巨大儿0~18月龄生长随访分析

目的：调查巨大儿出生后的生长情况以及18月龄时超重发生率和相关因素。方法：84例无基础疾病的巨大儿纳入研究,定期随访其生长情况,并比较分析18月龄时超重的相关因素。结果：18月龄时,84例巨大儿中有24%超重（20/84）,男婴的超重比例高于女婴（30% vs 11%,P<0.05）。18月龄时超重组的6月龄超重比例及12月龄超重比例均高于非超重组（80% vs 22%,P<0.01;80% vs 13%,P<0.01）。 Spearman相关分析显示,巨大儿出生体重、0~6月体重增长、7~12月体重增长和13~18月体重增长与其18月龄时按身长的体重Z评分均呈正相关（P<0.05）,其中0~6月体重增长与18月龄时Z评分相关性最高（r=0.597,P<0.01）。结论：对出生巨大儿,应重点干预出生后6个月内的体重快速增长,尤其是男婴,以预防幼儿期肥胖。     

重庆市城区婴幼儿饮食行为干预效果观察

目的：探讨如何利用儿保门诊为婴幼儿建立良好的饮食行为,纠正不良饮食习惯,以促进婴幼儿的生长发育。方法：在重庆市城区随机抽取0~3月龄婴儿作为研究对象,干预组接受本研究的所有干预措施,对照组按常规保健服务,定期监测两组婴幼儿的食物引入时间、各种辅食的添加频次及不健康食物的进食频次等饮食行为的指标变化判断干预效果。结果：干预组婴儿食物引入时间较为合理（P＜0.01）,9月龄及12月龄进食肉类、蔬菜、水果的频率较高（P＜0.01）,进食甜饮料的频率较低（P＜0.05）;干预组18月龄及24月龄幼儿进食甜饮料的频率显著低于对照组（P＜0.01）,24月龄幼儿进食冰激凌的频率低于对照组（P＜0.01）。结论：饮食行为干预可促进婴幼儿合理引入食物,规律添加辅食,降低不健康食物如甜饮料及冰激凌的进食频率,从而有效改善婴幼儿的饮食行为。     

夜间喂养终止时间对婴幼儿生长发育的影响

目的 探讨夜间喂养终止时间对儿童30月龄时身高、体重、营养状况及龋齿患病率的影响。方法 选择2014年1月至2015年9月出生并在儿童保健门诊按要求完成健康体检的416例儿童,在其30月龄体检时采用综合儿童保健记录并辅以自制调查问卷的方式,将6月龄后继续夜间喂养者作为研究组（n=269）,6月龄终止夜间喂养者作为对照组（n=147）。比较两组儿童在30月龄时身高、体重、超重/肥胖发生率及龋齿患病率的差异。结果 研究组儿童30月龄时平均身高低于对照组（92.4±3.0 cm vs 93.3±2.8 cm,P < 0.05）,且具有更高的超重/肥胖发生率（23.8% vs 12.2%,P < 0.05）和更高的龋齿患病率（14.9% vs 7.5%,P < 0.05）。结论 6月龄后继续夜间喂养影响婴幼儿生长发育、造成营养过剩以及增加龋齿患病率。     

Williams综合征儿童早期运动发育特征

目的 分析Williams综合征（Williams syndrome,WS）儿童的早期运动发育情况,为临床早期干预提供依据。 方法 对2018年9月至2021年8月间59例0~24月龄的WS儿童的临床资料进行回顾性分析,其中男40例,女19例。根据Peabody运动发育量表（Peabody Developmental Motor Scale Ⅱ）测试结果,分析不同年龄患儿的运动发育情况。 结果 男女儿童月龄和运动商的比较差异均无统计学意义（P>0.05）。<6月龄组、6~<12月龄组、12~<18月龄组和18~24月龄组的粗大运动商分别为94±5、78±11、71±8、63±8,精细运动商分别为94±5、80±10、74±9、65±9,粗大运动商和精细运动商随着月龄增长逐渐下降（P<0.05）。<6月龄组、6~<12月龄组、12~<18月龄组和18~24月龄组的粗大运动发育异常率分别为0%、53%、87%、93%,精细运动发育异常率分别为0%、47%、67%、93%,粗大运动和精细运动发育异常率均随月龄增长而上升（P<0.05）。 结论 6个月以内WS儿童未表现出明显的运动能力落后,但随年龄增长其运动能力逐渐降低,运动发育迟缓率逐渐增加。因此必须做好该人群运动能力的随访工作,早期制订干预策略以减少运动发育迟缓的发生。 中国当代儿科杂志,2022,24（9）：984-987］     

不同参考标准下重庆城区儿童超重／肥胖检出率比较

目的比较3种筛查标准下重庆城区儿童超重/肥胖现况,寻求适宜的儿童肥胖筛查标准。方法按照整群抽样原则抽取本市3个城区的12534名2～18岁儿童作为调查对象,测量其身高及体质量。并分别采用WHO的身高标准体质量法标准(标准1)、国际肥胖工作组(IOTF)的超重/肥胖体质量指数(BMI)标准(标准2)和国立卫生统计中心/疾病预防控制中心(NCHS/CDC)的BMI标准(标准3)评价儿童的超重/肥胖。结果按照标准1、2和3的规定,重庆城区儿童的超重检出率分别为13.0%、9.8%、9.8%;肥胖检出率分别为9.8%、2.9%、6.0%,均有显著性差异(Pa<0.001),且男童超重/肥胖检出率均高于女童。3种标准间,健康儿童、超重儿童或肥胖儿童的BMI均值均有显著性差异(Pa<0.001)。采用标准1和2得到的超重检出率,或采用标准1和3得到的超重检出率均在6岁前和14岁后2个年龄段存在统计学差异(Pa<0.01)。在2～6岁各年龄组,采用标准1和3得到的儿童肥胖检出率比较无显著性差异;在6～18岁各年龄组,采用标准1得到的肥胖检出率均显著高于采用标准2和3得到的肥胖检出率(Pa<0.01);在3～6岁、8～10岁、13岁组采用标准2和3得到的儿童肥胖检出率比较有显著性差异。结论儿童肥胖已经成为重庆城区重要的健康问题之一。采用3种标准筛查的儿童超重/肥胖检出率在2～18岁各年龄组均有所不同,应谨慎使用。     

乌鲁木齐市4所幼儿园学龄前儿童单纯性肥胖的影响因素

目的：探讨乌鲁木齐市3～7岁儿童肥胖症的发生率及其影响因素。方法：随机抽取乌鲁木齐市4所城区幼儿园3～7岁儿童1 730名作为研究对象,测量其身高、体重,采用问卷调查相关影响因素,按照身高标准体重法判定肥胖,采用单因素和多因素logistic回归分析影响肥胖的因素。结果：乌鲁木齐市学龄前儿童单纯性肥胖的发生率为7.1%,超重率为13.2%,5岁以上儿童肥胖发生率最高。肥胖发生的危险因素有家族中肥胖人数、母亲的BMI（身体质量指数Body Mass Index）不正常、父亲较少参加运动、家庭不正常的运动和饮食习惯及父母的错误认知。结论：乌鲁木齐市学龄前儿童单纯性肥胖的发生率较高,应尽快采取相应的干预措施,预防肥胖重点应放在学龄前期。     

不同营养状况下儿童青少年骨龄发育提前或落后的风险分析

目的 分析不同营养状况下儿童青少年的骨龄发育特点，探讨超重、肥胖及消瘦与骨龄发育提前或落后的相关性。方法 运用CHN法对2012年1月至2019年2月期间在首都儿科研究所附属儿童医院就诊的4~18岁7 062例（男3 310例，女3 752例）儿童的左手腕部骨龄进行评价，利用“儿童生长发育与营养评估系统”计算体质指数Z值（BMIZ），BMIZ＜-2为消瘦组，BMIZ＞+1和BMIZ＞+2分别为超重组和肥胖组，比较不同性别和营养状况下骨龄年龄差（BAD）的差异，并对超重、肥胖儿童骨龄提前的发生风险进行分析。结果 消瘦和正常儿童平均骨龄与年龄相符，超重、肥胖儿童骨龄提前，且女童提前幅度大于男童，超重男、女童分别提前1.10岁和1.36岁（P=0.000）；肥胖男、女童分别提前1.60岁和1.78岁（P=0.000）。与正常体重相比，超重男、女童骨龄提前的风险分别增加2.358倍（95% CI：2.759~4.086）和2.483倍（95% CI：2.928~4.144）；肥胖男、女童骨龄提前的风险分别增加5.820倍（95% CI：5.066~9.181）和7.537倍（95% CI：6.319~11.534）；消瘦男、女童骨龄落后的风险分别增加1.540倍（95% CI：1.481~4.355）和3.790倍（95% CI：2.245~10.221）（P均＜0.05）。结论 超重肥胖增加骨龄提前的风险，超重男、女童骨龄提前风险接近，肥胖女童骨龄提前风险大于男童。消瘦增加骨龄落后的风险。     

基因拷贝数变异与汉、维、哈三民族儿童超重/肥胖患病风险之间的关联研究

目的 了解新疆汉族、维吾尔族（简称维族）、哈萨克族（简称哈族）儿童超重/肥胖患病情况与基因拷贝数变异（CNV）之间的关系。方法 以新疆伊犁、阿勒泰和克拉玛依3个城市中的幼儿园作为研究现场,采用分层整群抽样方法抽取3~7岁儿童,测量身高、体重并采集口腔黏膜脱落细胞,采用CNVplex®方法检测FTO_1、IRX3_1、IRX3_2、MC4R_1、MC4R_2等5个位点CNV。结果 调查儿童603名,其中男307名,女296名;汉族261名,维族194名,哈族148名。汉族、维族、哈族儿童超重/肥胖率分别为28.3%、10.3%、31.1%（P < 0.001）。在哈族儿童中,IRX3_1、MC4R_2两位点CNV与超重/肥胖相关（P < 0.05）。多因素logistic回归分析显示,汉族和哈族儿童发生超重/肥胖的风险分别是维族儿童的3.443倍（95%CI：2.016~5.880）和3.924倍（95%CI：2.199~7.001）;IRX3_1位点CNV是超重/肥胖的危险因素（P=0.028,OR=2.251,95%CI：1.418~5.651）。结论 IRX3_1 CNV与汉族、维族、哈族儿童超重/肥胖的患病风险有关,尤其应关注哈族儿童中IRX3_1 CNV与超重/肥胖之间的关联性。     

儿童少年精神障碍患者入院时营养状况评价

目的 评价儿童少年精神科住院患者的营养状况,了解其营养不良及肥胖的发生率.方法　选择2010年1-6月入住新乡医学院第二附属医院儿童少年精神科患儿362例.男185例,女177例;年龄7～18岁.参照<2000年中国儿童青少年身高标准体重筛查标准>对其进行营养状况评价.结果　362例患儿中,营养不良发生率为18.8%,超重发生率为16.9%,肥胖发生率为8.8%.抑郁症、情绪障碍患儿营养不良的发生率较高,精神分裂症患儿超重和肥胖的发生率较高.结论　儿童少年精神科住院儿者存在营养问题,应对儿童青少年精神障碍住院患者进行常规营养状况筛查和干预.     

贫困地区18月龄幼儿维生素B12营养状况与膳食的相关性

目的：了解中国贫困地区18月龄幼儿的维生素B12（VB12）营养状况,以及不同食物干预对幼儿VB12营养状况的影响。方法：研究对象来自于一项婴儿辅食的随机对照干预研究。研究对象于6月龄时入组,分别给予免费肉类、强化米粉、普通米粉进行干预,随访至18月龄;18月龄时采集静脉血检测血清VB12、同型半胱氨酸（tHcy）、Hb等,并测量体格生长指标。结果：共入选217名18月龄幼儿,其中肉类干预组61名,强化米粉干预组85名,普通米粉干预组71名。217名幼儿的VB12中位数为342（85~2 700）pg·mL-1,tHcy中位数为8.20（3.30~20.40）μmol·L-1,Hb中位数为124（90~158）g·L-1。85名（39.2%）VB12<300 pg·mL-1,42名（19.4%）<200 pg·mL-1;26名（12.0%）tHcy>12 μmol·L-1;52名（24.0%）Hb<115 g·L-1。肉类干预组、强化米粉干预组和普通米粉干预组VB12中位数分别为335、422和281 pg·mL-1,3组间差异有统计学意义（P=0.013）;3组VB12<300 pg·mL-1的比例分别为肉类干预组39.4%（24名）、强化米粉干预组28.2%（24名）、普通米粉干预组52.1%（37名）,3组间差异有统计学意义（P=0.010）。结论：贫困地区幼儿VB12缺乏较普遍,与膳食中VB12摄入不足有关,强化米粉和肉类等干预有助于改善幼儿VB12营养状况。     

Prevalence of overweight,obesity, and associated risk factors among school children and adolescents in Tianjin,China

To estimate the prevalence and determinants of overweight and obesity among school children and adolescents (7–18 years), a cross-sectional study was conducted in Tianjin City of Northeast China. Five primary and middle schools were selected using a multistage random cluster sampling. Anthropometric measurements were taken by the research team. Then, standardized questionnaires on socioeconomic status, diet and lifestyle, parental weight and height were sent to the parents to be completed together with their child. Overall, 3,140 students were screened for overweight and associated risk factors. Body mass index classification reference proposed by the Working Group on Obesity in China was used as a screening reference to calculate the prevalence of overweight in these groups. The prevalence of overweight and obesity was found to be 12.5% and 15.7%, respectively. Logistic regression analysis (overweight compared with normal weight) showed that, overweight in children was significantly associated with male gender, parental obesity, parental educational level, mother’s history of gestational diabetes, high birth weight, less hours of physical activity per day, urban residence, motorized transportation, and eating food not prepared at home. After adjusting for parental obesity, the odds ratio of overweight children was increased by urban residence (rural as a reference, 2.68, 2.16–3.32), positive gestational diabetes (2.76, 1.37–4.50), and fast-food/restaurant food service (2.03, 1.34–3.07). Children who walked to school and participated in outdoor activities were 54% and 63% less likely to be overweight respectively. Conclusions: The prevalence of overweight and obesity is high among school children and adolescents in Tianjin. Changes in lifestyle, high socioeconomic status, parental obesity, mother’s history of gestational diabetes, and high birth weight are among the highly associated risk factors of overweight. An educational approach about maintaining a healthy weight should be introduced much earlier to high-risk children, parents, and women of childbearing age.     

完全母乳喂养婴儿超重的危险因素分析

目的探讨3～4月龄完全母乳喂养婴儿发生超重的危险因素,为儿童肥胖的早期干预提供理论依据。方法选取2009年7-10月青岛大学医学院附属医院和青岛市市北区妇幼保健院符合条件的3～4月龄婴儿340名作为研究对象。男182例(53.5%),女158例(46.5%)。自行设计婴儿生长发育情况调查问卷,对抚养者进行一般状况和婴儿超重危险因素调查;测量婴儿的体格生长指标。按照喂养方式的不同分为完全母乳喂养婴儿组(162例)和非完全母乳喂养婴儿组(178例)。应用病例对照研究的方法探讨完全母乳喂养婴儿发生超重的危险因素。结果 3～4月龄婴儿超重的流行情况:3～4月龄婴儿超重检出率为17.6%,男婴和女婴的超重检出率分别为16.5%、19.0%,差异无统计学意义(χ2=0.365,P=0.546)。完全母乳喂养组婴儿的超重检出率高于非完全母乳喂养组婴儿(χ2=4.457,P=0.035)。完全母乳喂养组男婴的超重检出率(22.2%)高于非完全母乳喂养组男婴(13.5%)(χ2=6.108,P=0.013),而2种不同喂养方式组女婴的超重检出率差异无统计学意义。3～4月龄完全母乳喂养婴儿超重的危险因素:父亲文化水平高、经阴道分娩、每次喂养持续时间长、喂养间隔时间短以及夜间喂养次数较多是3～4月龄完全母乳喂养婴儿发生超重的危险因素。结论完全母乳喂养婴儿超重现象较严重,为预防超重发生,改善喂养行为是重要的。     

The association of maternal overweight and obesity with breastfeeding duration

OBJECTIVE: To determine whether maternal prepregnancy overweight or obesity has an independent effect on breastfeeding duration. STUDY DESIGN: A prospective birth cohort study of 1803 live-born children and their mothers ascertained through antenatal clinics at the major tertiary obstetric hospital in Perth, Australia, were followed until 3 years of age. Unconditional logistic, Cox regression, and Kaplan Meier analyses were used to model the association between maternal prepregnancy overweight and obesity and the duration of predominant or any breastfeeding allowing for adjustment of confounders (infant factors: gender, birth weight, gestational age, age solids introduced, and older siblings; maternal factors: smoking, education, age, race, marital status, pregnancy and birth complications, cesarean section, and socioeconomic status). RESULTS: Overweight and obese women were more likely to have discontinued breastfeeding at any time before 6 months than normal weight women (P < .0005) following adjustment for potential confounders. CONCLUSION: We have shown that prepregnancy body mass index is associated with reduced breastfeeding duration, and that mothers who are overweight or obese before pregnancy tend to breastfeed their infants for a shorter duration than normal weight mothers independent of maternal socioeconomic and demographic characteristics.     

Overweight and obesity in pediatric liver transplant recipients: prevalence and predictors before and after transplant, United Network for Organ Sharing Data, 1987-2010

Perito ER, Glidden D, Roberts JP, Rosenthal P. Overweight and obesity in pediatric liver transplant recipients: Prevalence and predictors before and after transplant, United Network for Organ Sharing Data, 1987–2010.
Pediatr Transplantation 2012: 16: 41–49. © 2011 John Wiley & Sons A/S. Abstract: Obesity is extremely common in adult liver transplant recipients and healthy U.S. children. Little is known about the prevalence or risk factors for post‐transplant obesity in pediatric liver transplant recipients. UNOS data on all U.S. liver transplants 1987–2010 in children 6 months–20 yr at transplant were analyzed. Subjects were categorized as underweight, normal weight, overweight, or obese by CDC guidelines. Predictors of weight status at and after transplant were identified using multivariate logistic regression. Of 3043 children 6–24 months at transplant, 14% were overweight. Of 4658 subjects 2–20 yr at transplant, 16% were overweight and 13% obese. Children overweight/obese at transplant were more likely to be overweight/obese at one, two, and five yr after transplant in all age groups after adjusting for age, ethnicity, primary diagnosis, year of transplant, and transplant type. Weight status at transplant was not associated with overweight/obesity by 10 yr after transplant. The prevalence of post‐transplant obesity remained high in long‐term follow‐up, from 20% to 50% depending on age and weight status at transplant. Weight status at transplant is the strongest predictor of post‐transplant overweight/obesity. To optimize long‐term outcomes in pediatric liver transplant recipients, monitoring for obesity and its comorbidities is important.     

Obesity and under-nutrition in a tertiary paediatric hospital

OBJECTIVE: (i) To determine the prevalence of over- and under-nutrition in both inpatients and outpatients in a tertiary paediatric hospital; (ii) to compare the prevalence of over-nutrition with that in the Australian community and (iii) to determine whether nutritional status has an impact on length of stay in hospital. METHODS: Patients aged over 12 months were proportionately sampled from medical and surgical wards and outpatient clinics. Data were collected for 245 inpatients (54% male) and 272 outpatients (55% male). Children's height, weight and body mass index (kg/m2) were measured. Overweight, obesity and under-nutrition were defined according to international criteria. Prevalence of overweight and obesity was compared with that in the 1995 Australian National Nutrition Survey (NNS). RESULTS: Similar proportions of inpatients and outpatients were underweight (6%) and wasted (4%). The prevalence of overweight and obesity in inpatients (22%) was similar to the NNS but was significantly higher in outpatients (32%, P < 0.0001). In a regression model to predict inpatient length of stay, nutritional status (P = 0.004) and the interaction between age and nutritional status (P = 0.009) were significant predictors. For over-nourished inpatients, length of stay increased significantly with age. For normally nourished and under-nourished inpatients, length of stay was relatively constant, regardless of age. CONCLUSIONS: There is a high prevalence of over-nutrition in paediatric patients, and increased length of stay for older over-nourished inpatients. These issues need to be addressed in terms of opportunities for intervention and impact on hospital resources.     

Breastfeeding and obesity at 14 years: a cohort study

AIM: To determine the influence of breastfeeding on overweight and obesity in early adolescence. METHODS: Data about breastfeeding duration, BMI of children at 14 years, and confounding variables, were collected from an ongoing longitudinal study of a birth cohort of 7776 children in Brisbane. Prevalence of overweight and obesity at 14 years was assessed according to duration of breastfeeding, with logistic regression being used to adjust for the influence of confounders. RESULTS: Data were available for 3698 children, and those not included were significantly different in age, educational level, income, race, birthweight, and small-for-gestational-age status. Breastfeeding for longer than six months was protective of obesity (OR 0.6, 95% CI 0.4, 0.96) though not of overweight. When confounding variables were considered the effect size diminished and lost statistical significance OR 0.8 (95% CI 0.5, 1.3). Breastfeeding for less than 6 months had no effect on either obesity or overweight though a trend was found for increased prevalence of overweight at 14 years with shorter periods of breastfeeding. CONCLUSION: This investigation contributes to the gathering body of evidence that breastfeeding for longer than 6 months has a modest protective effect against obesity in adolescence.     

陕南农村地区6~12月龄婴儿贫血的风险因素分析

目的探讨陕南农村地区6~12月龄婴儿的贫血发生情况及其风险因素。方法采用问卷调查方法收集陕南农村地区6~12月龄婴儿的个人和家庭基本情况、喂养行为信息,并测定血红蛋白含量。采用多因素logistic逐步回归法分析婴儿贫血发生的风险因素。结果共有1 802例婴儿及其家庭参与该调查,有效样本1 770例。婴儿贫血检出865例(48.87%,865/1 770)。多因素logistic逐步回归分析显示,生后一直母乳喂养(多未科学添加辅食)增加婴儿患贫血的风险(OR=1.768,P0.01);辅食添加符合WHO推荐的最小进餐频率标准(OR=0.779,P0.05)及使用配方奶喂养(OR=0.658,P0.01)是婴儿贫血的保护因素。结论在陕南农村地区6~12月龄婴儿贫血依然是严重的公共卫生问题。喂养不当会增加婴儿贫血的风险,减少婴儿贫血的关键是科学添加辅食。     

Addressing obesity in the first 1000 days in high risk infants: Systematic review

Early intervention is critical for addressing the challenge of childhood obesity. Yet many preventive interventions do not target infants most at risk of future overweight or obesity. This systematic review examines interventions delivered before 2 years that aim to ameliorate excess weight gain among infants at high risk of overweight or obesity, due to sociodemographic characteristics, parental weight or health status, infant feeding or health behaviours. We searched six databases for interventions: (a) delivered before age two, (b) specifically aimed at infants at high risk of childhood obesity and (c) that reported outcomes by weight status beyond 28 days. The search identified over 27,000 titles, and 49 papers from 38 studies met inclusion criteria: 10 antenatal interventions, 16 postnatal and 12 conducted both before and after birth. Nearly all targeted infant and/or maternal nutrition. Studies varied widely in design, obesity risk factors, outcomes and quality. Overall, nine interventions of varying quality reported some evidence of significantly improved child weight trajectory, although effects tended to diminish over time. Interventions that improved weight outcomes tended to engage parents for a longer period, and most offered health professional input and support. Two studies of limited quality reported significantly worse weight outcomes in the intervention group.     

Overweight and obesity in Norwegian children: prevalence and socio‐demographic risk factors

Aim: The aim of this study was to estimate the prevalence of childhood overweight and obesity and to identify socio‐demographic risk factors in Norwegian children. Methods: The body mass index of 6386 children aged 2–19 years was compared with the International Obesity Task Force (IOTF) cut‐off values to estimate the prevalence of overweight including obesity (OWOB) and obesity (OB). The effect of socio‐demographic factors on this prevalence was analysed using multiple ordinal logistic regression analysis in a subsample of 3793 children. Results: The overall prevalence of OWOB was 13.8% (13.2% in boys and 14.5% in girls, p = 0.146), but the prevalence was higher in primary school children aged 6–11 years (17%, p < 0.001). The risk of being OWOB or OB increased in children with fever siblings (p = 0.003) and with lower parental educational level (p = 0.001). There was no association with parental employment status, single‐parent families or origin. Conclusion: The prevalence of OWOB and OB in Norwegian primary school children is of concern. Socio‐demographic factors have pronounced effects on the current prevalence of overweight and obesity in a cohort of Norwegian children. This knowledge could help to work out strategies to reduce the burden of overweight and obesity in children.