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Title: [A national epidemiological survey on obesity of children under seven years of age in nine cities of China in 2016].
Author: Capital Institute of Pediatrics, Coordinating Study Group of Nine Cities on the Physical Growth and Development of Children.
Journal: Zhonghua Er Ke Za Zhi; 2018 Oct 02; 56(10):745-752. PubMed ID: 30293278.
Abstract:
Objective: To investigate the prevalence and risk factors of obesity in 2016 and to determine secular trend of the prevalence between 1986 and 2016 among Chinese children under seven years of age. Methods: Data of a total of 110 485 children from 1 month to 7 years of age were collected by stratified-clustered-random sampling method in the nine cities (including northern China (Beijing, Harbin, Xi'an), Central (Shanghai, Nanjing, Wuhan), Southern (Guangzhou, Fuzhou, Kunming)) from June to November in 2016. Overweight and obesity were defined by the weight for height of the American National Center for Health Statistics/World Health Organization (NCHS/WHO) reference and be over 10% as overweight and over 20% as obesity (20%-29% as mild, 30%-49% as moderate and over 50% as severe). The normal children were matched with obese children in sex, age and height in the case-control designs and the data were analyzed by χ(2) test and conditional Logistic regression model. Results: (1) The overall overweight prevalence was 8.4% (9 317/110 485) with boys 8.4% (4 843/57 917) and girls 8.5% (4 474/52 568) and the overall obesity prevalence was 4.2% (4 712/110 485) with boys 4.9% (2 860/57 917) and girls 3.6% (1 852/52 568). The obesity prevalence was significantly different across age groups (χ(2)=3 777.586, P<0.01), the lowest 0.9% (144/16 380) (boys 1.1% (97/8 668), girls 0.6% (47/7 712)) at 1-<2 year and the highest 11.3% (1 248/11 072) (boys 14.0% (822/5 861), girls 8.2% (426/5 211)) at 6-<7 years. The overall obesity prevalence was 4.6% (2 534/54 970) for suburban rural children and 4.0% (2 178/55 515) for urban children. The overall obesity prevalence in northern, central and southern China was 4.7% (1 985/42 294), 4.4% (1 543/35 260) and 3.6% (1 184/32 931) respectively. The mild obesity prevalence was 2.8% (3 146/110 485) and the moderate 1.1% (1 272/110 485) and severe obesity 0.3% (294/110 485). (2) To ensure data comparability, the 2016 urban data were compared with the previous survey urban data. Compared with the 1986 and 2006 survey data, the obesity prevalence increased from 0.9% (660/71 420) and 3.8%(2 227/59 302) to 4.6% (1 341/29 054) for boys, from 0.9% (596/66 609) and 2.5%(1 323/53 643) to 3.1% (837/26 461) for girls. The increase in prevalence of obesity mainly appeared after 3 years of age. The obesity prevalence among north, central and south China increased from 1.8% (562/31 301) and 3.2% (1 137/35 439) to 4.2% (864/20 372), from 0.9% (464/52 138) and 3.9%(1 412/37 031) to 4.2% (764/18 485), from 0.4% (230/54 590) and 2.5% (1 001/40 475) to 3.4% (550/16 658) when compared with 1986 and 2006. (3) Multivariate Logistic regression analysis showed that high birth weight (odds ratio (OR)=1.559 (1.038-2.343), χ(2)=4.580, P<0.05), cesarean section (OR=1.651 (1.230-2.216), χ(2)=11.132, P<0.01), gestational diabetes (OR=3.364 (1.406-8.047), χ(2)=7.433, P<0.01), father overweight (OR=1.935 (1.417-2.642), χ(2)=17.267, P<0.01) or father obesity (OR=3.580 (2.304-5.561), χ(2)=32.196, P<0.01), mother overweight (OR=2.305 (1.611-3.298), χ(2)=20.854, P<0.01) or mother obesity (OR=5.232 (2.751-9.949), χ(2)=25.462, P<0.01), good appetite (OR=8.313 (5.385-12.833), χ(2)=91.403, P<0.01), eating fast (OR=6.359 (4.539-9.010), χ(2)=112.513, P<0.01), eating shortly before sleeping (OR=1.553 (1.113-2.166), χ(2)=6.707, P<0.01), long screen watching duration (2-<3 hours: OR=1.973 (1.423-2.736), χ(2)=16.594, P<0.01 or ≥3 hours: OR=2.275 (1.413-3.661), χ(2)=11.448, P<0.01), short night sleep duration (8-<9 h/day) (OR=1.600 (1.074-2.385), χ(2)=5.331, P<0.05), low education of mother (OR=1.589 (1.298-1.945), χ(2)=20.174, P<0.01) may be risk factors for children's obesity; moderate and excessive outdoor activities (e.g. running, jumping) may be protective factors against obesity (OR=0.540 (0.342-0.853), χ(2)=6.990, P<0.01). Conclusions: In recent ten years the rapidly increasing trend of children obesity has not been effectively curbed and there has been a new situation in the obesity prevalence of suburban rural children exceeding urban children. The key roles of mother in the early growth and development and family in the formation of good behavior habits of their children should be paid attention to, and family-based obesity prevention and control strategies for preschool children should be developed and improved to correct unhealthy family sharing environment and children's lifestyle. 目的： 调查2016年我国9个城市7岁以下儿童单纯性肥胖流行现状及其影响因素和掌握1986—2016年肥胖流行变化趋势。 方法： 采用分层整群随机抽样的方法，于2016年6—11月调查北京市、哈尔滨市、西安市（北片），上海市、南京市、武汉市（中片），广州市、福州市、昆明市（南片）9个城市7岁以下儿童110 485名。将儿童身高的体重≥美国国家健康统计中心和（或）世界卫生组织（NCHS/WHO）标准体重的110%定义为超重、≥120%定义为肥胖（其中120%~129%为轻度肥胖，130%~149%为中度肥胖，≥150%为重度肥胖）。肥胖影响因素采用病例对照研究，按"同性别、年龄相近、身高相差≤5 cm"随机数字表选择体重正常儿童与肥胖儿童进行配对，资料分析采用χ(2)检验及条件Logistic模型。 结果： （1）7岁以下儿童超重总检出率为8.4%（9 317/110 485），其中男8.4%（4 843/57 917）、女8.5%（4 474/52 568）；肥胖总检出率为4.2%（4 712/110 485），其中男4.9%（2 860/57 917）、女3.6%（1 852/52 568）。各年龄组肥胖检出率差异有统计学意义（χ(2)=3 777.586，P<0.01），1~<2岁组最低，为0.9%（144/16 380）[男1.1%（97/8 668）、女0.6%（47/7 712）]，6~<7岁组最高，为11.3%（1 248/11 072）[男14.0%（822/5 861）、女8.2%（426/5 211）]。城区、郊区肥胖总检出率分别为4.0%（2 178/55 515）、4.6%（2 534/54 970）。北、中、南三片肥胖总检出率分别为4.7%（1 985/42 294）、4.4%（1 543/35 260）、3.6%（1 184/32 931）。轻度、中度、重度肥胖检出率分别为2.8%（3 146/110 485）、1.1%（1 272/110 485）、0.3%（294/110 485）。（2）为保证数据可比性，将2016年城区数据与以往调查城区数据进行比较。与1986、2006年相比，男、女童肥胖检出率分别从0.9%（660/71 420）、3.8%（2 227/59 302）增长到4.6%（1 341/29 054）、0.9%（596/66 609）、2.5%（1 323/53 643）增长到3.1%（837/26 461）。肥胖增长主要集中在3岁以后。北、中、南三片肥胖检出率与1986、2006年相比分别从1.8%（562/31 301）、3.2%（1 137/35 439）增长到4.2%（864/20 372），0.9%（464/52 138）、3.9%（1 412/37 031）增长到4.2%（764/18 485），0.4%（230/54 590）、2.5%（1 001/40 475）增长到3.4%（550/16 658）。（3）多因素条件Logistic模型分析结果显示：高出生体重[比值比（OR）=1.559（1.038~2.343），χ(2)=4.580，P<0.05]，剖宫产[OR=1.651（1.230~2.216），χ(2)=11.132，P<0.01]，孕期糖尿病[OR=3.364（1.406~8.047），χ(2)=7.433，P<0.01]，父亲超重[OR=1.935（1.417~2.642），χ(2)=17.267，P<0.01]或肥胖[OR=3.580（2.304~5.561），χ(2)=32.196，P<0.01]，母亲超重[OR=2.305（1.611~3.298），χ(2)=20.854，P<0.01]或肥胖[OR=5.232（2.751~9.949），χ(2)=25.462，P<0.01]，目前食欲好[OR=8.313（5.385~12.833），χ(2)=91.403，P<0.01]，进食速度快[OR=6.359（4.539~9.010），χ(2)=112.513，P<0.01]、临睡前吃东西[OR=1.553（1.113~2.166），χ(2)=6.707，P<0.01]，视屏时间长[2~<3 h OR=1.973（1.423~2.736），χ(2)=16.594，P<0.01或≥3 h OR=2.275（1.413~3.661），χ(2)=11.448，P<0.01]，夜间睡眠时间短（每天8~<9 h）[OR=1.600（1.074~2.385），χ(2)=5.331，P<0.05]，母亲文化程度低[OR=1.589（1.298~1.945），χ(2)=20.174，P<0.01]可能是肥胖的危险因素；中等强度以上（追逐跑跳等）的户外活动可能是肥胖的保护因素[OR=0.540（0.342~0.853），χ(2)=6.990，P<0.01]。 结论： 近10年来儿童肥胖快速增长态势没有得到有效遏制，并且出现郊区超过城区的新情况。应关注母亲在子女生命早期生长发育及家庭在儿童良好行为习惯养成中扮演的关键角色，制定和完善以家庭为基础的学前儿童肥胖防控人群策略，纠正不健康的家庭共享环境和儿童生活行为方式。.

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