儿童早期单纯肥胖症的流行病学及危险因素研究进展

儿童早期肥胖率在发达国家居高不下并保持上升趋势,在发展中国家的城市地区日益蔓延,部分地区的增长失控,肥胖率已接近发达国家.在不同人群中,儿童早期肥胖率分布的差异较大.危险因素包括:父母肥胖,高或低的出生体重,出生追赶和体重增长过快,家长错误的喂养行为和观念等,与儿童早期营养相关的家庭因素,不合理饮食、运动和睡眠时间少,看电视和静坐时间长等儿童不良行为习惯.     

Dietary risk factors for development of childhood obesity

PURPOSE OF REVIEW: Controversial information exists on the contribution of several dietary factors for overweight development in childhood, but there is no doubt that obesity prevalence is increasing. We review the most up-to-date information in order to clarify the evidence-based dietary aspects influencing obesity development in children and adolescents. RECENT FINDINGS: Longitudinal studies are the preferred method for analysing the relationship between dietary factors and obesity development. With the exception of infants, there are no conclusive associations between energy intake or diet composition and later overweight development in children. Among formula or mixed-fed infants, the increase in energy intake has been associated with an increased risk of being overweight during childhood. Breastfeeding seems to be a protective factor for later obesity development. In terms of food intake, longitudinal studies have only found a clear and positive association between obesity development and sugar-sweetened beverage consumption; this is not the case with snacking, fast food or food portion sizes. Cross-sectional studies have found correlations between being overweight in childhood and buying lunch at school, eating supper while watching television or without family supervision, consuming less energy at breakfast or more at dinner, and missing breakfast. SUMMARY: Results from longitudinal studies must be taken into account in order to design preventive strategies to counteract the increased prevalence of obesity and its consequences in children. Lack of breastfeeding, high early energy intake and high intake of sugar-sweetened beverages seem to be the main dietary factors contributing to obesity development.     

中国成年人代谢异常相关的体质指数和腰围切点研究

目的 研究中国成年人BMI和腰围与各项代谢危险因素之间的相关性,确定超重肥胖的适宜BMI和腰围切点。方法 中国慢性病前瞻性研究于2004-2008年进行基线调查,并于2013-2014年随机抽取了5%的研究对象进行第2次重复调查。本研究剔除体格指标或代谢危险因素变量缺失或极端值、自报患有恶性肿瘤者,基线纳入501 201人,第2次重复调查纳入19 201人。比较不同BMI和腰围下代谢危险因素异常率,通过受试者工作特征（ROC）曲线分析,确定预测高血压、糖尿病、血脂异常和危险因素聚集的适宜BMI和腰围切点。结果 随BMI或腰围的增加,高血压、糖尿病、血脂异常和危险因素聚集患病率均呈现上升的趋势。依据正确指数最大的原则选取BMI超重切点和腰围切点,男性和女性BMI超重切点均接近24.0 kg/m²,男性腰围切点接近85 cm,女性腰围切点约为80~85 cm。男性和女性中,检出各项代谢危险因素特异度达到90%的BMI切点范围为27.0~28.9 kg/m²,多数接近28.0 kg/m²,以28.0 kg/m²作为肥胖切点。结论 本研究在更新开展的大样本调查中进一步验证了中国肥胖问题工作组2002年推荐的超重和肥胖标准,超重和肥胖的BMI切点分别为24.0和28.0 kg/m²;中心性肥胖的腰围适宜切点男性为85 cm,女性为80~85 cm。     

肥胖和多代谢异常的相关性研究

[目的 ]　探讨肥胖和多代谢异常的关系。　 [方法 ]　在常熟市慢性病基线调查和多中心合作研究调查的人群中确定肥胖组和对照组 ,应用病例对照研究的方法 ,对两组人群的血压、血脂和血糖进行分析比较。　 [结果 ]　肥胖组中的血压和血脂水平和异常率均要高于对照组 ,并且体重指数 (BMI)和收缩压、舒张压、血清胆固醇以及三酰甘油之间有很好的线性关系。肥胖组的血糖水平和对照组相比 ,在女性其差异具有显著性 ,而在男性则差异不显著。总体而言 ,肥胖组代谢异常率要比对照组高 ,差异具有显著性。　 [结论 ]　在代谢综合征中 ,肥胖起着重要作用。必须重视肥胖问题 ,特别在社区卫生服务中 ,应该积极开展肥胖的防治工作     

The choice of cutoffs for obesity and the effect of those values on risk factor estimation

Several studies have examined risk factors for overweight and obesity. However, inconsistent results have been observed for estimations of some risk factors, such as the infant feeding method, and for their link to childhood obesity. These studies originated from different countries and used different body mass index cutoffs to define overweight and obesity. Using a theoretical approach and data obtained in preschoolers, we show that the identification of genuine risk factors for overweight or obesity does not depend on the choice of the reference system. However, for meaningful international comparisons, in particular for those of prevalence, studies should also report estimates by using a widely accepted international reference system.     

Prospective study of physical and psychosocial risk factors for sickness absence

AIM: To investigate the associations between psychosocial and physical work environment exposures and sickness absence from work taking into account health, health behaviour and employer characteristics known to affect sickness absence. METHODS: In 1995, a random sample of 5574 employees aged 18-64 years were interviewed. In 2000, 3792 of those still employed supplied data on days absent from work the year preceding the date of follow-up. Associations between risk factors at baseline and sickness absence at follow-up were studied. Logistic regression analyses were performed. RESULTS: Sickness absence was associated with working with arms lifted/hands twisted, extreme bending/stooping of the back/neck, repetitive monotonous work, low skill discretion, low decision authority, obesity, current and former smoking, poor self-rated health, female gender, increasing age and public employer. The aetiological fraction attributable to differences in work environment exposures was calculated to be 40%. CONCLUSION: The study suggests a potential for reducing sickness absence through multifactorial interventions towards smoking, obesity, physical and psychosocial work environment exposures. The study showed that differences in work environment exposures account for 40% of the cases of high sickness absence.     

济南市儿童肥胖和代谢综合征患病率及其影响因素

目的探讨济南市儿童肥胖和肥胖儿童代谢综合征的患病率及其影响因素。方法在济南市5个区和下辖章丘市农村各随机抽取1所小学,对每所小学4~6年级学生进行人体测量,其中45例肥胖儿童给予生活干预治疗3个月,比较干预前后血脂、血糖、胰岛素、高敏C反应蛋白等指标变化。采用SPSS 13.0软件,代谢综合征危险因素的分析采用非条件logistic回归分析。结果接受调查学生3 354例,其中男生1 698例,女生1 656例;市区内各区肥胖、超重比较,差异无统计学意义。儿童肥胖的患病率市区是14.1%,农村是4.1%;超重患病率市区是17.3%,农村4.1%;肥胖儿童代谢综合征患病率市区23.1%,农村18.8%;对总的调查人群,市区代谢综合征患病率为2.7%,农村0.5%。生活干预后动脉粥样硬化的危险因素明显改善。结论济南市儿童肥胖、超重、代谢综合征的患病率已经呈现流行趋势,改变儿童生活方式势在必行。     

Heritability of the risk factors characteristic for the metabolic syndrome: a twin study

Both genetic and environmental factors play role in the pathogenesis of the metabolic syndrome. The magnitude of genetic and environmental influences on the components of metabolic syndrome may vary in different populations. Aims: The present study was aimed to determine the effects of genetic and environmental factors on risk factors characteristic for the metabolic syndrome. Methods: A total of 101 (63 monozygotic and 38 dizygotic) adult twin pairs (n=202; mean age: 43.3±15.8 years) were investigated. Medical history was recorded and physical examination was carried out for each subject. Fasting venous blood samples were used for measuring laboratory parameters. The presented estimates include the heritability structural equation (A-C-E) model results. In Model-1, all presented parameters are age- and gender- corrected. In Model-2, parameters were corrected for age, gender, body mass index and waist circumference. Results: Heritability in waist circumference (as well as in other anthropometric parameters such as weight and height) was high (Model-1: 71.0-88.1%). Similarly, genetic factors had the highest proportion of total phenotypic variance in systolic and diastolic blood pressure (Model-2: 57.1% and 57.7%, respectively). Based on the results of Model-2, unique environmental factors dominate alterations in serum triglycerides values (55.9%) while shared environmental factors proved to be substantial in alterations of HDL-cholesterol and fasting blood glucose values (58.1% and 57.1%, respectively). Comparing the results of Model-1 and Model-2, the difference in A-C-E model varied from 0.0% to 17.1%, indicating that only a minor proportion of genetic and environmental influences can be explained by the effects of anthropometric parameters. Conclusions: Among adult Hungarian healthy people, genetic factors have substantial influence on waist circumference and blood pressure values while environmental factors dominate alterations in serum triglycerides, HDL-cholesterol and fasting blood glucose values. The different heritability of individual risk factors challenges the original unifying concept of the metabolic syndrome. The results may be useful for establishing and implementing primary cardiovascular prevention both at individual and population levels.     

Associations between early body mass index trajectories and later metabolic risk factors in European children: the IDEFICS study

Faster growth seems to be a common factor in several hypotheses relating early life exposures to subsequent health. This study aims to investigate the association between body mass index (BMI) trajectories during infancy/childhood and later metabolic risk in order to identify sensitive periods of growth affecting health. In a first step, BMI trajectories of 3301 European children that participated in the multi-centre Identification and Prevention of Dietary and Lifestyle-induced Health Effects in Children and Infants (IDEFICS) study were modelled using linear-spline mixed-effects models. The estimated random coefficients indicating initial subject-specific BMI and rates of change in BMI over time were used as exposure variables in a second step and related to a metabolic syndrome (MetS) score and its single components based on conditional regression models (mean age at outcome assessment: 8.5 years). All exposures under investigation, i.e. BMI at birth, rates of BMI change during infancy (0 to <9 months), early childhood (9 months to <6 years) and later childhood (≥6 years) as well as current BMI z-score were significantly associated with the later MetS score. Associations were strongest for the rate of BMI change in early childhood (1.78 [1.66; 1.90]; β estimate and 99 % confidence interval) and current BMI z-score (1.16 [0.96; 1.38]) and less pronounced for BMI at birth (0.62 [0.47; 0.78]). Results slightly differed with regard to the single metabolic factors. Starting from birth rapid BMI growth, especially in the time window of 9 months to <6 years, is significantly related to later metabolic risk in children. Much of the associations of early BMI growth may further be mediated through the effects on subsequent BMI growth.     

A registry-based case-control study of risk factors for the development of multiple non-fatal injuries on the job

Using compensation records of Taiwan, we conducted a case-control study nested within a cohort of 77,846 active workers who experienced at least one incidence of non-fatal work-related injury between 1994 and 1996 in order to explore factors associated with risk of sustaining multiple non-fatal injuries in the workplace. Cases (n = 2,616) were workers with more than three incidences of non-fatal injury during the study period and controls (n = 3,974) were randomly sampled from workers who experienced only one incidence of non-fatal injury during the same period. Compared with construction workers, workers employed in mining and quarrying (OR = 2.7), manufacturing (OR = 1.2), commerce (OR = 1.6), transport, storage and communication (OR = 1.3) and social, personal and community service (OR = 1.4) were all at significantly elevated risk of multiple non-fatal injuries. Both age and wage showed a significant dose-response effect on the risk of developing multiple non-fatal injuries. The preliminary analysis suggests that workers in certain industries are at significantly elevated risks of multiple work-related non-fatal injuries, in particular those in the mining and quarry industries. Additionally, further preventive measures should be aimed at protecting older workers from such injuries and further studies would help provide more specific interpretations on the positive association between higher wage earning and risk of multiple non-fatal injuries.     

呼吸机相关肺炎发病率及危险因素前瞻性研究

目的了解呼吸机相关肺炎(VAP)发病率及其危险因素,为预防VAP提供依据。 方法对 2006年1月-2011年12月2所三级甲等综合医院使用呼吸机患者开展VAP前瞻性监测,选取发生VAP医院感染患者作为VAP组,未发生VAP医院感染患者作为非VAP组（1∶1配比）,进行危险因素分析。结果共监测使用呼吸机患者2 550 例,发生VAP 475例,机械通气总日数32 623 d,VAP发病率为14.56‰。单因素分析表明：反复呼吸道感染病史、1个月内使用广谱抗菌药物、多次住院、昏迷、低蛋白血症、脱机失败后再次插管、使用糖皮质激素、机械通气＞5 d、误吸、口腔卫生情况差是VAP发生的危险因素。多因素logistic 回归分析显示,昏迷(OR 95% CI：1.38～2.93)、低蛋白血症(OR 95% CI：1.12～2.10)、使用糖皮质激素(OR 95% CI：1.10～2.24)、脱机失败再次插管(OR 95% CI：2.14～4.74)、机械通气＞5 d(OR 95% CI：2.55～4.83)、误吸(OR 95% CI：1.24～2.77)、口腔卫生情况差(OR 95% CI：1.72～3.74)是VAP发生的独立危险因素。结论VAP发病率较高,其危险因素众多,应采取正确的口腔清洁、抬高头位、及时评估撤机、改善营养状况等综合干预措施,降低VAP的发病率。     

Blastomycosis in Missouri: epidemiology and risk factors for endemic disease

Between 1992 and 1999, 93 cases of blastomycosis, including 25 laboratory confirmed cases, were identified in Missouri (annual incidence, 0.2/100,000 population). Mississippi County in southeastern Missouri had the highest incidence (12/100,000) with a much higher rate among blacks than whites in this county (43.21/100,000). The mortality rate, 44% was also higher among blacks. To determine risk factors for endemic blastomycosis, a case-control study was conducted among southeastern Missouri residents. Independent risk factors for blastomycosis were black race and a prior history of pneumonia. No environmental exposures or socioeconomic factors were significantly associated with increased risk. The increased risk among blacks may possibly be related to genetic factors, but further studies are needed to clarify this. However, heightened awareness of the disease and a better understanding of the risk factors are important and may lead to earlier diagnosis and start of treatment, possibly improving outcome.     

高血压预测最佳肥胖指标及其切点值筛选

目的筛选预测高血压的最佳肥胖指标并确定其切点值,为高血压的预防控制提供参考依据。方法采用分层随机抽样方法对在辽宁省2010年第三次国民体质监测3个监测点（沈阳、丹东、朝阳市）抽取的5 817名20~69岁成年居民进行体格检查;应用logistic回归模型筛选预测高血压的肥胖指标,通过受试者工作特征曲线（ROC）评价腰围身高比（WSR）、腰围、体质指数（BMI）、腰臀比（WHR）、腹部皮褶厚度和锥削度指数（CI）对高血压的预测效果,以最大约登指数确定其切点值。结果辽宁省20~69岁成年居民高血压检出率为24.9%,其中男性居民为31.6%,高于女性居民的18.3%,差异有统计学意义（χ²=136.7,P<0.001）;logistic回归分析结果表明,WSR和BMI为预测成年居民高血压的肥胖指标,其中男、女性WSR的β值分别为0.50和0.58,均大于BMI的0.23和0.20;与其他肥胖指标比较,WSR预测高血压的受试者工作特征曲线下面积（AUC）最大（男性：0.67,95%CI=0.65~0.69;女性：0.72,95%CI=0.70~0.75）,且女性WSR的AUC大于男性（P<0.05）;WSR预测高血压的切点值男性为0.50,女性为0.49;男、女性WSR大于切点值者高血压的危险度分别是小于切点值者的2.62倍（OR=2.62,95%CI=2.22~3.09）和4.51倍（OR=4.51,95%CI=3.62~5.61）。结论WSR是预测20~69岁成年居民特别是女性高血压的最佳肥胖指标。     

产后抑郁症的发生率及其心理社会因素研究

目的调查产后抑郁症的发生率以及相关的心理社会因素.方法采用爱丁堡产后抑郁量表(Edinburgh PostnatalDepression Scale,EPDS)对427例产后4～6周妇女的抑郁状态进行调查,相关的心理社会因素用logistic回归模型分析.结果产后抑郁症的发生率为7.3%(31/427);产后缺乏社会支持、孕期抑郁情绪、过低或过高的家庭收入与产后抑郁症密切相关.结论心理社会因素对产后抑郁症发生的影响不容忽视.     

产后抑郁症的发生率及其心理社会因素研究

目的 :调查产后抑郁症的发生率以及相关的心理社会因素。方法 :采用爱丁堡产后抑郁量表 ( Edinburgh PostnatalDepression Scale,EPDS)对 4 2 7例产后 4～ 6周妇女的抑郁状态进行调查 ,相关的心理社会因素用 logistic回归模型分析。结果 :产后抑郁症的发生率为 7.3% ( 31/ 4 2 7) ;产后缺乏社会支持、孕期抑郁情绪、过低或过高的家庭收入与产后抑郁症密切相关。结论 :心理社会因素对产后抑郁症发生的影响不容忽视     

不同类型肥胖与心血管疾病危险因素关联的比较

目的 比较不同类型肥胖与心血管疾病(CVD)危险因素的关联,为预防和控制心血管疾病提供科学依据.方法 利用"2002年中国居民营养与健康状况调查"资料,按照<中国成人超重和肥胖症预防控制指南>中判定肥胖的界值点[体重指数(BMI):24kg/m2和28 kg/m2;腰围:男性85 cm和95 cm,女性80 cm和90 cm]判定肥胖类型,比较不同类型肥胖人群与罹患CVD危险因素的关联;用logistic回归和多元线性回归分析BMI和腰围与CVD危险因素的关系.结果 与体重和腰围均在正常范围的人群(OR=1)相比,正常体重并高腰围Ⅰ(男性85～95 cm,女性80～90 cm)的人群、超重但腰围正常的人群罹患CVD危险因素的风险为1～2倍,超重并高腰围Ⅰ、肥胖但腰围正常的人群为2～3倍,超重并高腰围Ⅱ(男性≥95 cm,女性≥90 cm)、肥胖并高腰围Ⅰ或Ⅱ(男性≥85 cm,女性≥80 cm)的人群为≥3倍;同一腰围组中,随着BMI增加罹患CVD危险因素的风险也呈逐渐增加趋势;BMI和腰围同时解释CVD危险因素变异的1.7%～9.4%,大于BMI或腰围单独解释的比例(1.5%～9.0%);BMI对于收缩压的标化回归系数为0.129,略大于腰围(0.123),腰围对甘油三酯、总胆固醇和高密度脂蛋白胆同醇标化回归系数的绝对值大于BMI.结论 BMI和腰围与CVD危险因素独立相关,建议评估疾病危险时同时使用BMI和腰围两项指标.     

儿童肥胖的流行趋势及影响因素研究进展

儿童期单纯肥胖症是21世纪世界各国面临的最大公共卫生挑战之一,对儿童乃至成人后的健康构成了严重的威胁。儿童肥胖是遗传和环境因素交互作用的结果,但环境因素极其重要。目前发现儿童肥胖的影响因素有:父母肥胖与受教育程度低、家长错误的喂养观念与行为、母亲初潮年龄过早、围产期营养不良、母乳喂养不足、儿童不合理饮食、睡眠时间过少、久坐行为伴随电视游戏等。该文对有关儿童肥胖的诊断标准、流行趋势、分布特征及环境影响因素研究进行了综述,为针对性地开展儿童肥胖早期干预提供了流行病学参考。