郴州市城区12-14岁学生超重、肥胖和低体重的流行病学研究
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摘要
研究背景
作为经济快速发展的发展中国家和人口大国,我国面临儿童青少年超重、肥胖率的急剧上升趋势和低体重率高居不下的双重压力。如何全面分析儿童和青少年心身成长中存在的问题及其影响因素,采取有针对性的措施引导其健康成长,是亟待解决的重要的公共卫生和社会问题。本领域的既往研究很少全面评估儿童和青少年低体重、超重、肥胖的流行状况,在相关危险因素研究方面有待进一步深入,且较少关注低体重、超重和肥胖对儿童、青少年心理健康的影响,特别是对其自尊心理发展的影响。
目的
通过对郴州城区12-14岁学生的研究以达到三个目的:
1.了解学生低体重、超重、肥胖的现况以及不同体重学生血压的分布情况;
2.从生物学因素、行为和生活方式、社会环境、医疗卫生服务及利用等维度分别研究学生低体重、超重、肥胖的危险因素和保护因素;
3.研究低体重、超重和肥胖对学生心理健康特别是对学生自尊心理发展的影响,为后续的研究提供基线资料。
方法
采用横断面研究设计,应用随机整群抽样方法,于2007年4月抽取郴州市城区3所中学12-14岁学生2042名,对他们进行问卷调查和身体测量。问卷调查内容包括根据生物学因素、行为生活方式、社会环境、医疗卫生服务及利用等维度设计的条目和心理学测量工具(包括自尊量表、焦虑量表和抑郁量表)。身体测量包括身高、体重、腰围(WC)、臀围(HC)和血压的测量,然后计算体质指数(BMI)、腰臀比(WHR)、腰围身高比(WHTR);采用中国肥胖问题工作组超重和肥胖筛查标准筛查出超重和肥胖学生,采用修订的身高标准体重法筛查出低体重学生。将研究对象分为4组:低体重、正常体重、超重、肥胖组。采用率、构成比和直条图描述低体重、正常体重、超重、肥胖的分布情况以及腰围、臀围、腰臀比和腰围身高比的分布情况。然后,以正常体重学生为对照组,分别以低体重、超重、肥胖学生为病例组,采用单因素和多因素非条件logistic回归模型筛选出影响学生低体重、超重、肥胖的危险因素和保护因素;最后,探讨低体重、超重和肥胖对学生自尊、焦虑和抑郁的影响,并采用结构方程专用分析软件Amos(Analysis of Moment Structures)7.0作结构方程模型分析(structural equation modeling,SEM),分析超重和肥胖与学生自尊、焦虑、抑郁的关系。
结果
1.通过随机整群抽样,本研究共获得郴州市城区2042名12-14岁的学生样本,其中男生1088名(53.3%),女生954名(46.7%);
2.2007年郴州市城区12-14岁学生低体重、超重、肥胖率分别为17.5%、10.6%和5.9%,其中男生低体重、超重、肥胖率分别为14.8%、13.1%和7.4%,女生低体重、超重和肥胖率分别为20.0%、7.8%和4.2%;12岁组学生低体重、超重、肥胖率分别为8.7%、11.2%和7.1%,13岁组学生低体重、超重、肥胖率分别为19.9%、10.3%和5.6%,14岁组学生低体重、超重、肥胖率分别为28.4%、10.9%和4.7%;
3.男生低体重率低于女生(χ~2=11.638,P=0.000),超重率(χ~2=15.528,P=0.000)、肥胖率(χ~2=9.643,P=0.002)均高于女生;
4.学生低体重率随着年龄的增长而增高(χ~2=60.251,P=0.000),超重率(χ~2=0.387,P=0.824)、肥胖率(χ~2=2.167,P=0.339)在不同年龄组学生中的分布差异无统计学意义;
5.12-14岁年龄组学生高血压患病率为4.7%(95/2038),其中男生高血压患病率为5.0%(54/1088),女生高血压患病率为4.3%(41/950);男女生高血压患病率差异无统计学意义(χ~2=0.478,P=0.489);高血压患病率随着体重增加而增高(χ~2=59.020,P=0.000);
6.多因素非条件logistic回归分析结果显示,影响学生低体重的因素有:女生(OR=2.909,95%CI:2.048-4.133)、年龄大(OR=2.953,95%CI:2.258-3.860)、吃饭速度慢(OR=1.576,95%CI:1.207-2.059)是学生低体重的危险因素;而母亲受教育程度高(OR=0.798,95%CI:0.693-0.917)、每天睡眠时间长(OR=0.798,95%CI:0.644-0.990)、无偏食挑食习惯(OR=0.698,95%CI:0.506-0.963)为学生低体重的保护因素;
7.多因素非条件logistic回归分析结果显示,影响学生超重的因素有:父亲年龄偏大(OR=2.040,95%CI:1.365-3.048)、经常吃豆制品(OR=1.296,95%CI:1.045-1.607)、不喜欢吃零食(OR=1.508,95%CI:1.140-1.994)、无偏食挑食习惯(OR=1.548,95%CI:1.098-2.183)是学生超重的危险因素;而女生(OR=0.613,95%CI:0.434-0.866)、非独生子女(OR=0.553,95%CI:0.354-0.863)、父亲体型偏瘦(OR=0.565,95%CI:0.429-0.744)为学生超重的保护因素;
8.多因素非条件logistic回归分析结果显示,影响学生肥胖的因素有:母亲受教育程度高(OR=2.244,95%CI:1.466-3.436)、无偏食挑食习惯(OR=2.298,95%CI:1.413-3.735)、每餐食量大(OR=1.611,95%CI:1.167-2.224)、不关心自己健康(OR=1.759,95%CI:1.294-2.391)是学生肥胖的危险因素,而女生(OR=0.594,95%CI:0.363-0.971)、非独生子女(OR=0.229,95%CI:0.103-0.509)为学生肥胖的保护因素;
9.学生自尊得分为(25.56±2.90)分、焦虑得分为(44.13±9.07)分、抑郁得分为(50.79±8.95)分;其中男、女生自尊得分分别为(25.61±3.11)分和(25.12±2.54)分,焦虑得分分别为(43.73±8.60)分和(44.69±9.26)分,抑郁得分分别为(50.47±8.74)分和(51.25±8.91)分;
10.经性别分层,仅见低体重女生抑郁得分高于正常体重女生(t=-2.203,P=0.028),其余差异无统计学意义(P＞0.05);低体重学生中有较高比例的焦虑(χ~2=5.496,P=0.019)和抑郁情绪(χ~2=19.036,P=0.000):
11.正常体重男生自尊得分高于同性别的超重和肥胖学生(F=16.343,P=0.000);正常体重女生自尊得分高于同性别的超重和肥胖学生(F=29.056,P=0.000);正常体重女生焦虑得分低于肥胖女生(F=7.606,P=0.000);正常体重女生抑郁得分低于超重和肥胖女生(F=9.612,P=0.000);而正常体重、超重和肥胖男生焦虑得分、抑郁得分的比较差异无统计学意义(P＞0.05);超重和肥胖的学生中有较高比例的焦虑(χ~2=9.388,P=0.009)或抑郁情绪(χ~2=21.486,P=0.000):
12.结构方程模型(SEM)分析结果显示,超重和肥胖(BMI)对自尊有直接(负向)效应(β=-0.212,P＜0.05),对负性情绪无直接效应(β=0.00);自尊对负性情绪有直接(负向)效应(β=-0.216,P＜0.05);超重和肥胖可通过自尊途径间接影响负性情绪(β=0.046)。
结论
1.2007年郴州市城区12-14岁学生低体重、超重、肥胖率分别为17.5%、10.6%和5.9%,其中男生低体重、超重、肥胖率分别为14.8%、13.1%和7.4%,女生低体重、超重、肥胖率分别为20.0%、7.8%和4.2%;
2.男生超重率、肥胖率高于女生,低体重率低于女生;
3.年龄越大,低体重率越高;不同年龄学生超重率、肥胖率差异无统计学意义;
4.2007年郴州市城区12-14岁学生高血压患病率为4.7%,其中男生高血压患病率为5.0%,女生高血压患病率为4.3%;随着体重的增加,高血压患病率增高;
5.生物学因素、行为生活方式和家庭环境可能对学生低体重、超重、肥胖有影响;
6.与正常体重学生相比,低体重、超重、肥胖可能对学生心理健康有不同程度的影响;
7.自尊作为中介变量(mediated variable)调节超重和肥胖与负性情绪的关系。
本研究的特色和创新
1.扩大了影响因素的研究范围:从生物学因素、行为生活方式、社会环境、医疗卫生服务及利用分别探讨学生超重、肥胖、低体重的危险因素和保护因素;
2.选择了合适的对照:选择正常体重学生为对照并分别探讨超重、肥胖、低体重的危险因素和保护因素,保证了结果的真实性;
3.研究超重的影响因素:将超重学生从学生群体中分离出来,并探讨超重的危险因素和保护因素;
4.采用结构方程模型:探讨超重和肥胖与学生自尊、焦虑、抑郁的关系,揭示了自变量对应变量的直接和间接影响。
Background
As a developing country with fast development in economy and large number of population,China faces double burdens of rapidly increasing in overweight and obese children and adolescent and slowly decreasing in underweight children and adolescent.How to analysis the existing problems in development of spirit and body for children and adolescent and its influencing factors and take efficient measures to guide them growing up healthily is important public and social problems for us to solve urgently.The past studies in this field seldom overall access epidemic status of underweight,overweight,and obesity for children and adolescent and related factors need to be studied deeply.The past studies also seldom focus on effects of underweight,overweight,and obesity on mental health especially in self esteem among children and adolescent.
Objective
We chosen the students aged 12-14 years in urban Chenzhou,Hunan Province as study sample to arrive three goals:
1.To assess the prevalence of underweight,overweight,and obesity among students aged 12-14 years in Urban Chenzhou,Hunan Province. To study the distributions of blood pressure(BP) among different groups.
2.To separately assess the risk factors and protective factors of underweight,overweight,and obesity among students aged 12-14 years from four domains which include biological factors,behavior and lifestyle,social environment and medical care demand and utilization.
3.To evaluate effects of underweight,overweight,and obesity on mental health especially self esteem among students.
All what we do above are to provide bases for future researches.
Methods
With cross-sectional design and through cluster sampling randomly, A total of 2042 students(1088 for boys,954 for girls) aged 12-14 years from 3 middle schools in Urban Chenzhou were investigated by questionnaire and physically measured by height,weight,waist circumference(WC),and hip circumference(HC) in April,2007.The questionnaire was designed to include the items related to four domains which included biological factors,behavior and lifestyle,social environment,medical care demand and utilization,and psychological test tools included self esteem scale(SES),self rating anxiety scale(SAS), and self rating depression scale(SDS).Body mass index(BMI) was calculated by weight in kilograms divided squared height in meters, waist-hip circumference ratio(WHR) by WC divided HC,and waist-height ratio(WHTR) by WC divided height.Overweight and obesity were categorized with body mass index(BMI) cutoffs from Working Group of Obesity in China(WGOC) and underweight was categorized by the revised Chinese standards of weight-for-height.We used prevalence,constituent ratio or bar chart to describe the distributions of underweight,normal weight,overweight,and obese students.We separately acted underweight,overweight,and obese students as case and those normal weight students as control.Mono-factor logistic regression and multiple logistic regression were used to screen the significantly variables.At last,structural equation modeling(SEM) was used by AMOS(Analysis of Moment Structures ) 7.0 software to analysis relationships between overweight and obesity,anxiety,depression,and self esteem of students.
Results
1.Through cluster sampling randomly,2042 students aged 12-14 years(1088 for boys and 954 for girls) were investigated.
2.The prevalence of underweight,overweight,and obesity among students aged 12-14 years in urban Chenzhou in 2007 were 17.5%,10.6% and 5.9%,respectively.The prevalence of underweight,overweight,and obesity for boys were 14.8%,13.1%and 7.4%,respectively.The prevalence of underweight,overweight,and obesity for girls were 20.0%, 7.8%and 4.2%,respectively.The prevalence of underweight,overweight, and obese students at age of 12 were 8.7%,11.2%and 7.1%,respectively. The prevalence of underweight,overweight,and obese students at age of 13 were 19.9%,10.3%and 5.6%,respectively.The prevalence of underweight,overweight,and obese students at age of 14 were 28.4%, 10.9%and 4.7%,respectively.
3.The prevalence of underweight was lower in boys than girls (X~2=11.638,P=0.000) the prevalence of overweight was higher in boys than girls(X~2=15.528,P=0.000) and.the prevalence of obesity was higher in boys than girls(X~2=9.643,P=0.002).
4.The prevalence of underweight among students increased with age (X~2=60.251,P=0.000).There were no significantly differences among overweight students at different age(X~2=0.387,P=0.824).There were no significantly differences among obese students in different age (X~2=2.167,P=0.339)
5.The prevalence of students with hypertension was 4.7%(5.0%for boys and 4.3%for girls).There was no significantly differences between boys and girls(X~2=0.478,P=0.489).The prevalence of students with hypertension increased with weight(X~2=59.020,P=0.000).
6.Multiple logistic regression showed that female students (OR=2.909,95%CI:2.048-4.133 ),elder students(OR=2.953,95%CI: 2.258-3.860,and slowly eating(OR=1.576,95%CI:1.207-2.059) were risk factors for underweight students.Multiple logistic regression also showed that mother with higher education level(OR=0.798,95%CI: 0.693-0.917 ),longer sleeping time daily(OR=0.798,95%CI: 0.644-0.990),and no food preference or choosy in food(OR=0.698, 95%CI:0.506-0.963) were protective factors for underweight students.
7.Multiple logistic regression showed that elder father(OR=2.040, 95%CI:1.365-3.048),eating food made of bean frequently(0R=1.296, 95%CI:1.045-1.607),no fond of eating snack(OR=1.508,95%CI: 1.140-1.994),and no food preference or choosy in food(OR=1.548, 95%CI:1.098-2.183 ) were risk factors for overweight students.Multiple logistic regression also showed that female students(OR=0.613,95%CI: 0.434-0.866 ),not from one child family(OR=0.553,95%CI: 0.354-0.863),and thinner father(OR=0.565,.95%CI:0.429-0.744) were protective factors for overweight students.
8.Multiple logistic regression showed that mother with higher educational level(OR=2.244,95%CI:1.466-3.436),no food preference or choosy in food(OR=2.298,95%CI:1.413-3.735),eating more food every meal(OR=1.611,95%CI:1.167-2.224),and not caring self health (OR=1.759,95%CI:1.294-2.391 ) were risk factors for obese students. Multiple logistic regression also showed that female students(OR=0.594, 95%CI:0.363-0.971 ) and not from one.child family(OR=0.229,95%CI: 0.103-0.509) were protective factors for obese students.
9.The mean scores of SES,SAS,and SDS were(25.56±2.90), (44.13±9.07) and(50.79±8.95),respectively.The mean scores of SES for both boys and girls were(25.61±3.11 ) and(25.12±2.54),respectively. The mean scores of SAS for both boys and girls were(43.73±8.60) and (44.69±9.26),respectively.The mean scores of SDS for both boys and girls were(50.47±8.74) and(51.25±8.91 ),respectively.
10.For girls,the mean score of SDS was higher in underweight students than those normal weight students(t=-2.203,P=0.028 ).There no other significantly differences of SES,SAS,and SDS between underweight and normal weight students in same sex(P＞0.05).But the underweight students had more anxiety emotion than those normal weight students(X~2=5.496,P=0.019) and more depression emotion than those normal weight students(X~2=19.036,P=0.000).
11.The mean scores of SES of male students with normal weight were higher than those overweight and obese students with same sex (F=16.343,P=0.000).The mean scores of SES of female students with normal weight were higher than those overweight and obese students with same sex(F=29.056,P =0.000).The mean scores of SAS of female students with normal weight were lower than those obese female students (F=7.606,P=0.000).The mean scores of SDS of female students with normal weight were lower than those overweight and obese female students(F=9.612,P=0.000).There no other significantly differences of SAS and SDS for boys between normal weight,overweight,and obese students(P＞0.05) But the overweight and obese students had more anxiety emotion than those normal weight students(X~2=9.388,P=0.009) and more depression emotion than those normal weight students (X~2=21.486,P=0.000)
12.SEM showed that overweight and obesity had direct negative effect on students' self esteem(β=-0.212,P＜0.01) and no direct positive effect on students' negative emotion(β=0.000) Self esteem had direct negative effect on students' negative emotion(β=-0.216,P＜0.01) Overweight and obesity had indirect effect on students' negative emotion through self esteem pathway.
Conclusions
1.The prevalence of underweight,overweight,and obesity among students aged 12-14 years in urban Chenzhou in 2007 are 17.5%,10.6%, and 5.9%,respectively.The prevalence of underweight,overweight,and obesity for boys are 14.8%,13.1%,and 7.4%,respectively.The prevalence of underweight,overweight,and obesity for girls were 20.0%, 7.8%,and 4.2%,respectively.
2.The prevalence of overweight and obesity is higher in boys than girls and the prevalence of underweight is lower in boys than girls.
3.The prevalence of underweight increased with age.There were no significantly differences among overweight or obese students at different age.
4.The prevalence of students with hypertension was 4.7%(5.0%for boys and 4.3%for girls).The prevalence of students with hypertension increased with weight.
5.Biological factors,behavior and lifestyle,and social environmental factors especially family factors may have important influences on underweight,overweight,and obese students.
6.Underweight,overweight,and obesity may have different effects on students',psychological status.
7.Self esteem as a mediated variable may mediate the relationships between overweight and obesity and negative omotion.
Innovation
1.Having extended the domains of the study and research:We are from four domains which include biological factors,behavior and lifestyle,social environment,and medical care demand and utilization to assess the risk factors and protective factors of underweight,overweight, and obese students.
2.Having chosen the control correctly:We have chosen the normal weight students as control to separately assess the risk factors and protective factors of underweight,overweight,and obese students.
3.Having studied the risk factors and protective factors of overweight.
4.Having adopted SEM:We have adopted the SEM to explore the direct and indirect effects of overweight and obesity on self esteem, anxiety,and depression among students.
作为经济快速发展的发展中国家和人口大国,我国面临儿童青少年超重、肥胖率的急剧上升趋势和低体重率高居不下的双重压力。如何全面分析儿童和青少年心身成长中存在的问题及其影响因素,采取有针对性的措施引导其健康成长,是亟待解决的重要的公共卫生和社会问题。本领域的既往研究很少全面评估儿童和青少年低体重、超重、肥胖的流行状况,在相关危险因素研究方面有待进一步深入,且较少关注低体重、超重和肥胖对儿童、青少年心理健康的影响,特别是对其自尊心理发展的影响。
目的
通过对郴州城区12-14岁学生的研究以达到三个目的:
1.了解学生低体重、超重、肥胖的现况以及不同体重学生血压的分布情况;
2.从生物学因素、行为和生活方式、社会环境、医疗卫生服务及利用等维度分别研究学生低体重、超重、肥胖的危险因素和保护因素;
3.研究低体重、超重和肥胖对学生心理健康特别是对学生自尊心理发展的影响,为后续的研究提供基线资料。
方法
采用横断面研究设计,应用随机整群抽样方法,于2007年4月抽取郴州市城区3所中学12-14岁学生2042名,对他们进行问卷调查和身体测量。问卷调查内容包括根据生物学因素、行为生活方式、社会环境、医疗卫生服务及利用等维度设计的条目和心理学测量工具(包括自尊量表、焦虑量表和抑郁量表)。身体测量包括身高、体重、腰围(WC)、臀围(HC)和血压的测量,然后计算体质指数(BMI)、腰臀比(WHR)、腰围身高比(WHTR);采用中国肥胖问题工作组超重和肥胖筛查标准筛查出超重和肥胖学生,采用修订的身高标准体重法筛查出低体重学生。将研究对象分为4组:低体重、正常体重、超重、肥胖组。采用率、构成比和直条图描述低体重、正常体重、超重、肥胖的分布情况以及腰围、臀围、腰臀比和腰围身高比的分布情况。然后,以正常体重学生为对照组,分别以低体重、超重、肥胖学生为病例组,采用单因素和多因素非条件logistic回归模型筛选出影响学生低体重、超重、肥胖的危险因素和保护因素;最后,探讨低体重、超重和肥胖对学生自尊、焦虑和抑郁的影响,并采用结构方程专用分析软件Amos(Analysis of Moment Structures)7.0作结构方程模型分析(structural equation modeling,SEM),分析超重和肥胖与学生自尊、焦虑、抑郁的关系。
结果
1.通过随机整群抽样,本研究共获得郴州市城区2042名12-14岁的学生样本,其中男生1088名(53.3%),女生954名(46.7%);
2.2007年郴州市城区12-14岁学生低体重、超重、肥胖率分别为17.5%、10.6%和5.9%,其中男生低体重、超重、肥胖率分别为14.8%、13.1%和7.4%,女生低体重、超重和肥胖率分别为20.0%、7.8%和4.2%;12岁组学生低体重、超重、肥胖率分别为8.7%、11.2%和7.1%,13岁组学生低体重、超重、肥胖率分别为19.9%、10.3%和5.6%,14岁组学生低体重、超重、肥胖率分别为28.4%、10.9%和4.7%;
3.男生低体重率低于女生(χ~2=11.638,P=0.000),超重率(χ~2=15.528,P=0.000)、肥胖率(χ~2=9.643,P=0.002)均高于女生;
4.学生低体重率随着年龄的增长而增高(χ~2=60.251,P=0.000),超重率(χ~2=0.387,P=0.824)、肥胖率(χ~2=2.167,P=0.339)在不同年龄组学生中的分布差异无统计学意义;
5.12-14岁年龄组学生高血压患病率为4.7%(95/2038),其中男生高血压患病率为5.0%(54/1088),女生高血压患病率为4.3%(41/950);男女生高血压患病率差异无统计学意义(χ~2=0.478,P=0.489);高血压患病率随着体重增加而增高(χ~2=59.020,P=0.000);
6.多因素非条件logistic回归分析结果显示,影响学生低体重的因素有:女生(OR=2.909,95%CI:2.048-4.133)、年龄大(OR=2.953,95%CI:2.258-3.860)、吃饭速度慢(OR=1.576,95%CI:1.207-2.059)是学生低体重的危险因素;而母亲受教育程度高(OR=0.798,95%CI:0.693-0.917)、每天睡眠时间长(OR=0.798,95%CI:0.644-0.990)、无偏食挑食习惯(OR=0.698,95%CI:0.506-0.963)为学生低体重的保护因素;
7.多因素非条件logistic回归分析结果显示,影响学生超重的因素有:父亲年龄偏大(OR=2.040,95%CI:1.365-3.048)、经常吃豆制品(OR=1.296,95%CI:1.045-1.607)、不喜欢吃零食(OR=1.508,95%CI:1.140-1.994)、无偏食挑食习惯(OR=1.548,95%CI:1.098-2.183)是学生超重的危险因素;而女生(OR=0.613,95%CI:0.434-0.866)、非独生子女(OR=0.553,95%CI:0.354-0.863)、父亲体型偏瘦(OR=0.565,95%CI:0.429-0.744)为学生超重的保护因素;
8.多因素非条件logistic回归分析结果显示,影响学生肥胖的因素有:母亲受教育程度高(OR=2.244,95%CI:1.466-3.436)、无偏食挑食习惯(OR=2.298,95%CI:1.413-3.735)、每餐食量大(OR=1.611,95%CI:1.167-2.224)、不关心自己健康(OR=1.759,95%CI:1.294-2.391)是学生肥胖的危险因素,而女生(OR=0.594,95%CI:0.363-0.971)、非独生子女(OR=0.229,95%CI:0.103-0.509)为学生肥胖的保护因素;
9.学生自尊得分为(25.56±2.90)分、焦虑得分为(44.13±9.07)分、抑郁得分为(50.79±8.95)分;其中男、女生自尊得分分别为(25.61±3.11)分和(25.12±2.54)分,焦虑得分分别为(43.73±8.60)分和(44.69±9.26)分,抑郁得分分别为(50.47±8.74)分和(51.25±8.91)分;
10.经性别分层,仅见低体重女生抑郁得分高于正常体重女生(t=-2.203,P=0.028),其余差异无统计学意义(P＞0.05);低体重学生中有较高比例的焦虑(χ~2=5.496,P=0.019)和抑郁情绪(χ~2=19.036,P=0.000):
11.正常体重男生自尊得分高于同性别的超重和肥胖学生(F=16.343,P=0.000);正常体重女生自尊得分高于同性别的超重和肥胖学生(F=29.056,P=0.000);正常体重女生焦虑得分低于肥胖女生(F=7.606,P=0.000);正常体重女生抑郁得分低于超重和肥胖女生(F=9.612,P=0.000);而正常体重、超重和肥胖男生焦虑得分、抑郁得分的比较差异无统计学意义(P＞0.05);超重和肥胖的学生中有较高比例的焦虑(χ~2=9.388,P=0.009)或抑郁情绪(χ~2=21.486,P=0.000):
12.结构方程模型(SEM)分析结果显示,超重和肥胖(BMI)对自尊有直接(负向)效应(β=-0.212,P＜0.05),对负性情绪无直接效应(β=0.00);自尊对负性情绪有直接(负向)效应(β=-0.216,P＜0.05);超重和肥胖可通过自尊途径间接影响负性情绪(β=0.046)。
结论
1.2007年郴州市城区12-14岁学生低体重、超重、肥胖率分别为17.5%、10.6%和5.9%,其中男生低体重、超重、肥胖率分别为14.8%、13.1%和7.4%,女生低体重、超重、肥胖率分别为20.0%、7.8%和4.2%;
2.男生超重率、肥胖率高于女生,低体重率低于女生;
3.年龄越大,低体重率越高;不同年龄学生超重率、肥胖率差异无统计学意义;
4.2007年郴州市城区12-14岁学生高血压患病率为4.7%,其中男生高血压患病率为5.0%,女生高血压患病率为4.3%;随着体重的增加,高血压患病率增高;
5.生物学因素、行为生活方式和家庭环境可能对学生低体重、超重、肥胖有影响;
6.与正常体重学生相比,低体重、超重、肥胖可能对学生心理健康有不同程度的影响;
7.自尊作为中介变量(mediated variable)调节超重和肥胖与负性情绪的关系。
本研究的特色和创新
1.扩大了影响因素的研究范围:从生物学因素、行为生活方式、社会环境、医疗卫生服务及利用分别探讨学生超重、肥胖、低体重的危险因素和保护因素;
2.选择了合适的对照:选择正常体重学生为对照并分别探讨超重、肥胖、低体重的危险因素和保护因素,保证了结果的真实性;
3.研究超重的影响因素:将超重学生从学生群体中分离出来,并探讨超重的危险因素和保护因素;
4.采用结构方程模型:探讨超重和肥胖与学生自尊、焦虑、抑郁的关系,揭示了自变量对应变量的直接和间接影响。
Background
As a developing country with fast development in economy and large number of population,China faces double burdens of rapidly increasing in overweight and obese children and adolescent and slowly decreasing in underweight children and adolescent.How to analysis the existing problems in development of spirit and body for children and adolescent and its influencing factors and take efficient measures to guide them growing up healthily is important public and social problems for us to solve urgently.The past studies in this field seldom overall access epidemic status of underweight,overweight,and obesity for children and adolescent and related factors need to be studied deeply.The past studies also seldom focus on effects of underweight,overweight,and obesity on mental health especially in self esteem among children and adolescent.
Objective
We chosen the students aged 12-14 years in urban Chenzhou,Hunan Province as study sample to arrive three goals:
1.To assess the prevalence of underweight,overweight,and obesity among students aged 12-14 years in Urban Chenzhou,Hunan Province. To study the distributions of blood pressure(BP) among different groups.
2.To separately assess the risk factors and protective factors of underweight,overweight,and obesity among students aged 12-14 years from four domains which include biological factors,behavior and lifestyle,social environment and medical care demand and utilization.
3.To evaluate effects of underweight,overweight,and obesity on mental health especially self esteem among students.
All what we do above are to provide bases for future researches.
Methods
With cross-sectional design and through cluster sampling randomly, A total of 2042 students(1088 for boys,954 for girls) aged 12-14 years from 3 middle schools in Urban Chenzhou were investigated by questionnaire and physically measured by height,weight,waist circumference(WC),and hip circumference(HC) in April,2007.The questionnaire was designed to include the items related to four domains which included biological factors,behavior and lifestyle,social environment,medical care demand and utilization,and psychological test tools included self esteem scale(SES),self rating anxiety scale(SAS), and self rating depression scale(SDS).Body mass index(BMI) was calculated by weight in kilograms divided squared height in meters, waist-hip circumference ratio(WHR) by WC divided HC,and waist-height ratio(WHTR) by WC divided height.Overweight and obesity were categorized with body mass index(BMI) cutoffs from Working Group of Obesity in China(WGOC) and underweight was categorized by the revised Chinese standards of weight-for-height.We used prevalence,constituent ratio or bar chart to describe the distributions of underweight,normal weight,overweight,and obese students.We separately acted underweight,overweight,and obese students as case and those normal weight students as control.Mono-factor logistic regression and multiple logistic regression were used to screen the significantly variables.At last,structural equation modeling(SEM) was used by AMOS(Analysis of Moment Structures ) 7.0 software to analysis relationships between overweight and obesity,anxiety,depression,and self esteem of students.
Results
1.Through cluster sampling randomly,2042 students aged 12-14 years(1088 for boys and 954 for girls) were investigated.
2.The prevalence of underweight,overweight,and obesity among students aged 12-14 years in urban Chenzhou in 2007 were 17.5%,10.6% and 5.9%,respectively.The prevalence of underweight,overweight,and obesity for boys were 14.8%,13.1%and 7.4%,respectively.The prevalence of underweight,overweight,and obesity for girls were 20.0%, 7.8%and 4.2%,respectively.The prevalence of underweight,overweight, and obese students at age of 12 were 8.7%,11.2%and 7.1%,respectively. The prevalence of underweight,overweight,and obese students at age of 13 were 19.9%,10.3%and 5.6%,respectively.The prevalence of underweight,overweight,and obese students at age of 14 were 28.4%, 10.9%and 4.7%,respectively.
3.The prevalence of underweight was lower in boys than girls (X~2=11.638,P=0.000) the prevalence of overweight was higher in boys than girls(X~2=15.528,P=0.000) and.the prevalence of obesity was higher in boys than girls(X~2=9.643,P=0.002).
4.The prevalence of underweight among students increased with age (X~2=60.251,P=0.000).There were no significantly differences among overweight students at different age(X~2=0.387,P=0.824).There were no significantly differences among obese students in different age (X~2=2.167,P=0.339)
5.The prevalence of students with hypertension was 4.7%(5.0%for boys and 4.3%for girls).There was no significantly differences between boys and girls(X~2=0.478,P=0.489).The prevalence of students with hypertension increased with weight(X~2=59.020,P=0.000).
6.Multiple logistic regression showed that female students (OR=2.909,95%CI:2.048-4.133 ),elder students(OR=2.953,95%CI: 2.258-3.860,and slowly eating(OR=1.576,95%CI:1.207-2.059) were risk factors for underweight students.Multiple logistic regression also showed that mother with higher education level(OR=0.798,95%CI: 0.693-0.917 ),longer sleeping time daily(OR=0.798,95%CI: 0.644-0.990),and no food preference or choosy in food(OR=0.698, 95%CI:0.506-0.963) were protective factors for underweight students.
7.Multiple logistic regression showed that elder father(OR=2.040, 95%CI:1.365-3.048),eating food made of bean frequently(0R=1.296, 95%CI:1.045-1.607),no fond of eating snack(OR=1.508,95%CI: 1.140-1.994),and no food preference or choosy in food(OR=1.548, 95%CI:1.098-2.183 ) were risk factors for overweight students.Multiple logistic regression also showed that female students(OR=0.613,95%CI: 0.434-0.866 ),not from one child family(OR=0.553,95%CI: 0.354-0.863),and thinner father(OR=0.565,.95%CI:0.429-0.744) were protective factors for overweight students.
8.Multiple logistic regression showed that mother with higher educational level(OR=2.244,95%CI:1.466-3.436),no food preference or choosy in food(OR=2.298,95%CI:1.413-3.735),eating more food every meal(OR=1.611,95%CI:1.167-2.224),and not caring self health (OR=1.759,95%CI:1.294-2.391 ) were risk factors for obese students. Multiple logistic regression also showed that female students(OR=0.594, 95%CI:0.363-0.971 ) and not from one.child family(OR=0.229,95%CI: 0.103-0.509) were protective factors for obese students.
9.The mean scores of SES,SAS,and SDS were(25.56±2.90), (44.13±9.07) and(50.79±8.95),respectively.The mean scores of SES for both boys and girls were(25.61±3.11 ) and(25.12±2.54),respectively. The mean scores of SAS for both boys and girls were(43.73±8.60) and (44.69±9.26),respectively.The mean scores of SDS for both boys and girls were(50.47±8.74) and(51.25±8.91 ),respectively.
10.For girls,the mean score of SDS was higher in underweight students than those normal weight students(t=-2.203,P=0.028 ).There no other significantly differences of SES,SAS,and SDS between underweight and normal weight students in same sex(P＞0.05).But the underweight students had more anxiety emotion than those normal weight students(X~2=5.496,P=0.019) and more depression emotion than those normal weight students(X~2=19.036,P=0.000).
11.The mean scores of SES of male students with normal weight were higher than those overweight and obese students with same sex (F=16.343,P=0.000).The mean scores of SES of female students with normal weight were higher than those overweight and obese students with same sex(F=29.056,P =0.000).The mean scores of SAS of female students with normal weight were lower than those obese female students (F=7.606,P=0.000).The mean scores of SDS of female students with normal weight were lower than those overweight and obese female students(F=9.612,P=0.000).There no other significantly differences of SAS and SDS for boys between normal weight,overweight,and obese students(P＞0.05) But the overweight and obese students had more anxiety emotion than those normal weight students(X~2=9.388,P=0.009) and more depression emotion than those normal weight students (X~2=21.486,P=0.000)
12.SEM showed that overweight and obesity had direct negative effect on students' self esteem(β=-0.212,P＜0.01) and no direct positive effect on students' negative emotion(β=0.000) Self esteem had direct negative effect on students' negative emotion(β=-0.216,P＜0.01) Overweight and obesity had indirect effect on students' negative emotion through self esteem pathway.
Conclusions
1.The prevalence of underweight,overweight,and obesity among students aged 12-14 years in urban Chenzhou in 2007 are 17.5%,10.6%, and 5.9%,respectively.The prevalence of underweight,overweight,and obesity for boys are 14.8%,13.1%,and 7.4%,respectively.The prevalence of underweight,overweight,and obesity for girls were 20.0%, 7.8%,and 4.2%,respectively.
2.The prevalence of overweight and obesity is higher in boys than girls and the prevalence of underweight is lower in boys than girls.
3.The prevalence of underweight increased with age.There were no significantly differences among overweight or obese students at different age.
4.The prevalence of students with hypertension was 4.7%(5.0%for boys and 4.3%for girls).The prevalence of students with hypertension increased with weight.
5.Biological factors,behavior and lifestyle,and social environmental factors especially family factors may have important influences on underweight,overweight,and obese students.
6.Underweight,overweight,and obesity may have different effects on students',psychological status.
7.Self esteem as a mediated variable may mediate the relationships between overweight and obesity and negative omotion.
Innovation
1.Having extended the domains of the study and research:We are from four domains which include biological factors,behavior and lifestyle,social environment,and medical care demand and utilization to assess the risk factors and protective factors of underweight,overweight, and obese students.
2.Having chosen the control correctly:We have chosen the normal weight students as control to separately assess the risk factors and protective factors of underweight,overweight,and obese students.
3.Having studied the risk factors and protective factors of overweight.
4.Having adopted SEM:We have adopted the SEM to explore the direct and indirect effects of overweight and obesity on self esteem, anxiety,and depression among students.
引文
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