母乳喂养与儿童单纯性肥胖的研究现状

目前儿童单纯性肥胖(CSO)已成为重要公共卫生问题。全球单纯性肥胖儿童越来越多,并且发病呈低龄化趋势。1990年,世界卫生组织(WHO)和联合国儿童基金会提出“保护、促进和支持母乳喂养”宣言,母乳不仅是婴儿最理想的食物,而且母乳喂养还具有较多益处,可预防CSO,但是门诊亦可见母乳喂养婴幼儿仍然发生CSO。笔者拟对母乳喂养与CSO常见相关因素与发病机制,如个体生命早期发育影响相关学说,瘦素、脂联素、长链多不饱和脂肪酸(LCPUFA)、胰岛素、胰岛素样生长因子(IGF)-1等相关激素,母乳喂养行为等的最新研究进展进行阐述,旨在为指导合理母乳喂养,预防CSO提供参考。     

Maternal employment, breastfeeding, and health: evidence from maternity leave mandates

Public health agencies around the world have renewed efforts to increase the incidence and duration of breastfeeding. Maternity leave mandates present an economic policy that could help achieve these goals. We study their efficacy, focusing on a significant increase in maternity leave mandates in Canada. We find very large increases in mothers' time away from work post-birth and in the attainment of critical breastfeeding duration thresholds. We also look for impacts of the reform on self-reported indicators of maternal and child health captured in our data. For most indicators we find no effect.     

北京市小学生身体活动与家庭经济地位的关系

目的 分析在校小学生身体活动模式,以及社会经济地位(SES)与身体活动的关系.方法 选择北京市海淀区8所小学2～5年级学生共1502人,使用"7天回顾性身体活动问卷",了解儿童日常身体活动状况.结果 广播体操/伸展运动、跑步、游戏、走队列等活动是小学生常见的校内活动,比例分别为94.13%、85.55%、77.26%、71.32%;劳动、游戏、跑步、散步等活动是常见的校外活动,比例分别为72.14%、69.70%、65.05%、64.64%;而小学生中参加球类运动的较少.与SES低的学生相比,SES高的学生在校内参加舞蹈、上下楼梯的比例较高,踢毽子、跳绳的比例较低,而在校外参加滑雪/滑冰/轮滑、上下楼梯、游泳的比例较高,散步、跳绳、踢毽子、跳皮筋的比例较低(P＜0.05).结论 中国小学生身体活动既存在数量性不足,也存在结构性不足(即趣味性强的运动普及程度低).除年龄、性别外,家庭SES也是影响小学生参加身体活动的重要因素.     

婴儿期母乳喂养与孤独症发生的关系

目的:探讨婴儿期母乳喂养与孤独症发生之间的关系。方法:选取2004年1月～2005年12月期间在我院就诊的372例孤独症患儿作为孤独症组,同时随机抽取在我院儿童保健门诊参加系统保健的正常儿童1116例作为对照组,两组儿童的年龄、性别构成一致。参照国外同类调查问卷并结合我国具体情况设计自制调查问卷对研究对象的生长发育情况和婴儿期喂养情况等进行调查,分析婴儿期母乳喂养与孤独症发生之间的关系。结果:单因素分析发现孤独症组儿童4个月内纯母乳喂养率为20.97%,对照组儿童4个月内的纯母乳喂养率为51.08%,对照组明显高于孤独症组(χ2=102.874,P<0.01)。在母乳喂养持续时间方面,孤独症组儿童平均母乳喂养持续时间为(3.82±0.46)月,对照组为(6.61±0.49)月,两组儿童的平均母乳喂养持续时间不同(t=2.74,P<0.01);孤独症组儿童母乳喂养持续时间小于3个月和3～6个月的比例分别是26.34%和15.32%,对照组分别是9.23%和10.66%,孤独症组高于对照组(P<0.01,0.05);孤独症组儿童母乳喂养持续时间大于或等于9个月的比例为35.22%,而对照组为55.02%,孤独症组低于对照组(P<0.01)。多因素Logistic回归分析发现喂养类型是孤独症发生的危险因素(OR=1.429),母乳喂养持续时间是孤独症发生的保护因素(OR=0.528)。结论:婴儿期喂养方式与孤独症的发生有关;4个月内母乳喂养比例越高,母乳喂养持续时间越长,儿童孤独症的发生率越低。     

Health across early childhood and socioeconomic status: examining the moderating effects of differential parenting

Variations in parenting within the family (i.e. differential parenting) are associated with various domains of child adjustment, whereby disfavoured siblings exhibit poorer social and emotional outcomes. To date there is no research examining the effects of differential parenting on children's general health, or the way in which differential parenting interacts with socioeconomic markers to predict general health over time. The present study assessed 501 Canadian families at 2 time points separated by 18 months. Differential maternal negativity predicted worse health 18 months later. Moreover, the association between maternal education and child health was strongest when children were also exposed to high levels of differential negativity. Findings indicate that multiple forms of social disadvantage (i.e. between families and between siblings) can operate independently or in a cumulative fashion to predict health across early childhood.     

Neighborhood influences on the association between maternal age and birthweight: a multilevel investigation of age-related disparities in health

It was hypothesized that the relationship between maternal age and infant birthweight varies significantly across neighborhoods and that such variation can be predicted by neighborhood characteristics. We analyzed 229,613 singleton births of mothers aged 20-45 years from Chicago, USA in 1997-2002. Random coefficient models were used to estimate the between-neighborhood variation in age-birthweight slopes, and both intercepts- and-slopes-as-outcomes models were used to evaluate area-level predictors of such variation. The crude maternal age-birthweight slopes for neighborhoods ranged from a decrease of 17 g to an increase of 10 g per year of maternal age. Adjustment for individual-level covariates reduced but did not eliminate this between-neighborhood variation. Concentrated poverty was a significant neighborhood-level predictor of the age-birthweight slope, explaining 44.4% of the between-neighborhood variation in slopes. Neighborhoods of higher economic disadvantage showed a more negative age-birthweight slope. The findings support the hypothesis that the relationship between maternal age and birthweight varies between neighborhoods. Indicators of neighborhood disadvantage help to explain such differences.     

母乳喂养对生命早期危险因素与儿童肥胖关联的修饰作用研究进展

儿童肥胖已成为全球共同关注的公共健康问题,其发生发展与生命早期危险因素暴露密切相关。近年来,越来越多流行病学研究证据显示,母乳喂养对儿童肥胖的生命早期危险因素如肥胖高遗传风险、母亲患妊娠糖尿病、出生巨大儿等因素带来的健康危险效应具有修饰作用。本文通过对该领域现有的研究结果进行综述,总结母乳喂养对儿童肥胖遗传及生命早期环境危险因素的修饰作用,为明确母乳喂养对特定高危儿童的肥胖防控效益和实施针对性的防控策略提供参考。     

Age, socioeconomic status and obesity growth

We use panel data from the National Longitudinal Survey of Youth (NLSY) to examine how body weight changes with age for a cohort moving through early adulthood, to investigate how the age-obesity gradient differs with socioeconomic status (SES) and to study channels for these SES disparities. Our results show first that weight increases with age and is inversely related to SES during childhood. Second, the obesity gradient widens over the lifecycle, consistent with research on other health outcomes. Third, a substantial portion of the “effect” of early life conditions operates through race/ethnicity and the translation of advantaged family backgrounds during childhood into higher levels of subsequent education. By contrast, little of the SES gap appears to propagate through household composition, family income or health behaviors. Fourth, adult SES has independent effects after controlling for childhood status.     

The influence of indigenous status and community indigenous composition on obesity and diabetes among Mexican adults

In many high-income countries, indigenous populations bear a higher burden of obesity and diabetes than non-indigenous populations. Less is known about these patterns in lower- and middle-income countries. We assessed the hypothesis that obesity and diabetes were less prevalent among indigenous than non-indigenous adults in Mexico, home to the largest indigenous population in Latin America. We investigated socioeconomic explanations for differences. In a related line of inquiry, we examine whether adults in communities with higher versus lower percentages of indigenous residents were buffered against these conditions. We assessed whether differences were partially explained by lower development in higher-indigenous communities.     

The relationship between maternal pre-pregnancy body mass index and exclusive breastfeeding initiation: Findings from an Australian obstetric cohort

BackgroundTo assess the type of infant nutrition at initiation of first feed in association with increasing maternal pre-pregnancy Body Mass Index in an Australian obstetric population.MethodsA retrospective cohort study from 2008 to 2013 was undertaken. Body Mass Index was available for 12,347 women categorised into groups according to: underweight (≤18 kg/m²); normal weight (19?24 kg/m²); overweight (25?29 kg/m²); obese class I (30?34 kg/m²); obese class II (35?39/kg²) and obese class III (40+ kg/m²). Type and initiation of infant feeding is routinely recorded in the study hospital’s birthing outcomes system. Six body mass index categories and mode of infant feeding were examined using logistic regression. Confounding factors that were controlled for included smoking status, parity, country of birth and maternal age.ResultsWithin this cohort, 609 (4.93%) women were underweight, 6235 (50.50%) had a normal BMI, 3116 (25.24%) were overweight, 1314 (10.64%) were obese class I, 596 (4.83%) were obese class II and 477 (3.86%) were obese class III. In adjusted models’, as BMI rose, women were significantly less likely to initiate exclusive breastfeeding and more likely to exclusively formula feed. Women with a BMI of 40+ kg/m² had an AOR of 2.91(CI 1.94?4.25) for initiating exclusive formula at the time of their infant’s first feed.ConclusionsWomen who are overweight or obese are significantly less likely to initiate exclusive breastfeeding and more likely to give exclusive formula at the time of their newborn infants first feed. Effective breastfeeding interventions are required for these high-risk groups in the days leading up to and within the first hours after birth.     

成年早期体重状态及至中年期体重变化与新发2型糖尿病的关系

目的 探讨成年早期体重状态及至中年期体重变化与2型糖尿病间的关系。方法 利用中国心血管流行病学多中心协作研究的14组35~59岁(男女各半)人群样本心血管病危险因素调查资料,采用多因素logistic回归分别探讨25岁时体重状态和随后其变化与新发糖尿病的关系。结果 共12 674人纳入分析,其25岁时低体重组(BMI<18.5 kg/m2)、正常体重组(BMI 18.5~23.9 kg/m2)、超重组(BMI 24.0~27.9 kg/m2)和肥胖组(BMI≥28.0 kg/m2)中年期糖尿病发病率分别为2.4%(30/1 263)、2.8%(266/9 562)、4.0%(70/1 739)和6.4%(7/110),呈明显上升趋势(趋势检验P<0.01)。25岁至中年时期体重变化<-7.5 kg组、-7.5~-2.6 kg组、-2.5~2.5 kg组、2.6~7.5 kg组、7.6~12.5 kg组和>12.5 kg组糖尿病发病率分别为2.5%(18/712)、1.3%(21/1 629)、2.1%(48/2 330)、2.3%(59/2 585)、3.7%(94/2 518)和4.6%(133/2 900),也呈明显上升趋势(趋势检验P<0.01)。多因素logistic回归分析显示,25岁时超重/肥胖以及随后的体重增加均与中年时期新发糖尿病正相关(趋势检验P<0.01)。结论 成年早期超重/肥胖以及随后的体重增加均与中年期新发糖尿病独立相关。     

重庆市6月龄婴儿喂养现状及母乳喂养影响因素研究

目的 调查重庆市大足区6月龄婴儿母乳喂养行为现状及其影响因素.方法 将重庆市大足区所有社区预防接种点进行编码,然后按照东、南、西、北分为4个地区,在每个地区随机选取1个社区预防接种点作为调查地点,采用偶遇法在调查时间段内对进入预防接种点的6月龄婴儿母亲进行婴儿喂养情况及母乳喂养相关因素的问卷调查,采用描述流行病学分析方...     

社区老年人社会经济地位与轻度认知功能障碍的相关性研究

目的  探讨老年人社会经济地位(socioeconomic status,SES)与轻度认知功能障碍(mild cognitive impairment,MCI)患病的关联。方法  数据来源于湖北老年记忆队列(the Hubei Memory and Aging Cohort Study,HMACS);共纳入7 887名≥65岁老年人,他们完成了3全套神经心理评估和临床体格检查。SES通过受教育程度、职业性质和家庭人均月收入综合评定;MCI由专家组根据Petersen标准和中国痴呆与认知障碍诊治指南进行诊断;多因素logistic回归分析模型分析老年人SES与MCI患病的关联。结果  共纳入7 887名调查对象,平均年龄(71.74±5.58)岁,MCI检出率为23.00%(95% CI: 22.07%~23.93%);低SES组MCI检出率(44.65%)高于中SES组MCI检出率(16.89%)和高SES组MCI检出率(9.18%);女性高于男性;农村高于城市。分层分析发现：城市男性低SES组MCI患病风险为高SES组的6.276倍(OR=6.276, 95% CI: 4.017~9.805),城市女性低SES组MCI患病风险为高SES组的3.978倍(OR=3.978, 95% CI: 2.943~5.376);依据现有SES标准,农村女性老年人SES分布不均匀。结论  低SES组老年人MCI检出率较高,认知功能障碍的防控要密切关注低SES组老年人,特别是社区低收入、低教育程度的老年人。     

Early childhood origins of the income/health gradient: the role of maternal health behaviors

Several recent studies in the US, Canada, and the UK have demonstrated a positive relationship between family income and child health, though the mechanisms underlying this relationship are poorly understood. Using data from the 1988 US National Maternal and Infant Health Survey and the 1991 follow-up, this paper tests whether maternal health status and health behaviors during pregnancy and early infancy can explain the relationship between family income and subjective health status at age 3. We find that, while a detailed set of controls for health risk factors including maternal smoking, drinking, and vitamin use during pregnancy, as well as breastfeeding and secondhand smoke exposure after birth, are significantly related to family income and maternal education, they do not explain the relationship between family income and maternal-assessed health of the child. We suggest that these results point to either more salient pathways through which family income impacts child health, such as maternal stress, or to the possibility that differences in subjective health status do not correspond to differences in objective health status in the same way for higher- and lower-income respondents.     

Socioeconomic status and health: youth development and neomaterialist and psychosocial mechanisms

There is substantial debate in the field of epidemiology over the theoretical underpinnings of socioeconomic status (SES)-disease mechanisms in the developed world. In particular, it has been debated whether psychosocial mechanisms are important in understanding these relationships, compared with material influences. Within an interdisciplinary context, this review synthesizes the youth development and resilience literatures in examination of this hypothesis. This review provides evidence that both classes of mechanisms are critical to understanding and addressing SES-disease mechanisms over the lifecourse. Research findings demonstrating the effects of these classes of factors point to the complicated and dynamic nature of how SES may impact disease. In the epidemiologic literature, investigators predominantly consider the cumulative impact of biological insults over time. A developmental perspective, however, provides evidence of the importance of psychosocial influences early in life on socioeconomic and health trajectories over the lifecourse. Future epidemiologic research should consider cumulative and developmental influences of early adversity--both psychosocial and material--on later health. This perspective may be particularly relevant to appropriately evaluating the impact of selection and causation in research on SES and disease and will also hopefully provide clarity to this ongoing theoretical debate.     

四川凉山彝族社会经济状况与超重/肥胖关系的研究

目的 探讨四川凉山彝族社会经济状况（SES）与超重/肥胖的关系。方法 采用分层整群抽样的方法,在凉山彝族自治州开展横断面调查,对20~80岁彝族农民和城镇移民社会经济状况与超重/肥胖的关系进行研究。以文化程度、个人年收入、SES综合指标作为社会经济状况的指标。用非条件logistic回归模型分析社会经济状况与超重/肥胖（BMI ≥ 24.0 kg/m²）的关系。结果 共纳入彝族农民1 894人,彝族移民1 162人。调整年龄、吸烟、饮酒、体力活动后,相对于文盲,彝族农民男性文化程度较高组（小学及初中、高中及以上）超重/肥胖OR值分别为1.71（95%CI：1.13~2.58）、4.15（95%CI：2.10~8.22）;年收入≥ 5 000元组相比于<5 000元组OR值为1.66（95%CI：1.12~2.44）;中、高SES综合指标组相比于低SES组OR值为1.65（95%CI：1.02~2.67）、3.26（95%CI：1.97~5.42）。彝族农民女性年收入≥ 5 000元组相比于<5 000元组OR值为1.49（95%CI：1.10~2.02）;中SES综合指标组相比于低SES综合指标组OR值为1.47（95%CI：1.11~1.95）。彝族移民中,未发现社会经济状况与超重/肥胖存在显著性关联。结论 彝族农民社会经济状况与超重/肥胖存在正向关联。     

高出生体重与儿童期超重肥胖及代谢异常的关系

目的探讨高出生体重与儿童期超重肥胖及代谢异常的关系,为增强高出生体重儿成人期的健康水平提供参考依据。方法采用历史性队列研究的流行病学方法,随机抽取无锡地区1993-1995年出生的1 435对巨大儿和正常出生体重儿作为研究对象,每个巨大儿按出生日期±2个月及性别一致的原则匹配一个对照。测量身高、体重和血压,并从中抽取300名儿童采血,检测相关生化指标。结果巨大儿组超重与肥胖检出率(13.10%,2.86%)均高于对照组(9.69%,1.61%)(P<0.01);巨大儿组与对照组相比,发生超重和肥胖的RR值分别为1.35和1.78,AR值分别为3.41%和1.26%;两组儿童的收缩压、舒张压及偏高血压检出率的差异均无统计学意义(P值均>0.05);两组之间各生化指标、胰岛素和C肽异常的检出率及胰岛素抵抗差异均无统计学意义(P值均>0.05)。结论高出生体重与儿童期超重和肥胖有关,对高出生体重儿童未来生长情况的变化应给予持续关注。     

儿童肥胖对高血压发病率影响的随访研究

目的 探讨儿童肥胖状态及肥胖状态的改变对其高血压发病率的影响.方法 采取前瞻队列研究的方法,抽取2004年北京市儿童青少年代谢综合征队列人群中2189名6～16岁血压正常儿童,于2010年12月对其随访,进行身高、腰围(WC)、体重和血压的测量.分别以体质指数(BMI)和WC作为评价超重、肥胖、腹型肥胖的指标.以不同肥胖状态组设置哑变量,以随访时点是否高血压作为结局变量,进行非条件logistic回归分析,分析基线肥胖状态及肥胖状态的改变与高血压发病率之间的关系,并计算相应的OR值及95%CI值.结果 共完成了1184名在校学生的随访,6年间高血压累积发病率为19.9%(236/1184).男性高血压发病率(23.2%,149/643)高于女性(16.1%,87/541) (χ2=9.257,P=0.002).基线非超重组、超重组、肥胖组随访期间高血压累积发病率分别为8.7%(45/519)、19.3%(35/181)、32.4%(156/484)(χ2=9.332,P<0.001),基线非肥胖组与腹型肥胖组随访期间高血压累积发病率分别为10.3%(63/613)、30.7%(173/567) (χ2=77.753,P<0.001).基线肥胖组的高血压发病危险高于基线非超重组(BMI:OR=4.9,95%CI:3.4～7.0)和基线非肥胖组(WC:OR=3.9,95%CI:2.8～5.3);基线时BMI、WC水平相同时,随访时BMI、WC水平增加,高血压发病危险增加.控制年龄、性别,基线BMI和WC每增加1 kg/m2和1 cm,高血压发病风险分别增加0.21和0.07倍,OR(95%CI)值分别为1.21(1.16～1.26)和1.07(1.05～1.09);随访时BMI和WC改变量每增加1 kg/m2和1 cm,高血压发病风险分别增加0.16和0.05倍,OR(95%CI)值分别为1.16(1.11～1.22) 和1.05(1.03～1.07).结论 儿童肥胖及肥胖水平升高的改变会增加其高血压发病风险.

Abstract：

Objective To explore the impact of obesity level and the level change in childhood on hypertension incidence.Methods A perspective cohort study was conducted.As part of Beijing Child and Adolescent Metabolic Syndrome Study,2189 aged 6-16 year non-hypertensive children was followed up in December,2010.In this study,height,weight,waist circumference (WC) and blood pressure was measured at follow-up,and body mass index (BMI) and WC was respectively used to assess overweight,obesity and abdominal obesity.Non-conditional logistic regression was used to evaluate the association between baseline obesity status, change of obesity status and hypertension incidence. OR and 95%CI were computed in the model using obese status as dummy variable and hypertension at follow up visit as dependent variable.Results The total hypertension incidence of 1184 subjects during 6 years follow-up was 19.9%(236/1184).The hypertension incidence in male (23.2%,149/643) was higher than that in female (16.1%,87/541) (χ2=9.257,P=0.002).The hypertension incidence of non-overweight,overweight and obese children at baseline was 8.7%(45/519),19.3%(35/181) and 32.4%(156/484)respectively (χ2=9.332,P<0.001),and the incidence of non-obese and abdominal obese children at baseline was respectively 10.3%(63/613) and 30.7%(173/567) (χ2=77.753,P<0.001).Hypertension incidence in the baseline obesity group was higher than the non-overweight (BMI:OR=4.9,95%CI:3.4-7.0) and non-obese group (WC:OR=3.9,95%CI: 2.8-5.3).The hypertension incidence increased with the follow-up BMI/WC level,based on the same baseline level of BMI and WC.The hypertension risk increased to 0.21 and 0.07 times respectively with elevation of baseline BMI level by 1 kg/m2 and WC level by 1 cm,and OR(95%CI) were 1.21(1.16-1.26) and 1.07(1.05-1.09),respectively.Similarly,the hypertension risk increased 0.16 and 0.05 times respectively with the elevation of BMI level change by 1 kg/m2 and 1 cm,and OR (95%CI) were 1.16(1.11-1.22) and 1.05(1.03-1.07),respectively.Conclusion Obesity and increased obesity level change in childhood can increase the risk of incident hypertension.