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目的探讨中国城市化水平对儿童青少年体质指数(BMI)和超重肥胖的影响。方法采用分层多阶段整群随机抽样方法,选择"中国健康与营养调查"中1997—2011年中国九省儿童青少年作为研究对象,利用城市化指数测量方法,将城市化水平分为低、中、高三类,采用多水平模型分析城市化水平对儿童青少年BMI和超重肥胖的影响。结果在多水平随机截距线性模型中,控制年龄、总能量摄入、膳食脂肪供能比、身体活动量和静坐时间、家庭收入、父母受教育水平和父母超重肥胖情况等变量后,高城市化水平社区男孩BMI均值相对低城市化水平社区男孩增加了0.61(95%CI 0.031.19,P<0.05),城市化水平对女孩BMI的影响无统计学意义(P=0.59);在多水平随机截距Logistic回归模型中,控制年龄、基线BMI、总能量摄入、膳食脂肪供能比、身体活动量和静坐时间、家庭收入、父母受教育水平和父母超重肥胖情况等变量后,不同城市化水平社区男、女发生超重肥胖的危险性差异均没有统计学意义(男:P=0.17,女:P=0.57)。结论高城市化水平社区男孩BMI高于低城市化水平社区男孩,城市化水平对女孩BMI没有影响,城市化水平与儿童青少年超重肥胖无显著相关性,说明社区本身城市化水平的高低可能不是影响超重肥胖的直接因素,其主要通过对儿童青少年生活方式和家庭因素的影响,间接影响儿童青少年超重和肥胖。
Abstract：Objective To explore the impacts of different urbanization levels on BMI and overweight/obesity among children and adolescents.Methods The samples were collected by the cluster random sampling method from the China Health and Nutrition Survey which included children and adolescents between 1997 and 2011.Multilevel mixed-effect regression analysis was used to investigate the impacts of differenturbanization levels, which were divided into low, middle and high based on an urbanization index,on overweight/obesity among children and adolescents.Results In the multilevel mixed-effect linear regression analysis,after controlled age,total energy intake,the percentage of energy from fat, physical activity, sedentary time, family income,educational levels and overweight/obesity of parents,the BMI values of boys who lived in the high urbanization level community were higher than those who lived in the low urbanization level community( 95% CI 0.03-1.19,P < 0.05).There was no association of urbanization with BMI values in the girls.In the multilevel mixed-effect Logistic regression analysis, after controlled age, BMI baseline, total energy intake, the percentage of energy from fat, physical activity, sedentary time, family income,educational levels and overweight/obesity of parents, there were no association of urbanization with the prevalence of overweight/obesity in both boys and girls( boys P =0.17,girls P = 0.57).Conclusion The BMI values of boys who lived in the high urbanization level community are higher than those who lived in the low urbanization level community.There is no association of urbanization with BMI values in the girls and with the prevalence of overweight/obesity in both boys and girls.It is probably because community urbanization do not directly but indirectly affect children 's overweight and obesity through changing life style and family factors of children and adolescents.
[1]POPKIN B M.The nutrition transition:an overview of world patterns of change[J].Nutr Rev,2004,62(7 Pt 2):S140-143.
[2]FRASER B.Latin America's urbanisation is boosting obesity[J].Lancet,2005,365(9476):1995-1996.
[3]VAN DE POEL,O'DONNELL,VAN DOORSLAER E.Urbanization and the spread of diseases of affluence in China[J].Econ Hum Biol,2009,7(2):200-216.
[4]POPKIN B M.The nutrition transition and its health implications in lower-income countries[J].Public Health Nutr,1998,1(1):5-21.
[5]SOBNGWI E,MBANYA J C,UNWIN N C,et al.Exposure over the life course to an urban environment and its relation with obesity,diabetes,and hypertension in rural and urban Cameroon[J].Int J Epidemiol,2004,33(4):769-776.
[6]FOTSO J C.Child health inequities in developing countries:differences across urban and rural areas[J].Int J Equity Health,2006(5):9.
[7]JONESE-SMITH J C,POPKIN B M.Understanding community context and adult health changes in China:development of an urbanicity scale[J].Soc Sci Med,2010,71(8):1436-1446.
[8]“中国健康与营养调查”项目组.1989—2009年中国九省区居民膳食营养素摄入状况及变化趋势:(一)健康与营养调查项目总体方案[J].营养学报,2011,35(3):234-236.
[9]中国肥胖问题工作组,季成叶.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):10-15.
[10]王志宏,张兵,王惠君,等.中国成年人红肉摄入量对体重指数、体重及超重危险性影响的多水平纵向研究[J].中华流行病学杂志,2013,34(7):661-667.
[11]SKRONDAL A,RABE-HESKETH S.Multilevel and longitudinal modeling using stata[M].2nd ed.College Statim:Stata Press,2005.
[12]王济川,谢海义,姜法宝.多层统计分析模型:方法与应用[M].北京:高等教育出版社,2008.
[13]JOHNSON J A,JOHNSON A M.Urban-rural differences in childhood and adolescent obesity in the United States:a systematic review and meta-analysis[J].Child Obes,2015,11(3):233-241.
[14]ITOI A,YAMADA Y,WATABAVKE Y,et al.Physical activity,energy intake,and obesity prevalence among urban and rural schoolchildren aged 11-12 years in Japan[J].Appl Physiol Nutr Metab,2012,37(6):1189-1199.
[15]ISMAILOV R M,LEATHERDALE S T.Rural-urban differences in overweight and obesity among a large sample of adolescents in Ontario[J].Int J Pediatr Obes,2010,5(4):351-360.
[16]EBRAHIM S,KINRA S,BOWEN L,et al.The effect of rural-to-urban migration on obesity and diabetes in India:a cross-sectional study[J].PLo S Med,2010,7(4):e1000268.
[17]DO L M,TRAN T K,ERIKSSON B,et al.Preschool overweight and obesity in urban and rural Vietnam:differences in prevalence and associated factors[J].Glob Health Action,2015,8:28615.
[18]ZHANG Y X,ZHAO J S,CHU Z H.Prevalence of overweight and obesity among children and adolescents is associated with urbanization in Shandong,China[J].Int J Cardiol,2014,176(3):1212-213.
[19]CHEN T J,MODIN B,JI C Y,et al.Regional,socioeconomic and urban-rural disparities in child and adolescent obesity in China:a multilevel analysis[J].Acta Paediatr,2011,100(12):1583-1589.
[20]MAYNARD L M,GALUSKA D A,BLANCK H M,et al.Maternal perceptions of weight status of children[J].Pediatrics,2003,111(5 Pt 2):1226-1231.
基本信息:
DOI：10.19813/j.cnki.weishengyanjiu.2016.06.004
中图分类号:R723.14
引用信息:
[1]王晓蕾,王惠君,苏畅.中国九省城市化水平对儿童青少年超重肥胖影响的多水平研究[J].卫生研究,2016,45(06):888-896.DOI:10.19813/j.cnki.weishengyanjiu.2016.06.004.
基金信息:
中国疾病预防控制中心和美国北卡罗莱纳大学人口中心合作项目“中国健康与营养调查”(No.R01-HD30880,DK056350,R01-HD38700); 中国疾病预防控制中心和美国约翰霍普金斯大学合作项目“儿童肥胖的多水平系统研究”(No.U54)
2016-09-27
2016
2016-09-28
2016
1
2016-11-30
2016-11-30