肥胖和母乳喂养对儿童哮喘及哮喘样症状影响的交互效应

摘要

目的：探讨肥胖和母乳喂养对儿童哮喘及哮喘样症状影响的交互效应。方法采用整群随机抽样法,在沈阳市5个行政区各抽取2所幼儿园和1所小学,5个行政区共10所幼儿园和5所小学。采用国际统一标准问卷ATS调查表,对所选学校儿童出生时的喂养方式、生活环境和呼吸系统疾病与症状等状况进行调查,同时对儿童进行体质测量。结果本次研究共发放9335份问卷,回收问卷共8371份,应答率为89．7%,经逻辑审查符合上机进行统计分析的共8212份问卷,合格率为98．1%。儿童超重和肥胖率分别为12．7%和15．5%,母乳喂养率为78．9%。肥胖儿童哮喘患病率(8．5%)显著高于正常体重儿童患病水平(5．8%)(χ2=13．48, P=0．0012)；而母乳喂养儿童哮喘患病率(6．05%)显著低于非母乳喂养儿童患病水平(7．38%)(χ2=4．05, P=0．04)。多因素分析结果显示,在母乳喂养的儿童中,与正常体重的儿童相比,肥胖儿童患有哮喘的风险性增加了38%( OR=1．38,95%CI=1．05~1．82)；而在非母乳喂养的儿童中,肥胖对哮喘的风险性增加了56%( OR =1．56,95%CI =0．99~2．44),进一步分析结果显示肥胖与母乳喂养对儿童咳痰及喘息的交互效应具有统计学意义(P<0．05)。结论母乳喂养可显著降低超重肥胖对儿童患有哮喘及哮喘样症状的影响,两者存在显著的交互效应。%Objective To investigate the interactive effects of obesity and breast feeding on asthma and asthma related symptoms among children. Methods Using a cluster random sampling method, 1 elemen-tary school and 2 kindergartens were randomly selected from each district of Shenyang. A total of 5 elementary schools and 10 kindergartens were included. The information about obesity and the type of breastfeeding, living environment and respiratory diseases were collected by an international standard questionnaire from American Thoracic Society while measuring physical system of children. Results A total of 9335 questionnaires were distributed to all the students enrolled in the selected schools, and 8371 completed questionnaires which collect-ed with a response rate of 89. 7%. Finally, 8212 questionnaires were used for further analysis with a qualified rate of 98. 1%. The percentage of overweight and obesity among children are 12. 7% and 15. 5% respectively. The percentage of breastfeeding was 78. 9%. The prevalence of obesity children with asthma (8. 5%) is nota-bly higher than normal children (5. 8%) with a significant difference (χ2 =13. 48, P=0. 0012), while the prevalence of breastfeeding children with asthma ( 6. 05%) is notably lower than non-breastfeeding children (7. 38%) with a significant difference (χ2 =4. 05; P=0. 04). Multivariate factor analysis showed that com-pared with normal weight children, obesity of breastfeeding children increased asthma risk by 38% ( OR =1. 38, 95%CI=1. 05 ~1. 82); while in non-breastfeeding children, obesity increased the risk of asthma by 56% (OR=1. 56, 95%CI=0. 99 ~2. 44). Further analysis showed obesity and breastfeeding for persistent phlegm and current wheeze in children. Conclusion Breastfeeding can significantly reduce the overweight obesity of children with asthma and asthma-like symptoms, and there is a significant impact on interaction.