發(fā)布時間：2018-06-20 22:19

  本文選題：高出生體重 + 環(huán)境因素��； 參考：《復旦大學》2012年博士論文

【摘要】：[研究背景] 肥胖己成為21世紀全球公共衛(wèi)生的嚴重問題之一,中國兒童青少年肥胖也正進入高發(fā)期。經濟增長和都市化進程,引起生活環(huán)境的改變,如過度能量攝入、低體力活動、靜坐生活方式增多等,肥胖患病率也隨之呈現(xiàn)明顯增加趨勢。兒童青少年肥胖危害深遠,不僅導致身心疾患和生理功能障礙,影響學習能力,更為嚴重的是兒童青少年肥胖可發(fā)展為成人肥胖,引起高血壓、心臟病、糖尿病等慢性疾病,從而導致長期病態(tài)和早期死亡。超重、肥胖是多種慢性病的主要危險因素之一,而兒童青少年肥胖已經成為這些疾病的隱患。因此對兒童青少年肥胖問題必須加以重視。 肥胖是遺傳和環(huán)境因素綜合作用的結果。大量研究表明,引起兒童青少年肥胖的危險因素多種多樣且相互關聯(lián),主要包括遺傳、出生體重、飲食、體育鍛煉、父母行為意識、社會經濟、精神心理等因素。肥胖是多因素、長期作用的結果,原因錯綜復雜。遺傳因素決定個體肥胖發(fā)生的易感性,而各種環(huán)境因素則促進肥胖的發(fā)生。研究證實,從胎兒到成年期的各年齡階段中,肥胖的發(fā)生和發(fā)展有鮮明的生長發(fā)育軌跡現(xiàn)象,探討這些現(xiàn)象及其影響因素,不僅有助于為兒童青少年肥胖的預防提供理論依據(jù),有效開展早期干預,而且對減少成年期肥胖相關疾病、保障終身健康都具有重要意義。 [研究目的] 本研究擬了解巨大兒和正常出生體重兒隊列在兒童期和青少年期超重、肥胖發(fā)生的現(xiàn)況和相關危險因素：分析從出生到兒童期再到青少年期,兒童青少年體重變化趨勢；探討出生體重與生活行為因素之間的交互作用、父母超重肥胖對子代超重肥胖的影響以及超重肥胖和相關生活行為因素的家庭聚集性。 [研究方法] 本研究選擇江蘇省無錫市的一個縣級市(江陰市)和兩個中心行政區(qū)(惠山區(qū)和錫山區(qū))出生于1993-1995年的活產嬰兒作為研究對象,其中出生體重大于等于4000克者作為暴露組,小于4000克同時大于等于2500克者作為對照組。采用歷史性隊列研究設計,基線數(shù)據(jù)來源于這三個地區(qū)在90年代初建立的婦女圍產保健數(shù)據(jù)庫,包括母親的一般人口學特征、健康狀況、初次孕產期檢查、產前復查、產時及圍產期檢查等。2005年10月至2006年10月期間進行兒童期隨訪,隨訪所用調查表的內容主要包括研究對象的個人生長發(fā)育情況、生活方式、飲食運動習慣及其家庭特征和父母生活方式等,同時進行體格檢查(身高、體重、血壓等)。在此基礎上,于2010年10月至2011年10月期間再次對已進入青春期的研究對象進行第二次隨訪,除收集與上次隨訪類似的信息外,本次隨訪信息更具體化和詳細化,增加收集父母的相關信息,仍然進行體格檢查(身高、體重及血壓等)。 采用體質指數(shù)(BMI)作為結局變量,并以中國肥胖工作組(WGOC)發(fā)表的中國兒童青少年性別年齡別BMI參考值作為判定超重與肥胖的標準。以超重肥胖者作為病例,按同性別、同年齡配以對照,進行病例對照研究。 應用Epidata3.1軟件建立數(shù)據(jù)庫和設置核查程序,雙遍錄入所有數(shù)據(jù)。運用SPSS16.0和SAS9.2等軟件進行統(tǒng)計分析,主要方法包括t檢驗、方差分析、χ2檢驗、秩和檢驗、非條件Logistic回歸分析、因子分析、相關分析、廣義線性混合效應模型等。 [研究結果] 1.隊列概況 本次隊列研究起點為研究對象出生時,經過兒童期和青少年期兩次隨訪,最終進入分析的合格對象為2236人,其中出生時1108人為巨大兒,1128人為正常出生體重兒；男生1488名,占66.55%(暴露組737名,對照組751名),女生748名,占33.45%(暴露組371名,對照組377名)。 2.基線調查結果 過期妊娠、母親孕前BMI較高和母親孕期增加體重較多均是嬰兒高出生體重的危險因素,OR值分別為2.31(95%CI：1.48,3.63)、1.17(95%CI：1.07,1.27)、1.11(95%CI：1.08,1.14)。 3.兒童期隨訪調查結果 兒童期實際隨訪到2870人,年齡在10-13歲之間。本人群兒童期超重檢出率為12.03%(男生15.66%,女生4.81%),肥胖檢出率為2.15%(男生2.42%,女生1.61%),超重肥胖檢出率為14.18%(男生18.08%,女生6.42%)；暴露組中超重檢出率為13.45%,肥胖檢出率為2.80%,對照組中超重檢出率為10.64%,肥胖檢出率為1.51%。 暴露組的超重肥胖檢出率(16.25%)高于對照組的超重肥胖檢出率(12.15%),差別有統(tǒng)計學意義(P=0.003)；暴露組與對照組相比,發(fā)生超重和肥胖的RR分別為1.26(95%CI：1.01,1.58)和1.86(95%CI：1.03,3.33),AR分別為2.81%和1.29%。不同出生體重組之間兒童BMI均值不同,超重率和肥胖率有明顯的隨出生體重增加而增高的趨勢(P0.01)。 兒童期超重肥胖的影響因素分析：多因素非條件Logistic回歸分析表明,男性(OR=2.06)、高出生體重(OR=1.48)、母親超重肥胖(OR=2.22)、嬰兒期人工喂養(yǎng)(OR=2.80)和混合喂養(yǎng)(OR=2.70)、經常吃油炸食品(OR=1.41)、經常吃夜宵(OR=4.59)、看電視時間較長(OR=1.37)、收入較高(OR=1.47)、父親飲酒(OR=1.34)均為兒童超重肥胖的危險因素。牛奶食用次數(shù)較多(OR=0.66)為保護因素。 4.青少年期隨訪調查結果 青少年期實際隨訪到2236人,隨訪率為77.91%,年齡在15-18歲之間。青少年期超重檢出率為9.35%(男生10.28%,女生7.49%),肥胖檢出率為1.83%(男生2.09%,女生1.34%),超重肥胖檢出率為11.18%(男生12.37%,女生8.83%)；暴露組超重檢出率為11.73%,肥胖檢出率為2.44%,對照組超重檢出率為7.00%,肥胖檢出率為1.24%。 暴露組的超重肥胖檢出率(14.17%)高于對照組的超重肥胖檢出率(8.24%),差別有統(tǒng)計學意義(P0.001)。暴露組與對照組相比,發(fā)生超重和肥胖的RR分別為1.68(95%CI：1.28,2.19)和1.96(95%CI：1.04,3.72),AR分別為4.73%和1.20%。不同出生體重組之間青少年BMI均值不同,超重率和肥胖率有明顯的隨出生體重增加而增高的趨勢(P0.05)。 青少年期超重肥胖的影響因素分析：多因素非條件Logistic回歸分析表明,男性(OR=1.43)、高出生體重(OR=1.62)、雙親均超重肥胖(OR=2.56)、母親超重肥胖(OR=1.87),父親超重肥胖(OR=1.85)、經常每頓吃得很飽(OR=1.45)、進餐速度偏快(OR=1.34)、使用電腦時間較長(OR=1.40)、母親中等文化程度(OR=1.46)和較高文化程度(OR=2.01)均為青少年超重肥胖的危險因素,校內活動時間較多(OR=0.69)、母親對肥胖持反對態(tài)度(OR=0.65)為保護因素。 出生體重與生活行為因素的交互作用分析：采用因子分析方法,共提取蛋白類食物、靜坐生活方式、果蔬類食物、體育活動、飲食習慣和飲食偏好6個公因子。二分類Logistic回歸分析顯示,出生體重分別與蛋白類食物、果蔬類食物對超重肥胖的發(fā)生有相乘交互作用；出生體重與蛋白類食物、果蔬類食物、飲食偏好的交互作用相對超額危險度分別為-1.65(95%CI：-3.29,-0.01)、1.36(95%CI：0.37,2.36)和1.19(95%CI：0.14,2.23),均具有統(tǒng)計學意義,表明兩者之間存在相加交互作用。交互作用歸因比分別為76.74%、55.06%、48.29%。 5.兒童青少年超重肥胖的隊列分析 在所有研究對象2236人中,出生時1108人為巨大兒,進入兒童期有317(14.18%)名兒童超重或肥胖,進入青少年期有250(11.18%)名青少年超重或肥胖。按照性別分組,男生出生時49.53%為巨大兒,兒童期18.08%超重肥胖,青少年期12.37%超重肥胖；女生出生時49.60%為巨大兒,兒童期6.42%超重肥胖,青少年期8.82%超重肥胖。由此可見從兒童期到青少年期,男生的超重肥胖檢出率降低,而女生的超重肥胖檢出率升高。 研究對象在不同時間體重變化趨勢分析：性別與時間有交互作用,即男生和女生的體重異常率隨時間的變化趨勢不同。出生體重與時間沒有交互作用,說明兩因素的作用效果相互獨立。從兒童期至青少年期,從總體來看,BMI分級轉好率大于轉差率,差別有統(tǒng)計學意義(P=0.003)；分性別來看,男生BMI分級轉好率大于轉差率,差別有統(tǒng)計學意義(P=0.004),女生BMI分級雖轉好率大于轉差率,但差別無統(tǒng)計學意義(P=0.286)。 6.父母超重肥胖對子女超重肥胖影響的分析 父母超重肥胖狀況為雙親均正常、父親超重肥胖、母親超重肥胖、雙親均超重肥胖,其子女超重肥胖檢出率依次為：12.01%、14.20%、15.94%、29.09%(兒童期)和7.52%、13.34%、13.43%、16.67%(青少年期),總體均呈現(xiàn)增加趨勢(P0.01)。 青少年BMI與其父母超重肥胖狀況關系的多元線性回歸分析結果顯示,青少年BMI與其父母超重肥胖狀況呈顯著正相關,偏回歸系數(shù)為0.54(95%CI：0.37,0.71)；青少年超重肥胖與其父母超重肥胖狀況關系的多因素Logistic回歸分析結果顯示,父親超重肥胖、母親超重肥胖、雙親均超重肥胖的家庭與雙親均正常的家庭相比,其子女超重肥胖的危險性(OR值)分別為1.73(95%CI：1.23,2.42)、1.89(95%CI：1.18,3.02)和2.36(95%CI：1.49,3.73)。進一步分析不同性別青少年超重肥胖與其父母超重肥胖狀況的關系,結果顯示,在男生組,父親超重肥胖和雙親均超重肥胖與雙親均正常相比,其子女超重肥胖的危險性(OR值)分別為1.83(95%CI：1.24,2.71)和2.05(95%CI：1.17,3.61),但在母親超重肥胖者中,未觀察到此效應；在女生組,母親超重肥胖和雙親均超重肥胖與雙親均正常相比,其子女超重肥胖的危險性(OR值)分別為2.49(95%CI：1.09,5.68)和3.07(95%CI：1.36,6.92),但在父親超重肥胖者中,未觀察到此效應；由此推測母親超重肥胖可能對其女兒超重肥胖的影響較大,而父親超重肥胖可能對其兒子超重肥胖的影響較大；與雙親體重均正常相比,雙親同時超重肥胖對女兒(OR=3.07)超重肥胖產生的影響可能大于對兒子(OR=2.05)的影響。 青少年與其父(母)親在超重肥胖和生活行為因素等方面的相關關系：父(母)親和子女在BMI、BMI分級、飲酒、飲茶、吃油炸食品、每頓吃得很飽、進餐速度、對肥胖的態(tài)度、對體型的評價、是否需減肥方面有正相關關系。 [結論] 1.該隊列超重率較高,兒童期超重肥胖率均高于青少年期�？刂瞥叵蚍逝职l(fā)展是一個重要的預防措施,兒童期是超重肥胖的高發(fā)階段,應引起高度重視。 2.高出生體重是影響兒童、青少年超重肥胖的獨立危險因素,肥胖的一級預防應從胎兒期抓起；生活行為因素可能修飾出生體重與肥胖的關系,高出生體重的兒童青少年應作為高危人群進行重點干預,通過改變其不良的生活行為習慣,來降低肥胖發(fā)生的危險性。 3.父母超重肥胖是兒童、青少年超重肥胖的獨立危險因素,且關聯(lián)存在性別差異；父母與子女超重肥胖及其生活行為因素存在相關性。對兒童青少年肥胖的預防和干預,應重視家庭環(huán)境因素。
[Abstract]:[research background]
Obesity has become one of the serious problems of public health in the world in the twenty-first Century. The obesity of children and adolescents in China is also entering a period of high incidence. The economic growth and urbanization have caused changes in the living environment, such as excessive energy intake, low physical activity, and more sedentary lifestyles. The prevalence of obesity is also obviously increasing. Obesity is far-reaching, not only causes physical and mental disorders and physical dysfunction, but also affects learning ability. More serious is that obesity in children and adolescents can develop into adult obesity, cause chronic diseases such as hypertension, heart disease, diabetes and so on, which lead to long-term morbid and early death. Overweight and obesity are the main risk factors for many chronic diseases. First, obesity of children and adolescents has become a hidden danger of these diseases. Therefore, attention should be paid to obesity in children and adolescents.
Obesity is the result of the combination of genetic and environmental factors. A large number of studies have shown that the risk factors for obesity in children and adolescents are varied and interrelated, mainly including heredity, birth weight, diet, physical exercise, parents' behavior consciousness, social economy, mental psychology and other factors. Obesity is the result of multiple factors, the result of long-term effect, and the wrong reason. The genetic factors determine the susceptibility of individual obesity, and the various environmental factors promote the occurrence of obesity. The study confirms that the occurrence and development of obesity have a distinct growth and development trajectory from the fetal to adult stages. The study of these phenomena and its influencing factors will not only contribute to obesity for children and adolescents. To provide theoretical basis for prevention, effective early intervention, and to reduce obesity related diseases in adulthood and ensure lifelong health.
[research purposes]
The present study is to understand the prevalence and risk factors of overweight and obesity in childhood and adolescence, the analysis of the trend of weight change from birth to childhood to adolescence, the trend of weight change in children and adolescents, the interaction between birth weight and life behavior factors, and the overweight and obesity of parents. The impact of overweight and obesity on offspring and family aggregation of overweight, obesity and related life behavior factors.
[research methods]
In this study, a county-level city (Jiangyin city) in Wuxi, Jiangsu, and two central administrative regions (Huishan and Xishan districts) were selected as the subjects of 1993-1995 years of live birth. The birth weight is more than 4000 grams as exposure group, less than 4000 grams and equal to 2500 grams as the control group. A historical cohort is used. Research design, baseline data derived from the women's perinatal health care database established in the three regions in the early 90s, including the general demographic characteristics of the mother, health status, initial pregnancy examination, prenatal review, delivery and perinatal examination, between October and October 2006.2005 years for childhood follow-up, and the contents of the follow-up questionnaire. It mainly includes the individual growth and development of the subjects, lifestyle, eating habits, family characteristics and parents' lifestyle, and physical examination (height, weight, blood pressure, etc.). On this basis, second follow-up studies on the subjects that have entered puberty from October 2010 to October 2011 are followed up. In the last follow-up with similar information, the follow-up information more specific and detailed, increase collect information of parents, still physical examination (body weight and blood pressure height, etc.).
The body mass index (BMI) was used as the outcome variable and the standard of gender and age BMI of Chinese children and adolescents published by the Chinese obesity working group (WGOC) was used as the criterion to determine overweight and obesity. The cases of overweight and obesity were compared with the same sex and age, and a case-control study was performed.
Using Epidata3.1 software to set up a database and set up a verification program, double entry of all data. Using SPSS16.0 and SAS9.2 software for statistical analysis, the main methods include t test, variance analysis, chi 2 test, rank sum test, unconditional Logistic regression analysis, factor analysis, correlation analysis, and generalized linear mixed effect model.
[results]
1. queue profile
The starting point of this cohort study was two times of childhood and adolescence, and 2236 of them were qualified, of which 1108 were large, 1128 were normal birth weight, 1488 were boys, 66.55% (737 in exposure group, 751 in control group), 748 in girls, and 33.45% (371 in exposure group). The name, the control group 377).
2. baseline survey results
Prolonged pregnancy, pre pregnancy BMI increased higher and more body weight during pregnancy were risk factors of high birth weight infants, OR values were 2.31 (95%CI:1.48,3.63), 1.17 (95%CI:1.07,1.27), 1.11 (95%CI:1.08,1.14).
3. childhood follow-up survey results
In childhood, 2870 people were followed up to 10-13 years of age. The prevalence rate of overweight in children was 12.03% (boys 15.66%, girls 4.81%), obesity detection rate was 2.15% (boys 2.42%, girls 1.61%), overweight and obesity detection rate was 14.18% (boys 18.08%, female 6.42%), the exposure group was 13.45%, obesity detection rate was 2.80%. The detection rate of overweight was 10.64%, and the detection rate of obesity was 1.51%.
The prevalence rate of overweight and obesity in the exposure group (16.25%) was higher than that of the control group (12.15%), and the difference was statistically significant (P=0.003). Compared with the control group, the RR of overweight and obesity was 1.26 (95%CI:1.01,1.58) and 1.86 (95%CI:1.03,3.33) respectively, and AR was 2.81% and 1.29%. in different birth weight groups, respectively, BMI. The mean rate of overweight and obesity increased significantly with the increase of birth weight (P0.01).
Analysis of influencing factors of overweight and obesity in childhood: multiple factors unconditional Logistic regression analysis showed that male (OR=2.06), high birth weight (OR=1.48), mother overweight and obesity (OR=2.22), infant artificial feeding (OR=2.80) and mixed feeding (OR=2.70), often eating fried foods (OR=1.41), frequent snack (OR=4.59), and longer television time (OR=1.37) Higher income (OR=1.47). Father drinking (OR=1.34) is a risk factor for overweight and obesity in children. Milk consumption is more frequent (OR=0.66) as a protective factor.
4. adolescent follow-up survey results
In adolescence, 2236 people were followed up, the rate of follow-up was 77.91%, the age was 15-18 years old. The prevalence rate of overweight was 9.35% (boys 10.28%, girls 7.49%), the obesity detection rate was 1.83% (boys 2.09%, girls 1.34%), the prevalence rate of overweight and obesity was 11.18% (boys 12.37%, girls 8.83%); the prevalence rate of overweight in the exposure group was 11.73% and obesity detection rate. For 2.44%, the overweight group had a detection rate of 7%, and the detection rate of obesity was 1.24%.
The prevalence rate of overweight and obesity in the exposure group (14.17%) was higher than that of the control group (8.24%), and the difference was statistically significant (P0.001). Compared with the control group, the RR of overweight and obesity was 1.68 (95%CI:1.28,2.19) and 1.96 (95%CI:1.04,3.72), respectively, and AR was 4.73% and 1.20%. in different birth weight groups, BMI, respectively. The mean rate of overweight and obesity increased significantly with the increase of birth weight (P0.05).
Analysis of the influencing factors of overweight and obesity in adolescence: multiple factors unconditional Logistic regression analysis showed that male (OR=1.43), high birth weight (OR=1.62), both parents were overweight and obese (OR=2.56), mother overweight and obesity (OR=1.87), father overweight and obesity (OR=1.85), often eat very full (OR=1.45), eat faster (OR=1.34), when using a computer, and use a computer. Between long (OR=1.40), mother of secondary education (OR=1.46) and higher education (OR=2.01) were risk factors of overweight and obese adolescents, school activities more time (OR=0.69), the mother is opposed to obesity (OR=0.65) was a protective factor.
Analysis of the interaction between birth weight and life behavior factors: using factor analysis, 6 common factors were extracted from protein food, sedentary lifestyle, fruit and vegetable food, physical activity, diet habit and diet preference. Two classification Logistic regression analysis showed that the weight of birth weight was respectively with protein food and fruit and vegetable food to overweight and obesity. The interaction of birth weight and protein food, fruit and vegetable food and diet preference were -1.65 (95%CI:-3.29, -0.01), 1.36 (95%CI:0.37,2.36) and 1.19 (95%CI:0.14,2.23), respectively, which showed that there was an additive interaction between them. The ratio is 76.74%, 55.06%, 48.29%., respectively.
Cohort analysis of overweight and obesity in 5. children and adolescents
Among all 2236 subjects, 1108 were born at birth, 317 (14.18%) children were overweight or obese in childhood, 250 (11.18%) were overweight or obese in adolescence. According to the sex group, boys were 49.53% at birth, 18.08% overweight in childhood, 12.37% overweight and obesity in adolescence; girls were 12.37%. When 49.60% for macrosomia, 6.42% childhood overweight and obesity, adolescent overweight and obesity 8.82%. Thus from childhood to adolescence, overweight and obese boys rate decreased, and the overweight and obese girls higher detection rates.
The analysis of the trend of body weight change at different time: gender and time have interaction, that is, the change trend of body weight abnormality rate of boys and girls is different with time. There is no interaction between birth weight and time. It shows that the effect of the two factors is independent. From childhood to adolescence, the overall rate of BMI grading turns better. Greater than the slip, the difference was statistically significant (P=0.003); sex, male BMI grade better rate than the slip, the difference was statistically significant (P=0.004), BMI has better classification rate than girls slip, but the difference was not statistically significant (P=0.286).
6. the influence of overweight and obesity on overweight and obesity of children
Parents were overweight and obese, father overweight and obesity, mother overweight and obesity, both parents were overweight and obese, the rate of overweight and obesity in their children were 12.01%, 14.20%, 15.94%, 29.09% (childhood) and 7.52%, 13.34%, 13.43%, 16.67% (Adolescence), and the overall trend was increased (P0.01).
The multivariate linear regression analysis of the relationship between adolescent BMI and their parents' overweight and obesity showed that adolescent BMI and their parents were positively correlated with overweight and obesity, and the partial regression coefficient was 0.54 (95%CI:0.37,0.71), and the multiple factor Logistic regression analysis of overweight and obesity in adolescents and their parents' overweight and obesity showed that the father was the father. The risk of overweight and obesity in their children (OR value) was 1.73 (95%CI:1.23,2.42), 1.89 (95%CI:1.18,3.02) and 2.36 (95%CI:1.49,3.73), respectively, compared with the normal families of both parents and parents. Further analysis was made of overweight and obesity in different sex adolescents and their parents. The results showed that in boys, the risk of overweight and obesity (OR) was 1.83 (95%CI:1.24,2.71) and 2.05 (95%CI:1.17,3.61) for overweight and obesity and 2.05 (95%CI:1.17,3.61) in the father's overweight and obese parents, but in the mothers of overweight and obese mothers, the effect was not observed; in the female group, the mother was overweight and obese and double. The risk of overweight and obesity in their children (OR) was 2.49 (95%CI:1.09,5.68) and 3.07 (95%CI:1.36,6.92), but the effect was not observed in the father's overweight and obese children, and the mother overweight and obesity may have a greater impact on the overweight and obesity of her daughter, and the father was overweight and obese. The son can have great effect on overweight and obesity; and their weight were compared to normal, overweight and obesity of parents and daughter (OR=3.07) effect of overweight and obesity may produce greater than that of the son (OR=2.05) effect.
Youth with his father (mother) related pro in overweight and obesity and lifestyle factors such as: the father (mother) children in BMI BMI affinity, grading, drinking, drinking tea, eating fried food, every meal to eat very full, eat
【學位授予單位】：復旦大學
【學位級別】：博士
【學位授予年份】：2012
【分類號】：R589.2

【引證文獻】

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