比较不同课外静态生活时间对心血管代谢危险因素的影响。 结果 被调查儿童每天课外静态生活时间平均为194.3 min（男生200.3 min，女生187.3 min），四分位数分组分别为≤ 130.0、131.0~、181.0~、≥ 241.0 min。在控制混杂因素后，与每天课外静态生活时间最低组相比，每天课外静态生活时间最高组发生中央型肥胖、超重肥胖、总胆固醇异常、甘油三酯异常以及低密度脂蛋白胆固醇异常的OR值及其95% CI分别为1.39（1.08~1.80），1.44（1.16~1.80），1.26（1.05~1.51），1.63（1.34~1.98）和1.28（1.06~1.55）。 结论 过长的课外静态生活时间会增加儿童中央型肥胖、超重肥胖的风险，并且与儿童的血脂紊乱有关，应加强对我国儿童青少年生活方式的干预，减少儿童青少年静态生活时间。 Abstract:Objective To evaluate sedentary lifestyles after school in children aged 7 to 12 year-old living in Guangzhou, and to explore the association between sedentary behaviors after school with cardiometabolic risk factors. Methods Using the method of stratified cluster random sampling, this study recruited 7 to 12 year-old primary students (n=4 294) in Guangzhou. The physical examination and questionnaire were used to collect the sedentary lifestyles after school and cardiometabolic risk factors, analyzing the impact of different aedentary behavoir time after school on cardiometabolic risk factors. Results The average sedentary time after school per day were 194.3 min (boys: 200.3 min; girls: 187.3 min). Inter-quartile ranges of sedentary time after school per day were ≤ 130.0, 131.0-180.0, 181.0-240.0, and ≥ 241.0 min/d. Controlling for confounding factors, the odd ratios (OR) of central obesity, overweight/obesity, high TC status, high TG status and high LDL-C status in the highest compared to the lowest quartile of sedentary time after school per day were 1.39 (95%CI: 1.08-1.80), 1.44 (95%CI: 1.16-1.80), 1.26(95%CI: 1.05-1.51), 1.63(95%CI: 1.34-1.98), 1.28(95%CI: 1.06-1.55), respectively. Conclusions Sedentary lifestyles have a positive relationship with childhood central obesity, overweight/obesity and dyslipidemia in primary school children. Therefore, it is essential to strengthen the intervention to the lifestyles of teenagers and reduce the sedentary behavior time of children and teenagers. -
Key words:
- Sedentary lifestyle /
- Cardiometabolic risk factor /
- Children
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表 1 广州市7~12岁儿童的基本资料(x±s)
Table 1. The basic characteristics of children aged 7 to 12 in Guangzhou (x±s)
特征 合计 男生 女生 t/χ2值 P值 年龄(岁) 9.6±1.6 9.6±1.6 9.6±1.5 0.994 0.320 身高(cm) 139.2±11.4 139.2±11.3 139.1±11.6 0.254 0.800 体重(kg) 33.9±10.5 34.9±11.0 32.7±9.9 6.921 ＜0.001 每周体力活动水平(MET-min/week)a 3 303.4±2 527.4 3 405.4±2 608.5 3 185.9±2 425.9 2.834 0.005 每天课外静态生活时间(min) 194.3±93.9 200.3±95.1 187.3±92.0 4.553 ＜0.001 相关疾病家族史a(%) 2.644 0.104 有 2 766(64.4) 1 507(65.5) 1 259(63.1) 无 1 528(35.6) 793(34.5) 735(36.9) 父亲文化程度a(%) 3.797 0.284 初中及以下 268(6.3) 144(6.4) 124(6.3) 高中或中专 850(20.1) 475(21.0) 375(19.0) 大专 1 052(24.9) 569(25.2) 483(24.5) 本科及以上 2 061(48.7) 1 073(47.5) 988(50.2) 母亲文化程度a(%) 6.071 0.108 初中及以下 380(9.0) 193(8.5) 187(9.5) 高中或中专 833(19.7) 474(21.0) 359(18.2) 大专 1 133(26.8) 608(26.9) 525(26.7) 本科及以上 1 881(44.5) 984(43.6) 897(45.6) 人均月收入(元) 8.738 0.068 ＜5 000 924(21.5) 486(21.1) 438(22.0) 5 000~ 1 113(25.9) 618(26.9) 495(24.8) 8 000~ 1 071(24.9) 542(23.6) 529(26.5) ≥15 000 569(13.3) 325(14.1) 244(12.2) 拒绝回答 617(14.4) 329(14.3) 288(14.4) 注：P值为不同性别比较结果；a有63人未报告体力活动情况，63人未报告父亲学历，67人未报告母亲学历；相关疾病家族史指三代以内直系/旁系血亲患肥胖、高血压、糖尿病、心血管疾病的情况。 
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表 2 广州市7~12岁儿童不同课外静态生活时间四分位数分组心血管代谢危险因素比较(x±s)
Table 2. The comparison of cardiometabolic risk factors in different sedentary time groups(x±s)
测量指标 合计 每天课外静态生活时间四分位数分组 F1 P1 F2 P2 Q1(N=1 096) Q2 (N=1 218) Q3(N=1 017) Q4(N=963) WC(cm) 59.52±9.08 58.54±8.64 58.67±8.61 59.96±9.30 61.24±9.66 20.358 ＜0.001 5.977 ＜0.001 BMI(kg/m2) 17.15±3.21 16.80±2.99 16.86±3.06 17.35±3.33 17.70±3.41 18.723 ＜0.001 6.921 ＜0.001 SBP(mmHg) 102.10±11.09 101.59±10.90 101.61±11.09 102.60±11.11 102.77±11.24 3.426 0.016 0.877 0.452 DBP(mmHg) 64.94±8.43 64.67±8.40 64.43±8.42 65.24±8.21 65.56±8.67 4.039 0.007 1.928 0.123 FBG(mmol/L) 5.02±0.49 4.98±0.58 5.01±0.41 5.02±0.42 5.09±0.53 9.614 ＜0.001 6.009 ＜0.001 TC(mmol/L) 4.40±0.76 4.37±0.76 4.42±0.78 4.42±0.73 4.40±0.77 1.045 0.371 1.769 0.151 TG(mmol/L) 0.84±0.37 0.79±0.31 0.83±0.35 0.84±0.38 0.90±0.44 13.668 ＜0.001 11.200 ＜0.001 LDL-C(mmol/L) 2.65±0.70 2.63±0.68 2.66±0.70 2.65±0.67 2.67±0.75 0.669 0.571 1.408 0.238 HDL-C(mmol/L) 1.54±0.33 1.55±0.33 1.55±0.33 1.55±0.33 1.51±0.32 4.264 0.005 2.764 0.040 注：P1采用方差分析比较每天静态生活时间不同分组间差别；P2采用协方差分析调整年龄、性别比较每天静态生活时间不同分组间差别。
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表 3 广州市7~12岁儿童不同课外静态生活时间四分位数分组心血管代谢危险因素异常检出率比较(%)
Table 3. The comparison of abnormal detection rates of cardiometabolic risk factors in different sedentary time groups(%)
特征 合计 每天课外静态生活时间四分位数分组 χ2值 P值 Q1 Q2 Q3 Q4 WC(cm) 15.593 ＜0.001 正常腰围 3 675(85.6) 956(87.2) 1 076(88.3) 849(83.5) 794(82.5) 中央型肥胖 619(14.4) 140(12.8) 142(11.7) 168(16.5) 169(17.5) BMI(kg/m2) 24.933 ＜0.001 正常体重 3 358(78.2) 894(81.6) 980(80.5) 767(75.4) 717(74.5) 超重 500(11.6) 115(10.5) 135(11.1) 128(12.6) 122(12.7) 肥胖 436(10.2) 87(7.9) 103(8.5) 122(12.0) 124(12.9) BP(mmHg) 4.963 0.026 正常血压 3 317(77.2) 865(78.9) 953(78.2) 767(75.4) 732(76.0) 正常高值 436(10.2) 103(9.4) 133(10.9) 99(9.7) 101(10.5) 高血压 541(12.6) 128(11.7) 132(10.8) 151(14.8) 130(13.5) FBG(mmHg) 2.289 0.130 正常血糖 3 944(91.8) 1 012(92.3) 1 126(92.4) 935(91.9) 871(90.4) 空腹血糖受损 347(8.1) 82(7.5) 92(7.6) 82(8.1) 91(9.4) 糖尿病 3(0.1) 2(0.2) 0(0.0) 0(0.0) 1(0.1) TC(mmHg) 2.032 0.154 理想水平 2 270(52.9) 614(56.0) 624(51.2) 535(52.6) 497(51.6) 临界高值 1 464(34.1) 348(31.8) 433(35.6) 338(33.2) 345(35.8) TC升高 560(13.0) 134(12.2) 161(13.2) 144(14.2) 121(12.6) TG(mmHg) 17.659 ＜0.001 理想水平 2 942(68.5) 798(72.8) 832(68.3) 697(68.5) 615(63.9) 临界高值 879(20.5) 199(18.2) 254(20.9) 208(20.5) 218(22.6) TG升高 473(11.0) 99(9.0) 132(10.8) 112(11.0) 130(13.5) LDL-C(mmHg) 3.036 0.081 理想水平 2 801(65.2) 737(67.2) 786(64.5) 665(65.4) 613(63.7) 临界高值 930(21.7) 230(21.0) 274(22.5) 210(20.6) 216(22.4) LDL升高 563(13.1) 129(11.8) 158(13.0) 142(14.0) 134(13.9) HDL-C(mmHg) 0.941 0.332 HDL降低 163(3.8) 44(4.0) 39(3.2) 33(3.2) 47(4.9) 临界低值 335(7.8) 82(7.5) 93(7.6) 88(8.7) 72(7.5) 理想水平 3 796(88.4) 970(88.5) 1 086(89.2) 896(88.1) 844(87.6) 注：P值由线性趋势检验得出。
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表 4 不同课外静态生活时间分组对心血管代谢危险因素的影响模型分析结果[OR(95%CI)]
Table 4. Analysis of the effects of different sedentary life time groups on cardiovascular metabolic risk factors[OR(95%CI)]
指标 每天静态生活时间四分位数分组 P值 Q1 Q2 Q3 Q4 中央型肥胖 1.00 0.88(0.68~1.14) 1.30(1.01~1.67)a 1.39(1.08~1.80)a 0.001 超重肥胖 1.00 1.05(0.85~1.31) 1.34(1.08~1.67)b 1.44(1.16~1.80)b 0.002 血压升高 1.00 1.00(0.82~1.23) 1.17(0.95~1.44) 1.09(0.88~1.35) 0.400 FBG异常 1.00 0.93(0.68~1.28) 1.00(0.72~1.38) 1.09(0.79~1.51) 0.804 TC异常 1.00 1.23(1.04~1.46)a 1.16(0.97~1.38) 1.26(1.05~1.51)a 0.044 TG异常 1.00 1.26(1.05~1.51)a 1.27(1.05~1.54)a 1.63(1.34~1.98)b ＜0.001 LDL-C异常 1.00 1.17(0.98~1.40) 1.13(0.94~1.36) 1.28(1.06~1.55)a 0.076 HDL-C异常 1.00 0.94(0.72~1.22) 1.07(0.81~1.40) 1.07(0.81~1.42) 0.734 注：采用Logistic回归分析模型进行分析，P值为对每天静态生活时间四分位数分组的回归系数检验结果；按照相关标准，将各个指标均划分为正常和异常(包含临界和异常两个阶段)，变量赋值为0=正常，1=异常；控制因素为性别、年龄、每周体力活动水平、相关疾病家族史、父母亲文化程度以及家庭人均月收入。a表示P < 0.05, b表示P < 0.01。
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