【摘要】：目的了解2006~2014年天津市3~6歲兒童超重和肥胖的流行趨勢,從個人、家庭和生活方式等方面探討天津市兒童超重肥胖發(fā)生的影響因素,并進一步研究兒童肥胖與血脂、血糖、血尿酸的關(guān)系,為制定天津市3~6歲兒童超重肥胖預防和干預措施提供依據(jù)。方法1.2006~2014年,在天津市46所市級監(jiān)測幼兒園收集145078例3~6歲兒童的體檢信息,包括兒童身高、體重,計算體重指數(shù)(body mass index,BMI)Z值(Z-scores),分析兒童生長發(fā)育的長期變化趨勢。2.于2015年采用整群抽樣的方法,根據(jù)兒童保健手冊統(tǒng)一編碼,回顧性研究2013年和2014年共計1286例兒童的體檢指標,采用卡方檢驗、Logistic回歸、重復測量方差分析、t檢驗分析不同兒童身高、體重、BMI及超重肥胖構(gòu)成情況隨年齡的變化趨勢,以及在不同年齡、性別間的差異性。3.對2015年1286例在園兒童進行生長發(fā)育和健康狀況調(diào)查及體格檢查。采用方差分析、Logistic回歸探討天津市兒童超重肥胖發(fā)生的影響因素。4.于2015年采用整群抽樣的方法,對抽取3305例兒童進行空腹血清總膽固醇、甘油三酯、血糖、血尿酸檢測,采用t檢驗、方差分析及Logistic回歸分析方法探討兒童肥胖與血脂、血糖、血尿酸的關(guān)系。結(jié)果1.從2006年到2014年,天津市3~6歲兒童年齡別身高Z值顯著增長,從0.34增長到0.54;兒童年齡別體重Z值保持穩(wěn)定;年齡別BMI Z值從0.40下降到0.23。兒童超重率從2006年的23.4%下降到20.7%,肥胖率從2006年的7.0%增長到2010年的7.9%,從2010年到2014年保持穩(wěn)定。男孩的超重和肥胖率遠高于女孩。3~6歲兒童肥胖率隨著年齡急劇增長,從3歲的4.9%增長到6歲的11.6%,增長了2.4倍。2.2013~2015年縱向研究顯示,3年間男童體重、身高和BMI均高于女童(P0.05),2014和2015年6歲童身高、體重高于5歲童(P0.05)。2013年6歲童身高、體重和BMI高于5歲童,差異有統(tǒng)計學意義(P0.05);6歲童的體重變化高于5歲兒童,變化顯著差異有統(tǒng)計學意義(P0.05),6歲更高(P0.05);BMI變化趨勢,差異無統(tǒng)計學意義(P0.05)。三年不同年齡兒童的肥胖和超重構(gòu)成差異無統(tǒng)計學意義(p0.05)。2013年不同性別的肥胖和超重構(gòu)成差異無統(tǒng)計學意義(p0.05);2014年和2015年男童的肥胖、超重構(gòu)成高于女童(p0.05)。3.在1286名兒童中2013年進入隊列的體重正常兒童1072名,在2015年肥胖發(fā)生率為4.6%,超重發(fā)生率為7.2%,超重或肥胖合計發(fā)生率為11.8%。logistic回歸分析顯示男孩、人工喂養(yǎng)、看屏幕(包括電視、手機、電腦)時間較長、吃飯時間較快是天津市托幼機構(gòu)5~6歲兒童肥胖的危險因素(p0.05)。父母文化程度、平均每天睡眠時間、從托幼機構(gòu)回家后是否吃主食,與兒童肥胖的發(fā)生無關(guān)聯(lián)(p0.05)。4.不同性別兒童,血清總膽固醇異常率差異有統(tǒng)計學意義(p0.05),男童低于女童。不同年齡兒童,3歲童血脂異常率及血清總膽固醇異常率高于其他年齡組,差異有統(tǒng)計學意義(p0.05)。不同體型兒童血脂異常率、血清總膽固醇異常率差異無統(tǒng)計學意義(p0.05)。但肥胖兒童血清甘油三酯異常率遠高于正常兒童(p0.05)。不同性別兒童,血清總膽固醇及甘油三酯水平差異有統(tǒng)計學意義(p0.05),女童高于男童。不同年齡階段的兒童,血清總膽固醇差異有統(tǒng)計學意義(p0.05)。不同體型的兒童,血清甘油三酯水平差異有統(tǒng)計學意義(p0.05)。在不同性別、年齡及體型的3~6歲兒童中,血糖異常率差異無統(tǒng)計學意義(p0.05)。不同性別的3~6歲兒童血糖水平差異有統(tǒng)計學意義(p0.05),男孩平均血糖水平高于女孩。不同年齡階段的兒童,血糖水平差異有統(tǒng)計學意義(p0.05),隨年齡的增長,平均血糖水平逐漸增高。不同體型的兒童,血糖水平差異有統(tǒng)計學意義(p0.05),肥胖兒童的平均血糖水平高于正常體型兒童。血尿酸異常率在不同年齡及性別兒童間差異無統(tǒng)計學意義(p0.05),但不同體型兒童的血尿酸異常率差異有統(tǒng)計學意義(p0.05),肥胖兒童的水平要高于正常體型兒童。此外,隨年齡增長,血尿酸水平呈上升趨勢,但不同年齡組間差異無統(tǒng)計學意義(p0.05)。而不同性別、體型兒童的血尿酸水平差異有統(tǒng)計學意義(p0.05),男孩血尿酸水平高于女孩,肥胖兒童血尿酸水平高于正常體型兒童。血清總膽固醇、甘油三酯、血尿酸與超重或肥胖的發(fā)生有關(guān)聯(lián)(p0.05),血糖與超重或肥胖的發(fā)生無相關(guān)性(p0.05)。結(jié)論從2006年到2014年,天津市3~6歲兒童的超重患病率總體呈緩慢下降趨勢,肥胖患病率呈上升趨勢,以6歲兒童最為明顯。超重及肥胖的患病率有性別差異,男童高于女童,不同性別間變化趨勢較為一致。兒童超重和肥胖的發(fā)生受時間和性別雙重因素交互作用的影響。性別男、人工喂養(yǎng)、看屏幕(包括電視、手機、電腦)時間較長、吃飯時間較快是5~6歲兒童肥胖的危險因素;出生后4個月內(nèi)混合喂養(yǎng)是兒童肥胖的保護性因素。肥胖兒童的血脂、血糖、血尿酸水平高于正常體型兒童,且隨年齡增長水平呈增高趨勢。兒童的超重和肥胖受外界因素影響,應(yīng)重視3~6歲兒童超重肥胖的預防及健康教育,以降低該年齡段兒童超重肥胖患病率;兒童家長及各醫(yī)療保健部門應(yīng)適時監(jiān)測兒童體格發(fā)育狀況,及時發(fā)現(xiàn)超重肥胖狀況,針對兒童這一特殊群體予以有效干預。
[Abstract]:Objective To study the prevalence of overweight and obesity in children from 3 to 6 years of age in Tianjin from 2006 to 2014, and to explore the factors affecting the incidence of overweight and obesity in Tianjin from the aspects of personal, family and lifestyle, and to further study the relationship between the obesity of children and blood fat, blood sugar and blood uric acid. In ord to provide that basis for the development of the prevention and intervention measure of overweight and obesity in children between 3 and 6 years of age in Tianjin. Methods From 2006 to 2014,145078 children aged from 3 to 6 years of age were collected in the 46 municipal monitoring kindergartens in Tianjin, including the height and weight of the child, the body mass index (BMI) and the Z-scan, and the long-term trend of the growth and development of the children was analyzed. By means of cluster sampling in 2015, according to the uniform coding of the children's health care manual, a retrospective study of 1286 children's physical examination indexes in 2013 and 2014 was carried out. The chi-square test, logistic regression, repeated measures of variance analysis and t-test were used to analyze the height and weight of different children. The composition of BMI and overweight was the trend of age, and the difference in age and sex. The development and health status of 1286 children in the park were investigated and the physical examination was carried out in 1286 in 2015. An analysis of variance and logistic regression were used to study the factors affecting the incidence of overweight and obesity in Tianjin. The total cholesterol, triglyceride, blood sugar and blood uric acid in 3305 children were tested by cluster sampling in 2015, and the relationship of obesity with blood fat, blood sugar and blood uric acid was discussed by t-test, variance analysis and logistic regression analysis. Results 1. From 2006 to 2014, the Z-value of the children in Tianjin from 3 to 6 years of age increased significantly, from 0.34 to 0.54; the Z value of the age of the child remained stable; the value of the age-specific BMI Z decreased from 0.40 to 0.23. The rate of overweight of children fell from 23.4 per cent in 2006 to 20.7 per cent, and the rate of obesity increased from 7.0 per cent in 2006 to 7.9 per cent in 2010 and remained stable from 2010 to 2014. The rate of overweight and obesity of boys was much higher than that of girls. The rate of obesity in children between 3 and 6 years increased with age, from 4.9% in the age of 3 to 11.6% in the 6-year-old, increasing by 2.4 times. The vertical study from 2013 to 2015 showed that the weight, height and BMI of boys in the three years were higher than that of the girl (P0.05), and the height of the 6-year-old boys in 2014 and 2015. The body weight was higher than that of the 5-year-old (P0.05). The height, body weight and BMI of the 6-year-old children were higher than that of the 5-year-old children (P0.05). The change of the weight of the 6-year-old children was higher than that of the 5-year-old children (P0.05). The change of the body weight of the 6-year-old children was higher than that of the 5-year-old (P0.05). The change of BMI was higher (P0.05). The difference was not significant (P0.05). The difference of obesity and overweight in children with different age in three years was not statistically significant (p0.05). The difference of obesity and overweight in different sexes in 2013 was not statistically significant (p0.05); the obesity and overweight of boys in 2014 and 2015 were higher than that of girls (p0.05). Of the 1286 children who entered the cohort in 2013,1072 were normal, the incidence of obesity was 4.6% in 2015, the incidence of overweight was 7.2%, and the total incidence of overweight or obesity was 11.8%. Logistic regression analysis showed that the time of the boy, the artificial feeding, the viewing screen (including the TV, the mobile phone, the computer) was long, The risk factors of the obesity of children between 5 and 6 years of age in the kindergartens in Tianjin are the risk factors of the obesity of children between 5 and 6 years old in Tianjin (p0.05). The degree of parental culture, the average daily sleep time, whether to eat the staple food from the children's children's home and the occurrence of obesity in the children (p0.05). The difference of abnormal rate of serum total cholesterol in children with different sex was statistically significant (p0.05), and boys were lower than that of girls. The abnormal rate of blood lipid and serum total cholesterol in children with different ages was higher than that of other age groups (p0.05). There was no statistical difference between the abnormal rate of blood lipid and the abnormal rate of serum total cholesterol (p0.05). The abnormal rate of serum triglyceride in obese children was much higher than that of normal children (p0.05). The difference of serum total cholesterol and triglyceride in children with different sex was statistically significant (p0.05), and girls were higher than that of boys. The difference of serum total cholesterol in children with different age groups was statistically significant (p0.05). There was a significant difference in serum triglyceride levels in children with different body size (p0.05). There was no significant difference in the rate of blood glucose (p0.05) among the 3-6-year-old children with different sex, age and body size. The difference of blood glucose levels between 3 and 6 years of age in different sexes was statistically significant (p0.05), and the average blood sugar level of boys was higher than that of girls. The difference of blood glucose level in children with different age groups was statistically significant (p0.05), with the increase of age and the increase of the average blood glucose level. The difference of blood glucose level in children with different body size was statistically significant (p0.05), and the average blood sugar level of obese children was higher than that of normal children. The abnormal rate of uric acid in children with different age and sex was not statistically significant (p0.05), but there was a significant difference in the rate of blood uric acid in different types of children (p0.05), and the level of obese children was higher than that of normal children. In addition, with the increase of age, the level of serum uric acid was on the rise, but there was no significant difference between the age group and the age group (p0.05). The levels of serum uric acid in children with different sex and body type were statistically significant (p0.05). The level of serum uric acid in boys was higher than that of girls, and the level of blood uric acid in obese children was higher than that of normal children. Serum total cholesterol, triglyceride, and blood uric acid were associated with the occurrence of overweight or obesity (p0.05), and there was no correlation between blood glucose and overweight or obesity (p0.05). Conclusion From 2006 to 2014, the prevalence of overweight in Tianjin from 3 to 6 years of age is generally decreasing, and the prevalence of obesity is on the rise, with the most obvious in 6-year-old children. There was a gender difference in the prevalence of overweight and obesity. The incidence of overweight and obesity in children is influenced by the interaction of time and gender. Sex male, artificial feeding, viewing screen (including television, mobile phone, computer) is long, and the time for eating is the risk factor of the obesity of children between 5 and 6 years; the mixed feeding within 4 months after birth is a protective factor for children's obesity. The level of blood lipid, blood sugar and blood uric acid in obese children was higher than that of normal children, and the level of blood glucose increased with age. The overweight and obesity of children are affected by external factors, and the prevention and health education of overweight and obesity among children aged 3 to 6 should be paid attention to, so as to reduce the prevalence of overweight and obesity of children in the age group; and the parents and the health care departments of the children shall timely monitor the physical development of the children and find out the overweight and obesity situation in time. Effective intervention is given to the particular group of children.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：博士
【學位授予年份】：2016
【分類號】：R723.14

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