生长曲线的拟合方法及营养评价界值点的选择

平滑技术和分布转换是生长曲线拟合的两大理论问题。三次样条函数和分段多项式是目前最常用的曲线平滑技术。鉴于偏态分布资料无法直接获得准确的标准差单位（SDS,或Z分）曲线,美国国家健康统计中心（NCHS）分别计算上半部和下半部的标准差,而分布转换却能解决上述问题,将原始数据正态转换后再做平滑处理不仅可以获得合理的Z分曲线,极端（或边际）曲线估计亦更为精确,目前常用的转换有Box-Cox正态转换和Box-Cox 幂指数转换。身高和体重是两项最简单的、能用于评估居民营养状况的人体测量指标。近年来随着对人体测量学的深入研究,这些指标应用范围不断扩大,各国家或地区结合实际已制定（或选用）了儿童生长参照标准,并根据生长及营养状况确定了适宜的界值点。从目前研究看,儿童体格生长指标界值点多是以人群为基础的统计界值,更多地是从营养监测、卫生经济学和公共卫生理论角度考虑,这种筛查界值点并不是一个独立的诊断标准,临床应用时要结合其它指标及临床症状或体征。     

体质量指数和腰围与肥胖儿童心血管危险因素关系的研究

目的 探讨体质量指数(BMI)、腰围与肥胖儿童心血管危险因素的关系.方法 回顾性分析2001年1月至2005年12月在上海交通大学医学院附属仁济医院肥胖病专科门诊就诊的6～18(11.8±3.0)岁患儿283例,其中男179例(11.4±3.0)岁,女104例(12.3±3.0)岁,测体重、身高、腰围、臀围、血压、血清总三酰甘油(甘油三酯,TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C),并计算BMI和腰臀比.结果 283例患儿血脂水平异常147例(51.9%),其中1项指标异常100例,2项异常34例,3项异常和4项全部异常为11例和2例.131例患儿TG升高,42例TC升高,HDL-C降低和LDL-C升高分别为20例和17例.283例患儿中高血压131例(46.3%),收缩压(SP)增高112例,舒张压(DP)增高88例,69例两者均增高.校正年龄和性别后,BMI与血清TG水平正相关(r=0.13,P<0.05).腰围不仅与血清TG水平呈正相关(r=0.21,P<0.01),还与血清HDL-C负相关(r=-0.14,P<0.05).腰围与血脂紊乱程度也呈正相关,而BMI则无类似关系.BMI和腰围均与SP、DP呈正相关.腰围异常患儿SP、DP和血清TG明显增高,而HDL-C明显降低.高血压组儿童腰围、血清Tc、LDL-C水平明显高于血压正常组儿童.结论 肥胖儿童易并发脂质代谢紊乱和高血压等心血管危险因素.BMI和腰围与肥胖儿童心血管危险因素关系密切.不同年龄、性别,腰围第95百分位值可作为腰围正常与否的临界点.     

超重肥胖儿童青少年代谢综合征流行现状调查

目的 了解上海市浦东新区川沙地区超重肥胖儿童青少年中代谢综合征(MS)的流行现状和临床特点.方法 对432例7～15岁超重肥胖儿童青少年进行体格测量和血液生化检测.应用Cook定义诊断MS,具有下列5项中至少3项者诊断为MS:腹型肥胖、高血压、高血糖、高甘油三脂(TG)血症和低高密度脂蛋白胆固醇(HDL-C)血症.结果 腹型肥胖、高血压、高血糖、高TG血症和低HDL-C血症的总检出率分别为85.9%、44.4%、13.4%、48.6%和9.0%.具有0、1、2和3项及3项以上MS组分者分别占4.4%、28.3%、36.3%和31.0%.约95%的个体至少有1项MS组分异常,约60%～70%的个体至少有2项异常.共检出MS134例,检出率为31.0%.结论 川沙地区超重肥胖儿童青少年多存在明显的代谢紊乱,MS的流行已相当严重,接近发达国家水平.     

Prevalence of overweight and obesity in youth with diabetes in USA: the SEARCH for Diabetes in Youth Study

Liu LL, Lawrence JM, Davis C, Liese AD, Pettitt DJ, Pihoker C, Dabelea D, Hamman R, Waitzfelder B, Kahn HS. Prevalence of overweight and obesity in youth with diabetes in USA: the SEARCH for Diabetes in Youth Study.
Objective: Obesity's association with type 2 diabetes (T2DM) is well established, but is less clear with type 1 diabetes (T1DM). We calculated the prevalence of overweight and obesity among diabetic youth in the USA from a six-center, population-based study of racially and ethnically diverse youth with diabetes, and we compared these rates with estimates among nondiabetic youth.
Design/setting: Diabetic participants were examined in 2001−2004 for the SEARCH for Diabetes in Youth study (SEARCH) and nondiabetic participants were examined during the same years of the National Health and Nutrition Examination Survey (NHANES).
Participants: 3953 diabetic youth and 7666 nondiabetic youth aged 3−19 yr.
Main outcome measures: Overweight was defined as body mass index (BMI) from the 85th to <95th percentile for age and sex and obesity defined as ≥95th percentile. Diabetes type was categorized as T1DM or T2DM based on physician diagnosis.
Results: Among youth with T2DM, the prevalence of overweight was 10.4% and obesity was 79.4%. Among youth with T1DM, 22.1% were overweight. The prevalence of overweight among youth with T1DM was higher than among those without diabetes overall (22.1% vs. 16.1%) (P <.05). The obesity rate for T1DM was 12.6% overall (range Non-Hispanic White 10.7%−African-American 20.1%).
Conclusions: As expected, most of the youth with T2DM were obese. Youth with T1DM had a higher prevalence of overweight, but not of obesity, than nondiabetic youth. Future studies of obesity among youth with diabetes of all types will further our understanding of the impact of obesity on diabetes both as a risk factor and a comorbidity.     

上海地区7 326名在校学生高血压分布趋势及相关因素分析

目的了解上海城区中小学生血压现况、高血压检出率,为预防儿童高血压提供依据。方法测量上海城区11所中小学7326名6-18岁在校学生身高、体重、血压。结果在校学生高血压总检出率为6．9％（502／7326例）,高血压检出率在体质指数（BMI）正常学生中仅为4．8％（303／6053例）,在超重和肥胖学生分别为8．8％（84／946例）、17．9％（113／630例）;超重和肥胖学生高血压检出率显著高于BMI正常者（χ^2=98．9、78、7,P均〈0．01）;上海地区6—18岁儿童青少年血压与BMI独立正相关。结论在校儿童青少年超重和肥胖者高血压的危险性明显增加,上海地区6—18岁在校学生血压与BMI独立相关。防治儿童青少年超重和肥胖是预防高血压的重要措施。     

两种标准筛查儿童超重和肥胖的比较

目的 探讨更适合中国儿童的超重、肥胖初筛标准.方法 对广西南宁地区13万余儿童(年龄7～18周岁)进行流行病学调查,参照国内、国际两种儿童超重及肥胖标准进行分析比较.结果 大多数年龄组超重及肥胖儿童国内标准的检出率均高于国际标准,肥胖的发生率在7～10岁组升高,男童超重及肥胖的检出率高于女童.结论 使用国内的儿童超重及肥胖标准可能更有利于我国儿童青少年超重、肥胖的早期干预.     

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目的 分析超重和肥胖儿童的骨强度状况.方法 以2003年10月至2007年1月在首都儿科研究所门诊查体的1270名2～18岁儿童青少年为研究对象,2～6岁学龄前儿童按WHO/NCHS身高别体重标准判定超重与肥胖,>6～18岁学龄儿童根据中国肥胖工作组制定的体重指数(BMI)标准判定超重与肥胖.用Omnisense7000P型定量超声仪测量骨强度、Genius型体成份仪测量体成份.结果 学龄前肥胖儿童胫、桡骨骨强度均低于正常儿童,胫、桡骨骨强度下降风险分别是正常儿童的6.87倍和2.24倍;超重组与正常组无差别.学龄儿童正常、超重、肥胖组的胫骨骨强度依次下降,肥胖、超重组胫骨骨强度下降风险是正常组的9.73和2.54倍;学龄肥胖组桡骨骨强度低于正常组,超重组与正常组无差别.肥胖儿童不同部位骨强度存在差异.肥胖儿童的体脂含量与骨强度呈负相关(r胫=-0.35;r桡=-0.33).结论 肥胖儿童骨强度较正常儿童差,临床工作中应关注肥胖儿童的骨健康状况,并且应多部位测量以便全面了解骨强度状况.     

Socio‐economic and ethnic differences in the prevalence of overweight and obesity among school children

Aims: To trial the collection of measurements to provide population‐based prevalence of overweight and obesity in school children in western Sydney and examine the association between healthy weight and ethnicity and socio‐economic status (SES) in a socio‐economically and culturally diverse population. Methods: A cross‐sectional population‐based survey of 2341 children in Years 4 and 7 (mean ages 9 and 12 years, respectively) in 2007. Results: Nineteen per cent of children were overweight and a further 6% were obese. The prevalence of combined overweight and obesity was similar for boys and girls (26% vs. 24%, P= 0.35). SES was significantly associated with the prevalence of unhealthy weight: the odds of being overweight or obese were 1.79 times (95% confidence interval (CI) 1.35 to 2.36) higher for children from the lowest quartile than for children from the highest quartile. Compared to children from an English speaking background, children from a non‐English speaking background were significantly more likely to be overweight or obese (21% vs. 31%, P < 0.001). The prevalence of combined overweight and obesity was significantly higher for children from a Pacific Island (odds ratio (OR) 2.66, 95% CI 1.63 to 4.33), Middle Eastern (OR 1.63, 95% CI 1.22 to 2.17) or European (OR 1.67, 95% CI 1.12 to 2.49) background than for English speaking background children. Conclusion: Large jumps in the prevalence of overweight and obesity in children observed from the 1980s appear to be diminishing, with comparable prevalence reports in 2004 and 2007. Ethnicity and SES are each independently associated with the prevalence of unhealthy weight in children.     

饮食和运动干预对超重/肥胖打工者子女控制BMI的效果研究

目的 探讨饮食和运动干预对改善打工者子女超重/肥胖的长期效果.方法 采用自身前后对照的类实验性研究,于2010年3月对北京市两个打工者子女小学的30例9～12岁超重/肥胖儿童进行为期11周的饮食和运动干预.结果 干预后1周体重指数(BMI)明显低于干预前水平,差异有统计学意义(P＜0.05),但干预后2个月、3个月、6个月与干预前相比,BMI升高,差异有统计学意义(P＜0.05).结论 饮食和运动干预能有效改善BMI,但对BMI维持时间较短,其长期效果需要进一步探讨.超重/肥胖的控制是一个长期过程,需要得到其父母的共同监督和参与才能获得较好的维持效果.     

Prevalence trends of obesity and overweight among 10-year-old children in western Sweden and relationship with parental body mass index

AIM: To determine the regional prevalence, secular and family-related trends of obesity and overweight among 10-y-old children. METHODS: A cross-sectional study of 10-y-old children, born in 1990, was performed during September 2000 to June 2001 at school health centres in three communities in the western part of Sweden. Evaluation was performed in 6311 children, or 81% of the target population. Data from a cohort of children, born in 1974, who form the national growth charts, were available for comparison. RESULTS: The mean body mass index was 17.9 kg/m2 in 10-y-old children born in 1990 and 17.0 kg/m2 for 10-y-olds born in 1974 (p < 0.0001). Of the 10-y-old children in 2000-2001, born in 1990, 18% were overweight and 2.9 % obese, which corresponds to a twofold increase in presence of overweight and a fourfold increase in presence of obesity among 10-y-old children from 1984 to 2000. There was a significant correlation between parental and child body mass index. The prevalence of obesity and being overweight appeared to be higher in children whose parents did not participate in the study. CONCLUSION: During a 16-y period, from 1984 to 2000, a twofold increase in being overweight and a fourfold increase in obesity were seen among 10-y-old children in the western part of Sweden. Parental ponderosity or reluctance to participate in the study was related to a higher prevalence of being overweight or obese in the children. There is a need for the healthcare system to recognize the threats to the health of the population of this new "epidemic" and initiate preventive measures and treatment programmes.     

Parental perception of overweight and underweight in children and adolescents

Aims: To compare the parental perception of overweight and underweight in their children to objective criteria, based on body mass index (BMI), waist circumference and triceps skinfold thickness, and to explore the effects of potential determinants. Methods: Logistic regression of anthropometric measurements, socio‐demographic characteristics and self‐reported parental height and weight on the parental perception of their child’s weight status in 3770 children aged 2–19. Results: Seventy per cent of overweight/obese children and 40.8% of underweight children were perceived having normal weight by parents. In 2‐ to 5‐year‐old overweight children, 91.2% were considered to have normal weight. For a given BMI, primary school age children, adolescents and girls had a higher probability to be assigned as overweight, whereas adolescents and girls had a lower probability to be assigned as underweight. Overweight parents more readily assigned their children as underweight, but there was no effect of parental educational level or parental underweight. Conclusion: Parental ability to recognize overweight or underweight in their offspring was generally poor. The findings emphasize the need for objective criteria based on physical measurements in the routine follow up of children, as parental ability to recognize weight problems in their children is nonreliable.