中国7~17岁儿童青少年宏量营养素摄入与中心性肥胖的关系

梁芬; 南颖; 宋玮琦; 王劲东; 孙宇; 张文婷; 刘丹; 毛琛

doi:10.16462/j.cnki.zhjbkz.2021.05.005

中国7~17岁儿童青少年宏量营养素摄入与中心性肥胖的关系

doi: 10.16462/j.cnki.zhjbkz.2021.05.005

梁芬¹,
南颖²,
宋玮琦¹,
王劲东¹,
孙宇¹,
张文婷¹,
刘丹¹,
毛琛^1, ,

1.
510515 广州，南方医科大学公共卫生学院流行病学系
2.
510515 广州，南方医科大学护理学院

梁芬和南颖为共同第一作者

基金项目:

第五届中国科协青年人才托举工程项目 2019QNRC001

广东省高等学校珠江学者岗位计划资助项目 2019

广东省高水平大学建设计划 G820332010

广东省高水平大学建设计划 G618339167

广东省高水平大学建设计划 G618339164

详细信息

通讯作者:
毛琛，E-mail：maochen9@smu.edu.cn

中图分类号: R153.2
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- 被引次数: 0
出版历程
- 收稿日期: 2021-03-16
- 修回日期: 2021-04-06
- 网络出版日期: 2021-06-16
- 刊出日期: 2021-05-10

Study on the association between macronutrients intake and abdominal obesity in Chinese children and adolescents aged 7-17 years

1.
Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China
2.
School of Nursing, Southern Medical University, Guangzhou 510515, China

Funds:

Young Elite Scientists Sponsorship Program by CAST 2019QNRC001

Guangdong Province Universities and Colleges Pearl River Scholar Funded Scheme 2019

The Construction of High-level University of Guangdong G820332010

The Construction of High-level University of Guangdong G618339167

The Construction of High-level University of Guangdong G618339164

More Information

Corresponding author: MAO Chen, E-mail: maochen9@smu.edu.cn

摘要

摘要: 目的探讨三大宏量营养素供能比对儿童青少年中心性肥胖前期/中心性肥胖的影响。方法本研究采用横断面研究，对象为1997—2011年中国营养与健康调查6轮调查中膳食及腰围数据完整的7~17岁的儿童青少年。根据中国疾病预防控制中心营养与食品安全所的研究标准判定儿童青少年中心性肥胖前期/中心性肥胖。采用多因素Logistic回归分析模型分析宏量营养素供能比与中心性肥胖前期/中心性肥胖的关系。结果调整相关混杂因素后，与脂肪供能比 < 25%组相比，≥30%组增加中心性肥胖前期/中心性肥胖风险(OR=1.29, 95% CI: 1.12~1.48)；与蛋白质供能比 < 10%组相比，≥15%组增加中心性肥胖前期/中心性肥胖风险(OR=1.47, 95% CI: 1.19~1.82)；与碳水化合物供能比 < 55%组相比，55%~ < 65%组(OR=0.75, 95% CI: 0.64~0.87)与≥65%组(OR=0.68, 95% CI: 0.58~0.80)都降低了中心性肥胖前期/中心性肥胖风险。男生蛋白质供能比≥15%增加中心性肥胖前期/中心性肥胖的风险与女生相比更大(OR=1.78, 95% CI: 1.31~2.41, 交互作用P=0.012)。结论儿童青少年膳食结构中，脂肪和蛋白质供能比越高、碳水化合物供能比越低会增加中心性肥胖前期/中心性肥胖发生风险。
- 儿童 /
- 青少年 /
- 宏量营养素 /
- 中心性肥胖 /
- 腰围
Abstract: Objective To explore the effect of macronutrient energy supply ratios on precentral obesity/central obesity in children and adolescents. Methods A cross-sectional study was conducted on children and adolescents aged 7-17 year. Dietary and waist circumference data were collected from the six rounds of the China Health and Nutrition Survey (CHNS) during 1997 to 2011. According to the research criteria of National Institute of Nutrition and Food Safety of Chinese Center for Disease Control and Prevention, precentral obesity/central obesity in children and adolescents was determined. Multivariate Logistic regression was used to analyze the relationship between macronutrient energy supply ratios and precentral obesity/central obesity. Results After adjusting confounders, the group with more than 30% fat supply increased the risk of precentral obesity/central obesity (OR=1.29, 95% CI: 1.12-1.48) compared with the group with fat energy supply less than 25%. Compared with the protein energy ratio less than 10% group, the ratio greater than or equal to 15% group increased the risk of precentral obesity/central obesity (OR=1.47, 95% CI: 1.19-1.82). The risk ofprecentral obesity/central obesity were both decreased in the 55% to 65% group (OR=0.75, 95% CI: 0.64-0.87) and ratio greater than or equal to 65% group (OR=0.68, 95% CI: 0.58-0.80) compared with the group with a carbohydrate energy supply ratio of less than 55%. The increased risk of precentral obesity/central obesity was greater in boys with protein energy ratio greater than or equal to 15% than in girls (OR=1.78, 95% CI: 1.31-2.41, interaction P=0.011). Conclusion Dietary structure of children and adolescents with lower carbohydrate energy ratio and higher fat and protein energy ratio increase the risk of precentral obesity/central obesity.
- Children /
- Adolescents /
- Macronutrients /
- Abdominal obesity /
- Waist circumference

HTML全文

图 1 1997—2011年7~17岁儿童青少年宏量营养素供能比中心性肥胖前期/中心性肥胖的人群比例变化趋势

Figure 1. The change trend of the macronutrients intake ratio and the proportion of precentral obesity/central obesity among children and adolescents aged 7-17 years, 1997-2011

下载: 全尺寸图片幻灯片

图 2 按年龄、性别分层对宏量营养素供能比与中心性肥胖前期/中心性肥胖的多因素Logistic回归分析

注：校正了年龄、性别、城乡、家庭人均年收入、父母肥胖、经常参加体育锻炼和摄入总能量/RNI。

Figure 2. Multiple Logistic regression analysis on the association of macronutrient energy supply ratios and precentral obesity/central obesity in groups stratified by age and sex

下载: 全尺寸图片幻灯片

表 1 6 360名7~17岁儿童青少年基本特征[n(%)]

Table 1. The demographic characteristics of 6 360 children and adolescents aged 7-17 years old [n(%)]

变量	合计 (N=6 360)	非肥胖组 (n=4 929)	中心性肥胖前期/ 中心性肥胖组 (n=1 431)	χ²值	P值
年龄(岁)				11.872	0.001
7~ < 12	3 529(55.5)	2 792(56.6)	737(51.5)
12~17	2 831(44.5)	2 137(43.4)	694(48.5)
性别				27.387	＜0.001
男	3 360(52.8)	2 691(54.6)	669(46.8)
女	3 000(47.2)	2 238(45.4)	762(53.2)
城乡				37.750	＜0.001
城市	1 958(30.8)	1 423(28.9)	535(37.4)
农村	4 402(69.2)	3 506(71.1)	896(62.6)
家庭人均年收入				33.402	＜0.001
低	1 916(30.1)	1 557(31.6)	359(25.1)
中	3 223(50.7)	2 487(50.5)	736(51.4)
高	1 221(19.2)	885(18.0)	336(23.5)
父母肥胖				124.192	＜0.001
否	4 906(77.1)	3 958(80.3)	948(66.2)
是	1 454(22.9)	971(19.7)	483(33.8)
摄入总能量/RNI(%)				2.128	0.345
< 80	3 022(47.5)	2 366(48.0)	656(45.8)
80~ < 100	1 821(28.6)	1 401(28.4)	420(29.4)
≥100	1 517(23.9)	1 162(23.6)	355(24.8)
经常进行体育锻炼				10.977	0.001
是	4 819(75.8)	3 782(76.7)	1 037(72.5)
否	1 541(24.2)	1 147(23.3)	394(27.5)
碳水化合物供能比(%)				61.281	＜0.001
< 55	2 203(34.6)	1 588(32.2)	615(43.0)
55~ < 65	1 917(30.1)	1 512(30.7)	405(28.3)
≥65	2 240(35.2)	1 829(37.1)	411(28.7)
脂肪供能比(%)				42.218	＜0.001
< 25	2 687(42.2)	2 159(43.8)	528(36.9)
25~ < 30	1 053(16.6)	846(17.2)	207(14.5)
≥30	2 620(41.2)	1 924(39.0)	696(48.6)
蛋白质供能比(%)				31.738	＜0.001
< 10	1 121(17.6)	910(18.5)	211(14.7)
10~ < 15	4 249(66.8)	3 314(67.2)	935(65.3)
≥15	990(15.6)	705(14.3)	285(19.9)

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表 2 宏量营养素供能比与7~17岁儿童青少年中心性肥胖前期/中心性肥胖的多因素Logistic回归分析模型分析

Table 2. Multivariate Logistic regression analysis of macronutrient energy supply ratio and precentral obesity/central obesity among children and adolescents aged 7-17 years

变量	总人数/(中心性肥胖前期/中心性肥胖数)	模型1^a		模型2^b		模型3^c
变量	总人数/(中心性肥胖前期/中心性肥胖数)	OR(95% CI)值	P值	OR(95% CI)值	P值	OR(95% CI)值	P值
摄入总能量/RNI(%)
< 80	3 022/656	1.00		1.00		1.00
80~ < 100	1 821/420	1.08(0.94~1.24)	0.271	1.09(0.95~1.26)	0.206	1.08(0.94~1.25)	0.268
≥100	1 517/355	1.10(0.95~1.28)	0.196	1.11(0.96~1.29)	0.170	1.08(0.93~1.25)	0.317
趋势性检验P值			0.119		0.258		0.415
碳水化合物供能比(%)
< 55	2 203/615	1.00		1.00		1.00
55~ < 65	1 917/405	0.69(0.60~0.80)	0.000	0.73(0.63~0.84)	0.000	0.75(0.64~0.87)	＜0.001
≥65	2 240/411	0.58(0.50~0.67)	0.000	0.62(0.54~0.72)	0.000	0.68(0.58~0.80)	＜0.001
趋势性检验P值			＜0.001		＜0.001		＜0.001
脂肪供能比(%)
< 25	2 687/528	1.00		1.00		1.00
25~ < 30	1 053/207	1.01(0.84~1.20)	0.996	0.97(0.81~1.16)	0.750	0.93(0.78~1.12)	0.459
≥30	2 620/696	1.48(1.30~1.68)	＜0.001	1.39(1.21~1.59)	＜0.001	1.29(1.12~1.48)	＜0.001
趋势性检验P值			＜0.001		＜0.001		＜0.001
蛋白质供能比(%)
< 10	1 121/211	1.00		1.00		1.00
10~ < 15	4 249/935	1.22(1.03~1.44)	0.021	1.19(1.00~1.40)	0.046	1.13(0.95~1.33)	0.183
≥15	990/285	1.74(1.42~2.14)	＜0.001	1.61(1.31~1.99)	＜0.001	1.47(1.19~1.82)	0.001
趋势性检验P值			＜0.001		＜0.001		0.001
注：^a模型1：未校正任何因素；^b模型2：校正了年龄、性别、城乡；^c模型3：进一步校正家庭人均年收入、父母肥胖和经常参加体育锻炼；除摄入总能量/RNI外，其余三个宏量营养素供能比都校正了摄入总能量/RNI。

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参考文献(35)

[1]	Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013[J]. Lancet, 2014, 384(9945): 766-781. DOI: 10.1016/s0140-6736(14)60460-8.
[2]	Han JC, Lawlor DA, Kimm SY. Childhood obesity[J]. Lancet, 2010, 375(9727): 1737-1748. DOI: 10.1016/S0140-6736(10)60171-7.
[3]	Ebbeling CB, Pawlak DB, Ludwig DS. Childhood obesity: public-health crisis, common sense cure[J]. Lancet, 2002, 360(9331): 473-482. DOI: 10.1016/S0140-6736(02)09678-2.
[4]	Després JP. Is visceral obesity the cause of the metabolic syndrome?[J]. Ann Med, 2006, 38(1): 52-63. DOI: 10.1080/07853890500383895.
[5]	Després JP, Lemieux I. Abdominal obesity and metabolic syndrome[J]. Nature, 2006, 444(7121): 881-887. DOI: 10.1038/nature05488.
[6]	Ebbeling CB, Pawlak DB, Ludwig DS. Childhood obesity: public-health crisis, common sense cure[J]. Lancet, 2002, 360(9331): 473-482. DOI: 10.1016/S0140-6736(02)09678-2.
[7]	Morales LS, Flores YN, Leng M, et al. Risk factors for cardiovascular disease among Mexican-American adults inthe United States and Mexico: a comparative study[J]. Salud Publica Mex, 2014, 56: 197-205. DOI: 10.21149/spm.v56i2.7335.
[8]	Ford ES, Maynard LM, Li C. Trends in mean waist circumference and abdominal obesity among US adults, 1999-2012[J]. JAMA, 2014, 312(11): 1151-1153. DOI: 10.1001/jama.2014.8362.
[9]	Després JP, Lemieux I. Abdominal obesity and metabolic syndrome[J]. Nature, 2006, 444(7121): 881-887. DOI: 10.1038/nature05488.
[10]	Daniels SR, Khoury PR, Morrison JA. Utility of different measures of body fat distribution in children and adolescents[J]. Am J Epidemiol, 2000, 152(12): 1179-1184. DOI: 10.1093/aje/152.12.1179.
[11]	Rathnayake KM, Roopasingam T, Dibley MJ. High carbohydrate diet and physical inactivity associated with central obesity among premenopausal housewives in Sri Lanka[J]. BMC Res Notes, 2014, 7: 564. DOI: 10.1186/1756-0500-7-564.
[12]	Carolina Population Center at the University of North Carolina. China Health and Nutrition Survey[EB/OL]. (2020-12-07)[2021-02-20]. https://www.cpc.unc.edu/projects/china.
[13]	中国疾病预防控制中心营养与食品安全所, 湖北省疾病预防控制中心, 首都儿科研究所, 等. WS/T 424-2013人群健康监测人体测量方法[S]. 北京: 中华人民共和国卫生部, 2013. Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Hubei Provincial Center for Disease Control and Prevention, Children's Hospital Affiliated to Capital Institute of Pediatrics, et al. WS/T 424-2013 Anthropometric measurements method in health surveillance[S]. Beijing: Ministry of Health of the People's Republic of China, 2013.
[14]	Ma GS, Ji CY, Ma J, et al. Waist circumference reference values for screening cardiovascular risk factors in Chinese children and adolescents aged 7-18 years[J]. Chin J Epidemiol, 2010, 31(6): 609-615. http://www.cqvip.com/qk/83601a/201004/34169352.html
[15]	中国营养学会. 中国居民膳食营养素参考摄入量[J]. 营养学报, 2001, (3): 193-196. https://www.cnki.com.cn/Article/CJFDTOTAL-YYXX201404004.htm Chinese Society for Nutrition. Chinese Dietary Reference Intakes[J]. Acta Nutrimenta Sinica, 2001, (3): 193-196. https://www.cnki.com.cn/Article/CJFDTOTAL-YYXX201404004.htm
[16]	Emmett PM, Jones LR. Diet, growth, and obesity development throughout childhood in the Avon Longitudinal Study of Parents and Children[J]. Nutr Rev, 2015, 73(Suppl 3): 175-206. DOI: 10.1093/nutrit/nuv054.
[17]	Gupta N, Goel K, Shah P, et al. Childhood obesity in developing countries: epidemiology, determinants, and prevention[J]. Endocr Rev, 2012, 33(1): 48-70. DOI: 10.1210/er.2010-0028.
[18]	中华人民共和国国家卫生和计划生育委员会. WS/T 428—2013成人体重判定[S]. 北京: 中国标准出版社, 2013. National Health and Family Planning Commission of the People's Republic of China. WS/T 428—2013 Criteria of weight for adults[S]. Beijing: Standards Press of China, 2013.
[19]	Rubin DB. Missing Data, Imputation, and the Bootstrap: Comment[J]. J Am Stat Assoc, 1994, 89(426): 478. DOI: 10.1080/01621459.1994.10476768.
[20]	Zhu ZN, Yang XG, Fang YH, et al. Trends and Disparities of Energy Intake and Macronutrient Composition in China: A Series of National Surveys, 1982-2012[J]. Nutrients, 2020, 12(8): 2168. DOI: 10.3390/nu12082168.
[21]	葛可佑. 中国人群膳食结构的变化[J]. 卫生研究, 1996, 25(S1): 28-32. https://www.cnki.com.cn/Article/CJFDTOTAL-WSYJ6S1.004.htm Ge KY. The change of dietary pattern of Chinese populations[J]. J Hyg Res, 1996, 25(S1): 28-32. https://www.cnki.com.cn/Article/CJFDTOTAL-WSYJ6S1.004.htm
[22]	张琪, 潘晓群, 杨婕, 等. 中国成年女性能量及宏量营养素摄入与超重肥胖关系的研究[J]. 中华疾病控制杂志, 2014, 18(4): 296-300. https://www.cnki.com.cn/Article/CJFDTOTAL-JBKZ201404007.htm Zhang Q, Pan XQ, Yang J, et al. Study on the associations of energy and macronutrients intake with overweight and obesity in Chinese female adults[J]. Chin J Dis Control Prev, 2014, 18(4): 296-300. https://www.cnki.com.cn/Article/CJFDTOTAL-JBKZ201404007.htm
[23]	Mohammadbeigi A, Asgarian A, Moshir E, et al. Fast food consumption and overweight/obesity prevalence in students and its association with general and abdominal obesity[J]. J Prev Med Hyg, 2018, 59(3): E236-E240. DOI: 10.15167/2421-4248/jpmh2018.59.3.830.
[24]	Cui Z, Hardy LL, Dibley MJ, et al. Temporal trends and recent correlates in sedentary behaviours in Chinese children[J]. Int J Behav Nutr Phys Act, 2011, 8: 93. DOI: 10.1186/1479-5868-8-93.
[25]	Grigorakis DA, Georgoulis M, Psarra G, et al. Prevalence and lifestyle determinants of central obesity in children[J]. Eur J Nutr, 2016, 55(5): 1923-1931. DOI: 10.1007/s00394-015-1008-9.
[26]	Tudor-Locke C, Ainsworth BE, Adair LS, et al. Physical activity and inactivity in Chinese school-aged youth: the China Health and Nutrition Survey[J]. Int J Obes Relat Metab Disord, 2003, 27(9): 1093-1099. DOI: 10.1038/sj.ijo.0802377.
[27]	Aparicio A, Rodríguez-Rodríguez EE, Aranceta-Bartrina J, et al. Differences in meal patterns and timing with regard to central obesity in the ANIBES (Anthropometric data, macronutrients and micronutrients intake, practice of physical activity, socioeconomic data and lifestyles in Spain) Study[J]. Public Health Nutr, 2017, 20(13): 2364-2373. DOI: 10.1017/s1368980017000635.
[28]	Tzotzas T, Kapantais E, Tziomalos K, et al. Epidemiological survey for the prevalence of overweight and abdominal obesity in Greek adolescents[J]. Obesity (Silver Spring), 2008, 16(7): 1718-1722. DOI: 10.1038/oby.2008.247.
[29]	Lobstein T, Baur L, Uauy R, et al. Obesity in children and young people: a crisis in public health[J]. Obes Rev, 2004, 5(Suppl 1): 4-104. DOI: 10.1111/j.1467-789x.2004.00133.x.
[30]	de Moraes AC, Fadoni RP, Ricardi LM, et al. Prevalence of abdominal obesity in adolescents: a systematic review[J]. Obes Rev, 2011, 12(2): 69-77. DOI: 10.1111/j.1467-789x.2010.00753.x.
[31]	Zhang M, Zhao X, Li M, et al. Abnormal adipokines associated with various types of obesity in Chinese children and adolescents[J]. Biomed Environ Sci, 2011, 24(1): 12-21. DOI: 10.3967/0895-3988.2011.01.002.
[32]	Wibaek R, Vistisen D, Girma T, et al. Associations of fat mass and fat-free mass accretion in infancy with body composition and cardiometabolic risk markers at 5 years: The Ethiopian iABC birth cohort study[J]. PLoS Med, 2019, 16(8): e1002888. DOI: 10.1371/journal.pmed.1002888.
[33]	Ashwell M, Gunn P, Gibson S. Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis[J]. Obes Rev, 2012, 13(3): 275-286. DOI: 10.1111/j.1467-789x.2011.00952.x.
[34]	Umer A, Kelley GA, Cottrell LE, et al. Childhood obesity and adult cardiovascular disease risk factors: a systematic review with meta-analysis[J]. BMC Public Health, 2017, 17(1): 683. DOI: 10.1186/s12889-017-4691-z.
[35]	Hu L, Huang X, You C, et al. Prevalence of overweight, obesity, abdominal obesity and obesity-related risk factors in Southern China[J]. PLoS One, 2017, 12(9): e0183934. DOI: 10.1371/journal.pone.0183934.