上海市浦东新区中小学生超重和肥胖现况及其膳食影响因素
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摘要
[目的]了解上海市浦东新区中小学生超重和肥胖现况及其影响因素,为制定超重和肥胖的防治策略提供参考依据。[方法]采用多阶段分层随机抽样法选择研究对象。第一阶段采用按规模大小成比例的概率抽样方法在浦东新区抽取3所小学、4所初中、2所高中,第二阶段采用简单随机抽样法从各年级抽取1个班级,第三阶段采用简单随机抽样法从每班抽取18名学生(男女各半)。实际完成调查609名中小学学生,先后开展基本情况调查、"3天24小时"膳食调查和体格检查,并对可能引起超重和肥胖的人口学、膳食、身体活动等相关因素进行单因素和多因素logistic回归分析。[结果]浦东新区中小学生总体超重率为13.96%,肥胖率为11.82%,男生肥胖率(14.85%)高于女生(8.82%)(P <0.05)。多因素logistic回归分析显示,年龄增长(OR=0.86)、女性(OR=0.47)和蛋白质摄入过量(OR=0.32)、维生素B2摄入不足(OR=0.42)、锌摄入不足(OR=0.46)(均相对于适量摄入)可能是学生罹患超重和肥胖的保护性因素;初中阶段(相对于小学)(OR=2.43)、父亲文化程度为大专/职校(相对于小学及以下)(OR=2.96)和蔬菜类摄入不足(OR=1.61)、视黄醇摄入不足(OR=1.89)、维生素E摄入不足(OR=1.89)(均相对于适量摄入)可能是学生罹患超重和肥胖的危险因素。[结论]浦东新区中小学生超重、肥胖检出率较高,与年龄、性别、家长文化程度和蔬菜摄入不足等膳食因素密切相关。
[Objective] To investigate the prevalence and influencing factors of overweight and obesityamong primary and secondary school students in Pudong New Area of Shanghai, and provide ascientific basis for preventing overweight and obesity in students.[Methods] A multi-stage stratified random sampling was conducted. In the first stage, threeprimary schools, four middle schools, and two high schools were selected by probabilityproportionate to size(PPS) sampling method. In the second stage, one classroom from eachgrade of the selected schools was selected by simple random sampling method. In the thirdstage, 18 students(half male and half female) from each classroom were selected by simplerandom sampling method. A total of 609 students completed the investigation including asurvey collecting general information, 3-day 24-hour dietary recall, and physical examination.Single-factor and multiple logistic regression models were established to evaluate selecteddemographic, dietary, and physical activity-related factors potentially associated with overweightand obesity.[Results] The overall prevalence rate of overweight among the selected students in Pudong NewArea was 13.96%; the overall prevalence rate of obesity was 11.82%, and boys(14.85%) had a higher obesity rate than girls(8.82%)(P < 0.05). The multiple logistic regression analysis results showed that older age(OR=0.86), female(OR=0.47), excessive intake of protein(OR=0.32), and insufficient vs. adequate intakes of vitamin B2(OR=0.42) or zinc(OR=0.46) were associated with not reporting overweightor obesity; middle school students(vs. primary school students, OR=2.43), fathers with college/vocational school education(vs. fatherswith education level of primary school and below, OR=2.96), and students with inadequate vs. adequate intakes of vegetable(OR=1.61),retinol(OR=1.89), or vitamin E(OR=1.89) were associated with reporting overweight or obesity.[Conclusion] Overweight and obesity are prevalent among primary and secondary school students in Pudong New Area of Shanghai, and are associated with age, gender, parental educational level, and diet such as inadequate intake of vegetable.
[Objective] To investigate the prevalence and influencing factors of overweight and obesityamong primary and secondary school students in Pudong New Area of Shanghai, and provide ascientific basis for preventing overweight and obesity in students.[Methods] A multi-stage stratified random sampling was conducted. In the first stage, threeprimary schools, four middle schools, and two high schools were selected by probabilityproportionate to size(PPS) sampling method. In the second stage, one classroom from eachgrade of the selected schools was selected by simple random sampling method. In the thirdstage, 18 students(half male and half female) from each classroom were selected by simplerandom sampling method. A total of 609 students completed the investigation including asurvey collecting general information, 3-day 24-hour dietary recall, and physical examination.Single-factor and multiple logistic regression models were established to evaluate selecteddemographic, dietary, and physical activity-related factors potentially associated with overweightand obesity.[Results] The overall prevalence rate of overweight among the selected students in Pudong NewArea was 13.96%; the overall prevalence rate of obesity was 11.82%, and boys(14.85%) had a higher obesity rate than girls(8.82%)(P < 0.05). The multiple logistic regression analysis results showed that older age(OR=0.86), female(OR=0.47), excessive intake of protein(OR=0.32), and insufficient vs. adequate intakes of vitamin B2(OR=0.42) or zinc(OR=0.46) were associated with not reporting overweightor obesity; middle school students(vs. primary school students, OR=2.43), fathers with college/vocational school education(vs. fatherswith education level of primary school and below, OR=2.96), and students with inadequate vs. adequate intakes of vegetable(OR=1.61),retinol(OR=1.89), or vitamin E(OR=1.89) were associated with reporting overweight or obesity.[Conclusion] Overweight and obesity are prevalent among primary and secondary school students in Pudong New Area of Shanghai, and are associated with age, gender, parental educational level, and diet such as inadequate intake of vegetable.
引文
[1]蒋一方.儿童肥胖症[M].北京:中国医药科技出版社,2009:1-2.
[2]REILLY J J,METHVEN E,MCDOWELL Z C,et al.Health consequences of obesity[J].Arch Dis Child,2003,88(9):748-752.
[3]PESCUD M,PETTIGREW S,MCGUIGAN M R,et al.Factors influencing overweight children's commencement of and continuation in a resistance training program[J].BMCPublic Health,2010,10:709.
[4]李朝阳,周煜玲.单纯性肥胖儿童综合健康干预治疗的效果分析[J].护理实践与研究,2011,8(3):4-6.
[5]中国肥胖问题工作组.中国学龄儿童青少年超重、肥胖筛查体重指数值分类标准[J].中华流行病学杂志,2004,25(2):97-102.
[6]沈丽娜,柏品清,傅灵菲,等.2015年上海市浦东新区中小学生膳食与营养状况的特征[J].环境与职业医学,2018,35(12):1100-1105.
[7]中国营养学会.中国学龄儿童膳食指南(2016)[M].北京:人民卫生出版社,2016.
[8]葛可佑.怎样应用膳食营养素参考摄入量(DRIs)评价个体和群体的膳食[J].卫生研究,2002,31(1):1-4.
[9]2015年上海市中小学生《国家学生体质健康标准(2014年修订)》测试结果[N].解放日报,2016-12-24(04).
[10]盛秋明,李卫国,张海涛,等.浦东新区7~15岁学生肥胖流行现状及腰围和腰围身高比值分布[J].中国学校卫生,2010,31(1):15-18.
[11]马军,吴双胜.中国学龄儿童青少年超重肥胖流行趋势分析[J].中国学校卫生,2009,30(3):195-197,200.
[12]石倩,王莉,王芳芳,等.儿童超重和肥胖影响因素的logistic回归分析[J].中国儿童保健杂志,2012,20(2):106-108.
[13]刘庆武.郴州市城区12-14岁学生超重、肥胖和低体重的流行病学研究[D].长沙:中南大学,2009.
[14]刘菲菲,郑辉列,刘勇.南昌地区小学生肥胖现状及其影响因素[J].中国学校卫生,2005,26(11):893-894.
[15]MOREIRA P,PADR?O P E.Educational,economic and dietary determinants of obesity in Portuguese adults:A crosssectional study[J].Eat Behav,2006,7(3):220-228.
[16]李珊珊,王海俊,吴双胜,等.北京市不同体型小学生饮食行为调查[J].中国学校卫生,2010,31(6):662-664.
[17]童方,米杰,程红,等.儿童青少年奶制品摄入频次与体格发展关联性研究[J].中国食物与营养,2012,18(4):79-83.
[18]MAJOR G C,CHAPUT J P,LEDOUX M,et al.Recent developments in calcium-related obesity research[J].Obes Rev,2008,9(5):428-445.
[19]廖小华,黄晓丽.肥胖对儿童青少年心理健康的影响[J].湖南人文科技学院学报,2009(6):133-134.
[20]王春生.单纯性肥胖儿童心理社会行为因素及心理健康调查分析[J].陕西医学杂志,2005,34(5):635-637.
[21]ZHOU S S,LI D,ZHOU Y M,et al.B-vitamin consumption and the prevalence of diabetes and obesity among the USadults:population based ecological study[J].BMC Public Health,2010,10:746.
[22]周士胜,臧益民.B族维生素过量与心血管病风险[J].心脏杂志,2012,24(1):110-113.
[23]郜蕊,陈静,周筱燕.单纯性肥胖高中生血清钙铁锌铜对脂代谢影响[J].中国公共卫生,2011,27(4):494-495.
[24]周筱燕,陈静,郑晓丽,等.单纯性肥胖青少年血清钙铁锌铜对糖代谢的影响[J].广东医学,2011,32(8):1029-1031.
[25]STRAUSS R S.Comparison of serum concentrations of alphatocopherol and beta-carotene in a cross-sectional sample of obese and nonobese children(NHANESⅢ).National health and nutrition examination survey[J].J Pediatr,1999,134(2):160-165.
[26]MORINOBU T,MURATA T,TAKAYA R,et al.Nutritional status of beta-carotene,alpha-tocopherol and retinol in obese children[J].Int J Vitam Nutr Res,2002,72(3):119-123.
[2]REILLY J J,METHVEN E,MCDOWELL Z C,et al.Health consequences of obesity[J].Arch Dis Child,2003,88(9):748-752.
[3]PESCUD M,PETTIGREW S,MCGUIGAN M R,et al.Factors influencing overweight children's commencement of and continuation in a resistance training program[J].BMCPublic Health,2010,10:709.
[4]李朝阳,周煜玲.单纯性肥胖儿童综合健康干预治疗的效果分析[J].护理实践与研究,2011,8(3):4-6.
[5]中国肥胖问题工作组.中国学龄儿童青少年超重、肥胖筛查体重指数值分类标准[J].中华流行病学杂志,2004,25(2):97-102.
[6]沈丽娜,柏品清,傅灵菲,等.2015年上海市浦东新区中小学生膳食与营养状况的特征[J].环境与职业医学,2018,35(12):1100-1105.
[7]中国营养学会.中国学龄儿童膳食指南(2016)[M].北京:人民卫生出版社,2016.
[8]葛可佑.怎样应用膳食营养素参考摄入量(DRIs)评价个体和群体的膳食[J].卫生研究,2002,31(1):1-4.
[9]2015年上海市中小学生《国家学生体质健康标准(2014年修订)》测试结果[N].解放日报,2016-12-24(04).
[10]盛秋明,李卫国,张海涛,等.浦东新区7~15岁学生肥胖流行现状及腰围和腰围身高比值分布[J].中国学校卫生,2010,31(1):15-18.
[11]马军,吴双胜.中国学龄儿童青少年超重肥胖流行趋势分析[J].中国学校卫生,2009,30(3):195-197,200.
[12]石倩,王莉,王芳芳,等.儿童超重和肥胖影响因素的logistic回归分析[J].中国儿童保健杂志,2012,20(2):106-108.
[13]刘庆武.郴州市城区12-14岁学生超重、肥胖和低体重的流行病学研究[D].长沙:中南大学,2009.
[14]刘菲菲,郑辉列,刘勇.南昌地区小学生肥胖现状及其影响因素[J].中国学校卫生,2005,26(11):893-894.
[15]MOREIRA P,PADR?O P E.Educational,economic and dietary determinants of obesity in Portuguese adults:A crosssectional study[J].Eat Behav,2006,7(3):220-228.
[16]李珊珊,王海俊,吴双胜,等.北京市不同体型小学生饮食行为调查[J].中国学校卫生,2010,31(6):662-664.
[17]童方,米杰,程红,等.儿童青少年奶制品摄入频次与体格发展关联性研究[J].中国食物与营养,2012,18(4):79-83.
[18]MAJOR G C,CHAPUT J P,LEDOUX M,et al.Recent developments in calcium-related obesity research[J].Obes Rev,2008,9(5):428-445.
[19]廖小华,黄晓丽.肥胖对儿童青少年心理健康的影响[J].湖南人文科技学院学报,2009(6):133-134.
[20]王春生.单纯性肥胖儿童心理社会行为因素及心理健康调查分析[J].陕西医学杂志,2005,34(5):635-637.
[21]ZHOU S S,LI D,ZHOU Y M,et al.B-vitamin consumption and the prevalence of diabetes and obesity among the USadults:population based ecological study[J].BMC Public Health,2010,10:746.
[22]周士胜,臧益民.B族维生素过量与心血管病风险[J].心脏杂志,2012,24(1):110-113.
[23]郜蕊,陈静,周筱燕.单纯性肥胖高中生血清钙铁锌铜对脂代谢影响[J].中国公共卫生,2011,27(4):494-495.
[24]周筱燕,陈静,郑晓丽,等.单纯性肥胖青少年血清钙铁锌铜对糖代谢的影响[J].广东医学,2011,32(8):1029-1031.
[25]STRAUSS R S.Comparison of serum concentrations of alphatocopherol and beta-carotene in a cross-sectional sample of obese and nonobese children(NHANESⅢ).National health and nutrition examination survey[J].J Pediatr,1999,134(2):160-165.
[26]MORINOBU T,MURATA T,TAKAYA R,et al.Nutritional status of beta-carotene,alpha-tocopherol and retinol in obese children[J].Int J Vitam Nutr Res,2002,72(3):119-123.
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