The prevalence of abnormal glucose metabolism and its associated factors in children aged 6-12 years in Guangzhou
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摘要:
目的 了解广州市6~12岁儿童空腹血糖(fasting plasma glucose，FPG)水平和糖代谢异常现状及其影响因素。 方法 采用分层整群随机抽样方法，在广州市抽取5所小学共4 690名6~12岁儿童进行问卷调查、体格检查和FPG检测。根据FPG值对儿童糖尿病(diabetes mellitus, DM)(FPG≥7.0 mmol/L)、空腹血糖受损(impaired fasting glucose, IFG)(6.1 mmol/L≤FPG＜7.0 mmol/L)和糖代谢异常(FPG≥6.1 mmol/L)进行筛查。采用多因素线性回归分析模型和多因素logistic回归分析模型分析儿童FPG和糖代谢异常的影响因素。 结果 广州市6~12岁儿童FPG平均水平为(5.16±0.34) mmol/L，糖代谢异常率、IFG和DM检出率分别为0.79%、0.64%和0.15%。多因素线性回归分析模型结果显示男童(β=0.161, 95% CI：0.089~0.135, P＜0.001)、9~12岁儿童(9~＜11岁: β=0.071, 95% CI：0.025~0.075, P＜0.001; 11~12岁: β=0.090, 95% CI：0.056~0.126, P＜0.001)、腹型肥胖儿童(β=0.042, 95%CI: 0.009~0.078, P=0.013)FPG水平较高。多因素logistic回归分析模型分析结果腹型肥胖(β=1.576, OR=4.838, 95% CI：2.200~10.638, P＜0.001)、未每天吃早餐的儿童(β=1.158, OR=3.184, 95% CI：1.069~9.484, P=0.038)糖代谢异常风险较高。 结论 广州市6~12岁儿童糖代谢异常率偏低，腹型肥胖、未每天吃早餐是儿童糖代谢异常的危险因素。 Abstract:Objective To investigate the prevalence of abnormal glucose metabolism and its associated risk factors in children aged 6-12 years in Guangzhou, China. Methods We adopted the method of stratified cluster random sampling to recruit a total of 4 690 children aged 6-12 from 5 primary schools in Guangzhou. All participants completed the questionnaire survey, physical examination, and fasting plasma glucose (FPG) detection. Children were screened for diabetes mellitus (DM) (FPG≥7.0 mmol/L), impaired fasting glucose (IFG) (6.1 mmol/L≤FPG < 7.0 mmol/L), and abnormal glucose metabolism (FPG≥6.1 mmol/L) based on FPG. Multiple linear regression and multiple logistic regression were used to analyze the risk factors of FPG and abnormal glucose metabolism. Results The average FPG of children was (5.16±0.34) mmol/L. The prevalence of abnormal glucose metabolism, IFG, and DM were 0.79%, 0.64%, and 0.15%, respectively. Boys (β=0.161, 95%CI: 0.089-0.135, P < 0.001), 9-12 years children (9- < 11 years old: β=0.071, 95%CI: 0.025-0.075, P < 0.001; 11-12 years old: β=0.090, 95%CI: 0.056-0.126, P < 0.001), and children with abdominal obesity (β=0.042, 95%CI: 0.009-0.078, P=0.013) had higher FPG levels. Children with abdominal obesity (β=1.576, OR=4.838, 95%CI: 2.200-10.638, P < 0.001) and children who did not eat breakfast every day (β=1.158, OR=3.184, 95%CI: 1.069-9.484, P=0.038) had a higher risk of abnormal glucose metabolism. Conclusions The prevalence of abnormal glucose metabolism in children aged 6-12 years in Guangzhou is low. Abdominal obesity and not eating breakfast every day are risk factors of abnormal glucose metabolism in children. -
表 1 广州市6~12岁儿童基本情况
Table 1. Basic information of children aged 6-12 years in Guangzhou
特征 Characteristic 合计 ①
Total ①男童 ① Boy ① 女童 ① Girl ① t/χ2值
valueP值
value人数 Number of participants 4 690(100.00) 2 490(53.09) 2 200(46.91) 年龄/岁 Age /years 9.12±1.75 9.11±1.75 9.13±1.75 -0.390 0.697 DM家族史 Family history of DM 0.121 0.728 无 No 2 555(70.62) 1 367(70.87) 1 188(70.34) 有 Yes 1 063(29.38) 562(29.13) 501(29.66) BMI/(kg·m-2) 17.29±3.26 17.6±3.46 16.93±2.99 6.904 ＜0.001 超重肥胖 Overweight and obesity 76.661 ＜0.001 否 No 3 419(76.47) 1 713(71.32) 1 706(82.46) 是 Yes 1 052(23.53) 689(28.68) 363(17.54) 腹型肥胖 Abdominal obesity 60.372 ＜0.001 否 No 3 965(86.16) 1 995(82.40) 1 970(90.33) 是 Yes 637(13.84) 426(17.60) 211(9.67) 血脂异常 Dyslipidemia 3.602 0.058 否 No 3 274(69.81) 1 768(71.00) 1 506(68.45) 是 Yes 1 416(30.19) 722(29.00) 694(31.55) 注：BMI，体质指数；DM，糖尿病。
①以(x±s)或人数(占比/%)表示。
Note: BMI, body mass index; DM, diabetes mellitus.
① (x±s) or number of people (proportion/%)。
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表 2 广州市6~12岁儿童糖代谢流行状况
Table 2. Prevalence of glucose metabolism in children aged 6-12 years in Guangzhou
特征
Characteristic参与者人数(占比/%)
Number of participants (proportion/%)FPG水平
level (mmol/L, x±s)糖代谢异常儿童人数(占比/%)
Number of children with abnormal glucose metabolism (proportion/%)IFG儿童人数(占比/%)
Number of children with IFG (proportion/%)DM儿童人数(占比/%)
Number of children with DM (proportion/%)合计 Total 4 690(100.00) 5.16±0.34 37(0.79) 30(0.64) 7(0.15) 性别 Gender 男 Boy 2 490(53.09) 5.21±0.34 22(0.88) 19(0.76) 3(0.12) 女 Girl 2 200(46.91) 5.10±0.34 15(0.68) 11(0.50) 4(0.18) t/χ2值 value 11.547 0.607 1.268 0.026 P值 value ＜0.001 0.436 0.260 0.872 ① 年龄组/岁 Age group/years 6~＜9 1 832(39.06) 5.11±0.36 17(0.93) 13(0.71) 4(0.22) 9~＜11 1 611(34.35) 5.17±0.34 13(0.81) 11(0.68) 2(0.12) 11~12 1 247(26.59) 5.22±0.32 7(0.56) 6(0.48) 1(0.08) F/χ2值 value 39.772 1.284 0.685 0.907 P值 value ＜0.001 0.526 0.710 0.714 ② DM家族史 Family history of DM 无 No 2 555(70.62) 5.15±0.34 19(0.74) 15(0.59) 4(0.16) 有 Yes 1 063(29.38) 5.14±0.35 10(0.94) 8(0.75) 2(0.19) t/χ2值 value 0.676 0.367 0.326 0.000 P值 value 0.499 0.545 0.568 1.000 ① 超重肥胖 Overweight and obesity 否 No 3 419(76.47) 5.15±0.34 21(0.61) 17(0.50) 4(0.12) 是 Yes 1 052(23.53) 5.22±0.35 15(1.43) 12(1.14) 3(0.29) t/χ2值 value -5.635 6.635 5.191 0.592 P值 value ＜0.001 0.010 0.023 0.442 ① 腹型肥胖 Abdominal obesity 否 No 3 965(86.16) 5.15±0.34 24(0.61) 20(0.50) 4(0.10) 是 Yes 637(13.84) 5.22±0.37 13(2.04) 10(1.57) 3(0.47) t/χ2值 value -5.102 14.181 8.107 2.868 P值 value ＜0.001 ＜0.001 0.004 ① 0.090 ① 血脂异常 Dyslipidemia 否 No 3 274(69.81) 5.16±0.34 26(0.79) 22(0.67) 4(0.12) 是 Yes 1 416(30.19) 5.15±0.35 11(0.78) 8(0.56) 3(0.21) t/χ2值 value 1.281 0.004 0.176 0.101 P值 value 0.200 0.951 0.675 0.751 ① MVPA/(h·d-1) ≥1 1 265(35.41) 5.15±0.33 6(0.47) 6(0.47) 0(0.00) ＜1 2 307(64.59) 5.14±0.35 23(1.00) 17(0.74) 6(0.26) t/χ2值 value 0.571 2.771 0.891 1.934 P值 value 0.568 0.096 0.345 0.164 ① SSB摄入/(杯·周-1) SSB intake/(Cups·week-1) ＜2 2 324(64.92) 5.13±0.35 19(0.82) 13(0.56) 6(0.26) ≥2 1 256(35.08) 5.17±0.33 10(0.80) 10(0.80) 0(0.00) t/χ2值 value -3.473 0.005 0.706 1.882 P值 value 0.001 0.946 0.401 0.170 ① 油炸食品摄入 Fried food intake 否 No 1 724(47.65) 5.14±0.34 14(0.81) 10(0.58) 4(0.23) 是 Yes 1 894(52.35) 5.15±0.35 15(0.79) 13(0.69) 2(0.11) t/χ2值 value -1.283 0.005 0.159 0.274 P值 value 0.200 0.946 0.690 0.601 ① 每天吃早餐 Eat breakfast every day 是 Yes 3 428(94.80) 5.14±0.34 25(0.73) 20(0.58) 5(0.15) 否 No 188(5.20) 5.19±0.41 4(2.13) 3(1.60) 1(0.53) t/χ2值 value -1.573 2.799 1.526 0.125 P值 value 0.116 0.094 ① 0.217 ① 0.724 ① 注：DM, 糖尿病；IFG, 空腹血糖受损；FPG, 空腹血糖；MVPA, 中高强度体力活动；SSB, 含糖饮料。
1.不同年龄段儿童FPG水平两两比较采用LSD法。
①采用连续性校正χ2检验；②采用Fisher确切概率法检验。
Note: DM, diabetes mellitus; IFG, impaired fasting glucose; FPG, fasting plasma glucose; MVPA, moderate to vigorous physical activity; SSB, sugar-sweetened beverages.
1.The LSD method was performed to compare the FPG levels in children of different age groups.
①Continuity correction χ2 test was adopted; ②The Fisher exact probability test was performed.
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表 3 广州市6~12岁儿童FPG水平多因素线性回归分析模型分析
Table 3. Multiple linear regression analysis of fasting plasma glucose levels in children aged 6-12 years in Guangzhou
因素 Factor 参与者人数(占比/%)
Number of participants (proportion /%)FPG水平 level /(mmol·L-1), (x±s) 标准化β值(95% CI)
Normalized β value (95% CI)t值
valueP值
value性别 Gender 男 Boy 2 490(53.09) 5.21±0.34 0.161(0.089~0.135) 女 Girl 2 200(46.91) 5.10±0.34 1.000 -9.571 ＜0.001 年龄组/岁 Age group/years 6~＜9 1 832(39.06) 5.11±0.36 1.000 9~＜11 1 611(34.35) 5.17±0.34 0.071(0.025~0.075) 3.966 ＜0.001 11~12 1 247(26.59) 5.22±0.32 0.090(0.056~0.126) 5.069 ＜0.001 DM家族史 Family history of DM 无 No 2 555(70.62) 5.15±0.34 1.000 有 Yes 1 063(29.38) 5.14±0.35 -0.018(-0.039~0.011) -1.108 0.268 腹型肥胖 Abdominal obesity 否 No 3 965(86.16) 5.15±0.34 1.000 是 Yes 637(13.84) 5.22±0.37 0.042(0.009~0.078) 2.483 0.013 血脂异常 Dyslipidemia 否 No 3 274(69.81) 5.16±0.34 1.000 是 Yes 1 416(30.19) 5.15±0.35 -0.018(-0.038~0.011) -1.057 0.291 MVPA/(h·d-1) ≥1 1 265(35.41) 5.15±0.33 1.000 ＜1 2 307(64.59) 5.14±0.35 0.008(-0.018~0.030) 0.483 0.629 SSB摄入/(杯·周-1) SSB intake/(Cups·week-1) ＜2 2 324(64.92) 5.13±0.35 1.000 ≥2 1 256(35.08) 5.17±0.33 0.031(-0.002~0.047) 1.800 0.072 油炸食品摄入 Fried food intake 否 No 1 724(47.65) 5.14±0.34 1.000 是 Yes 1 894(52.35) 5.15±0.35 -0.005(-0.027~0.020) -0.276 0.783 每天吃早餐 Eat breakfast every day 是 Yes 3 428(94.80) 5.14±0.34 1.000 否 No 188(5.20) 5.19±0.41 0.024(-0.014~0.089) 1.412 0.158 注：DM，糖尿病；MVPA, 中高强度体力活动；SSB, 含糖饮料；FPG, 空腹血糖。
Note: DM, diabetes mellitus; MVPA, moderate to vigorous physical activity; SSB, sugar-sweetened beverages; FPG, fasting plasma glucose.
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表 4 广州市6~12岁儿童糖代谢异常多因素logistic回归分析模型分析
Table 4. Multiple logistic regression analysis of abnormal glucose metabolism in children aged 6-12 years in Guangzhou
因素 Factor β值 value sx Wald χ2值 value OR值 value (95% CI) P值 value 性别 Gender 男 Boy 1.000 女 Girl 0.204 0.383 0.284 1.226 (0.579~2.597) 0.594 年龄组/岁 Age group/years 6~＜9 1.000 9~＜11 -0.214 0.421 0.259 0.807 (0.354~1.841) 0.611 11~12 0.128 0.537 0.056 1.136 (0.397~3.254) 0.812 DM家族史 Family history of DM 无 No 1.000 有 Yes 0.084 0.398 0.045 1.088 (0.499~2.372) 0.833 腹型肥胖 Abdominal obesity 否 No 1.000 是 Yes 1.576 0.402 15.375 4.838 (2.200~10.638) ＜0.001 血脂异常 Dyslipidemia 否 No 1.000 是 Yes -0.493 0.440 1.256 0.611 (0.258~1.447) 0.262 MVPA/(h·d-1) ≥1 1.000 ＜1 0.768 0.463 2.753 2.156 (0.870~5.344) 0.097 SSB摄入/(杯·周-1) SSB intake/ (Cups·week-1) ＜2 1.000 ≥2 -0.122 0.416 0.087 0.885 (0.392~1.998) 0.769 油炸食品摄入 Fried food intake 否 No 1.000 是 Yes -0.046 0.390 0.014 0.955 (0.445~2.051) 0.906 每天吃早餐 Eat breakfast every day 是 Yes 1.000 否 No 1.158 0.557 4.325 3.184 (1.069~9.484) 0.038 注：DM，糖尿病；MVPA, 中高强度体力活动；SSB, 含糖饮料。
Note: DM, diabetes mellitus; MVPA, moderate to vigorous physical activity; SSB, sugar-sweetened beverages.
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[1] 迟学彭, 于冬梅, 琚腊红, 等. 儿童青少年糖尿病患病现况及变化趋势研究[J]. 当代医学, 2019, 25(11): 190-193. DOI: 10.3969/j.issn.1009-4393.2019.11.087.Chi XP, Yu DM, Ju LH, et al. Study on the current situation and changing trend of diabetes mellitus in children and adolescents [J]. Contemp Med, 2019, 25(11): 190-193. DOI: 10.3969/j.issn.1009-4393.2019.11.087. [2] Wu HJ, Patterson CC, Zhang XG, et al. Worldwide estimates of incidence of type 2 diabetes in children and adolescents in 2021 [J]. Diabetes Res Clin Pract, 2022, 185: 109785. DOI: 10.1016/j.diabres.2022.109785. [3] 迟学彭, 赵丽云, 于冬梅, 等. 2016―2017年中国6~17岁儿童青少年血糖异常状况及相关因素[J]. 卫生研究, 2021, 50(5): 708-715. DOI: 10.19813/j.cnki.weishengyanjiu.2021.05.002.Chi XP, Zhao LY, Yu DM, et al. Relevant effects of pathoglycemia in Chinese children and adolescents aged 6-17 in 2016-2017 [J]. J Hyg Res, 2021, 50(5): 708-715. DOI: 10.19813/j.cnki.weishengyanjiu.2021.05.002. [4] Barrett CE, Zhou X, Mendez I, et al. Prevalence of mental, behavioral, and developmental disorders among children and adolescents with diabetes, United States (2016-2019) [J]. J Pediatr, 2023, 253: 25-32. DOI: 10.1016/j.jpeds.2022.09.008. [5] Zhao ZH, Sun CJ, Wang CF, et al. Rapidly rising incidence of childhood type 1 diabetes in Chinese population: epidemiology in Shanghai during 1997-2011 [J]. Acta Diabetol, 2014, 51(6): 947-953. DOI: 10.1007/s00592-014-0590-2. [6] 王绍华, 张镇权, 万帝, 等. 北京市延庆区初中生糖代谢异常及其影响因素[J]. 中华疾病控制杂志, 2019, 23(9): 1062-1066. DOI: 10.16462/j.cnki.zhjbkz.2019.09.009.Wang SH, Zhang ZQ, Wan D, et al. Current situation and influencing factors of abnormal glucose metabolism in junior middle school students in Yanqing District, Beijing [J]. Chin J Dis Control Prev, 2019, 23(9): 1062-1066. DOI: 10.16462/j.cnki.zhjbkz.2019.09.009. [7] Wang ZH, Zou ZY, Wang HJ, et al. Prevalence and risk factors of impaired fasting glucose and diabetes among Chinese children and adolescents: a national observational study [J]. Br J Nutr, 2018, 120(7): 813-819. DOI: 10.1017/S0007114518002040. [8] Lv YJ, Cai L, Gui ZH, et al. Effects of physical activity and sedentary behaviour on cardiometabolic risk factors and cognitive function in children: protocol for a cohort study [J]. BMJ Open, 2019, 9(10): e030322. DOI: 10.1136/bmjopen-2019-030322. [9] 吕雅杰, 赖丽娟, 李丹玲, 等. 广州市小学生体质健康监测系统问卷的信效度研究[J]. 中国妇幼保健, 2020, 35(8): 1511-1516. DOI: 10.19829/j.zgfybj.issn.1001-4411.2020.08.047.Lv YJ, Lai LJ, Li DL, et al. Study on the reliability and validity of physical health surveillance system questionnaire for primary school students in Guangzhou [J]. Matermal and Child Health Care of China, 2020, 35(8): 1511-1516. DOI: 10.19829/j.zgfybj.issn.1001-4411.2020.08.047. [10] 2010年全国学生体质与健康调研结果[J]. 中国学校卫生, 2011, 32(9): 1024, 1026. DOI: 10.16835/j.cnki.1000-9817.2011.12.003 .Results of the 2010 national students′ physical fitness and health survey [J]. Chin J Sch Health, 2011, 32(9): 1024, 1026. DOI:10.16835/j.cnki.1000-9817.2011.12.003 .[11] 中国2型糖尿病防治指南(2020年版)(上) [J]. 中国实用内科杂志, 2021, 41(8): 668-695. DOI: 10.19538/j.nk2021080106 .Guideline for the prevention and treatment of type 2 diabetes mellitus in China (2020 edition) (Part 1) [J]. Chinese Journal of Practical Internal Medicine, 2021, 41(8): 668-695. DOI:10.19538/j.nk2021080106 .[12] 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[S]. 中华人民共和国卫生行业标准WS/T 586-2018, 2018.National Health and Family Planning Commission of the People′s Republic of China. Screening for overweight and obesity among school-age children and adolescents [S]. Health Industry Standard of the People′s Republic of China WS/T 586-2018, 2018. [13] Xi B, Zong XN, Kelishadi R, et al. International waist circumference percentile cutoffs for central obesity in children and adolescents aged 6 to 18 years [J]. J Clin Endocrinol Metab, 2020, 105(4): e1569-e1583. DOI: 10.1210/clinem/dgz195. [14] 中华人民共和国国家卫生健康委员会. 7岁~18岁儿童青少年高腰围筛查界值[S]. 中华人民共和国卫生行业标准WS/T 611-2018, 2018.National Health Commission of the People′s Republic of China. High waist circumference screening threshold among children and adolescents aged 7-18 years [S]. People′s Republic of China Health Industry Standard WS/T 611-2018, 2018. [15] 中华儿科杂志编辑委员会, 中华医学会儿科学分会儿童保健学组, 中华医学会儿科学分会心血管学组, 等. 儿童青少年血脂异常防治专家共识[J]. 中华儿科杂志, 2009, 47(6): 426-428. https://www.cnki.com.cn/Article/CJFDTOTAL-XCYS201031009.htmEditorial Committee of Chinese Journal of Pediatrics, Child Health Group, Chinese Society of Pediatrics, Cardiovascular Group, Chinese Society of Pediatrics, et al. Expert consensus on prevention and treatment of dyslipidemia in children and adolescents [J]. Chin J Pediatr, 2009, 47(6): 426-428. https://www.cnki.com.cn/Article/CJFDTOTAL-XCYS201031009.htm [16] 迟学彭. 中国2002―2016年6~17岁儿童青少年血糖异常、糖尿病患病变化趋势及相关因素研究[D]. 北京: 中国疾病预防控制中心, 2022. DOI: 10.27511/d.cnki.gzyyy.2019.000027 .Chi XP. The trend and relevant factors of hyperglycemia and diabetes mellitus in Chinese children and adolescents of aged 6-17 in 2002 to 2016 [D]. Beijing: Chinese Center for Disease Control and Prevention, 2022. DOI:10.27511/d.cnki.gzyyy.2019.000027 .[17] Agbre-Yace M L, Oyenusi E E, Oduwole A O, et al. Prevalence of diabetes mellitus among children and adolescents in the district oF ABIDJAn in Cote d′Ivoire: a population-based study [J]. J Diabetes Metab Disord, 2015, 15: 38. DOI: 10.1186/s40200-016-0261-7. [18] Al-Rubeaan K. National surveillance for type 1, type 2 diabetes and prediabetes among children and adolescents: a population-based study (SAUDI-DM) [J]. J Epidemiol Community Health, 2015, 69(11): 1045-1051. DOI: 10.1136/jech-2015-205710. [19] 董彦会, 王西婕, 杨招庚, 等. 中国儿童青少年血糖分布情况[J]. 中国学校卫生, 2018, 39(10): 1449-1451. DOI: 10.16835/j.cnki.1000-9817.2018.10.003.Dong YH, Wang XJ, Yang ZG, et al. Analysis of blood glucose distribution of children and adolescents in China [J]. Chin J Sch Health, 2018, 39(10): 1449-1451. DOI: 10.16835/j.cnki.1000-9817.2018.10.003. [20] 于连龙, 张坚, 李素云, 等. 山东省6~17岁儿童青少年超重肥胖对血清维生素D与空腹血糖的影响[J]. 卫生研究, 2021, 50(4): 547-551. DOI: 10.19813/j.cnki.weishengyanjiu.2021.04.003.Yu LL, Zhang J, Li SY, et al. Impact of overweight and obesity on the relationship between serum vitamin D and fasting blood glucose in children aged 6-17 years in Shandong Province [J]. J Hygiene Res, 2021, 50(4): 547-551. DOI: 10.19813/j.cnki.weishengyanjiu.2021.04.003. [21] 万乃君. 北京市学龄儿童糖代谢异常的流行特征及影响因素[D]. 北京: 北京协和医学院, 2012.Wan NJ. Epidemiological characteristics and influencing factors of abnormal glucose metabolism among school-age children in Beijing [D]. Beijing: Peking Union Medical College, 2012. [22] 刘宏彦, 冷俊宏, 王蕾棽. 肥胖对儿童青少年健康影响的研究进展[J]. 中国城乡企业卫生, 2022, 37(2): 38-41. DOI: 10.16286/j.1003-5052.2022.02.013.Liu HY, Leng JH, Wang LS. Research progress on the impact of obesity on children and adolescents′ health [J]. Chin J Urban Rural Enterp Hyg, 2022, 37(2): 38-41. DOI: 10.16286/j.1003-5052.2022.02.013. [23] 杨忠平, 杨招庚, 邹志勇, 等. 中国7~18岁汉族学生2010―2014年腹型肥胖变化及其影响因素分析[J]. 中国儿童保健杂志, 2018, 26(9): 964-968. DOI: 10.11852/zgetbjzz2018-26-09-10.Yang ZP, Yang ZG, Zou ZY, et al. Analysis of prevalence of abdominal obesity in Chinese Han students aged 7-18 from 2010 to 2014 and related factors of abdominal obesity [J]. Chin J Child Health Care, 2018, 26(9): 964-968. DOI: 10.11852/zgetbjzz2018-26-09-10. [24] 胡霄, 姜红如, 张兵, 等. 中国十五省7~17岁儿童青少年心血管代谢性危险因素的流行特征[J]. 环境与职业医学, 2021, 38(8): 833-838. DOI: 10.13213/j.cnki.jeom.2021.21037.Hu X, Jiang HR, Zhang B, et al. Epidemiological characteristics of cardio-metabolic risk factors among children and adolescents aged 7-17 years in 15 provinces of China [J]. J Environ Occup Med, 2021, 38(8): 833-838. DOI: 10.13213/j.cnki.jeom.2021.21037. [25] Liang YJ, Xi B, Song AQ, et al. Trends in general and abdominal obesity among Chinese children and adolescents 1993-2009 [J]. Pediatr Obes, 2012, 7(5): 355-364. DOI: 10.1111/j.2047-6310.2012.00066.x. [26] Uemura M, Yatsuya H, Hilawe EH, et al. Breakfast skipping is positively associated with incidence of type 2 diabetes mellitus: evidence from the aichi workers′ cohort study [J]. J Epidemiol, 2015, 25(5): 351-358. DOI: 10.2188/jea.JE20140109. [27] 李莉华, 杨莹, 杨慧君, 等. 早餐频率与糖尿病前期的关联性分析[J]. 现代预防医学, 2020, 47(6): 1003-1007, 1010. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF202006012.htmLi LH, Yang Y, Yang HJ, et al. Relationship between frequency of breakfast consumption and pre-diabetes [J]. Modern Prev Med, 2020, 47(6): 1003-1007, 1010. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF202006012.htm [28] Pereira MA, Erickson E, McKee P, et al. Breakfast frequency and quality may affect glycemia and appetite in adults and children [J]. J Nutr, 2011, 141(1): 163-168. DOI: 10.3945/jn.109.114405. -
