本文選題：膳食 + 體力活動��； 參考：《復(fù)旦大學(xué)》2012年博士論文

【摘要】：學(xué)齡兒童超重和肥胖在全世界范圍內(nèi)呈現(xiàn)上升趨勢,而在我國,學(xué)齡兒童超重肥胖的發(fā)展同樣呈現(xiàn)全面流行趨勢。學(xué)齡兒童超重肥胖會給兒童帶來代謝性紊亂、心肺功能紊亂、發(fā)育障礙等生理方面的損害,也會帶來社會接受性低、自我意識受損等心理方面的影響,并且更可增加成年期肥胖的風(fēng)險(xiǎn),從而增加心血管疾病、糖尿病等一系列慢性病的發(fā)病風(fēng)險(xiǎn)。目前普遍認(rèn)為肥胖是由基因、膳食、運(yùn)動等遺傳和環(huán)境因素相互作用引起的。 研究目的 了解學(xué)齡兒童超重肥胖的流行病學(xué)特點(diǎn),探討膳食因素(特別是膳食模式)、體力活動(包括靜態(tài)運(yùn)動情況)、PPARγC161→T基因多態(tài)對兒童超重肥胖的易感性和血脂血糖的影響,并初步研究PPARγC161→T基因多態(tài)與膳食、體力活動交互作用對兒童超重肥胖易感性和血脂血糖的影響,為今后確定學(xué)齡兒童超重肥胖重點(diǎn)監(jiān)測人群和個(gè)性化防制措施提供合理的理論依據(jù)。 方法 采用整群隨機(jī)抽樣法,從上海市某區(qū)整群分層隨機(jī)抽取的6所學(xué)校抽取三、四、五年級的學(xué)齡兒童,每所學(xué)校每個(gè)年級隨機(jī)抽取2個(gè)班作為研究對象。采用3d24h小時(shí)膳食記錄法進(jìn)行膳食調(diào)查,通過發(fā)放自制的《7天回顧性身體活動調(diào)查問卷》,回顧過去7天包括各項(xiàng)運(yùn)動、出行方式和時(shí)間、各項(xiàng)靜態(tài)運(yùn)動時(shí)間等身體活動情況,由經(jīng)過培訓(xùn)的工作人員進(jìn)行身高、體重、腰圍體格檢查。抽取調(diào)查對象清晨空腹靜脈血5m1,檢測血清中血脂(包括總膽固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白)、血糖、胰島素的含量。采用酚-氯仿的方法提取血凝塊中的基因組DNA,然后通過PCR-RFLP方法進(jìn)行PPARγC161→T基因型分析。 結(jié)果 1、上海某區(qū)兒童超重肥胖流行現(xiàn)狀 上海某區(qū)學(xué)齡兒童超重率為10.4%,肥胖率為8.9%,超重肥胖率為19.3%,其中男性學(xué)齡兒童超重肥胖率為24.9%,女性為13.5%,男性高于女性(X2=25.506,P=-0.000)。 2、學(xué)齡兒童超重肥胖情況及影響因素分析 (1)膳食因素與學(xué)齡兒童超重肥胖 超重肥胖者大豆類和奶類的攝入低于正常組,糧谷類300g/d攝入者比≤300g/d者超重肥胖患病風(fēng)險(xiǎn)降低；膳食總抗氧化能力正常組7.92±3.36mmol,超重肥胖組7.38±3.18mmol,正常組高于超重肥胖組(P0.05),第1四分位數(shù)(Q1)的兒童超重肥胖風(fēng)險(xiǎn)最高,并且膳食總抗氧化能力與學(xué)齡兒童體重和腰圍成負(fù)相關(guān)；因子分析后富含優(yōu)質(zhì)蛋白和蔬菜水果的膳食模式因素1代表的健康飲食模式,是超重肥胖的保護(hù)性因素,其第4四分位數(shù)(Q4)超重肥胖風(fēng)險(xiǎn)低于第1四分位數(shù)(Q1),OR(95%CI)為0.615(0.387～0.978)。 (2)體力活動與學(xué)齡兒童超重肥胖 總靜態(tài)活動時(shí)間≥28h/w者超重肥胖風(fēng)險(xiǎn)高于28h/w者,OR(95%CI)為1.425(1.020～1.991),睡眠時(shí)間每天≥9h者超重肥胖風(fēng)險(xiǎn)低于9h兒童,其OR(95%CI)為0.516(0.337～0.790),靜態(tài)運(yùn)動時(shí)間和腰圍、BMI和體重呈正相關(guān),睡眠時(shí)間和這些體檢指標(biāo)負(fù)相關(guān)。 (3)綜合生活模式與學(xué)齡兒童超重肥胖 靜態(tài)運(yùn)動時(shí)間長、西方膳食模式為主、睡眠時(shí)間短的西方生活模式Q4組超重肥胖風(fēng)險(xiǎn)高于Q1組,OR(95%CI)為1.834(1.172～2.871),體力活動時(shí)間長、健康膳食模式為主、靜態(tài)運(yùn)動時(shí)間較少的健康生活模式的Q2組超重肥胖風(fēng)險(xiǎn)低于于Q1組,OR(95%CI)為0.560(0.351～0.894)。 (4) PPAR γC161→T基因多態(tài)性與學(xué)齡兒童超重肥胖 PPAR γC161→T基因多態(tài)性與性別、糧谷類的攝入、生活模式對學(xué)齡兒童超重肥胖存在交互作用；T突變基因是女性學(xué)齡兒童超重肥胖的危險(xiǎn)因素,OR(95%CI)為1.833(1.041-3.277),對男性兒童的影響沒有統(tǒng)計(jì)學(xué)意義；在糧谷類攝入300g/d水平的兒童中,T突變基因攜帶者超重肥胖風(fēng)險(xiǎn)降低,OR(95%CI)為0.275(0.083-0.914)；在西方生活模式因子得分的Q1組,T突變基因攜帶者超重肥胖風(fēng)險(xiǎn)增加,OR (95%CI)為2.248(1.022-4.948)。 (5)學(xué)齡兒童超重肥胖多影響因素分析 Logistic多因素回歸模型顯示,兒童超重肥胖的危險(xiǎn)因素有年齡的增加、男性、膳食總抗氧化能力低、靜態(tài)運(yùn)動時(shí)間長等,保護(hù)性因素有膳食模式1(健康飲食模式)、睡眠時(shí)間大于9h/d、糧谷類攝入300g/d；各體檢指標(biāo)影響因素采用多元線性回歸顯示,BMI的主要影響因素有年齡、性別、步行時(shí)間、睡眠時(shí)間,主要影響體重和腰圍的變量有年齡、性別、步行時(shí)間、靜態(tài)運(yùn)動時(shí)間和睡眠時(shí)間。 3、學(xué)齡兒童血糖血脂影響因素 (1)一般情況與學(xué)齡兒童血脂血糖 血脂血糖基本隨著年齡的增加而增加；超重肥胖者TG、LDL、LDL/HDL、 TCH/HDL、胰島素、HOMA指數(shù)都高于體重正常者,而HDL低于正常者。 (2)膳食營養(yǎng)素?cái)z入與學(xué)齡兒童血脂血糖 碳水化合物、膳食纖維、植物蛋白、糧谷類、水果類、蛋類的攝入、碳水化合物供能比與學(xué)齡兒童血糖血脂呈負(fù)相關(guān),飽和脂肪酸、單不飽和脂肪酸、晚餐供能比、魚肉類攝入與血脂血糖呈正相關(guān)：總學(xué)齡兒童中,膳食模式1(健康飲食模式)與葡萄糖呈現(xiàn)負(fù)相關(guān),在超重肥胖學(xué)齡兒童中,膳食模式2(西方飲食模式)與葡萄糖成正相關(guān)。 (3)體力活動情況與學(xué)齡兒童血脂血糖 TG和血糖與步行時(shí)間負(fù)相關(guān),步行次數(shù)與血糖負(fù)相關(guān)；寫作業(yè)時(shí)間和靜態(tài)運(yùn)動總時(shí)間與血糖正相關(guān)；運(yùn)動時(shí)間與血糖負(fù)相關(guān)。 (4)綜合生活模式與學(xué)齡兒童血脂血糖 西方生活模式因子得分與胰島素、HOMA指數(shù)呈現(xiàn)正相關(guān),健康生活模式與血糖負(fù)相關(guān)。 (5) PPAR γC161→T基因多態(tài)與學(xué)齡兒童血脂血糖 總學(xué)齡兒童和體重正常兒童中,T突變基因攜帶兒童TCH高于野生基因型兒童,但在超重肥胖兒童中,T等位基因攜帶者TG高于野生基因型；基因型和性別之間對TG存在交互作用,女性學(xué)齡兒童中,T突變基因攜帶者TCH和TG濃度高于野生基因型；西方生活模式和健康生活模式Q1組中,T突變基因攜帶者TCH濃度高于野生型。 (6)學(xué)齡兒童血脂血糖影響因素多元線性回歸 TCH, TG,血糖,HDL, TCH/HDL,胰島素的影響變量分別為基因攜帶者,寫作業(yè)時(shí)間,年齡、性別和膳食模式1健康飲食模式,年齡,做作業(yè)時(shí)間,年齡。 結(jié)論 1、上海某區(qū)兒童超重肥胖率的流行現(xiàn)狀嚴(yán)峻,且男生的超重和肥胖率均大于女生。 2、男性、膳食糧谷類攝入少、膳食總抗氧化能力低、健康飲食模式評分低、靜態(tài)活動時(shí)間長、睡眠時(shí)間短、PPAR γC161→T基因突變是學(xué)齡兒童超重肥胖風(fēng)險(xiǎn)因素。 3、不同性別、膳食、運(yùn)動等生活方式的學(xué)齡兒童,PPAR γC161→T基因多態(tài)性對超重肥胖所起的作用不同。T突變基因是女性學(xué)齡兒童、西方生活模式者超重肥胖的危險(xiǎn)因素,是糧谷類攝入300g/d兒童的保護(hù)性因素,可以為肥胖超重監(jiān)控的重點(diǎn)人群和個(gè)性化預(yù)防措施提供初步線索。 4、健康飲食模式評分低、靜態(tài)運(yùn)動時(shí)間長、運(yùn)動時(shí)間短、PPAR γC161→T基因突變與高血脂高血糖相關(guān)。 5、PPAR γC161→T基因多態(tài)性對學(xué)齡兒童血脂的影響受到性別和膳食、運(yùn)動生活方式等環(huán)境的影響。女性學(xué)齡兒童中、西方生活模式和健康生活模式因子Q1組中,T等位基因攜帶者TCH和(或)TG濃度高于野生型,可為學(xué)齡兒童血脂血糖監(jiān)測重點(diǎn)人群提供理論依據(jù)。
[Abstract]:Overweight and obesity in school-age children are on the rise in the world, but in China, the development of overweight and obesity in school age children also presents a comprehensive trend. Overweight and obesity in school-age children will bring about metabolic disorders, cardiopulmonary dysfunction, developmental disorders and other physiological aspects, and also bring low social acceptability and self meaning. It can increase the risk of obesity and increase the risk of obesity in adulthood, which increases the risk of a series of chronic diseases such as cardiovascular disease and diabetes. It is generally believed that obesity is caused by genetic and environmental factors such as gene, diet, exercise and so on.
research objective
To understand the epidemiological characteristics of overweight and obesity in school-age children, to explore the dietary factors (especially dietary patterns), physical activity (including static exercise), the effect of PPAR gamma C161 to T gene polymorphism on the susceptibility to overweight and obesity in children and the effect of blood lipid and blood glucose, and to study the interaction of PPAR gamma C161 to T gene polymorphism with dietary and physical activity. The susceptibility of overweight and obesity and the influence of blood lipid and blood sugar in children provide a reasonable theoretical basis for determining the key monitoring population and individual prevention measures for overweight and obesity in school-age children.
Method
A cluster random sampling method was used to extract three, four and five grade school aged children from 6 schools with stratified and random sampling in a district of Shanghai. 2 classes were randomly selected from each grade of each school. The dietary survey was carried out by the 3d24h hour diet recording method, and the self-made questionnaire on the retrospective physical activity of <7 days was carried out. In the past 7 days, the past 7 days include physical activity, travel mode and time, and static exercise time, and the body height, weight, and waist circumference of the trained staff were examined. The early morning venous blood was extracted from the subjects. The serum lipids (including total cholesterol, triglycerides, LDL, HDL, HDL) were detected. Protein), blood sugar, insulin content. Genomic DNA in blood clot was extracted by phenol chloroform method, and then PPAR gamma C161 to T genotypes were analyzed by PCR-RFLP method.
Result
1, the prevalence of overweight and obesity in children in a district of Shanghai
The overweight rate of school-age children in Shanghai was 10.4%, the obesity rate was 8.9%, the overweight and obesity rate was 19.3%, of which the rate of overweight and obesity in male school-age children was 24.9%, the female was 13.5%, and the male was higher than that of the female (X2=25.506, P=-0.000).
2, overweight and obesity in school age children and its influencing factors
(1) dietary factors and overweight and obesity in school-age children
The intake of soybean and milk in overweight and obese people was lower than that of the normal group, and the 300g/d intake of cereals was lower than that of those with less than 300g/d; the total dietary antioxidant capacity was 7.92 + 3.36mmol, the overweight and obesity group was 7.38 + 3.18mmol, the normal group was higher than the overweight group (P0.05), and the children with first four quantiles (Q1) were at the highest risk of overweight and obesity. The total antioxidant capacity of the diet was negatively correlated with the weight and waist circumference of school-age children; the healthy diet model, which was rich in quality protein and vegetables and fruits 1, was a protective factor for overweight and obesity, the fourth four quantile (Q4) was lower than first and four quantiles (Q1), and OR (95%CI) was 0.615 (0.387). To 0.978).
(2) physical activity and overweight and obesity in school-age children
The risk of overweight and obesity with total static time > 28h/w was higher than that of 28h/w, OR (95%CI) was 1.425 (1.020 ~ 1.991), the risk of overweight and obesity was lower than 9h children, and OR (95%CI) was 0.516 (0.337 ~ 0.790). The static exercise time and waist circumference were positively correlated with the weight of BMI and weight, and the sleep time was negatively correlated with these physical indexes.
(3) comprehensive life model and overweight and obesity of school-age children
The risk of overweight and obesity in the western life model Q4 group with long static exercise time, Western diet mode and short sleep time was higher than that of Q1 group, OR (95%CI) was 1.834 (1.172 ~ 2.871), physical activity time was long, the healthy diet mode was mainly, the Q2 group with less static exercise time was lower than the Q1 group, and OR (95%CI) was 0.5. 60 (0.351 to 0.894).
(4) PPAR gamma C161 to T polymorphism and overweight and obesity in school-age children.
PPAR gamma C161 / T gene polymorphism and sex, grain intake and life pattern have interaction effect on overweight and obesity in school-age children; T mutation gene is a risk factor for overweight and obesity in female school-age children, OR (95%CI) is 1.833 (1.041-3.277), and the effect on male children is not statistically significant; children in grain cereals intake 300g/d level are not statistically significant. In the T mutation carrier, the risk of overweight and obesity was reduced, and OR (95%CI) was 0.275 (0.083-0.914); the risk of overweight and obesity in the T mutant gene carriers was increased in the Q1 group with the Western lifestyle factor, and the OR (95%CI) was 2.248 (1.022-4.948).
(5) analysis of the factors affecting overweight and obesity in school-age children
Logistic multi factor regression model showed that the risk factors of overweight and obesity in children were increasing age, male, low dietary total antioxidant capacity, long static time, dietary pattern 1 (healthy diet mode), sleep time greater than 9h/d, cereals were taken into 300g/d, and the factors affecting the physical examination indexes were linear regression. The main influencing factors of BMI were age, sex, walking time, sleep time, and age, sex, walking time, statically exercise time and sleep time, which mainly influenced the weight and waist circumference.
3, the influencing factors of blood glucose and blood lipid in school-age children
(1) general situation and blood lipid and blood sugar of school-age children
Blood lipid and blood glucose increased with age; the TG, LDL, LDL/HDL, TCH/HDL, insulin, and HOMA index of overweight and obese people were higher than those of normal weight, and HDL was lower than those of normal ones.
(2) dietary intake of nutrients and blood lipids in school-age children
Carbohydrates, dietary fiber, plant protein, Cereals, fruits, eggs, and carbohydrates are negatively correlated with blood glucose and blood lipids in school-age children, saturated fatty acids, monounsaturated fatty acids, dinner energy ratios, fish intake and blood lipid and blood glucose Cheng Zhengxiang: total school age children, diet model 1 (healthy eating mode) and Portuguese. There was a negative correlation between sugar and glucose. In overweight and obese school-age children, dietary pattern 2 (Western diet pattern) was positively correlated with glucose.
(3) physical activity and blood lipid and blood sugar in school-age children
TG and blood glucose were negatively correlated with walking time, and the number of walking times was negatively correlated with blood sugar, and the writing time and the total static exercise time were positively related to blood glucose, and the exercise time was negatively correlated with blood glucose.
(4) comprehensive life pattern and blood lipid and blood sugar in school-age children
Western lifestyle factor score was positively correlated with insulin and HOMA index, and healthy lifestyle was negatively correlated with blood glucose.
(5) polymorphism of PPAR gamma C161 to T gene and blood glucose and blood glucose in school-age children.
Among school-age children and normal weight children, the T mutant gene carried children TCH higher than the wild genotypic children, but in overweight and obese children, the T allele carrier TG was higher than the wild genotype, and the genotype and sex had interaction with TG, and the TCH and TG concentration of T mutant gene carriers was higher than that of the wild genotypes in female school-age children. In the Western lifestyle and healthy lifestyle group Q1, the T mutation gene carrier TCH concentration was higher than that of the wild type.
(6) multiple linear regression of factors affecting blood glucose and blood glucose in school-age children
TCH, TG, blood sugar, HDL, TCH/HDL, and insulin were the gene carriers, respectively, to write job time, age, sex and dietary pattern 1 healthy eating patterns, age, work time, age.
conclusion
1, the prevalence of overweight and obesity among children in a certain district of Shanghai is serious, and the overweight and obesity rates of boys are greater than that of girls.
2, male, dietary grain intake is less, dietary total antioxidant capacity is low, healthy diet model score is low, static activity time is long, sleep time is short, PPAR gamma C161 T gene mutation is the risk factor of overweight and obesity in school-age children.
3, school-age children with different sex, diet, sports and other lifestyle, PPAR gamma C161 T gene polymorphism plays the role of overweight and obesity, different.T mutation genes are female school age children, the risk factors of overweight and obesity in Western life models are the protective factors for grain cereals intake of 300g/d children, which can be the key people for overweight and overweight monitoring. Group and individualized precautions provide preliminary clues.
4, low score of healthy diet pattern, long static exercise time, short exercise time, and PPAR gamma C161 to T gene mutation were associated with hyperlipidemia and hyperglycemia.
5, the influence of PPAR gamma C161 to T gene polymorphism on the blood lipid of school-age children is influenced by sex and diet, sports life style and other environment. In the female school age children, the TCH and (or) TG concentration of T allele carriers in the western life model and healthy lifestyle factor Q1 group are higher than those of the wild type, which can be used to monitor the blood lipid and blood glucose in school children. The group provides a theoretical basis.

【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2012
【分類號】：R725.8

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 駱彬;賈珊珊;杜麗梅;張曉偉;胡環(huán)宇;李增寧;;石家莊市長安區(qū)兒童肥胖現(xiàn)狀分析[J];公共衛(wèi)生與預(yù)防醫(yī)學(xué);2011年04期

2 魏俊香,劉娟,祁明珠,任海榮,郝改鳳,史雪梅;肥胖與血壓、血糖、血脂關(guān)系分析[J];中國臨床保健雜志;2005年05期

3 周蔚;夏劏;鄭薇薇;;上海市楊浦區(qū)中小學(xué)生肥胖現(xiàn)況及影響因素分析[J];上海預(yù)防醫(yī)學(xué);2010年04期

4 余濤;毛萌;;兒童單純性肥胖的診斷和治療[J];實(shí)用兒科臨床雜志;2007年11期

5 劉菲菲,鄭輝列,劉勇;南昌地區(qū)小學(xué)生肥胖現(xiàn)狀及其影響因素[J];中國學(xué)校衛(wèi)生;2005年11期

6 楊萬齡;王曉明;;兒童青少年超重肥胖現(xiàn)狀及成因的研究進(jìn)展[J];中國學(xué)校衛(wèi)生;2009年02期

7 馬軍;吳雙勝;;中國學(xué)齡兒童青少年超重肥胖流行趨勢分析[J];中國學(xué)校衛(wèi)生;2009年03期

8 曹向紅;王紅娟;于國偉;;蘭州市2008年兒童青少年超重肥胖流行狀況[J];中國學(xué)校衛(wèi)生;2011年06期

9 高仙;張華明;盧立新;張世偉;王培玉;;北京市西城區(qū)中學(xué)生體力活動情況及肥胖超重影響因素分析[J];中國學(xué)校衛(wèi)生;2012年01期

10 劉曉靜;崔君;劉蘭靜;龔小虎;;烏魯木齊市漢族學(xué)齡兒童青少年超重肥胖現(xiàn)狀[J];中國學(xué)校衛(wèi)生;2012年02期

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