目的 了解我国7岁以下儿童单纯性肥胖流行病学特征、变化趋势及其影响因素.方法 采用分层整群随机抽样方法,调查9个城市0～7 岁儿童112 945名.身高别体重≥世界卫生组织/国家健康统计中心(WHO/NCHS)标准10%确定为超重,≥20%确定为肥胖.病例对照研究按"同地区、同性别、年龄相近、身高相差≤3 cm"随机选择正常儿童与肥胖儿进行配对,资料采用多因素条件Logistic回归模型进行分析.结果 (1)超重总检出率为6.25%,男、女童分别为6.59%和5.88%.肥胖总检出率为3.19%,男、女童分别为3.82%和2.48%;各年龄组检出率差异有统计学意义,1个月组为1.86%,1岁后下降,3岁开始回升,6～7 岁达到最高为7.02%.北、中、南三个地区检出率不同,分别为3.21%、3.97%和2.47%.肥胖度分布以轻度肥胖居多,重度肥胖主要集中在3岁后,男童明显多于女童,北部地区高于中、南部地区.(2)与1986年相比,20年间肥胖检出率增长了2.78倍,平均年增长率为6.9%.检出率4岁后增长极快,性别差异显著,由北片高转移到中片高.(3)多因素条件Logistic回归分析:目前食欲、进食速度、母亲体重指数(BMI)、父亲BMI、孩子日常主要照管人、分娩方式、户外活动主要方式、每日平均看电视时间、出生体重及每日平均夜间睡眠时间与肥胖关系密切.结论 (1)20年间我国儿童肥胖呈现快速增长趋势,不同性别、年龄及地区的增长情况不同.应积极研究制定有效的人群控制策略.(2)目前食欲好、进食快、父母BMI偏大、剖腹产、高出生体重及看电视时间过长可能是肥胖发生的危险因素.孩子由父母照管、中等强度户外活动及充足的夜间睡眠可能对肥胖的发生具有一定的保护作用.%Objective To examine the epidemiological features of prevalence and influencing factors on obesity of Chinese children from 1 month to 7 years of age in nine cities.Methods Stratified-clustered-random sampling was used,and the sampling size was 112 945 persons.Overweight and obesity were defined by the weight for height of NCSH/WHO reference,being over 10% as overweight and over 20% as obesity.The normal children were matched with obese children by region,gender,age and height in the case-control designs,and the data were analyzed by multiple conditional Logistic regression model.Results (1)The overall prevalence of overweight was 6.25%,6.59% for boys and 5.88% for girls.The overall prevalence of obesity was 3.19%,3.82% for boys and 2.48% for girls.The prevalence of obesity in different age groups was significantly different,1.86% for 1 month to 1 year old,lower for 1 to 3 years old,higher again after 3 years of age and reached 7.02% for 6-7 years of age.There was a significant regional difference in prevalence,which in the central (3.97%) and northern (3.21%) regions was higher than that in the south (2.47%).Most of the obese children belonged to mild obesity.Severe obesity occured mainly after 3 years of age,and the prevalence of severe obesity for boys was significantly higher than the girls,in the northern part it was higher than those in the other two parts.(2) As compared with the survey data in 1986 and 1996,the prevalence of obesity increased by 2.78 times in the past 20 years,and the annual incremental rate was 6.9%.The prevalence of obesity increased rapidly after 4 years of age and significant gender difference was seen.The higher prevalence shifted from the north to the central part of China.(3) Results of the Logistic regression indicated that appetite,eating speed,high maternal and paternal BMI,child caretaker,mode of delivery,main style of the outdoor activities,hours of watching TV,birth weight and duration of night time sleep were significantly related to obesity.Conclusion (1)During the past 20 years the prevalence of child obesity showed a fast increasing trend in China.Degrees of the increasing trend differed across gender and age groups and regions.Effective strategies for intervention on population should be stipulated.(2) Good appetite,fast eating,high BMI of parents,caesarean birth,high birth-weight and excess hours of watching TV were possibly associated with increased risk of obesity in childhood,and those children looked after by their parents,medium intensity outdoor exercise and sufficient night sleep were associated with decreased risk of obesity.
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