杭州市中小学生中心性肥胖影响因素多水平模型分析
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摘要
目的了解杭州市中小学生中心性肥胖流行特征及其影响因素,为制定中小学生中心性肥胖及相关代谢性疾病的防控策略提供理论依据。方法采用分层随机整群抽样方法,抽取杭州市4个城区和5个郊县的23所学校711个班级在校学生27 967名进行体格测量,以同种族、同年龄、同性别腰围P_(90)作为诊断中心性肥胖的界值点。不同组间中心性肥胖检出率比较采用χ~2检验,影响因素分析采用多水平统计模型。结果杭州市中小学生中心性肥胖检出率为17.69%,城区学生(20.98%)高于郊县学生(15.61%),男生(20.40%)高于女生(14.92%),小学生(20.83%)高于初中生(19.89%)和高中生(15.30%),差异均有统计学意义(χ~2值分别为131.80,131.80,144.20,123.64,P值均<0.01)。学校和班级的随机效应均有统计学意义(P值均<0.01)。结论杭州市中小学生中心性肥胖检出率较高。除个体因素的影响外,学校和班级的宏观管理方面也有待进一步改进。
Objective To explore the epidemiological characteristics and influencing factors of abdominal obesity among primary and middle school students in Hangzhou, and to provide evidence for abdominal obesity prevention. Methods A total of 27 967 students from 711 classes 23 primary and middle schools in 4 districts and 5 counties in Hangzhou were investigated. The 90 th percentile(P_(90)) of waist circumference of the same ethnicity, age and gender was used as the diagnostic value for abdominal obesity. Chi-square test was used to identify the deference among groups. Multilevel analysis was applied on the influencing factors of abdominal obesity. Results The rate of abdominal obesity among primary and middle school students in Hangzhou was 17.69%, with urban(20.98%) higher than rural(15.61%), boys'(20.40%) higher than girls'(14.92%), highest in primary school students(20.83%) and lowest in high school students(15.30%). The effects of school and class on abdominal obesity among primary and middle school students were significant(P<0.01). Conclusion The rate of abdominal obesity among primary and middle school students in Hangzhou was higher than national average level. In addition to the individual factors, management on healthy food and nutrition should be a high priority on every class and every school.
Objective To explore the epidemiological characteristics and influencing factors of abdominal obesity among primary and middle school students in Hangzhou, and to provide evidence for abdominal obesity prevention. Methods A total of 27 967 students from 711 classes 23 primary and middle schools in 4 districts and 5 counties in Hangzhou were investigated. The 90 th percentile(P_(90)) of waist circumference of the same ethnicity, age and gender was used as the diagnostic value for abdominal obesity. Chi-square test was used to identify the deference among groups. Multilevel analysis was applied on the influencing factors of abdominal obesity. Results The rate of abdominal obesity among primary and middle school students in Hangzhou was 17.69%, with urban(20.98%) higher than rural(15.61%), boys'(20.40%) higher than girls'(14.92%), highest in primary school students(20.83%) and lowest in high school students(15.30%). The effects of school and class on abdominal obesity among primary and middle school students were significant(P<0.01). Conclusion The rate of abdominal obesity among primary and middle school students in Hangzhou was higher than national average level. In addition to the individual factors, management on healthy food and nutrition should be a high priority on every class and every school.
引文
[1] 降凌燕,焦振山.中心性肥胖诊断标准及其在代谢综合征诊断中的应用研究进展[J].中国慢性病预防与控制,2011,19(3):314-317.
[2] 李明健,罗贵军.BMI和中心型肥胖指标与糖尿病、高血压患病风险的相关性研究[J].中西医结合心脑血管病杂志,2017,15(21):2793-2795.
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[7] 杨虹.成年人中心性肥胖流行特征研究现状[J].应用预防医学,2010,16(2):125-128.
[8] 李欣,武静,左斯尧,等.中心性肥胖的流行特征研究现状[J].中国老年学杂志,2012,32(18):4105-4108.
[9] 张书平,吴金珊,张素华,等.2003—2013年重庆主城某社区居民超重和肥胖的流行趋势[J].重庆医学,2017,46(29):4018-4111.
[10] 马冠生,季成叶,马军,等.中国7～18岁学龄儿童青少年腰围界值点研究[J].中华流行病学杂志,2010,31(6):609-615.
[11] 刘慧彬,董彦会,王政和,等.中国六省市儿童青少年进食速度与代谢综合征的关联性[J].中国学校卫生,2017,38(4):484-488.
[12] 卫生部,中国国家标准化管理委员会.学生健康检查技术规范GB/T 26343—290[S].北京:中国标准出版社,2011.
[13] 季成叶,马军,何忠虎,等.中国汉族学龄儿童青少年腰围正常值[J].中国学校卫生,2010,31(3):257-259.
[14] 尹小俭,季成叶,季浏,等.中国儿童青少年腰围和BMI的相关性研究[J].成都体育学院学报,2013,39(12):64-70.
[15] 杨珉,李晓松.医学和公共卫生研究常用多水平统计模型[M].北京:北京大学医学出版社,2007:6-25.
[16] FORD E S,LI C.Defining the metabolic syndrome in children and adolescents:will the real definition please stand up?[J].J Pediatr,2008,152(2):160-164.
[17] 房红芸,刘丹,赵丽云,等.中国6～17岁儿童青少年腰围水平及中心性肥胖流行特征[J].中华流行病学杂志,2018,39(6):715-719.
[18] 季成叶.沿海大城市与北方乡村学生超重/肥胖检出率比较分析[J].中华疾病控制杂志,2010,14(7):583-589.
[2] 李明健,罗贵军.BMI和中心型肥胖指标与糖尿病、高血压患病风险的相关性研究[J].中西医结合心脑血管病杂志,2017,15(21):2793-2795.
[3] FOLSOM A R,STEVENS J,SCHREINER P J,et al.Body mass index,waist/hip ratio,and coronary heart disease incidence in African Americans and whites[J].Am J Epidemiol,1998,148(12):1187-1194.
[4] 田园,杨淞淳,余灿清,等.中国成年人中心性肥胖与缺血性心脏病发病风险的前瞻性研究[J].中华流行病学杂志,2018,39(9):1172-1178.
[5] GONCALVES F B,KOEK M,VERHAGEN H J M,et al.Body-mass index,abdominal adiposity,and cardiovascular risk[J].Lancet,2011,378(9787):227.
[6] 徐春燕,郭水根,沈瑶.中心性肥胖对肺功能的影响[J].临床肺科杂志,2018,23(2):281-283.
[7] 杨虹.成年人中心性肥胖流行特征研究现状[J].应用预防医学,2010,16(2):125-128.
[8] 李欣,武静,左斯尧,等.中心性肥胖的流行特征研究现状[J].中国老年学杂志,2012,32(18):4105-4108.
[9] 张书平,吴金珊,张素华,等.2003—2013年重庆主城某社区居民超重和肥胖的流行趋势[J].重庆医学,2017,46(29):4018-4111.
[10] 马冠生,季成叶,马军,等.中国7～18岁学龄儿童青少年腰围界值点研究[J].中华流行病学杂志,2010,31(6):609-615.
[11] 刘慧彬,董彦会,王政和,等.中国六省市儿童青少年进食速度与代谢综合征的关联性[J].中国学校卫生,2017,38(4):484-488.
[12] 卫生部,中国国家标准化管理委员会.学生健康检查技术规范GB/T 26343—290[S].北京:中国标准出版社,2011.
[13] 季成叶,马军,何忠虎,等.中国汉族学龄儿童青少年腰围正常值[J].中国学校卫生,2010,31(3):257-259.
[14] 尹小俭,季成叶,季浏,等.中国儿童青少年腰围和BMI的相关性研究[J].成都体育学院学报,2013,39(12):64-70.
[15] 杨珉,李晓松.医学和公共卫生研究常用多水平统计模型[M].北京:北京大学医学出版社,2007:6-25.
[16] FORD E S,LI C.Defining the metabolic syndrome in children and adolescents:will the real definition please stand up?[J].J Pediatr,2008,152(2):160-164.
[17] 房红芸,刘丹,赵丽云,等.中国6～17岁儿童青少年腰围水平及中心性肥胖流行特征[J].中华流行病学杂志,2018,39(6):715-719.
[18] 季成叶.沿海大城市与北方乡村学生超重/肥胖检出率比较分析[J].中华疾病控制杂志,2010,14(7):583-589.