母亲孕前BMI和孕期增重与学龄前儿童超重肥胖的相关性研究

目的探讨母亲孕前体质量指数(BMI)和孕期增重与学龄前儿童超重肥胖的相关性。方法选取2019年1月至2020年1月于余姚市妇幼保健院儿童保健科进行儿童保健咨询的3~5岁儿童共300例为研究对象,回顾性收集母亲孕前BMI和孕期增重情况,采用多因素Logistic回归模型进行相关性分析。结果儿童超重肥胖的发生率为35例(11.67%),在校正性别、年龄等混杂因素后,母亲孕前低体重的儿童出现超重肥胖的风险降低,母亲孕前超重肥胖的儿童出现超重肥胖的风险增加,其OR值及95%CI分别为0.602(0.413~0.755)、1.822(1.370~2.424),均P<0.05;母亲孕期增重过度的儿童出现超重肥胖的风险增加,其OR值及95%CI为1.298(1.009~1.669),P<0.05,但是母亲孕期增重不足并不会降低儿童出现超重肥胖的风险(P>0.05);母亲孕前超重肥胖且孕期增重过度的儿童出现超重肥胖的风险显著增加,母亲孕前低体重且孕期增重不足或孕期增重正常的儿童出现超重肥胖的风险显著降低,其OR值及95%CI分别为1.575(1.031~2.411)、0.556(0.343~0.872)、0.411(0.233~0.719),均P<0.05。结论母亲孕前BMI超重和孕期增重过度均是学龄前儿童发生超重肥胖的影响因素,并且母亲孕前BMI的影响更加严重。     

乌鲁木齐学龄前儿童超重肥胖现状及相关因素分析

  目的  了解学龄前儿童超重肥胖现状及其影响因素,为预防和控制乌鲁木齐市学龄前儿童超重肥胖的发生提供参考依据。  方法  采用分层整群抽样方法,于2021年10—12月抽取乌鲁木齐市10所幼儿园1 897名学龄前儿童,通过对身高、体重的测量了解学龄前儿童超重肥胖现状,应用一般资料调查问卷、学龄前儿童饮食行为量表、学龄前儿童照护人喂养行为量表、3~6岁儿童家庭养育环境量表、学龄前儿童体力活动问卷等分析其相关因素。  结果  学龄前儿童超重肥胖检出率为31.21%(592名),其中超重率为19.50%(370名),肥胖率为11.70%(222名)。儿童超重肥胖检出率在不同年龄、性别、儿童饮食习惯(喜食肉类)、父亲体质量指数、母亲体质量指数、母亲孕前体质量指数间差异均有统计学意义(χ2值分别为19.63,28.75,9.45,18.21,18.45,19.36,P值均 < 0.05)。多因素Logistic回归分析显示,性别、儿童饮食习惯、父亲体质量指数、母亲孕前体质量指数、过饱响应、外因性进食、主动进食能力、体重担忧、饮食行为限制、体力活动、家庭体力活动环境是学龄前儿童超重肥胖的相关因素(OR值分别为0.52,1.43,1.51,1.44,0.69,0.74,1.35,1.71,0.81,0.96,1.10,P值均 < 0.05)。  结论  乌鲁木齐市学龄前儿童超重肥胖问题严峻,应加强教育、控制饮食、科学锻炼,以防止儿童超重肥胖的发生。     

母亲孕前体质指数及孕期增重与学龄前儿童超重肥胖的关系研究

目的 探讨母亲孕前BMI及孕期增重与学龄前儿童超重肥胖的关系。方法 2016年6-11月,以广州市4 303名3~5岁学龄前儿童为研究对象,根据WHO标准和中国成人肥胖标准分别判断儿童和母亲孕前体重状态,参照美国医学研究所孕期增重推荐值判断母亲孕期增重情况。应用多因素二分类非条件logistic回归模型和协方差分析母亲孕前BMI和孕期增重与学龄前儿童超重肥胖的关系。结果 矫正混杂因素后,logistic回归分析显示,母亲孕前超重肥胖的儿童发生超重肥胖的风险是母亲孕前体重正常儿童的1.820倍（OR=1.820,95% CI：1.368~2.422）;与母亲孕期增重适宜的儿童相比,母亲孕期增重过度的儿童超重肥胖发生风险增加（OR=1.296,95% CI：1.007~1.667）。协方差分析结果也显示,母亲孕前体重超重肥胖和母亲孕期增重过度均增加儿童BMI Z值。根据母亲孕前BMI分为3组进行分层分析,结果显示,不同孕期增重组间儿童超重肥胖发生风险差异无统计学意义（P>0.05）。但与母亲孕前BMI适宜且孕期增重适宜组相比,母亲孕前超重肥胖且孕期增重过度组的儿童发生超重肥胖的风险增加（OR=1.574,95% CI：1.029~2.409）。结论 母亲孕前超重和孕期增重过度均增加学龄前儿童超重肥胖的风险,且母亲孕前超重较孕期增重过度对学龄前儿童超重肥胖发生的影响更大。     

广州市儿童生命早期因素与超重肥胖的关联

  目的  探讨广州市6~11岁儿童生命早期因素与超重肥胖之间的关系, 为儿童超重肥胖的预防提供科学依据。  方法  基线采用分层整群随机抽样的方法, 于2017年抽取广州市5所小学共5 172名学生作为研究对象, 进行2年的随访, 最终纳入学生3 315名。通过问卷调查收集学生的生命早期因素, 并测量基线和随访中身高和体重等指标。采用Logistic回归分析儿童生命早期因素与超重肥胖的关系。  结果  广州市6~11岁儿童超重肥胖发生率为8.7%。校正混杂因素后, Logistic回归分析显示, 母亲孕前消瘦的儿童超重肥胖发生风险比母亲孕前正常体重的儿童降低了46%(OR=0.54, 95%CI=0.38~0.76);母亲孕期增重过多的儿童超重肥胖发生风险比孕期增重正常的儿童增加了55%(OR=1.55, 95%CI=1.14~2.10);与自然分娩儿童相比, 剖宫产的儿童超重肥胖发生风险增加了30%(OR=1.30, 95%CI=1.00~1.68)(P值均 < 0.05)。  结论  母亲孕期增重过多和剖宫产增加儿童超重肥胖的发生风险, 母亲孕前消瘦降低儿童超重肥胖的发生风险。     

广州市某社区2~6岁儿童超重肥胖与生命早期因素研究

分析2~6岁儿童超重肥胖与生命早期因素的关系,为预防学龄前儿童超重肥胖提供理论依据.方法 采用随机整群抽样方法,于2018年在广州市抽取1个社区的所有托幼园所922名儿童为研究对象.调查内容包括问卷调查和体格检查.采用Logistic回归分析学龄前儿童超重肥胖与生命早期因素的关系.结果 学龄前儿童超重肥胖检出率为13.4%,男童超重肥胖检出率(16.1%)高于女童(10.1%),差异有统计学意义(Z=2.69,P<0.05).学龄前儿童超重肥胖检出率在大于胎龄儿、剖宫产、出生后6月内人工喂养、母亲孕前体质量指数(BMI)超重或肥胖、母亲孕期体重增重过多组内较高(P值均<0.01).二项式Logistic回归分析显示,大于胎龄儿(OR=2.62,95%CI=1.42~4.82)、剖宫产(OR=1.59,95%CI=1.08~2.36)、出生后6月内人工喂养(OR=2.00,95%CI=1.19~3.37);母亲孕前超重或肥胖(OR=1.97,95%CI=1.08~3.58)和母亲孕期增重过多(OR=2.07,95%CI=1.26~3.39)与学龄前儿童超重肥胖呈正相关(P值均<0.05);母亲孕前消瘦(OR=0.51,95%CI=0.29~0.88)与学龄前儿童超重肥胖呈负相关(P<0.05).结论 该社区2~6岁儿童超重肥胖检出率较高,学龄前儿童超重肥胖与出生体重、分娩方式、出生后6月内喂养方式、母亲孕前BMI和母亲孕期增重等生命早期因素相关,积极有效的早期干预可预防学龄前儿童超重肥胖.     

北京市7~18岁儿童青少年体成分百分位值变化特征

  目的  分析7~18岁儿童青少年不同性别、年龄体成分百分位值变化趋势特点,为制定百分位参考值提供科学依据。  方法  2020年9—12月采用分层整群随机抽样的方法,共纳入北京市7~18岁儿童青少年1 585人。利用GAMLSS法估计性别、年龄别的体脂率(BF%)、脂肪质量指数(FMI)和瘦体重(FFM)的P₂₅、P₅₀和P₇₅。  结果  在不同年龄组中,营养状况正常的男生体脂率在10岁左右出现峰值,其中10岁儿童青少年体脂率P₂₅、P₅₀和P₇₅分别为22.2%,26.1%和30.1%,肥胖男生的体脂率均处于较高的水平; 而女生不同营养状况下不同年龄组的体脂率变化不明显。营养状况正常和超重男生中,随着年龄的增加,FMI处于平缓水平; 但在肥胖的男生中,随着年龄的增加,FMI随着百分位的增高变化值逐渐增大,而女生逐渐减少。无论是在男生还是女生中,随着年龄的增加,FFM呈现增长的趋势,且男生增长的速度更快。  结论  在不同营养状况下,不同性别和年龄儿童青少年的体脂率、脂肪质量指数和瘦体重的百分位值存在一定的差异,在一定程度上可为制定儿童青少年体成分百分位参考值提供依据。     

学龄前儿童握力发展特点及与体成分的相关性

  目的  了解学龄前儿童握力的发育特点,并探讨握力与身高、体重和体成分指标的相关性。  方法  2020年9—10月,对北京4所幼儿园的900名学龄前儿童进行问卷调查,并进行身高、体重和握力测量,使用生物电阻抗方法检测体成分,采用偏相关、多元线性回归对握力与体成分指标的相关性进行分析。  结果  北京学龄前儿童握力随年龄增长逐渐升高,男童由(5.2±1.7)kg增至(9.3±2.5)kg,女童由(4.3±1.6)kg增至(7.9±2.5)kg(F值分别为57.93,48.77,P值均 < 0.01),男童握力高于女童(t=6.42,P < 0.01),肥胖男童握力高于超重和正常体重男童(F=5.35,P < 0.01)。调整身高、体重、出生体重、母亲文化程度及过去1周家中进食各类食物频率后,男童握力与瘦体重、上肢肌肉量呈正相关,与体脂肪呈负相关(r值分别为0.11,0.09,-0.18,P值均 < 0.05);女童握力与体脂肪呈负相关,与瘦体重呈正相关(r值分别为-0.09,0.09,P值均 < 0.05)。多元线性回归分析发现,年龄、瘦体重和上肢肌肉量对男童的握力影响有统计学意义(F=66.75,P < 0.01);年龄、瘦体重对女童的握力影响有统计学意义(F=150.81,P < 0.01)。  结论  学龄前期男童握力可以反映瘦体重和上肢骨骼肌水平的变化,女童可以反映瘦体重的变化。增加瘦体重可以提高学龄前儿童握力水平。     

孕期超重、儿童期饮食行为与儿童期体重的相关性研究

目的 分析孕前体重、孕期增加体重、儿童期饮食行为对儿童体重的影响,为管理儿童体重提供一定的科学依据。方法 选取2014年1月—2016年12月在南京大学医学院附属泰康仙林鼓楼医院及南通大学附属东台医院产科分娩的512例产妇及512例婴儿,收集母亲孕前体重指数(BMI)、孕期增重等资料。2019年12月—2020年3月随访并测量上述512名儿童的身高、体重,评定饮食行为。采用相关统计方法分析孕前体重、孕期增加体重、儿童期饮食行为对儿童体重的影响。结果 512名儿童年龄为3~6岁,有12.70%儿童超重/肥胖。相比于体重正常儿童,超重/肥胖儿童的母亲孕前超重/肥胖更常见(10.51% vs 38.46%,χ²=37.512,P=0.001),孕期超重更常见(7.83% vs 43.78%,χ²=75.201,P=0.001);不良饮食习惯、挑食、过饱响应得分更高(P=0.001)。Logistic回归分析也表明孕前体重(OR=1.109,95%CI:1.025~1.213)、孕期体重增加(OR=1.098, 95%CI:1.031~1.261)、儿童期饮食行为中不良饮食习惯(OR=1.113, 95%CI:1.054~1.257)、挑食(OR=1.257, 95%CI:1.232~1.467)、过饱响应(OR=1.284, 95%CI:1.135~1.513)是儿童超重的危险因素。结论 儿童体重受母亲孕前体重、孕期增重以及儿童期饮食习惯的综合影响。合理控制孕前BMI及孕期增重,积极指导儿童建立健康的饮食行为,有助于降低儿童超重/肥胖的发生率。     

儿童青少年身体成分与身体素质的关系

  目的  了解儿童青少年体脂率(FM%)、体脂指数(FMI)、去脂体质量指数(FFMI)和体质量指数(BMI)与身体素质的关联性,为探讨身体成分指标对儿童青少年体育锻炼程度的潜在价值提供参考。  方法  数据来源于2013年教育部国家学生体质健康标准修订北京地区样本,采用Inbody 230对北京市4 069名6~20岁儿童青少年进行身体成分测定,用四分位数法将FM%、FMI、FFMI和BMI分别分成4组,用GraphPad Prism 8.0软件对4组的体测成绩进行差异性分析。  结果  男生FM%(20.03±10.39)和FMI[(4.35±2.84)kg/m2]均小于女生,而FFMI[(14.21±4.95)kg/m2]和BMI[(20.31±4.27)kg/m2]均大于女生(t值分别为-13.36,-7.66,11.49,8.16,P值均 < 0.01)。在男生中随着FM%和FMI增加,50 m跑、1 000 m跑、立定跳远和引体向上的成绩呈下降趋势; 随着FFMI增加,50 m跑、立定跳远和引体向上成绩有上升趋势。在女生中,随着FM%和FMI增加,50 m跑时间逐渐缩短,800 m跑时间逐渐增长;FFMI越大50 m跑时间呈现出下降趋势,而在800 m跑中未见FFMI的显著趋势性。4个体成分指标对于坐位体前屈和1 min仰卧起坐无明显预测作用。  结论  FM%、FMI、FFMI和BMI对于儿童青少年身体素质有很好的预测作用。FFMI较高、FM%和FMI较低者在肌肉爆发力、肌肉耐力、柔韧性、有氧能力、无氧能力方面有更好表现,且这种趋势在男生中更为明显。     

孕前BMI、妊娠期糖尿病与儿童4岁时肥胖相关指标关联的出生队列研究

目的 探讨孕前BMI、妊娠期糖尿病（GDM）与儿童4岁时肥胖相关指标的关联。方法 基于已经建立的“马鞍山市优生优育队列”,对2013年10月至2015年4月出生的单胎活产儿,随访至4岁。在孕期首次填写问卷调查孕前身高、体重,在24～28周接受75 g口服糖耐量试验进行GDM诊断。在儿童4岁时测量身高、体重、腰围和体成分。组间比较采用χ²检验、方差分析或t检验,采用logistic回归模型与广义线性模型分析孕前超重/肥胖、孕前患有GDM与儿童肥胖相关特征的关系。结果 儿童4岁时超重、肥胖率分别为13.08%、6.03%。控制孕期和儿童人口统计学变量后,孕前母亲超重/肥胖者儿童在4岁时发生肥胖、腰围超标、腰围身高比超标的风险要高,其OR值（95% CI）分别为3.27（2.15～4.98）、2.32（1.72～3.14）和2.29（1.73～3.02）;且与体成分指标（骨骼肌、体脂肪、体脂百分比）相关（P<0.05）。孕期母亲患有GDM者,儿童4岁时肥胖发生风险要比母亲未患有GDM者高1.78倍（OR=1.78,95% CI：1.14～2.79）;但是孕期母亲患有GDM对4岁儿童腰围超标、腰围身高比超标发生风险并无影响,与体成分指标（骨骼肌、体脂肪、体脂百分比）无统计学关联。结论 孕前母亲超重/肥胖、孕期患有GDM是4岁儿童肥胖的独立危险因素,且孕前BMI与儿童体成分的各项指标相关。     

Association of Cesarean Delivery with Trajectories of Growth and Body Composition in Preschool Children

This study aimed to examine the association of cesarean delivery with trajectories of growth and body composition in preschool children. This ambidirectional cohort study was conducted between 2017 and 2020 in China. Information on the delivery mode, weight, and length/height of the children measured at routine healthcare visits was obtained from maternal and child health records. For three years while in kindergarten, children’s body mass index (BMI), fat mass index (FMI), fat-free mass index (FFMI), and percentage of body fat (FM%) were repeatedly measured. A BMI z score (zBMI) was calculated and standardized to WHO measures, and overweight and obesity were defined using the WHO reference. After adjustment for maternal age, maternal education, annual family income, prepregnancy BMI, gestational weight gain, gravidity, parity, gestational age, child sex, birthweight, breastfeeding duration, and the parent-reported dietary intake of the children, children born via cesarean delivery (n = 1992) versus those born vaginally (n = 1578) had higher zBMI growth rates beyond 36 months (β: 0.003; 95% CI: 0.001, 0.005 SD units/month) and elevated levels of FMI (β: 0.097; 95% CI: 0.026, 0.168 kg/m²), FM% (β: 0.402; 95% CI: 0.058, 0.745%) and zBMI (β: 0.073; 95% CI: 0.012, 0.133 units), but not FFMI (β: 0.022; 95% CI: −0.022, 0.066 kg/m²). The adjusted OR of overweight and obesity was 1.21 (95% CI: 1.04, 1.40). Cesarean delivery likely elevated zBMI growth rates and increased the risk of overweight and obesity in preschool children, with the elevation of fat mass but not fat-free mass.     

Body fat mass of exclusively breastfed infants born to overweight mothers

BackgroundAlthough there is evidence that maternal prepregnancy obesity (body mass index [BMI; calculated as kg/m²] ≥30) results in elevated risk of obesity in the offspring later in life, maternal prepregnancy overweight (BMI 25 to 29.9) has not been clearly demonstrated as a risk factor for the future development of obesity in the offspring.ObjectiveOur objective was to determine if body composition differs between infants born to lean or overweight breastfeeding women.DesignBody composition (PeaPod, COSMED USA, Inc) and anthropometric outcomes were measured in 65 infants born to lean mothers (n=46) (BMI 18.5 to 24.9) or overweight mothers (n=19) (BMI 25 to 29.9) between 2006 and 2007. Maternal body composition (BodPod, COSMED USA, Inc) was also measured.ResultsBody fat mass was higher in infants born to overweight mothers compared with infants born to lean mothers at age 2 weeks and 3 months (11.9% vs 15.3% and 24.1% vs 26.8%, respectively; P<0.05). After adjusting for gestational weight gain and birth weight, body fat mass was significantly greater only at age 2 weeks.ConclusionsInfants of overweight mothers have greater body fat mass in the neonatal period compared with infants of lean mothers, suggesting that maternal overweight may predispose fetal metabolism to favor fat storage. Although our data suggest that this effect is short lived, future studies are needed to investigate children beyond the infancy period to test if body composition is greater in offspring of overweight women.     

Maternal smoking during pregnancy and subcutaneous fat mass in early childhood. The Generation R Study

Maternal smoking during pregnancy increases the risk of obesity in the offspring. Not much is known about the associations with other measures of body composition. We assessed the associations of maternal smoking during pregnancy with the development of subcutaneous fat mass measured as peripheral and central skinfold thickness measurements in early childhood, in a population-based prospective cohort study from early fetal life onward in the city of Rotterdam, The Netherlands. The study was performed in 907 mothers and their children at the ages of 1.5, 6 and 24 months. As compared to non-smoking mothers, mothers who continued smoking during pregnancy were more likely to have a younger age and a lower educational level. Their children had a lower birth weight, higher risk of small size for gestational age and were breastfed for a shorter duration (P-values <0.01). We did not observe differences in peripheral, central and total subcutaneous fat mass between the offspring of non-smoking mothers, mothers who smoked in first trimester only and mothers who continued smoking during pregnancy (P > 0.05). Also, the reported number of cigarettes smoked by mothers in both first and third trimester of pregnancy were not associated with peripheral, central and total subcutaneous fat mass in the offspring at the ages of 1.5, 6 and 24 months. Our findings suggest that fetal exposure to cigarette smoke during pregnancy does not influence subcutaneous fat mass in early childhood. Follow-up studies are needed in children at older ages and to identify associations of maternal smoking during pregnancy with other measures of body composition.     

Prepregnancy body mass index and gestational weight gain in relation to child body mass index among siblings

There is increasing evidence that in utero effects of excessive gestational weight gain may result in increased weight in children; however, studies have not controlled for shared genetic or environmental factors between mothers and children. Using 2,758 family groups from the Collaborative Perinatal Project, the authors examined the association of maternal prepregnancy body mass index (BMI) and gestational weight gain on child BMI at age 4 years using both conventional generalized estimating equations and fixed-effects models that account for shared familial factors. With generalized estimating equations, prepregnancy BMI and gestational weight gain had similar associations with the child BMI z score (β = 0.09 units, 95% confidence interval (CI): 0.08, 0.11; and β = 0.07 units, 95% CI: 0.04, 0.11, respectively. However, fixed effects resulted in null associations for both prepregnancy BMI (β = 0.03 units, 95% CI: -0.01, 0.07) and gestational weight gain (β = 0.03 units, 95% CI: -0.02, 0.08) with child BMI z score at age 4 years. The positive association between gestational weight gain and child BMI at age 4 years may be explained by shared family characteristics (e.g., genetic, behavioral, and environmental factors) rather than in utero programming. Future studies should continue to evaluate the relative roles of important familial and environmental factors that may influence BMI and obesity in children.