我国11城市3～6岁儿童单纯肥胖症相关危险因素分析
|
摘要
【背景】肥胖是遗传和环境因素共同作用的结果。在过去的20～30年,我国乃至全球儿童肥胖的发生呈明显增长的趋势,我国城市地区肥胖的发生率已快于发达国家的速度在增长,其中3～6岁儿童肥胖增长最快。3～6岁是脂肪细胞数量增长旺盛时期,脂肪细胞数量过多增长会增加日后肥胖干预的难度,增加成人肥胖发生的危险,成为日后突出的公共卫生问题。对3～6岁儿童肥胖的危险因素进行分析,并做到早期、真对性的干预对遏制肥胖的发生发展有重要的意义。
【目的】为了探索我国城市3～6岁儿童家庭环境对肥胖的影响。初步了解3～6岁儿童生活方式和饮食习惯与肥胖的关系,为制定儿童肥胖干预策略提供针对性的流行病学依据。
【方法】采用分层整群抽样,分别从成都、济南、深圳、沈阳、上海、重庆、郑州、西安、长沙、青岛和海口11个城市中随机抽取3个城区,每个城区以幼儿园为单位随机抽取200人以上的幼儿园6所,由统一培训的医生对在册所有儿童进行体格测量,以WHO的身高别体重+2SD作为肥胖判断标准,且排除病理性肥胖。将调查中确诊的单纯肥胖症儿童与同性别、同年龄、同班级的正常体重儿童进行1:2配对后,对所有肥胖儿童和配对的正常体重儿童进行家长自填问卷调查,回收的完整调查问卷中2218份肥胖问卷和5380份正常体重问卷,分别作为本研究的肥胖组和对照组,利用SPSS15.0软件对问卷内容进行处理,并进行成组病例对照分析。对连续性变量、分类变量分别采用了t检验和x~2检验进行单因素分析;对单因素有意义的变量采用多因素logistic回归分析;对父母和儿童相同的连续性变量采用相关性检验。
【结果】单因素和多因素logistic回归分析结果显示,高出生体重(OR=1.48)、母亲是中小学文化程度(OR=1.2)、父亲超重(OR=1.55)、母亲超重(OR=1.81)、每周食用甜饮料≥3次(OR=1.34)、食欲好(OR=4.07)、进食速度快(OR=2.77)、4个月前母乳为辅混合喂养(OR=1.71)8个因素为儿童肥胖发生的危险因素;有45.6%、84.9%的肥胖儿童家长对儿童体型和肥胖对健康危害的认识做出不正确的评价和存在错误认识,53.4%、43.3%和51.2%的肥胖儿童家长分别有鼓励进食、食物奖励和不限制零食的行为;父母与儿童间在运动时间和看电视时间上均存在正向相关关系。
【结论】3～6岁儿童的家庭因素与肥胖的发生密切相关,家长不良的生活方式、饮食习惯和错误的育儿观念和行为是儿童肥胖发生的主要危险因素。儿童的饮食行为习惯从婴幼儿就开始形成,3～6是行为发育的敏感时期,来自家庭的错误饮食和行为习惯会影响儿童终生,促进日后肥胖的发生发展,增加肥胖的患病率和成人慢性病的发生率,因此,要尽早把家庭作为肥胖干预的对象,针对家庭危险因素的干预会提高干预的有效性。
[Background]
Obesity is a common health problem which was related with both genetic and environmental factors. In the past 20 to 30 years, the prevalence of childhood obesity was in a rapid growth trend both in china and other countries in the world. The prevalence of obesity in urban areas in China is increased faster than in other developed countries, especially in 3 to 6-year-old children. Child in 3 to 6 years old is a important period with increasing of fat cells. Excessive growth in the number of fat cells will increase the difficulty of future obesity intervention and the risk of adult obesity, which will become a prominent public health problem in the future.
[Object]
The purpose is to explore the family environment factors in 3 to 6-year-old children in urban China and to find out the relationship between the lifestyle/eating habits in preschool children and the obesity, in order to provide suggestions of intervention strategies to childrenhood obesity.
[Methods]
Case-control study and Stratify cluster sampling was used in this study. There were eleven cities were selected in the research. They were Chengdu, Jinan, Shenzhen, Shenyang, Shanghai, Chongqing, Zhengzhou, Xi'an, Changsha, Qingdao and Haikou. Three districts were selected randomly in each city. 6 kindergartens (There must be more than 200 children in the kindergarten) were selected randomly in each district. The questionnaires survey was conducted in obese children and matched (sex and age) normal weight children in each sample kindergarten. The questionnaire results with 2218 obese children (obese group) and 5380 normal weight children (control group) were analyzed in this study. SPSS15.0 was used to analyze the factors related to obesity. Pearson chi-square, t test, and mutivariant logistic regression, and related analysis were used to find out all the factors in this study.
[Results]
Univariate and multivariate logistic regression analysis showed that 8 risk factors were related to child obesity in this study. They were high birth weight((OR=1.48), low education level in mothers (OR=1.2), father overweight (OR=1.55), mother overweight (OR=1.81), sweet drinks consumption≥3 times/week (OR=1.34), strong appetite (OR=4.07), eating fast (OR=2.77), and no breastfeeding before 4 months of age (OR=1.71). There are 45.6% and 84.9% parents of obese children who do not make the correct evaluation on the health hazards of the body shape and obesity in children, respectively. 53.4%, 43.3% and 51.2% of parents of obese children used to encourage eating, food reward and no restrictions on the conduct of snacks, respectively. There is a positive correlation between parents and children's movement time and the time of watching TV.
[Conclusions]
Family environment is related to obesity in children in 3 to 6-year-old in urban China. Parent lifestyle, wrong eating habits and parental attitudes and behavior of childhood obesity are the major risk factors. The eating habits in early childhood are important to prevent obesity. It is necessary to intervene family lifestyle in order to control childhood obesity. Family risk factors for intervention will improve the effectiveness of intervention.
【目的】为了探索我国城市3～6岁儿童家庭环境对肥胖的影响。初步了解3～6岁儿童生活方式和饮食习惯与肥胖的关系,为制定儿童肥胖干预策略提供针对性的流行病学依据。
【方法】采用分层整群抽样,分别从成都、济南、深圳、沈阳、上海、重庆、郑州、西安、长沙、青岛和海口11个城市中随机抽取3个城区,每个城区以幼儿园为单位随机抽取200人以上的幼儿园6所,由统一培训的医生对在册所有儿童进行体格测量,以WHO的身高别体重+2SD作为肥胖判断标准,且排除病理性肥胖。将调查中确诊的单纯肥胖症儿童与同性别、同年龄、同班级的正常体重儿童进行1:2配对后,对所有肥胖儿童和配对的正常体重儿童进行家长自填问卷调查,回收的完整调查问卷中2218份肥胖问卷和5380份正常体重问卷,分别作为本研究的肥胖组和对照组,利用SPSS15.0软件对问卷内容进行处理,并进行成组病例对照分析。对连续性变量、分类变量分别采用了t检验和x~2检验进行单因素分析;对单因素有意义的变量采用多因素logistic回归分析;对父母和儿童相同的连续性变量采用相关性检验。
【结果】单因素和多因素logistic回归分析结果显示,高出生体重(OR=1.48)、母亲是中小学文化程度(OR=1.2)、父亲超重(OR=1.55)、母亲超重(OR=1.81)、每周食用甜饮料≥3次(OR=1.34)、食欲好(OR=4.07)、进食速度快(OR=2.77)、4个月前母乳为辅混合喂养(OR=1.71)8个因素为儿童肥胖发生的危险因素;有45.6%、84.9%的肥胖儿童家长对儿童体型和肥胖对健康危害的认识做出不正确的评价和存在错误认识,53.4%、43.3%和51.2%的肥胖儿童家长分别有鼓励进食、食物奖励和不限制零食的行为;父母与儿童间在运动时间和看电视时间上均存在正向相关关系。
【结论】3～6岁儿童的家庭因素与肥胖的发生密切相关,家长不良的生活方式、饮食习惯和错误的育儿观念和行为是儿童肥胖发生的主要危险因素。儿童的饮食行为习惯从婴幼儿就开始形成,3～6是行为发育的敏感时期,来自家庭的错误饮食和行为习惯会影响儿童终生,促进日后肥胖的发生发展,增加肥胖的患病率和成人慢性病的发生率,因此,要尽早把家庭作为肥胖干预的对象,针对家庭危险因素的干预会提高干预的有效性。
[Background]
Obesity is a common health problem which was related with both genetic and environmental factors. In the past 20 to 30 years, the prevalence of childhood obesity was in a rapid growth trend both in china and other countries in the world. The prevalence of obesity in urban areas in China is increased faster than in other developed countries, especially in 3 to 6-year-old children. Child in 3 to 6 years old is a important period with increasing of fat cells. Excessive growth in the number of fat cells will increase the difficulty of future obesity intervention and the risk of adult obesity, which will become a prominent public health problem in the future.
[Object]
The purpose is to explore the family environment factors in 3 to 6-year-old children in urban China and to find out the relationship between the lifestyle/eating habits in preschool children and the obesity, in order to provide suggestions of intervention strategies to childrenhood obesity.
[Methods]
Case-control study and Stratify cluster sampling was used in this study. There were eleven cities were selected in the research. They were Chengdu, Jinan, Shenzhen, Shenyang, Shanghai, Chongqing, Zhengzhou, Xi'an, Changsha, Qingdao and Haikou. Three districts were selected randomly in each city. 6 kindergartens (There must be more than 200 children in the kindergarten) were selected randomly in each district. The questionnaires survey was conducted in obese children and matched (sex and age) normal weight children in each sample kindergarten. The questionnaire results with 2218 obese children (obese group) and 5380 normal weight children (control group) were analyzed in this study. SPSS15.0 was used to analyze the factors related to obesity. Pearson chi-square, t test, and mutivariant logistic regression, and related analysis were used to find out all the factors in this study.
[Results]
Univariate and multivariate logistic regression analysis showed that 8 risk factors were related to child obesity in this study. They were high birth weight((OR=1.48), low education level in mothers (OR=1.2), father overweight (OR=1.55), mother overweight (OR=1.81), sweet drinks consumption≥3 times/week (OR=1.34), strong appetite (OR=4.07), eating fast (OR=2.77), and no breastfeeding before 4 months of age (OR=1.71). There are 45.6% and 84.9% parents of obese children who do not make the correct evaluation on the health hazards of the body shape and obesity in children, respectively. 53.4%, 43.3% and 51.2% of parents of obese children used to encourage eating, food reward and no restrictions on the conduct of snacks, respectively. There is a positive correlation between parents and children's movement time and the time of watching TV.
[Conclusions]
Family environment is related to obesity in children in 3 to 6-year-old in urban China. Parent lifestyle, wrong eating habits and parental attitudes and behavior of childhood obesity are the major risk factors. The eating habits in early childhood are important to prevent obesity. It is necessary to intervene family lifestyle in order to control childhood obesity. Family risk factors for intervention will improve the effectiveness of intervention.
引文
[1]http://info.med.hc360.com/2005/10/10151769113.shtm
[2]李炳臣、吴晓文、许波 小儿肥胖症与其成人期相关疾病的研究概况 实用医药杂志,2004,2(12):1118。
[3]WuGuanglin,YangHuimin,QiXiuying,JiaZhenlin.A case-control study for the association between Changein weight,family history and hypertension at different ages.Asia-Pacific Journal of Public health,2001;13(2):96-9
[4]汤晓萍,柴宁柳,黄童等.某地区学龄前儿童高血压发病状况及相关危险因素分析 心脑血管病防治,2005,5(4):11
[5]Fourth Report,the Diagnosis,Evaluation,and Treatment of High Blood Pressure in Children and Adolescents pediatriis,2004,114(2):555-576.
[6]李静,3～6岁儿童单纯性肥胖症与血压关系 中国公共卫生,2007,23(6):680
[7]赵颖新,王平,杜文冉等 学龄期单纯性肥胖儿童气质特征及心理行为问题探讨 中国儿童保健杂志,2007,15(6):175-176
[8]WHO,Fight childhood obesity to help predent diabetes.2004.
[9]SBU-report no.160(173).Obesity-Problems and interventions,A Systematic Review.The Swedish Council on Technology Assessment in HealthCare:Stockholm,2002(updare in Swedish 2005).
[10]饮食、身体活动与健康全球战略[A].见:第五十七届世界卫生大会2004年5月22日
[11]李辉,张璇,阎桂凤 八城市7岁以下儿童单纯性肥胖症的十年流行变化趋势.中国儿童保健杂志,2002,10(5):316
[12]首都儿科研究所、九市儿童体格发育调查协作组2006年全国九城市7岁以下儿童单纯性肥胖流行病学调查,中华儿科杂志2008,46(3)
[13]Samantha H.Drohan Managing Early Childhood Obesity in the Primary Care Setting:A Behavior Modification Approach Pediatr Nurs 2002,28(6):599-610
[14]中国肥胖问题工作组数据汇总分析协作组我国成人体重指数和腰围对相关疾病危险因素异常的预测价值:适宜体重指数和腰围切点的研究[J].中华流行病学杂志,2002,23(1):7-8
[15]Gortmaker SL,Must A,Perrin JM:Social and economic consequences of overweight in adolescenceand young adulthood.N Eng J Med 329:1008-1012,1993.
[16]蒋竞雄,刘松华,许立等 学龄前儿童超重相关因素分析[J].中国妇幼保健,2007,24(22)3398-3399
[17]蒋汝刚 学龄期儿童6098名单纯性肥胖及其影响因素分析[J].中国儿童保健杂志 2005,13(3):653
[18]芮溧,曾果 学龄前儿童肥胖危险因素Logistic模型分析.现代预防医学2008,35(9)1629-1630
[19]蒋竞雄,邢桂茹,王惠珊等 学龄前儿童家庭环境中超重和肥胖危险因素分析[J]中华儿科杂志,2007,45(3)
[20]马文军,马冠生,胡小琪等 我国4城市儿童少年饮料的消费现况.中国学校卫生2001,22(2)
[21]李东海,喻素彬,徐耀初 儿童肥胖发病机制研究进展[J].预防医学情报杂志,2003,1(19):24226.
[22]Barbara A.Dennison,Tara A.Erb,Paul L.Jenkins Television Viewing and Television in Bedroom Associated With Overweight Risk Among Low-Income Preschool Children.Pediatrics 2002;109;1028-1035
[23]Birch LL.Fisher JO Development of eating behaviours among children and adolescents.Pediatrics,1998,101(3):539-547
[24]LL Hui,EAS Nelson,LM Yu2 etal.Risk factors for childhood overweight in 6- to 7-y-old Hong Kong children.International Journal of Obesity 2003,27,1411-1418
[25]John J Reilly,Julie Armstrong,Ahmad R Dorosty etal.Early life risk factors for obesity in childhood:cohort study,BMJ 2005,330
[26]Birch LL.Fisher JO Development of eating behaviours among children and adolescents Pediatrics,1998,101(3):539 547
[27]Francis LA,Lee Y,Birch LL Parental weight status and girls television viewing,snacking,and body mass indxes.Obes Res,2003,11:143-151
[28]Adolfo J.Ariza,Edwin H.Chen,Helen J.Binns etal Risk Factors for Overweight in Five- to Six-Year-Old Hispanic-American Children:A Pilot Study Journal of Urban Health:Bulletin of the New York Academy of Medicine,2004,81(1):156
[29]Riehketts CD.Fat preferences,dietary fat intake and body composition in children.Eur J Clin Nutr,1997,51:778-781
[30]蒋竞雄,刘松华,许立等学龄前儿童超重相关因素分析[J]中国妇幼保健,2007,22:3398-3399
[31]Burke V,Beilin LJ,Simmer K et al.Breastfeeding andoverweight:longitudinal analysis in an Australian birth cohort.J Pediatr 2005,147(1):56-61
[32]Valeria Hirschler,Jinera Buqna Does low birth weight predict obesity/overweight and metabolic syndrome in elementary school children?Archives of Medical research,2008,39(8):796-802
[33]廖兵荣 出生体重与儿童单纯性肥胖关系.中国公共卫生,2007,23(6):456
[34]Singhal A,Lanigan J,Breastfeeding,early growth and later obesity.Obes Rev 2007,8:51-54.
[35]Sherry B,Food behaviors and other strategies to prevent andtreat pediatric overweight.Int J Obes 2005,29:S116-126.
[36]Prevention of Pediatric Overweight and Obesity.Committee on Nutrition,2003,102:424-430
[37]马丽萍,苏宜香.母乳喂养预防儿童肥胖及其机制的研究进展[J].中国妇幼健康研究,2006,17(1):32234.
[38]Gillman MW,Rifas2shiman SL,Camargo CA,etal.Risk of overweight among adolescents who were breastfed as infants[J]JAMA,2001,285:2461-2467.
[39]丁宗一 儿童期单纯肥胖症 河南科学技术出版社 2005年,10月第一版
[40]Carruth BR,Skinner JD.The role of dietary calcium and other nutrients in moderating body fat in preschool children.Int J Obes Relat Metab Disord.2001,25:559-566.
[41]Black RE,Williams SM,Jones IE,Goulding A.Children who avoid drinking cow milk have low dietary calcium intakes and poor bone health.Am J ClinNutr.2002,76:675-680.
[42]张新庆,周瑞华.学龄前肥胖儿童的肥胖因素分析[J].中国学校卫生。1994,15(2):90-91.
[39]Lrren Ritchie,PhD,RD;Greg Welk,PhD;Dennes Styne,MD Family Environment and Pediatric Overweight:What Is a Parent to Do?
[40]Pinki Sahota,Mary C J Rudolf,Rachael Dixey et al Randomised controlled trial of primary school based intervention to reduce risk factors for obesity BMJ
[41]Carruth BR,Skinner JD.The role of dietary calcium and other nutrients in moderating body fat in preschool children.Int JO besRelat Metab Disord.2001,25:559-566.
[42]Skinner JD,Bounds W,Carruth BR,Ziegler P.Longitudinal calcium intake is negatively related to children' s body fat indexes.J Am Diet Assoc.2003,103:1626-1631.
[43]JagoR,Baranowski T,Baranowski JC,etal.BMlfrom 3-6 years age is predicted by TV,ingand Physical activity,not diet[J].Int Jobe3(Lond),2005,29(6):P.557-64
[44]ReillyJJ,Earlylife risk factors for obesity in childhood:cohort study[J].BMJ2005(330):1357
[45]Williams TM,Handford AG Television and other leisure activities.In:Williams TM,ed The impact of Television:Anuturl Experimentin Three Communities.Orlanao,FL:Academic Press,1986,143-213(32)
[46]Williams TM,Handford AG Television and other leisure activities,In:Williams TM,ed The impact of Television:Anuturl Experimentin Three Communities.Orlanao,FL:Academic Press,1986,143-213(32)
[47]Sugimori H.Yoshida Katsumi Izu no factors that influence body mass index Takashetal.Analysis of from ages 3 to 6 years:Astudy based on the Toyam cohort study[J].Pediatrics lnternational,2004,46(3):302-310.
[48]吕书红.儿童肥胖流行趋势及干预对策探讨[J]7.中国健康教育,2002,8(8):526-527.
[1]SBU—report no 160(173).Obesity-Problems and interventions.A Systematic Review.The Swedish Council on Technology Assessment in Health Care:Stockholm,2002(updare in Swedish 2005).
[2]丁宗一 1986—1996年儿童期单纯性肥胖症研究[J].中华儿科杂志,1998,36:404-407.
[3]季成叶,孙军玲,陈天娇.中国学龄儿童青少年1985-2000年超重、肥胖流行趋势动态分析[J].中华流行病学杂志,2004,25(2):103-108.
[4]张晓燕,付伯津,叶涛et al.单纯肥胖症学龄前儿童生化指标病理对照分析[J].中国儿童保健杂志,2006,14(6):562-563
[5]张亨菊,李辉,管晓丽et al单纯性肥胖儿童脂肪肝、血糖及相关因素的研究[J].中华预防医学杂志,2001,9(35):5.
[6]李炳辰,吴晓文,许波 儿童肥胖症与其成人期相关疾病的研究概况[J].实用医药杂志,2004,21(12):1117
[7]丁宗一.我国儿童期单纯肥胖症的特点及预防.中华全科医师杂志[J].2004,3(2):90
[8]马冠生.儿童少年的饮食行为及影响因素 中国健康教育,2005,21(5):338-339.
[9]马文军,马冠生,李艳平ea tl.我国四城市儿童少年食用西式快餐频度和肥胖率关系的分析 营养学报,2004,26(6):487-488
[10]王婵娟,杨太和,傅荣.肥胖儿童86例饮食行为及相关因素分析[J].中国卫生学校,2005,26(1):30.
[11]王建国,崔明辰,苏爱芳.单纯性肥胖儿童营养知识—态度—饮食行为问题研究.医学综述,2007,13(17):1361
[12]Rosenstein D,Oster H:Differential facial responses to four basic tastes in newborns.Child Dev 1988;59:1555-1568.
[13]马文军,马冠生.儿童青少年饮食行为:4.饮料.国外医学卫生学分册,2000,27(4):218.
[14]马丽萍,苏宜香.母乳喂养预防儿章肥胖及其机制的研究进展[J]中国妇幼健康 研究,2006,17(1):32-34
[15]Lucas A.Lang-term programming effects of early nutrition-implication for the preterm infant(J).J perinatol.2005,25(s2):2-6
[16]LI L,Parson TJ,Power C.Breast feeding and obesity in childhood:cross2sectional study[J].BMJ,2003,327:9042905.
[17]刘湘云 儿童饮食行为[J].中国儿童保健杂志,1997,5:3
[18]胡小琪,马冠生,马文军ea tl.我国4城市儿童少年食物好恶及其影响因素调查.中国校医,2002,16(2):108
[19]马冠生 儿童少年的饮食行为 中国营养学会第九次全国营养学术会议论文摘要汇编,2004年10月10日
[20]马冠生,胡小琪,吴谨ea tl.父母提示对儿童少年饮食行为的影响[J].中国卫生学校,2002,23(6):486-487.
[21]Dietz WH.Therapeutic strategies in Childhood obesity,Horm Res,1993,39(suppl 3):86
[22]中华儿科杂志编辑委员会,中华医学会儿科学分会儿童保健学组.儿童期单纯肥胖症防治常规1中华儿科杂志,2000,38(9):568-570
[23]万燕萍,蔡威,汤庆娅ea tl.单纯性肥胖儿童合理饮食模式的探讨[J].中国临床营养杂志,2000,8(2):105.
[24]蒋竞雄,吴光驰,郭素怡.ea tl.儿童单纯肥胖症门诊治疗效果观察[J].中国儿童保健杂志,2001,9(1):15.
[25]蒋竞雄,夏秀兰,吴光驰.ea tl.学龄儿童单纯肥胖症的群体干预研究[J].中国儿童保健杂志,2002,10(6):365.
[26]Barlow SE,Dietz WH,obesity evaluation and treatment expert:conmmittee Recommendations[J].Pediatrics,1998,102:E29
[2]李炳臣、吴晓文、许波 小儿肥胖症与其成人期相关疾病的研究概况 实用医药杂志,2004,2(12):1118。
[3]WuGuanglin,YangHuimin,QiXiuying,JiaZhenlin.A case-control study for the association between Changein weight,family history and hypertension at different ages.Asia-Pacific Journal of Public health,2001;13(2):96-9
[4]汤晓萍,柴宁柳,黄童等.某地区学龄前儿童高血压发病状况及相关危险因素分析 心脑血管病防治,2005,5(4):11
[5]Fourth Report,the Diagnosis,Evaluation,and Treatment of High Blood Pressure in Children and Adolescents pediatriis,2004,114(2):555-576.
[6]李静,3～6岁儿童单纯性肥胖症与血压关系 中国公共卫生,2007,23(6):680
[7]赵颖新,王平,杜文冉等 学龄期单纯性肥胖儿童气质特征及心理行为问题探讨 中国儿童保健杂志,2007,15(6):175-176
[8]WHO,Fight childhood obesity to help predent diabetes.2004.
[9]SBU-report no.160(173).Obesity-Problems and interventions,A Systematic Review.The Swedish Council on Technology Assessment in HealthCare:Stockholm,2002(updare in Swedish 2005).
[10]饮食、身体活动与健康全球战略[A].见:第五十七届世界卫生大会2004年5月22日
[11]李辉,张璇,阎桂凤 八城市7岁以下儿童单纯性肥胖症的十年流行变化趋势.中国儿童保健杂志,2002,10(5):316
[12]首都儿科研究所、九市儿童体格发育调查协作组2006年全国九城市7岁以下儿童单纯性肥胖流行病学调查,中华儿科杂志2008,46(3)
[13]Samantha H.Drohan Managing Early Childhood Obesity in the Primary Care Setting:A Behavior Modification Approach Pediatr Nurs 2002,28(6):599-610
[14]中国肥胖问题工作组数据汇总分析协作组我国成人体重指数和腰围对相关疾病危险因素异常的预测价值:适宜体重指数和腰围切点的研究[J].中华流行病学杂志,2002,23(1):7-8
[15]Gortmaker SL,Must A,Perrin JM:Social and economic consequences of overweight in adolescenceand young adulthood.N Eng J Med 329:1008-1012,1993.
[16]蒋竞雄,刘松华,许立等 学龄前儿童超重相关因素分析[J].中国妇幼保健,2007,24(22)3398-3399
[17]蒋汝刚 学龄期儿童6098名单纯性肥胖及其影响因素分析[J].中国儿童保健杂志 2005,13(3):653
[18]芮溧,曾果 学龄前儿童肥胖危险因素Logistic模型分析.现代预防医学2008,35(9)1629-1630
[19]蒋竞雄,邢桂茹,王惠珊等 学龄前儿童家庭环境中超重和肥胖危险因素分析[J]中华儿科杂志,2007,45(3)
[20]马文军,马冠生,胡小琪等 我国4城市儿童少年饮料的消费现况.中国学校卫生2001,22(2)
[21]李东海,喻素彬,徐耀初 儿童肥胖发病机制研究进展[J].预防医学情报杂志,2003,1(19):24226.
[22]Barbara A.Dennison,Tara A.Erb,Paul L.Jenkins Television Viewing and Television in Bedroom Associated With Overweight Risk Among Low-Income Preschool Children.Pediatrics 2002;109;1028-1035
[23]Birch LL.Fisher JO Development of eating behaviours among children and adolescents.Pediatrics,1998,101(3):539-547
[24]LL Hui,EAS Nelson,LM Yu2 etal.Risk factors for childhood overweight in 6- to 7-y-old Hong Kong children.International Journal of Obesity 2003,27,1411-1418
[25]John J Reilly,Julie Armstrong,Ahmad R Dorosty etal.Early life risk factors for obesity in childhood:cohort study,BMJ 2005,330
[26]Birch LL.Fisher JO Development of eating behaviours among children and adolescents Pediatrics,1998,101(3):539 547
[27]Francis LA,Lee Y,Birch LL Parental weight status and girls television viewing,snacking,and body mass indxes.Obes Res,2003,11:143-151
[28]Adolfo J.Ariza,Edwin H.Chen,Helen J.Binns etal Risk Factors for Overweight in Five- to Six-Year-Old Hispanic-American Children:A Pilot Study Journal of Urban Health:Bulletin of the New York Academy of Medicine,2004,81(1):156
[29]Riehketts CD.Fat preferences,dietary fat intake and body composition in children.Eur J Clin Nutr,1997,51:778-781
[30]蒋竞雄,刘松华,许立等学龄前儿童超重相关因素分析[J]中国妇幼保健,2007,22:3398-3399
[31]Burke V,Beilin LJ,Simmer K et al.Breastfeeding andoverweight:longitudinal analysis in an Australian birth cohort.J Pediatr 2005,147(1):56-61
[32]Valeria Hirschler,Jinera Buqna Does low birth weight predict obesity/overweight and metabolic syndrome in elementary school children?Archives of Medical research,2008,39(8):796-802
[33]廖兵荣 出生体重与儿童单纯性肥胖关系.中国公共卫生,2007,23(6):456
[34]Singhal A,Lanigan J,Breastfeeding,early growth and later obesity.Obes Rev 2007,8:51-54.
[35]Sherry B,Food behaviors and other strategies to prevent andtreat pediatric overweight.Int J Obes 2005,29:S116-126.
[36]Prevention of Pediatric Overweight and Obesity.Committee on Nutrition,2003,102:424-430
[37]马丽萍,苏宜香.母乳喂养预防儿童肥胖及其机制的研究进展[J].中国妇幼健康研究,2006,17(1):32234.
[38]Gillman MW,Rifas2shiman SL,Camargo CA,etal.Risk of overweight among adolescents who were breastfed as infants[J]JAMA,2001,285:2461-2467.
[39]丁宗一 儿童期单纯肥胖症 河南科学技术出版社 2005年,10月第一版
[40]Carruth BR,Skinner JD.The role of dietary calcium and other nutrients in moderating body fat in preschool children.Int J Obes Relat Metab Disord.2001,25:559-566.
[41]Black RE,Williams SM,Jones IE,Goulding A.Children who avoid drinking cow milk have low dietary calcium intakes and poor bone health.Am J ClinNutr.2002,76:675-680.
[42]张新庆,周瑞华.学龄前肥胖儿童的肥胖因素分析[J].中国学校卫生。1994,15(2):90-91.
[39]Lrren Ritchie,PhD,RD;Greg Welk,PhD;Dennes Styne,MD Family Environment and Pediatric Overweight:What Is a Parent to Do?
[40]Pinki Sahota,Mary C J Rudolf,Rachael Dixey et al Randomised controlled trial of primary school based intervention to reduce risk factors for obesity BMJ
[41]Carruth BR,Skinner JD.The role of dietary calcium and other nutrients in moderating body fat in preschool children.Int JO besRelat Metab Disord.2001,25:559-566.
[42]Skinner JD,Bounds W,Carruth BR,Ziegler P.Longitudinal calcium intake is negatively related to children' s body fat indexes.J Am Diet Assoc.2003,103:1626-1631.
[43]JagoR,Baranowski T,Baranowski JC,etal.BMlfrom 3-6 years age is predicted by TV,ingand Physical activity,not diet[J].Int Jobe3(Lond),2005,29(6):P.557-64
[44]ReillyJJ,Earlylife risk factors for obesity in childhood:cohort study[J].BMJ2005(330):1357
[45]Williams TM,Handford AG Television and other leisure activities.In:Williams TM,ed The impact of Television:Anuturl Experimentin Three Communities.Orlanao,FL:Academic Press,1986,143-213(32)
[46]Williams TM,Handford AG Television and other leisure activities,In:Williams TM,ed The impact of Television:Anuturl Experimentin Three Communities.Orlanao,FL:Academic Press,1986,143-213(32)
[47]Sugimori H.Yoshida Katsumi Izu no factors that influence body mass index Takashetal.Analysis of from ages 3 to 6 years:Astudy based on the Toyam cohort study[J].Pediatrics lnternational,2004,46(3):302-310.
[48]吕书红.儿童肥胖流行趋势及干预对策探讨[J]7.中国健康教育,2002,8(8):526-527.
[1]SBU—report no 160(173).Obesity-Problems and interventions.A Systematic Review.The Swedish Council on Technology Assessment in Health Care:Stockholm,2002(updare in Swedish 2005).
[2]丁宗一 1986—1996年儿童期单纯性肥胖症研究[J].中华儿科杂志,1998,36:404-407.
[3]季成叶,孙军玲,陈天娇.中国学龄儿童青少年1985-2000年超重、肥胖流行趋势动态分析[J].中华流行病学杂志,2004,25(2):103-108.
[4]张晓燕,付伯津,叶涛et al.单纯肥胖症学龄前儿童生化指标病理对照分析[J].中国儿童保健杂志,2006,14(6):562-563
[5]张亨菊,李辉,管晓丽et al单纯性肥胖儿童脂肪肝、血糖及相关因素的研究[J].中华预防医学杂志,2001,9(35):5.
[6]李炳辰,吴晓文,许波 儿童肥胖症与其成人期相关疾病的研究概况[J].实用医药杂志,2004,21(12):1117
[7]丁宗一.我国儿童期单纯肥胖症的特点及预防.中华全科医师杂志[J].2004,3(2):90
[8]马冠生.儿童少年的饮食行为及影响因素 中国健康教育,2005,21(5):338-339.
[9]马文军,马冠生,李艳平ea tl.我国四城市儿童少年食用西式快餐频度和肥胖率关系的分析 营养学报,2004,26(6):487-488
[10]王婵娟,杨太和,傅荣.肥胖儿童86例饮食行为及相关因素分析[J].中国卫生学校,2005,26(1):30.
[11]王建国,崔明辰,苏爱芳.单纯性肥胖儿童营养知识—态度—饮食行为问题研究.医学综述,2007,13(17):1361
[12]Rosenstein D,Oster H:Differential facial responses to four basic tastes in newborns.Child Dev 1988;59:1555-1568.
[13]马文军,马冠生.儿童青少年饮食行为:4.饮料.国外医学卫生学分册,2000,27(4):218.
[14]马丽萍,苏宜香.母乳喂养预防儿章肥胖及其机制的研究进展[J]中国妇幼健康 研究,2006,17(1):32-34
[15]Lucas A.Lang-term programming effects of early nutrition-implication for the preterm infant(J).J perinatol.2005,25(s2):2-6
[16]LI L,Parson TJ,Power C.Breast feeding and obesity in childhood:cross2sectional study[J].BMJ,2003,327:9042905.
[17]刘湘云 儿童饮食行为[J].中国儿童保健杂志,1997,5:3
[18]胡小琪,马冠生,马文军ea tl.我国4城市儿童少年食物好恶及其影响因素调查.中国校医,2002,16(2):108
[19]马冠生 儿童少年的饮食行为 中国营养学会第九次全国营养学术会议论文摘要汇编,2004年10月10日
[20]马冠生,胡小琪,吴谨ea tl.父母提示对儿童少年饮食行为的影响[J].中国卫生学校,2002,23(6):486-487.
[21]Dietz WH.Therapeutic strategies in Childhood obesity,Horm Res,1993,39(suppl 3):86
[22]中华儿科杂志编辑委员会,中华医学会儿科学分会儿童保健学组.儿童期单纯肥胖症防治常规1中华儿科杂志,2000,38(9):568-570
[23]万燕萍,蔡威,汤庆娅ea tl.单纯性肥胖儿童合理饮食模式的探讨[J].中国临床营养杂志,2000,8(2):105.
[24]蒋竞雄,吴光驰,郭素怡.ea tl.儿童单纯肥胖症门诊治疗效果观察[J].中国儿童保健杂志,2001,9(1):15.
[25]蒋竞雄,夏秀兰,吴光驰.ea tl.学龄儿童单纯肥胖症的群体干预研究[J].中国儿童保健杂志,2002,10(6):365.
[26]Barlow SE,Dietz WH,obesity evaluation and treatment expert:conmmittee Recommendations[J].Pediatrics,1998,102:E29