武汉市8~10岁儿童碘营养状况及影响因素分析

陈芳; 吴凯; 杨燕; 徐明星

doi:10.16835/j.cnki.1000-9817.2021.01.008

武汉市8~10岁儿童碘营养状况及影响因素分析

doi: 10.16835/j.cnki.1000-9817.2021.01.008

湖北省武汉市疾病预防控制中心血吸虫病与地方病防制所地方病防治科，430015

基金项目:

武汉市卫生健康委科研计划资助项目 WG20Q02

详细信息

作者简介:
陈芳(1989-)女，安徽省人，硕士，主治医师，主要研究方向为地方病与寄生虫病

中图分类号: R 153.2 R 151 R 446
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- 被引次数: 0
出版历程
- 收稿日期: 2020-06-11
- 修回日期: 2020-09-10
- 网络出版日期: 2021-04-01
- 刊出日期: 2021-01-25

Study on iodine nutrition and related influencing factors of children aged 8-10 in Wuhan

Department for Endemic Disease Control Institute for Schistosomiasis and Endemic Disease, Wuhan Center for Disease Control and Prevention, Wuhan(430015), China

摘要

摘要: 目的了解武汉市学龄儿童碘营养状况及其相关因素，为调整儿童碘缺乏病防治策略提供依据。方法 2019年在武汉市5个区(洪山、汉阳、汉南、江夏、东西湖)按东、西、南、北、中各抽取1所小学的8~10岁儿童，采集儿童随机一次尿样、家庭食用盐样进行检测，同时进行身高、体重测量及自填式问卷调查。共收集有效问卷942份，其中男生484名，女生458名。结果儿童家庭食用盐碘含量中位数为23.20 mg/kg，儿童尿碘中位数为251.00 μg/L，儿童随机一次尿碘与性别、调查前1天是否食用海带、食用牛奶频次及是否接受过放射检查相关(P值均 < 0.05)。性别为男生(OR=1.38，95%CI=1.04~1.82)、调查前1天食用海带(OR=1.67，95%CI=1.13~2.47)及接受过放射检查(OR=1.26，95%CI=1.05~1.52)与儿童尿碘水平高于适宜值上限均呈正相关(P值均 < 0.05)。全市儿童碘缺乏病防治知识知晓率为69.64%。结论武汉市8~10岁儿童碘营养状况高于国际组织推荐的适宜量水平，儿童随机一次尿碘水平受多种因素影响，且儿童碘缺乏病知识知晓率偏低。应加强儿童及居民碘缺乏病健康教育，确保在防止发生碘缺乏的同时也避免碘过量。
- 碘 /
- 营养状况 /
- 回归分析 /
- 儿童
Abstract: Objective To understand the status of iodine nutrition and its related influencing factors of school-age children in Wuhan, so as to provide the basis for adjusting the strategies of IDD prevention and control. Methods In 5 districts of Wuhan (Hongshan, Hanyang, Hannan, Jiangxia, Dongxihu), non-boarding students aged 8-10 years old were selected from each of the five sample areas in the east, west, south, north and middle. Samples of urine and the cooking salt from their home were randornly colleted among children. Height, weight measurement and a self-administered questionnaire were conducted at the same time. A total of 942 valid questionnaires were collected, including 484 boys and 458 girls. Results The median of iodine content of children's household salt was 23.20 mg/kg, the median of urinary iodine of children in the city was 251.00 μg/L. Children's random urine iodine concentration was related to gender, whether kelp was consumed the day before the survey, the frequency of consuming milk, and whether they received radiological examinations(P < 0.05). Male (OR=1.38, 95%CI=1.04-1.82), consumption of kelp the day before the survey (OR=1.67, 95%CI=1.13-2.47) and radiological examination (OR=1.26, 95%CI=1.05-1.52) were risk factors for children with urinary iodine concentration higher than the upper limit of the appropriate value(P < 0.05). The awareness rate of children's iodine deficiency disease prevention knowledge in Wuhan was 69.64%. Conclusion The iodine nutritional status of children aged 8-10 years in Wuhan was higher than the appropriate level recommended by international organizations. The random urine iodine concentration of children was affected by many factors and the awareness rate of children's iodine deficiency disease knowledge in Wuhan was low. Therefore, health education for children and residents on iodine deficiency disorders should be strengthened, and they should be properly guided and intervened to ensure that iodine deficiency is prevented while iodine excess is avoided.
- Iodine /
- Nutritional status /
- Regression analysis /
- Child

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表 1 武汉市不同地区儿童家庭食用盐碘水平/(mg·kg^-1)

Table 1. Iodine levels of salt in children's families in different regions of Wuhan/(mg·kg^-1)

地区	检测份数	碘含量分布				中位数
地区	检测份数	< 5	5~ < 18	18~33	> 33	中位数
汉阳	196	0	0	196	0	23.02
洪山	194	2	7	184	1	25.15
东西湖	165	5	3	156	1	22.36
汉南	189	5	9	171	4	23.60
江夏	198	1	8	189	0	21.60
合计	942	13	27	896	6	23.20

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表 2 武汉市不同组别儿童尿碘水平分布/(μg·L^-1)

Table 2. Distribution of urinary iodine levels in different groups of children in Wuhan/(μg·L^-1)

组别	选项	样品份数	< 100	100~ < 200	200~ < 300	≥300
地区	汉阳	196	53(27.04)	59(30.10)	46(23.47)	38(19.39)
	洪山	194	11(5.67)	36(18.56)	63(32.47)	84(43.30)
	东西湖	165	37(22.42)	45(27.27)	45(27.27)	38(23.03)
	汉南	189	12(6.35)	27(14.29)	47(24.87)	103(54.50)
	江夏	198	14(7.07)	37(18.69)	54(27.27)	93(46.97)
性别	男	484	57(11.78)	97(20.04)	127(26.24)	203(41.94)
	女	458	70(15.28)	107(23.36)	128(27.95)	153(33.41)
年龄/岁	8	197	22(11.17)	36(18.27)	57(28.93)	82(41.62)
	9	263	40(15.21)	58(22.05)	63(23.95)	102(38.78)
	10	482	65(13.49)	110(22.82)	135(28.01)	172(35.68)
合计		942	127(13.48)	204(21.66)	255(27.07)	356(37.79)
注： ()内数字为构成比/%。

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表 3 儿童随机一次尿碘水平影响因素

Table 3. Influencing factors of random urine iodine level in children

组别	选项	人数	尿碘中位数/(μg·L^-1)	χ²/Z值	P值
性别	男	484	263.66	-2.89	0.00
	女	458	235.40
年龄/岁	8	197	274.00	3.81	0.15
	9	263	242.00
	10	482	242.15
BMI	正常	778	245.50	4.11	0.13
	超重	97	280.00
	肥胖	67	255.72
盐碘含量/(mg·kg^-1)	< 5	13	258.20	0.18	0.98
	5~ < 18	27	221.11
	18~33	896	251.81
	≥33	6	232.78
调查前1天是否食用海带	是	135	299.12	-2.95	0.00
	否	807	245.00
食用海带、紫菜、海苔等食品频次	每天都吃	27	335.00	1.66	0.65
	≥1次/周	323	251.00
	每两周1次	245	251.00
	每两周小于1次	347	248.47
食用鱼、虾、蟹、贝类等海产品频次	每天都吃	52	248.55	2.00	0.57
	≥1次/周	349	237.00
	每两周1次	235	247.00
	每两周小于1次	306	262.04
食用肉蛋类食品的频次	每天都吃	423	244.00	3.34	0.34
	≥1次/周	281	255.72
	每两周1次	190	260.50
	每两周小于1次	48	202.82
食用牛奶或奶制品的频次	每天都吃	436	228.71	9.54	0.02
	≥1次/周	260	272.15
	每两周1次	162	251.31
	每两周小于1次	84	271.90
吃海产品制成的零食频次	经常吃	40	265.50	1.08	0.58
	偶尔吃	617	250.00
	基本不吃	285	256.00
直系亲属是否患有甲状腺疾病	是	25	276.00	1.42	0.49
	否	642	255.76
	不知道	275	244.00
家庭成员是否抽烟	是	605	250.00	-0.77	0.44
	否	337	251.00
是否接受过放射检查	是	289	257.00	13.67	0.00
	否	420	270.50
	不知道	233	217.00
参加体育锻炼频次	每天都参加	322	266.58	4.54	0.21
	3~6次/周	301	249.00
	1~2次/周	252	248.65
	< 1次/周	67	200.00
儿童防治知识知晓率	< 60%	259	237.00	4.63	0.10
	60%~80%	419	260.50
	> 80%	264	252.05

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表 4 尿碘水平高于适宜值上限影响因素的Logistic回归分析(n=942)

Table 4. Logistic regression analysis of influencing factors of urine iodine level above the upper limit of the appropriate value (n=942)

自变量	β值	标准误	Wald χ²值	P值	OR值(OR值95%CI)
性别	0.32	0.14	5.12	0.02	1.38(1.04~1.82)
调查前1天是否食用海带	0.51	0.20	6.72	0.01	1.67(1.13~2.47)
是否接受过放射检查	0.23	0.10	5.89	0.02	1.26(1.05~1.52)

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参考文献(24)

[1]	单忠艳. 中国居民补碘指南解读[J]. 中国实用内科杂志, 2019, 39(4): 347-350. DOI: 10.19538/j.nk2019040108. SHAN Z Y. Interpretation of guidelines to iodine supplementation for Chinese residents[J]. Chin J Pract Intern Med, 2019, 39(4): 347-350. DOI: 10.19538/j.nk2019040108.
[2]	葛可佑. 中国营养师培训教材[M]. 北京: 人民卫生出版社, 2005: 489-492. GE K Y. Training materials for Chinese dietitians[M]. Beijing: People's Medical Publishing House, 2005 : 489-492.
[3]	陈芳, 吴凯, 杨燕, 等. 2017年武汉市碘缺乏病监测及水碘调查结果分析[J]. 中华地方病学杂志, 2018, 37(12): 976-980. DOI: 10.3760/cma.j.issn.2095-4255.2018.12.007. CHEN F, WU K, YANG Y, et al. Analysis of survey results of iodine deficiency disorders and water iodine in Wuhan City in 2017[J]. Chin J Endemiol, 2018, 37(12): 976-980. DOI: 10.3760/cma.j.issn.2095-4255.2018.12.007.
[4]	任天虹, 余晓丹. 上海市成年人群尿碘相关因素分析[J]. 中华流行病学杂志, 2013, 34(12): 1173-1175. DOI: 10.3760/cma.j.issn.0254-6450.2013.012.004. REN T H, YU X D. Factors related to urinary iodine in adults from Shanghai[J]. Chin J Epidemiol, 2013, 34(12): 1173-1175. DOI: 10.3760/cma.j.issn.0254-6450.2013.012.004.
[5]	曹永琴, 王燕玲, 窦瑜贵, 等. 甘肃省临夏回族自治州碘缺乏病健康教育效果评价[J]. 中华地方病学杂志, 2013, 32(2): 220-223. DOI: 10.3760/cma.j.issn.2095-4255.2013.02.026. CAO Y Q, WANG Y L, DOU Y G, et al. Effect evaluation of health education on iodine deficiency disorders prevention in Linxia Hni autonomous prefecture of Gausu Province[J]. Chin J Endemiol, 2013, 32(2): 220-223. DOI: 10.3760/cma.j.issn.2095-4255.2013.02.026.
[6]	柴辉. 调查问卷设计中信度及效度检验方法研究[J]. 世界科技研究与发展, 2010, 32(4): 548-550. https://www.cnki.com.cn/Article/CJFDTOTAL-SJKF201004038.htm CHAI H. Researches on reliability and validity of inspection procedure in questionnaire Design[J]. World Sci-Tech R D, 2010, 32(4): 548-550. https://www.cnki.com.cn/Article/CJFDTOTAL-SJKF201004038.htm
[7]	中华人民共和国卫生部. 尿中碘的砷铈催化分光光度法测定方法WS/T 107—2006[S]. 北京: 人民卫生出版社, 2006. Ministry of Health of the People's Republic of China. Method for determination of iodine in urine by As(M)-Ce4+ spectrophotometry WS /T 107-2006 [S]. Beijing: People's Medical Publishing House, 2006.
[8]	WHO, UNICEF, JCCIDD. Assessment of iodine deficiency disordersand monitoring their elimination. A guide for programme manager[M]. 3rd ed.Geneva: WHO, 2007.
[9]	国家质量技术监督局. 制盐工业通用试验方法碘的测定GB/T 13025.7—2012[S]. 北京: 中国标准出版社, 2012. The State Bureau of Quality and Technical Supervision. General test method in salt industry: determination of iodine GB/T 13025.7—2012[S]. Beijing: Standards Press of China, 2012.
[10]	中华人民共和国国家卫生和计划生育委员会. 学龄儿童青少年超重与肥胖筛查WS/T 586—2018[S]. 2018-08-01. National Health and Family Planning Commission of the People's Republic of China. Screening for overweight and obesity among school-age children and adolescents WS/T 586—2018[S]. 2018-08-01.
[11]	中华人民共和国卫生部, 中国国家标准化管理委员会. 碘缺乏病消除标准GB 16006—2008[S]. 北京: 中国标准出版社, 2008. Ministry of Health of the People's Republic of China, China National Standardization Management Committee. Criteria for elimination of iodine deficiency disorders GB 16006—2008[S]. Beijing: Standards Press of China, 2008.
[12]	石荣兴, 王军波, 赵建忠, 等. 北京市丰台区8~10岁儿童碘营养现状及其影响因素分析[J]. 中国学校卫生, 2011, 32(6): 649-651. https://www.cnki.com.cn/Article/CJFDTOTAL-XIWS201106007.htm SHI R X, WANG J B, Zhao J Z, et al. Nutritional status of iodine among children aged 8-10 years and its influencing factor in Fengtai District[J]. Chin J Sch Health, 2011, 32(6): 649-651. https://www.cnki.com.cn/Article/CJFDTOTAL-XIWS201106007.htm
[13]	刘湾湾, 彭慧, 张琴, 等. 2016—2018年上海市嘉定区重点人群碘营养状况及影响因素研究[J]. 中国地方病防治杂志, 2019, 34(3): 256-259. https://www.cnki.com.cn/Article/CJFDTOTAL-DYBF201903006.htm LIU W W, PENG H, ZHANG Q, et al. Study on results of investigation on iodine nutritional status of key population in Jiading District of Shanghai from 2016 to 2018[J]. Chin J Ctrl Enderm Dis, 2019, 34(3): 256-259. https://www.cnki.com.cn/Article/CJFDTOTAL-DYBF201903006.htm
[14]	KALOUMENOU I, DUNTAS L H, ALEVIZAKI M, et al. Gender, age, puberty, and BMI related changes of TSH and thyroid hormones in schoolchildren living in a long-standing iodine replete area[J]. Horm Metabol Res, 2010, 42(4): 285-289. doi: 10.1055/s-0029-1246184
[15]	刘丽波, 陈强. 放射性甲状腺疾病诊断解析[J]. 中国辐射卫生, 2019(5): 477-479. DOI: 10.13491/j.issn.1004-714x.2019.05.001. LIU L B, CHEN Q. Diagnostic analysis of radiational thyroid disease[J]. Chin J Radiol Health, 2019(5): 477-479. DOI: 10.13491/j.issn.1004-714x.2019.05.001.
[16]	王浩, 魏红, 田晓晓, 等. 徐州地区人群甲状腺患病情况及影响因素分析[J]. 中外健康文摘, 2014(20): 49-50. DOI: 10.3969/j.issn.1672-5085.2014.20.045. WANG H, WEI H, TIAN X X, et al. Analysis on prevalence and influence factors of thyroid disease in Xuzhou[J]. World Health Digest, 2014(20): 49-50. DOI: 10.3969/j.issn.1672-5085.2014.20.045.
[17]	杨佳露. 上海市浦东新区8~10岁学龄儿童尿碘水平与甲状腺疾病的关系[J]. 工业卫生与职业病, 2018, 44(6): 16-19. https://www.cnki.com.cn/Article/CJFDTOTAL-GYWZ201806005.htm YANG J L. The relationship between urinary iodine levels and thyroid diseases in school children aged 8-10 in Shanghai Pudong New Area[J]. Ind Health Occup Dis, 2018, 44(6): 16-19. https://www.cnki.com.cn/Article/CJFDTOTAL-GYWZ201806005.htm
[18]	葛苗苗, 罗雅婕, 邵继红, 等. 苏北某地区8~10岁儿童碘营养状况及影响因素分析[J]. 中国学校卫生, 2016, 37(9): 1294-1296. https://www.cnki.com.cn/Article/CJFDTOTAL-XIWS201609007.htm GE M M, LUO Y J, SHAO J H, et al. Study on iodine nutritional status and influencing factors among school-aged children in the north of Jiangsu Province[J]. Chin J Sch Health, 2016, 37(9): 1294-1296. https://www.cnki.com.cn/Article/CJFDTOTAL-XIWS201609007.htm
[19]	刘自远, 何卓高. 盐碘与尿碘的相关性研究[J]. 数理医药学杂志, 2002, 15(1): 39. https://www.cnki.com.cn/Article/CJFDTOTAL-SLYY200201020.htm LIU Z Y, HE Z G. Correlation study of salt iodized and urine iodized[J]. J Math Med, 2002, 15(1): 39. https://www.cnki.com.cn/Article/CJFDTOTAL-SLYY200201020.htm
[20]	LEUNG A M, BRAVERMAN L E, PEARCE E N. A dietary iodine questionnaire: correlation with urinary iodine and food diaries[J]. Thyroid, 2007, 17(8): 755-762. doi: 10.1089/thy.2006.0312
[21]	刘晓钟, 茅亚达, 季平, 等. 儿童尿碘浓度白天节律观察[J]. 中国地方病学杂志, 2002, 21(6): 478. https://www.cnki.com.cn/Article/CJFDTOTAL-ZDFB200206021.htm LIU X Z, MAO Y D, JI P, et al. Observation of the daytime rhythm of urinary iodine concentration of children[J]. Chin J Endemiol, 2002, 21(6): 478. https://www.cnki.com.cn/Article/CJFDTOTAL-ZDFB200206021.htm
[22]	DOGGUI R, EL ATI-HELLAL M, TRAISSAC P, et al. Pre-analytical factors influence accuracy of urine spot iodine assessment in epidemiological surveys[J]. Biol Trace Element Res, 2018, 186(2): 337-345. doi: 10.1007/s12011-018-1317-y
[23]	赵琦. 上海市高碘地区儿童碘营养状况及其影响因素的研究[D]. 上海: 复旦大学, 2005. ZHAO Q. Study on the status and impact factors on children'nutrition of iodine in high iodine district in Shanghai[D]. Shang Hai: Fudan University, 2005.
[24]	李菊, 李冬, 洪守祥, 等. 学龄前儿童碘营养状况与体重指数关系的横断面研究[J]. 现代预防医学, 2018, 45(24): 37-41, 45. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF201824008.htm LI J, LI D, HONG S X, et al. A cross-sectional study on the relationship between iodine nutritional status and body mass index in preschool children[J]. Modern Prev Med, 2018, 45(24): 37-41, 45. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF201824008.htm