本文選題：單純性肥胖 + 兒童�。� 參考：《華中科技大學(xué)》2013年博士論文

【摘要】：目的：旨在了解學(xué)齡前單純性肥胖和正常體重兒童的體格差異，探討肥胖對3-6歲兒童健康的危害；明確導(dǎo)致兒童肥胖的環(huán)境影響因素并觀察單純性肥胖兒童血清瘦素及脂聯(lián)素水平，探討兩者與兒童肥胖之間的關(guān)系。為從各個(gè)層面建立針對兒童早期肥胖的綜合干預(yù)策略和措施提供理論基礎(chǔ)；為以后建立長期的、有效的、科學(xué)的兒童肥胖健康促進(jìn)與健康教育模式提供參考依據(jù)，更好的促進(jìn)兒童的健康發(fā)育。 方法：于2011年8月-10月間，選取湖北省荊州市沙市區(qū)、武漢市武昌區(qū)、漢口、江夏、蔡甸、東西湖6個(gè)市區(qū)。以調(diào)查日期作為標(biāo)準(zhǔn)，以現(xiàn)場流行病學(xué)方法為基礎(chǔ)，用世界衛(wèi)生組織2006年頒布兒童生長標(biāo)準(zhǔn)為標(biāo)準(zhǔn)（身高別體重+2SD及以上判斷為肥胖），采取整群抽樣的方法，以湖北省內(nèi)6個(gè)市區(qū)所屬當(dāng)?shù)赜變簣@為單位（共計(jì)36所幼兒園），對3-6歲單純性肥胖兒童進(jìn)行流行病學(xué)調(diào)查，同時(shí)對每一個(gè)肥胖兒童選取一名對照兒童，對照兒童入選標(biāo)準(zhǔn)為居住在與肥胖兒童同一社區(qū)、性別相同、年齡相同（±3個(gè)月）、身高相同（±3厘米）、身高別體重在正常范圍的健康兒童。采用自編問卷，由經(jīng)過專業(yè)培訓(xùn)的調(diào)查員用統(tǒng)一的調(diào)查表對3-6歲兒童的家長或撫養(yǎng)人進(jìn)行面對面詢問。對所有兒童進(jìn)行人體測量并采集外周靜脈血3ml，用ELISA法測定血清瘦素及脂聯(lián)素水平。利用卡方檢驗(yàn)、t檢驗(yàn)、1:1配對條件logistic回歸、協(xié)方差分析對數(shù)據(jù)進(jìn)行分析。 結(jié)果：6個(gè)區(qū)縣共調(diào)查467對肥胖-對照兒童。 1.兒童各測量指標(biāo)分析：肥胖兒童組及對照兒童組的胸圍分別為58.68±5.10cm和49.93±3.50cm，腰圍分別為60.61±6.85cm和50.78±3.12cm，臀圍分別為66.06±5.12cm和55.60±3.50cm，收縮壓分別為95.39±9.22mmHg和87.76±6.72mmHg，舒張壓分別為62.06±6.25mmHg和58.49±6.13mmHg；肥胖兒童組和對照兒童組各皮褶厚度分別為：8.64±3.06mm和6.19±1.26mm（肱二頭�。�、13.27±3.76mm和8.14±1.89mm（腹部）、19.41±3.46mm和11.12±2.95mm（大腿）、10.03±2.85mm和6.66±1.45mm（肩胛下）、12.11±3.58mm和7.58±2.28mm（腰部），各測量值在兩組間均存在顯著差異（P0.001）。肥胖兒童組和對照兒童組的血紅蛋白值分別為126.07±9.21g/L和123.12±8.89g/L、脂聯(lián)素水平分別為8.93±5.11mg/L和13.60±5.81mg/L、瘦素水平分別為11.65±4.98μg/L和3.89±2.33μg/L，兩組間差異亦具有統(tǒng)計(jì)學(xué)意義（P0.05）。 2.家庭基本特征：467對兒童中，肥胖兒童組母親的生育年齡為27.02±3.85歲，稍高于對照組26.41±3.80歲，兩組差異有統(tǒng)計(jì)學(xué)意義（t=2.453，P0.05）。父親的生育年齡分別為28.92±4.88歲和29.34±4.47歲，差異無統(tǒng)計(jì)學(xué)意義，P0.05。肥胖兒童組和對照兒童組母親文化程度主要是大專及以上，所占比例分別為49.5%和50.1%；其父親的文化程度也主要集中分布在大專及以上，所占比例分別為54.6%和55.2%；兩組兒童母親的職業(yè)主要為商業(yè)或服務(wù)類人員，所占比例分別為35.8%和34.0%，父親的職業(yè)則主要為技術(shù)人員，所占比例分別為35.8%和33.4%，差異均無統(tǒng)計(jì)學(xué)意義，P0.05。肥胖兒童組和對照兒童組的家庭人均月收入分別集中在2000-2500元和2500-3000元（25.9%和28.9%），差異有統(tǒng)計(jì)學(xué)意義，P0.05。 3.兒童性格特點(diǎn)和生活習(xí)慣：對肥胖組兒童及對照組兒童的性格特點(diǎn)、飲食行為（早餐情況、食物偏好、宵夜習(xí)慣、進(jìn)餐次數(shù)、洋快餐頻率、零食攝入情況和進(jìn)餐速度等）、體力活動情況（久坐靜態(tài)行為、活動時(shí)間等）和睡眠時(shí)間進(jìn)行分析。發(fā)現(xiàn)兩組兒童在偏愛甜食（P=0.048）、肉類（P=0.000）、每日進(jìn)餐次數(shù)（P=0.000）、進(jìn)餐速度（P=0.000）、每日看電視時(shí)間（P=0.000）和運(yùn)動時(shí)間（P=0.001）上的存在顯著差異。 4.母親孕期情況分析：對肥胖兒童組及對照兒童組父母BMI、吸煙/飲酒情況、異常孕產(chǎn)史、孕早期陰道出血或損傷情況、妊娠期疾病、孕期母親體重變化、孕期母親生活習(xí)慣（各類食物攝入情況、情緒狀態(tài)、活動情況、睡眠時(shí)間等）等方面進(jìn)行分析。發(fā)現(xiàn)肥胖兒童組和對照兒童組母親BMI分別為22.29±2.89和21.23±2.53（t=5.908，P0.001）、父親BMI分別為24.29±3.17和23.20±2.79（t=5.386，P0.001）、母親孕期增加的體重分別為17.26±6.34Kg和14.93±5.98Kg（t=5.658，P0.001）、攝入豆類及其制品（P0.001）和甜食（P0.05）的頻率、睡眠時(shí)間（P0.05）和情緒狀態(tài)（P0.05）的差異具有統(tǒng)計(jì)學(xué)意義。 5.兒童的出生史：對兒童出生時(shí)的體重、身長、分娩方式以及分娩時(shí)的胎齡情況做比較，發(fā)現(xiàn)肥胖組兒童出生時(shí)的體重高于對照組（3514.52±524.01g vs3263.90±446.77g，P0.001），肥胖兒童組中巨大兒所占比例明顯高于對照組（15.0%vs8.8%，P0.05），出生時(shí)身長亦大于對照組兒童（50.84±1.81cm vs50.24±1.45cm，P0.05）。肥胖兒童組中剖宮產(chǎn)比例明顯高于對照兒童組（72.8%vs64.2%，P0.05）。兩組在分娩時(shí)胎齡上的差異不具有統(tǒng)計(jì)學(xué)意義（P0.05）。 6.兒童喂養(yǎng)史：肥胖組中純母乳喂養(yǎng)的兒童有282例，占60.4%，混合喂養(yǎng)的兒童有107例，占22.9%，人工喂養(yǎng)的兒童有78例，占16.7%；對照組中母乳喂養(yǎng)的兒童有315例，占67.5%，混合喂養(yǎng)的兒童有97例，占20.8%，人工喂養(yǎng)的兒童有55例，占11.8%。肥胖兒童組中純母乳喂養(yǎng)的比例明顯低于對照組（60.4%vs67.5%，P0.05）、母乳喂養(yǎng)時(shí)間≥6個(gè)月的比例明顯低于對照組（43.7%vs51.9%，P0.05）。兩組在初次添加輔食時(shí)間（P=0.046）和初次添加固體輔食時(shí)間（P=0.010）上的差異亦具有統(tǒng)計(jì)學(xué)意義。 7.家長對兒童肥胖相關(guān)知識的認(rèn)識程度：兩組家長在是否知曉體質(zhì)指數(shù)（BMI）（P=0.040）以及對兒童肥胖所持態(tài)度（P=0.019）上的差異有統(tǒng)計(jì)學(xué)意義。 8.肥胖影響因素分析結(jié)果：多因素條件logistic回歸分析結(jié)果顯示，兒童偏食肉類（OR=1.713）、每日看電視時(shí)間3h（OR=7.820）、母親BMI≥24（OR=3.884）、父親BMI≥24（OR=3.905）、出生體重≥4000g（OR=2.108）、孕期增加體重在13-20kg（OR=1.960），孕期增加體重20kg（OR=5.147）、血清瘦素水平10.45μg/L（OR=2.697）均為兒童肥胖的危險(xiǎn)因素。家庭人均月收入在2500-3000元（OR=0.183）、家庭人均月收入≥3000元（OR=0.135）、兒童進(jìn)餐速度較慢（OR=0.471）、孕期經(jīng)常攝入豆類及其制品（OR=0.406）、母乳喂養(yǎng)時(shí)間≥6個(gè)月（OR=0.486）、初次添加輔食時(shí)間在4-6個(gè)月（OR=0.383）、初次添加輔食時(shí)間6個(gè)月（OR=0.355）、血清瘦素水平4.40μg/L（OR=0.516）、家長知曉兒童肥胖原因3點(diǎn)（OR=0.222）均為兒童肥胖的保護(hù)因素。 9.母乳喂養(yǎng)時(shí)間與兒童血清瘦素及脂聯(lián)素水平：母乳喂養(yǎng)時(shí)間在4-6個(gè)月和≥6個(gè)月者，其血清瘦素水平均低于無母乳喂養(yǎng)者，差異具統(tǒng)計(jì)學(xué)意義（P0.05）。脂聯(lián)素水平的差異則不具統(tǒng)計(jì)學(xué)意義（P0.05）。 結(jié)論：環(huán)境因素及血清瘦素水平對3-6歲兒童單純性肥胖有影響作用。 1.兒童肥胖不僅僅體現(xiàn)在高體重，過量的脂肪也在身體各不同部位聚積，在3-6歲的年齡段，，肥胖已表現(xiàn)出了對兒童心血管的危害。 2.影響學(xué)齡前兒童肥胖發(fā)生的因素是多方面的。兒童不良的飲食和生活方式是導(dǎo)致肥胖的主要原因。同時(shí)，兒童肥胖與父母體重密切相關(guān)，父母超重的兒童易患肥胖。孕期母親的膳食習(xí)慣、體重增加、母乳喂養(yǎng)方式、輔食添加時(shí)間、家長對兒童肥胖知識的知曉情況、家庭經(jīng)濟(jì)情況均是影響兒童肥胖發(fā)生的因素。 3.肥胖兒童存在血清脂聯(lián)素水平偏低、瘦素水平偏高（瘦素抵抗）的現(xiàn)象，母乳喂養(yǎng)時(shí)間的延長可以降低兒童血清瘦素水平。 4.兒童單純性肥胖的發(fā)生應(yīng)重在預(yù)防并且盡早預(yù)防，兒童的父母應(yīng)接受健康科學(xué)的家庭喂養(yǎng)知識教育，同時(shí)幫助孩子在早期建立健康的飲食習(xí)慣和生活方式并長期保持下去，才能從根本上杜絕肥胖的發(fā)生。
[Abstract]:Objective: to understand the physical differences between preschool simple obesity and normal weight children, to explore the health hazards of obesity to 3-6 year old children, to clarify the environmental factors that lead to obesity in children and to observe the level of serum leptin and adiponectin in children with simple obesity, and to explore the relationship between obesity and obesity in children. Provide theoretical basis for early childhood obesity intervention strategies and measures for the future; to establish long-term, effective, and provide reference for health education of childhood obesity promoting scientific health, promote the healthy development of children better.
Methods: during the -10 month of August 2011, 6 cities in Jingzhou, Hubei, Jingzhou, Wuhan, Wuchang, Hankou, Jiangxia, Caidian and Dongxihu were selected as the standard, based on the field epidemiological method, and the standard of child growth was issued by WHO in 2006. A cluster sampling method was adopted to investigate the epidemiological investigation of children with simple obesity at the age of 3-6 (36 kindergartens) in 6 urban areas in Hubei province. At the same time, a control child was selected for each obese child. The standard for the control of children was to live in the same community as obese children, with the same sex and age. The same (3 months), the height of the same height (3 cm), the height of the normal range of healthy children. A self-made questionnaire was used by a trained investigator to conduct face-to-face inquiries on parents or dependants of 3-6 year old children with a unified questionnaire. All children were measured in human body and collected peripheral venous blood 3ml, measured by ELISA method. Serum leptin and adiponectin levels were analyzed by chi square test, t test, 1:1 paired conditional logistic regression and covariance analysis.
Results: 467 obesity control children were investigated in 6 districts and counties.
1. analysis of the measurement indexes of children: the chest circumference of the obese children and the control children was 58.68 + 5.10cm and 49.93 + 3.50cm respectively, the waist circumference was 60.61 + 6.85cm and 50.78 + 3.12cm respectively, the hip circumference was 66.06 + 5.12cm and 55.60 + 3.50cm respectively, and the systolic pressure was 95.39 + 9.22mmHg and 87.76 + 6.72mmHg respectively, and the diastolic pressure was 62.06 + 6.25mmHg and 58.49 + 6, respectively. .13mmHg, the thickness of skin pleats in obese children and control children were 8.64 + 3.06mm and 6.19 + 1.26mm (biceps brachii), 13.27 + 3.76mm and 8.14 + 1.89mm (abdomen), 19.41 + 3.46mm and 11.12 + 2.95mm (thigh), 10.03 + 2.85mm and 6.66 + 1.45MM (under scapula), 12.11 + 3.58mm and 7.58 + 2.28mm (waist), and the measured values were all in the two groups. Significant difference (P0.001). The hemoglobin values of obese children and control children were 126.07 + 9.21g/L and 123.12 + 8.89g/L respectively. Adiponectin levels were 8.93 + 5.11mg/L and 13.60 + 5.81mg/L respectively, and leptin levels were 11.65 + 4.98 g/L and 3.89 + 2.33 g/L respectively. The difference between the two groups was also statistically significant (P0.05).
2. the basic characteristics of the family: in 467 pairs of children, the birth age of the obese children was 27.02 + 3.85 years old, which was slightly higher than the control group of 26.41 + 3.80 years old. The two groups were statistically significant (t=2.453, P0.05). The age of the father was 28.92 + 4.88 and 29.34 + 4.47 years, respectively, with no statistical significance, P0.05. obese children group and control children group. The majority of mothers' education level is junior college and above, the proportion of which is 49.5% and 50.1% respectively. Their father's educational level is mainly concentrated in college and above, and the proportion is 54.6% and 55.2% respectively. The two groups of children's mothers are mainly commercial or service personnel, accounting for 35.8% and 34%, and the father's occupation is the principal. For the technical personnel, the proportion was 35.8% and 33.4%, there were no significant differences in P0.05., obese children group and control group of children's family income per month were concentrated in 2000-2500 yuan and 2500-3000 yuan (25.9% and 28.9%), the difference was statistically significant, P0.05.
3. children's personality characteristics and living habits: the personality characteristics of children in the obese group and the control group, diet behavior (breakfast, food preference, night habit, meal times, foreign fast food frequency, snack intake and meal speed, etc.), physical activity (sedentary static behavior, activity time, etc.) and sleep time were analyzed. Two groups of children in preference for sweets (P=0.048), meat (P=0.000), the number of meals per day (P=0.000), eating speed (P=0.000), daily TV time (P=0.000) and movement time (P=0.001) on the existence of significant differences.
4. maternal pregnancy analysis: BMI, smoking / drinking, abnormal pregnancy history, vaginal bleeding or injury in the early pregnancy, pregnancy disease, maternal weight change during pregnancy, mother's living habits (all kinds of food intake, emotional state, activity, sleep time, etc.) in the obese children group and the control children group. The mother BMI of the obese children group and the control child group was 22.29 + 2.89 and 21.23 + 2.53 (t=5.908, P0.001) respectively. The father BMI was 24.29 + 3.17 and 23.20 + 2.79 (t=5.386, P0.001) respectively. The maternal weight of mother's pregnancy was 17.26 + 6.34Kg and 14.93 + 5.98Kg (t=5.658, P0.001) respectively, and the frequency of legumes and their products (P0.001) and sweet food (P0.05) were consumed. There was a statistically significant difference in rates of sleep time (P0.05) and emotional state (P0.05).
5. birth history of children: the weight, length, mode of childbirth and gestational age of childbirth were compared. It was found that the weight of children at birth in obese group was higher than that of the control group (3514.52 + 524.01g vs3263.90 + 446.77g, P0.001). The proportion of giant children in obese children group was significantly higher than that of the control group (15.0%vs8.8%, P0.05), and the birth time was higher than that of the control group. The length is larger than that of the control group children (50.84 + 1.81cm vs50.24 + 1.45cm, P0.05). The obese group in cesarean section were significantly higher than the control group of children (72.8%vs64.2%, P0.05). The differences between the two groups in the gestational age at delivery was not statistically significant (P0.05).
6. children feeding history: there were 282 cases of pure breast-feeding children in the obese group, accounting for 60.4%, 107 children in mixed feeding, 22.9% and 16.7% in artificial feeding children, 315 in the control group, 67.5% in 315, 97 in mixed children, 20.8% in children, and 6. children in artificial feeding, accounting for 11.8%. obese children. The proportion of pure breastfeeding in the group was significantly lower than that in the control group (60.4%vs67.5%, P0.05), and the proportion of breastfeeding time for more than 6 months was significantly lower than that of the control group (43.7%vs51.9%, P0.05). The difference between the two groups at first addition of supplementary feeding time (P=0.046) and the initial addition of solid food time (P=0.010) was also statistically significant.
7. parents awareness of knowledge related to childhood obesity: two groups of parents are aware of the body mass index (BMI) (P=0.040) as well as on childhood obesity attitudes (P=0.019) there were significant differences.
8. analysis of influencing factors of obesity: the results of multiple factor Logistic regression analysis showed that children's meat (OR=1.713), TV time 3H (OR=7.820), mother BMI > 24 (OR=3.884), father BMI > 24 (OR=3.905), birth weight more than 4000g (OR=2.108), 13-20kg (OR=1.960) during pregnancy, and weight gain during pregnancy, The serum leptin level 10.45 g/L (OR=2.697) is a risk factor for children's obesity. The monthly income of the family is 2500-3000 yuan (OR=0.183), the per capita monthly income of the family is more than 3000 yuan (OR=0.135), the speed of children's meal is slower (OR=0.471), the regular intake of beans and their products (OR=0.406) during pregnancy (OR=0.406), and breast feeding time more than 6 months (OR=0.486), the first supplemented supplemented Feeding time at 4-6 months (OR=0.383), the first feeding time of 6 months (OR=0.355), serum leptin levels of 4.40 g/L (OR=0.516), 3 children parents know the causes of obesity (OR=0.222) were protective factors of children obesity.
9. children with breast feeding time of serum leptin and adiponectin levels: Breastfeeding time in 4-6 months and over 6 months, the serum leptin level was lower than that in non breastfeeding, the difference was statistically significant (P0.05). The difference in adiponectin levels is not statistically significant (P0.05).
Conclusion: environmental factors and serum leptin levels have an effect on simple obesity in children aged 3-6 years.
1. childhood obesity is not only reflected in the high weight, excessive fat accumulation in different parts of the body, at the age of 3-6 years old, obesity has shown cardiovascular harm to children.
2. the factors affecting the obesity of preschool children are multifaceted. Poor children's diet and lifestyle are the main causes of obesity. At the same time, children's obesity is closely related to the weight of parents, and the overweight children of the parents are prone to obesity. Knowledge of childhood obesity and family economic situation are all factors that influence obesity in children.
3. obese children have low levels of serum adiponectin, leptin levels (leptin resistance) phenomenon, prolonged breastfeeding can reduce the serum leptin levels in children.
4. the occurrence of simple obesity in children should be seriously prevented and prevented as soon as possible. The parents of children should accept the knowledge education of family feeding in the health science, and help the children to establish healthy eating habits and lifestyle in the early stage and keep it for a long time, in order to eradicate the occurrence of fat fat.
【學(xué)位授予單位】：華中科技大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2013
【分類號】：R723.14

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