上海市成人代谢异常型超重的流行趋势及人群教育水平的影响

目的  代谢异常型超重(metabolically unhealthy overweight, MUO)对人体健康的危害远甚于代谢正常型超重(metabolically healthy overweight, MHO)。本研究旨在了解上海市成人MUO的患病率水平及变化趋势，探讨人群教育水平的影响。方法  以上海市2002-2003年(n=12 302)、2009年(n=7 400)和2017年(n=19 023)3次抽样调查中35~74岁居民为研究对象，按其教育水平分为小学及以下组、初高中组和大学及以上组。根据有无超重和MS将人群分为代谢和体重正常(metabolically healthy, normal weight, MHNW)、代谢异常体重正常(metabolically unhealthy normal weight, MUNW)、MHO和MUO四种表型。采用多分类无序Logistic回归分析模型和广义估计方程分析二者关联。结果  男女性MUO的粗患病率和标化率上升(均有P < 0.001)。各教育程度组MUO标化率均上升，以小学及以下组增幅最大。三次调查均发现女性MUO标化率随教育程度的增加而降低，而2002-2003年和2009年调查发现男性MUO标化率随教育程度的提高而上升(均有P < 0.05)。以MHNW者为参比，调整年龄等因素后，相比于小学及以下组，初高中组男性患MUO风险升高，而初高中组和大学及以上组女性患MUO的风险降低(均有P < 0.05)。结论  上海市居民MUO患病率上升，且在低教育程度人群中增幅最大。应加大对低教育水平人群尤其是女性群体的健康宣教。

Prevalence trend of metabolically unhealthy overweight and impact of educational levels on Chi-nese adults of Shanghai

  Objective  Metabolically unhealthy overweight (MUO) is more harmful for human health than metabolically healthy overweight (MHO). This study aims to investigate the prevalence trend of MUO in Chinese adults in Shanghai, and to evaluate the impact of education attainment of the populations.  Methods  The study was based on three sampling surveys performed in residents aged 35-74 years in Shanghai in 2002-2003 (n=12 302), 2009 (n=7 400) and 2017 (n=19 023). All participants were classified into three groups according their educational levels: primary school or below, middle or high school and college or above, and categorized as four phenotypes based on the presence or absence of overweight and metabolic syndrome (MS): metabolically healthy, normal weight (MHNW), metabolically unhealthy, normal weight (MUNW), MHO and MUO. Multinomial Logistic regression and generalized estimating equation were employed to analyze the association between education level and four phenotypes.  Results  Both crude and age-standardized prevalence of MUO significantly increased in men and women (P < 0.001). The increase in age-standardized prevalence of MUO was observed in each subgroup of educational level and was the most substantial in the group of primary school or below. The age-standardized prevalence of MUO decreased along with increasing educational attainment in women in the three surveys, whereas the prevalence increased among men in the 2002-2003 and 2009 surveys (all P < 0.05). In the three surveys, after adjusting for age and other confounders, men with middle or high school educational level had a higher risk of MUO than those with educational level of primary school or below, whereas the risk was lower in women with educational levels of middle or high school and college or above (all P < 0.05).  Conclusion  The prevalence of MUO shows an upward trend in Chinese adults in Shanghai, and increases most among those with low educational levels. Interventions should be addressed in the population, particularly in women with lower educational levels.