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.     

两种评价方法对3912例儿童青少年超重及肥胖检出率的比较

目的 评价身高标准体重法(weight-for-height,WFH)和中国儿童体质指数(body mass index,BMI)法对儿童青少年超重及肥胖检出率的吻合程度.方法 于2006年8-10月采用分层整群随机抽样方法抽取上海市徐汇区3所小学和2所中学7～15岁儿童、青少年3 912人,其中男性2 070人,女性1 842人,分别用上述两种方法检测超重及肥胖儿童的人数,计算检出率并进行比较.结果 采用WFH及BMI标准对肥胖及超重的检出率分别为27.7%和26.5%,差异无统计学意义(x2=1.3683,P>0.05).两种方法对儿童青少年超重及肥胖的检出一致性较好(Kappa=0.70,P=0.013);并且均显示男性超重及肥胖率高于女性(WFH男:女=31.82%:21.72%;BMI男:女=30.82%:21.99%),超重比例高于肥胖(WFH 超重:肥胖=14.9%:12.9%BMI超重:肥胖=14.4%:12.1%),青春前期高于青春发育期.结论 WFH和BMI检测儿童、青少年超重及肥胖具有较好的一致性,两者均可应用于对儿童及青少年营养状况的评价.     

基于不同体块指数筛查标准的2011年北京市儿童青少年超重和肥胖检出率比较研究

目的 描述2011年北京市7~18岁儿童青少年超重和肥胖的检出率,并比较基于不同BMI筛查标准的检出率的差异。方法 研究对象为2011年北京市中小学体检的7~18岁学龄儿童青少年。采用BMI作为评价超重和肥胖的指标。超重和肥胖筛查分别采用4种不同的国内（CN2010和WGOC）和国际（IOTF和WHO2007）标准。不同BMI筛查标准之间超重、肥胖检出率比较采用McNemar检验。结果 ①92 212名男女生BMI在P50、P85和P95上均显著高于全国水平(2009年“中国0~18岁儿童青少年体块指数的生长曲线”),男女生在对应百分位曲线上无交叉现象,男生BMI水平高于女生。②基于CN2010和WGOC标准,男生肥胖检出率分别为17.8%和18.2%,女生检出率分别为10.8%和10.9%;基于IOTF和WHO2007标准,男生肥胖检出率分别为12.9%和21.0%,女生检出率分别为6.0%和8.6%。③基于CN2010和WGOC标准,男生超重（含肥胖）检出率两标准间差异无统计学意义,均为36.0%,各年龄组差异亦不明显,但女生检出率CN2010标准高于WGOC标准（28.1％ vs 24.1%）,在7~15岁组差异较为明显,但在16~18岁组差异较小;与国际标准相比,基于国内标准的男生超重（含肥胖）检出率略高于IOTF标准,但却明显低于WHO2007标准,女生检出率超重（含肥胖）明显高于IOTF标准,但与WHO2007标准较为接近。④与基于WGOC标准的2004年北京市7~18岁儿童青少年超重和肥胖检出率相比,2011年超重和肥胖检出率显著增长,男女肥胖检出率分别增长5.8%和3.8%,超重（含肥胖）检出率分别增长9.3%和7.6%。结论 2011年北京市7~18岁学生中有1/3处于超重或肥胖状态。国内标准与国际标准存在明显差异,在反映中国儿童的超重肥胖流行状况时建议采用国内标准,而理想的国内标准应实现2～18岁的统一,并与成人接轨。     

重庆城区婴幼儿超重与肥胖状况及影响因素的研究

目的：了解重庆城区婴幼儿超重与肥胖现况及其危险因素,为儿童肥胖早期干预提供依据。方法：采用分层整群抽样的方法,对生后1月龄的2139名儿童进行3、6、9、12和18月龄的生长监测、评估和问卷调查。以18月龄是否超重与肥胖为应变量进行多元回归分析。结果：（1）婴儿超重与肥胖检出率生后前半年增长迅速,6月龄达26.04%,之后逐渐降低,至18个月龄时为15.89%。（2）Logistic回归分析显示父亲营养状况、儿童出生时、6月龄、9月龄和12月龄的营养状况、3月龄喂养方式、12月龄蔬菜进食频次、18月龄甜饮料添加频次以及18月龄上床时间共9个因素与18月龄儿童超重与肥胖显著相关。结论：重庆城区婴幼儿超重与肥胖现状突出,存在多种因素共同作用,应给予早期综合干预。     

儿童单纯性肥胖的诊断和治疗

关于肥胖的诊断国内外并尚无统一的判断标准，WHO认为10岁以下和10岁以上应有不同的评价标准，推荐10岁以下儿童使用身高别体质量，10～24岁采用体质量指数（BMI），国际肥胖问题工作组织（IOTF）认为BMI适宜用来判断儿童青少年超重和肥胖。WHO和IOTF提出的18岁BMI超重、肥胖标准完全一样，分别为25和30kg／m^2，而中国肥胖问题工作组（WGOC）制定的标准较比前二者低，18岁BMI超重和肥胖界值点分别为24和28kg／m^2。儿童肥胖的治疗不同于成人，成人期可使用的手术去脂、药物减肥、饥饿疗法、禁食等，在儿童时期均不宜使用。目前国内外公认儿童肥胖治疗方法包括行为矫正、饮食调整和运动等综合治疗方案。     

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.     

北京市超重肥胖儿童青少年中黑棘皮症检出率及与胰岛素抵抗的关系

目的 分析超重、肥胖儿童青少年黑棘皮症(AN)与胰岛素抵抗的关系,为诊断胰岛素抵抗提供临床线索.方法 以2004年北京市儿童青少年代谢综合征调研中筛查出的1 877例6～18岁超重和肥胖儿童青少年作为研究对象.测量体重指数、腰围,并检测空腹血糖、胰岛素和血脂水平,采用稳态模式评估(HOMA-IR)法,评价个体胰岛素抵抗状况.结果 超重、肥胖儿童中黑棘皮症检出率分别为12.7%和26.3%;合并AN者的腰围、胰岛素、甘酰甘油(甘油三酯)、血压均分别显著高于单纯超重、肥胖者,肥胖合并AN者的高密度脂蛋白-胆固醇水平显著低于单纯肥胖者;超重、肥胖组中AN阳性者的HOMA-IR指数几何均值(P25～P75)分别为2.81(2.13～4.12)mU/L和3.69(2.53～5.34)mU/L,分别显著高于两组AN阴性者[2.03(1.45～3.01)mU/L;2.45(1.72～3.61)mU/L](P＜0.001).结论 超过1/4的肥胖儿童罹患黑棘皮症;具有黑棘皮症表型特征的超重、肥胖儿童更容易出现代谢异常指标的改变,以及胰岛素抵抗程度的加重;黑棘皮症可以作为筛查胰岛素抵抗患儿的临床表型特征.     

52例肥胖和超重儿童糖耐量及胰岛素释放试验分析

目的 了解肥胖和超重儿童糖代谢及胰岛细胞功能状况。方法 对52例单纯性肥胖与超重儿童进行口服糖耐量试验,并测定其血糖及胰岛素水平。计算胰岛素抵抗指数(IR),胰岛素敏感指数(IS),服糖后30min胰岛素增加值与血糖增加值的比值。并查甘油三酯、肝脏B超。体重指数(BMI)与IR之间、不同BMI组之间、糖耐量减低组与对照组之间进行比较。结果 发现糖尿病1例(1．9％),IGT者5例(9．6％)。IR≥2．8为胰岛素抵抗,占76．9％。BMI与IR之间无相关关系。不同BMI组之间IR、IS、服糖后30min胰岛素增加值与血糖增加值的比值差异均无统计学意义。糖耐量减低组与对照组之间IR、IS差异无统计学意义,服糖后30min胰岛素增加值与血糖增加值的比值之间差异有统计学意义。甘油三酯升高19例(37％),脂肪肝16例(53％)。结论 肥胖与超重儿童普遍存在胰岛素抵抗和敏感性下降,其与BMI程度无关。肥胖伴糖耐量减低儿童除胰岛素抵抗外存在明显的B细胞功能减退。许多肥胖和超重儿童同时存在脂代谢紊乱。     

血清谷丙转氨酶与儿童超重、肥胖的关系

目的：探讨血清谷丙转氨酶（ALT）与儿童超重、肥胖的关系。方法：对年龄7～18岁的2889例正常儿童及702例超重、肥胖儿童的资料进行分析,测量身高、体重、腰围、血压,检测空腹血糖、血脂、ALT、胰岛素等生化指标,计算胰岛素抵抗指数。结果：男童ALT水平高于女童。随着体重指数（BMI）的增加,男女童正常组、超重组、肥胖组ALT水平均逐渐增加。ALT与BMI、腰围、甘油三酯、胰岛素抵抗指数等相关。在超重、肥胖儿童中,男童ALT升高组BMI、腰围、血压、甘油三酯、低密度脂蛋白、胰岛素抵抗指数均较ALT正常组高（P<0.05）;女童ALT升高组腰围、血压、胰岛素抵抗指数高于ALT正常组,而高密度脂蛋白降低（P<0.05）。结论：ALT与儿童超重、肥胖及其引起代谢异常如血脂异常、胰岛素抵抗相关。     

Prevalence of overweight and obesity in the Netherlands in 2003 compared to 1980 and 1997

Objective

To assess the prevalence of overweight and obesity in children living in the Netherlands and compare the findings with the Third and Fourth National Growth Studies carried out in 1980 and 1997, respectively.

Design and methods

Data were obtained from the child health care system. International cut‐off points for body mass index (BMI) were used to determine overweight and obesity. Cases were weighted for ethnicity and municipality size in such a way that the sample matched the distribution in the general population. The LMS method was used to calculate the age‐related distribution of BMI, and the prevalence was calculated from the fitted distribution.

Patients

Data on 90 071 children aged 4–16 years were routinely collected by 11 community health services during 2002–2004.

Results

On average, 14.5% of the boys and 17.5% of the girls were overweight (including obesity), which is a substantial increase since 1980 (boys 3.9%, girls 6.9%) and 1997 (boys 9.7%, girls 13.0%). Similarly, 2.6% of the boys and 3.3% of the girls aged 4–16 years were obese, which is much higher than in 1980 (boys 0.2%, girls 0.5%) and 1997 (boys 1.2%, girls 2.0%). At the age of 4, 12.3% of the boys and 16.2% of the girls were already overweight.

Conclusions

The prevalence of overweight and obesity in the Netherlands is still rising, and at an even faster rate than before. Evidence‐based interventions are needed to counter the obesity epidemic, and there is an urgent need for pre‐school intervention programmes.     

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.     

Prevalence of Overweight and Obesity in a Large Clinical Sample of Children With Autism

BackgroundOverweight and obesity are major pediatric public health problems in the United States; however, limited data exist on the prevalence and correlates of overnutrition in children with autism.MethodsThrough a large integrated health care system's patient database, we identified 6672 children ages 2 to 20 years with an assigned ICD-9 code of autism (299.0), Asperger syndrome (299.8), and control subjects from 2008 to 2011 who had at least 1 weight and height recorded in the same visit. We calculated age-adjusted, sex-adjusted body mass index and classified children as overweight (body mass index 85th to 95th percentile) or obese (≥95th percentile). We used multinomial logistic regression to compare the odds of overweight and obesity between groups. We then used logistic regression to evaluate factors associated with overweight and obesity in children with autism, including demographic and clinical characteristics.ResultsCompared to control subjects, children with autism and Asperger syndrome had significantly higher odds of overweight (odds ratio, 95% confidence interval: autism 2.24, 1.74–2.88; Asperger syndrome 1.49, 1.12–1.97) and obesity (autism 4.83, 3.85–6.06; Asperger syndrome 5.69, 4.50–7.21). Among children with autism, we found a higher odds of obesity in older children (aged 12–15 years 1.87, 1.33–2.63; aged 16–20 years 1.94, 1.39–2.71) compared to children aged 6 to 11 years. We also found higher odds of overweight and obesity in those with public insurance (overweight 1.54, 1.25–1.89; obese 1.16, 1.02–1.40) and with co-occurring sleep disorder (obese 1.23, 1.00–1.53).ConclusionsChildren with autism and Asperger syndrome had significantly higher odds of overweight and obesity than control subjects. Older age, public insurance, and co-occurring sleep disorder were associated with overweight or obesity in this population.     

Predicting obesity in early adulthood in Japanese women

Aim:   We analysed the body measurements of Japanese women to determine which factors may forecast adult obesity and also performed a comparative study of the utility of body mass index (BMI), which is used widely in Western Europe, and percentage of overweight, which is used in Japan.
Methods:   Subjects included 244 Japanese women who were born between 1983 and 1986. Using a questionnaire, we investigated anthropometric values from birth to present and parents' present anthropometric data, and analysed factors that correlate with current BMI data.
Results:   (i) BMI after 10 years of age and BMI increase between ages 7 and 8 years correlated with BMI in adulthood. The carrying over rate of overweight increased with age. Meanwhile, percentage of overweight after 13 years onwards correlated with BMI in adulthood. (ii) Adult BMI positively correlated to both parents' BMI.
Conclusions:   (i) For a Japanese woman, BMI in childhood is a good indicator of young adult BMI, and has the possibility of becoming an important parameter to monitor obesity progression. (ii) Therefore, attempts to control obesity in elementary school girls are necessary. (iii) Parents' weights may potentially influence obesity in adulthood; however, further examination of other confounding factors is necessary.     

Prevalence of acanthosis nigricans in relation to anthropometric measures: Community‐based cross‐sectional study in Korean pre‐adolescent school children

Background: This cross‐sectional study was performed to assess the prevalence of acanthosis nigricans (AN) across various anthropometric measures and to identify the cut‐offs for anthropometric indices of adiposity for development of AN in Asian preadolescent school children. Methods: Body mass index (BMI), percentage weight for height (PWH), percentage body fat (PBF), and AN of the neck were evaluated in children in the fifth grade of all elementary schools in one metropolitan, Korean city (2117 boys and 1916 girls, mean age 10.9 ± 0.6 years, mean BMI 18.6 ± 3.3 kg/m²). Results: The prevalence of AN was 8.4% in boys and 5.1% in girls, and was proportional to the BMI, PWH, and PBF. The prevalence of AN rose steeply in the 80th and 90th percentiles of the BMI, PWH, and PBF in boys and girls, respectively. According to receiver operating characteristic analysis, AN was observed in boys with BMI >22.2 kg/m², and in girls with BMI >21.2 kg/m², which are below the current criteria for childhood obesity (local BMI 95th percentile and International Obesity Task Force BMI 30 kg/m²). Conclusions: AN has a good correlation with level of adiposity, and was already present in overweight children that were not considered obese by definition.     

Height-specific body mass index reference curves for Japanese children and adolescents 5−17 years of age

BACKGROUND: Body mass index (BMI) reference values in consideration of height variation have not previously been reported. This study established height-specific BMI reference curves for Japanese children and adolescents aged from 5 to 17 years. METHODS: The 2001 nationwide survey data were utilized for the study. First, the range of variation in BMI corresponding to height (mean +/- 2SD) at each age was compared with the range of variation in BMI corresponding to age (from minimum to maximum) at every cm height. Second, various age groups were combined, and percentile values of BMI (3rd, 5th, 15th, 50th, 85th, 95th, and 97th) were calculated for every cm height, regardless of age, and height-specific BMI reference values (males 100-179 cm, females 100-169 cm) were prepared. RESULTS: Variation in BMI due to variation in height at each age was significantly (P <0.05) greater than variation in BMI due to age at every cm height [males, 12.7 +/- 0.4 vs 9.2 +/- 0.4; females, 11.7 +/- 0.8 vs 8.8 +/- 0.3 (mean +/- SE)]. CONCLUSION: Although the use of standard values established in consideration of age and height is desirable for BMI-based guidelines for determining childhood overweight and obesity, to simplify the procedure for practical use, it is necessary to establish standard values by height, not by age. Height-specific BMI reference curves are useful for BMI-based evaluation of childhood overweight and obesity in the school health service and follow-up of obese children until adulthood.     

Bodyfat percentage in girls increased steadily with age and percentile rank of body mass index

BACKGROUND: The purpose of the present study was to determine the body composition of elementary school children by bioelectrical impedance analysis (BIA) method with a subject in a standing position. The method is frequently used in Japan. The other aim was to evaluate the relationship between the body composition and percentile rank of the body mass index (BMI) in Japanese children. METHODS: The number of subjects were 1042 children (530 boys and 512 girls aged from 6- to 12-years-old) from an elementary school. The bioelectrical impedance (BI) in the standing position was measured late in the morning before lunch. The fat percentage was derived from the body density according to the formula of Brozek et al. Each percentile value of BMI for each age and sex was determined from the frequency table of height and weight published by the Ministry of Education in Japan. RESULTS: The fat percentage in both boys and girls was significantly correlated with the BMI, however, girls showed a closer linear relation than boys. The fat percentage in girls increased steadily with age and percent rank of the BMI. The fat percentage in boys was scattered in a wide range at each percentile rank of the BMI. CONCLUSIONS: The fat percentage measured by the BIA in the standing position is closely associated with the percentile rank of the BMI in elementary school girls. For boys, it will be necessary to compare data among different types of BI measurement methods.