浙江省农村学生营养改善计划地区中小学生肥胖类型与血脂的关系

赵栋; 黄李春; 苏丹婷; 顾炜; 韩丹; 章荣华

doi:10.16835/j.cnki.1000-9817.2024098

浙江省农村学生营养改善计划地区中小学生肥胖类型与血脂的关系

doi: 10.16835/j.cnki.1000-9817.2024098

浙江省疾病预防控制中心营养与食品安全所，杭州 310051

基金项目:

浙江省医药卫生科技计划项目 2022RC123

详细信息

作者简介:
赵栋(1986-)，男，山东东阿人，硕士，主管医师，主要研究方向为学生营养与改善

通讯作者:
章荣华，E-mail：rhzhang@cdc.zj.cn

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R179 R723.14 R339.3⁺5
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出版历程
- 收稿日期: 2023-11-16
- 修回日期: 2023-12-28
- 网络出版日期: 2024-03-29
- 刊出日期: 2024-03-25

Association between obesity and dyslipidemia among rural primary and middle school students in Students Nutrition Improvement Program Areas of Zhejiang Province

Department of Nutrition and Food Safety, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou (310051), Zhejiang Province, China

摘要

摘要: 目的探讨中小学生不同肥胖类型与血脂指标的关联，为进一步控制中小学生肥胖及血脂偏高提供科学依据。方法于2021年9—11月在浙江省农村义务教育学生营养改善项目5个监测点采用分层整群随机抽样的方法选取1 244名中小学生进行身高、体重检测，并采集静脉血进行血脂检测。采用χ²检验和Logistic回归分析中小学生肥胖类型与血脂之间的关联。结果中小学生的超重率、肥胖率、腹型肥胖率、血脂偏高率分别为15.11%，12.46%，17.60%, 21.78%。高三酰甘油发生风险肥胖组是非超重肥胖组的3.97倍(95%CI=2.54~6.20)，腹型肥胖组是正常腰围组的4.45倍(95%CI=2.95~6.72)(P值均＜0.05)。胆固醇偏高超重肥胖且腰围正常组与非超重肥胖且腰围正常组相比OR值最高(OR=2.53，95%CI=1.45~4.42)，血脂和三酰甘油偏高超重肥胖且腰围异常组OR值最高(OR=1.82，95%CI=1.33~2.48；OR=3.64，95%CI=2.45~5.43)(P值均＜0.05)。结论浙江省农村义务教育学生营养改善计划地区中小学生超重肥胖、腹型肥胖、血脂异常检出率均较高。儿童腹型肥胖与血脂异常关系更为密切，应定期对中小学生进行腰围测量及相关知识的普及。
- 肥胖症 /
- 血脂异常 /
- 生长和发育 /
- 回归分析 /
- 学生
Abstract: Objective The study aimed to analyze the association between different types of obesity and dyslipidemia among rural primary and middle school students in Zhejiang Province, so as to inform strategies for prevention and control of childhood obesity and hyperlipidemia. Methods As part of Nutrition Improvement Programme for Rural Compulsory Education Students, 1 244 participants were selected by stratified cluster random sampling in 5 counties of Zhejiang Province during September to December 2021. Physical examination, detection of blood lipid and questionnaire survey were conducted. The Chi-square test and Logistic regression analyses were used to assess the association between different types of obesity and dyslipidemia. Results The prevalence rates of overweight, obesity, abdominal obesity, and hyperlipidemia were 15.11%, 12.46%, 17.60%, and 21.78%. Obesity and abdominal obesity were correlated to high risk of high triglycerides (OR=3.97, 95%CI=2.54-6.20; OR=4.45, 95%CI=2.95-6.72)(P < 0.05). Compared with the non overweight and obese group with normal waist circumference, the overweight and obesity group were correlated to high risk of high cholesterol (OR=2.53, 95%CI=1.45-4.42, P < 0.05). Abdominal overweight or obese group had the highest risk for dyslipidemia and triglycerides (OR=1.82, 95%CI=1.33-2.48; OR=3.64, 95%CI=2.45-5.43) (P < 0.05). Conclusions The prevalence rates of overweight, obesity, abdominal obesity, and hyperlipidemia are relatively high in rural primary and middle school students of Nutrition Improvement Programme for Rural Compulsory Education Students in Zhejiang Province. Abdominal obesity is a more important risk factor for hyperlipidemia. Waist circumference should be the focus of considerable attention.
- Obesity /
- Dyslipidemias /
- Growth and development /
- Regression analysis /
- Students
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表 1 不同性别和学段学生基本情况比较(x±s)

Table 1. Comparison of basic information among students of different genders and academic stages(x±s)

组别	选项	人数	统计值	BMI/(kg·m^-2)	腰围/cm	胆固醇/(mmol·L^-1)	三酰甘油/(mmol·L^-1)
学段	小学	727		18.11±3.57	61.53±9.06	4.57±0.83	1.05±0.51
	初中	517		20.59±3.75	67.73±9.44	4.14±0.77	1.18±0.62
			t值	-11.84	-11.69	9.25	-3.92
			P值	＜0.01	＜0.01	＜0.01	＜0.01
性别	男	618		19.48±4.17	65.75±10.67	4.32±0.82	1.06±0.59
	女	626		18.80±3.47	62.49±8.37	4.46±0.84	1.14±0.53
			t值	3.13	5.99	-2.94	-2.48
			P值	＜0.01	＜0.01	＜0.01	0.01

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表 2 不同BMI组中小学生血脂指标构成比较

Table 2. Comparison ratio of blood lipid index among primary and middle school students with different groups of BMI

BMI组别	人数	胆固醇			三酰甘油		血脂
BMI组别	人数	合适水平	临界高值	高胆固醇	合适水平	高三酰甘油	正常血脂	血脂偏高
非超重肥胖组	901	517(57.38)	263(29.19)	121(13.34)	835(92.67)	66(7.33)	728(80.80)	173(19.20)
超重组	188	90(47.87)	65(34.57)	33(17.55)	159(84.57)	29(15.43)	135(71.81)	53(28.19)
肥胖组	155	84(54.19)	54(34.84)	17(10.97)	118(76.13)	37(23.87)	110(70.97)	45(29.03)
χ²值		7.96			45.58		12.84
P值		0.09			＜0.01		＜0.01
注： ()内数字为构成比/%。

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表 3 不同腹型肥胖组中小学生血脂指标构成比较

Table 3. Comparison ratio of blood lipid index among primary and middle school students with different groups of abdominal obesity

腰围组别	人数	胆固醇			三酰甘油		血脂
腰围组别	人数	合适水平	临界高值	高胆固醇	合适水平	高三酰甘油	正常血脂	血脂偏高
正常腰围组	803	459(57.16)	241(30.01)	103(12.83)	748(93.15)	55(6.85)	653(81.32)	150(18.68)
腹型肥胖前期组	222	127(57.21)	64(28.83)	31(13.96)	199(89.64)	23(10.36)	173(77.93)	49(22.07)
腹型肥胖组	219	105(47.95)	77(35.16)	37(16.89)	165(75.34)	54(24.66)	147(67.12)	72(32.88)
χ²值		6.64			57.55		20.37
P值		0.16			＜0.01		＜0.01
注： ()内数字为构成比/%。

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表 4 中小学生肥胖类型与血脂关系的Logistic回归分析[n=1 244，OR值(95%CI)]

Table 4. Logistic regression analysis between obesity phenotypes and blood lipid among primary and middle school students[n=1 244, OR(95%CI)]

自变量	模型1			模型2
自变量	血脂	胆固醇	三酰甘油	血脂	胆固醇	三酰甘油
BMI组别
非超重肥胖组	1.00	1.00	1.00	1.00	1.00	1.00
超重组	1.65(1.16~2.37)^*	1.44(1.06~1.94)^*	2.31(1.44~3.69)^*	1.67(1.17~2.39)^*	1.47(1.08~1.99)^*	2.44(1.52~3.91)^*
肥胖组	1.72(1.17~2.53)^*	1.07(0.77~1.49)	3.97(2.54~6.20)^*	1.76(1.19~2.59)^*	1.08(0.77~1.52)	4.23(2.68~6.67)^*
腰围组别
正常腰围组	1.00	1.00	1.00	1.00	1.00	1.00
腹型肥胖前期组	1.23(0.86~1.77)	1.01(0.75~1.35)	1.57(0.94~2.62)	1.21(0.84~1.74)	0.95(0.70~1.27)	1.68(1.00~2.80)^*
腹型肥胖组	2.13(1.53~2.98)^*	1.43(1.08~1.90)^*	4.45(2.95~6.72)^*	2.15(1.54~2.99)^*	1.49(1.11~1.99)^*	4.56(3.01~6.90)^*
肥胖类型
非超重肥胖且腰围正常组	1.00	1.00	1.00	1.00	1.00	1.00
超重肥胖且腰围正常组	1.63(0.82~3.24)	2.53(1.45~4.42)^*	1.35(0.47~3.92)	1.52(0.76~3.04)	1.90(1.08~3.35)^*	1.71(0.58~5.04)
非超重肥胖且腰围异常组	1.46(0.95~2.22)	1.48(1.05~2.08)^*	1.63(0.89~2.98)	1.37(0.89~2.10)	1.24(0.88~1.76)	1.79(0.97~3.32)
超重肥胖且腰围异常组	1.82(1.33~2.48)^*	1.20(0.93~1.56)	3.64(2.45~5.43)^*	1.85(1.35~2.53)^*	1.24(0.95~1.62)	3.81(2.54~5.71)^*
注：因变量赋值——血脂和三酰甘油均为合适水平=0，高水平=1；胆固醇为合适水平=0，临界高值=1，高水平=2。模型2调整了性别和年龄；*P＜0.05。

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参考文献(22)

[1]	侯冬青, 董虹孛, 朱忠信, 等. 学龄儿童肥胖持续状态与心血管代谢异常发病风险[J]. 中华流行病学杂志, 2021, 42(3): 440-447. doi: 10.3760/cma.j.cn112338-20200812-01060 HOU D Q, DONG H B, ZHU Z X, et al. Change in obesity status and development of cardiometabolic disorders in school-age children[J]. Chin J Epidemiol, 2021, 42(3): 440-447. (in Chinese) doi: 10.3760/cma.j.cn112338-20200812-01060
[2]	席波. 预防成年期心血管疾病应始于儿童期[J]. 中华预防医学杂志, 2019, 53(7): 657-660. XI B. Prevention of adult cardiovascular disease should start from childhood[J]. Chin J Prev Med, 2019, 53(7): 657-660. (in Chinese)
[3]	FAN H, ZHU Q, ZHANG X. Child excess weight status, adult excess weight status, and cardiometabolic risk profile[J]. Front Pediatr, 2022, 8: 301.
[4]	NG M, FLEMING T, ROBINSON M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the global burden of disease study 2013[J]. Lancet, 2014, 384(9945): 766-781. doi: 10.1016/S0140-6736(14)60460-8
[5]	马爱娟, 董忠, 祁琨, 等. 北京市成年人不同体重异常判断指标与血脂异常的相关性研究[J]. 中华预防医学杂志, 2023, 57(3): 400-405. doi: 10.3760/cma.j.cn112150-20220526-00533 MA A J, DONG Z, QI K, et al. Study on the relationship between indexes of different abnormal weight and dyslipidemia in adults in Beijing City[J]. Chin J Prev Med, 2023, 57(3): 400-405. (in Chinese) doi: 10.3760/cma.j.cn112150-20220526-00533
[6]	OKORODUDU D O, JUMEAN M F, MONTORI V M, et al. Diagnostic performance of body mass index to identify obesity as defined by body adiposity: a systematic review and Meta-analysis[J]. Int J Obes (Lond), 2010, 34(5): 791-799. doi: 10.1038/ijo.2010.5
[7]	广东省中西医结合学会肥胖与体重管理专业委员会, 广东省预防医学会内分泌代谢病防治专业委员会. 儿童青少年超重肥胖的医学体重管理专家共识[J]. 国际内分泌代谢杂志, 2023, 43(3): 261-273. doi: 10.3760/cma.j.cn121383-20220815-08021 Obesity and Weight Management Professional Committee in Guangdong Association of Chinese Integrative Medicine, Professional Committee for the Prevention and Treatment of Endocrine and Metabolic Diseases in Guangdong Preventive Medicine Association. Expert consensus about medical weight management of overweight and obesity in children and adolescents[J]. Int J Endocrinol Metab, 2023, 43(3): 261-273. (in Chinese) doi: 10.3760/cma.j.cn121383-20220815-08021
[8]	肖培, 程红, 郁兆仓, 等. 基于体脂肪的肥胖评估指标在学龄儿童持续性血脂异常筛查中的应用[J]. 中华流行病学杂志, 2020, 41(12): 2066-2071. doi: 10.3760/cma.j.cn112338-20200805-01024 XIAO P, CHENG H, YU Z C, et al. Application of obesity indicators based on body fat in the screening of persistent dyslipidemia among school-aged children[J]. Chin J Epidemiol, 2020, 41(12): 2066-2071. (in Chinese) doi: 10.3760/cma.j.cn112338-20200805-01024
[9]	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]. 北京: 中国标准出版社, 2018. National Health and Family Planning Commission of the PRC. Screening for overweight and obesity among school age children and adolescents cents: WS/T 586-2018[S]. Beijing: Standards Press of China, 2018. (in Chinese)
[10]	中华人民共和国国家卫生和计划生育委员会. 7岁~18岁儿童青少年高腰围筛查界值: WS/T 611—2018[S]. 北京: 中国标准出版社, 2018. National Health and Family Planning Commission of the PRC. High waist circumference screening threshold among children and adolescents aged 7-18 years: WS/T 611-2018[S]. Beijing: Standards Press of China, 2018. (in Chinese)
[11]	向伟, 杜军保. 《儿童青少年血脂异常防治专家共识》解读[J]. 中华儿科杂志, 2009, 47(8): 637-639. doi: 10.3760/cma.j.issn.0578-1310.2009.08.019 XIANG W, DU J B. Intensive reading and interpretation of Experts Consensus for Prevention and Treatment of Dyslipidemia in Children and Adolescents[J]. Chin J Pediatr, 2009, 47(8): 637-639. (in Chinese) doi: 10.3760/cma.j.issn.0578-1310.2009.08.019
[12]	陈婷, 范奕, 宋孝光, 等. 江西省儿童青少年超重肥胖流行现状及影响因素分析[J]. 中国学校卫生, 2021, 42(11): 1724-1727. doi: 10.16835/j.cnki.1000-9817.2021.11.028 CHEN T, FAN Y, SONG X G, et al. Analysis of prevalence and risk factors of overweight and obesity among children and adolescents in Jiangxi Province[J]. Chin J Sch Health, 2021, 42(11): 1724-1727. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2021.11.028
[13]	袁金娜, 金冰涵, 斯淑婷, 等. 2009至2019年6~15岁中国儿童超重和肥胖趋势分析[J]. 中华儿科杂志, 2021, 59(11): 935-941. YUAN J N, JIN B H, SI S T, et al. Changing prevalence of overweight and obesity among Chinese children aged 6-15 during 2009-2019[J]. Chin J Pediatr, 2021, 59(11): 935-941. (in Chinese)
[14]	王晓红, 赵天旺, 雷朝秋, 等. 中国1993-2015年儿童青少年腰围及腹型肥胖流行趋势[J]. 中国学校卫生, 2020, 41(6): 897-900. doi: 10.16835/j.cnki.1000-9817.2020.06.026 WANG X H, ZHAO T W, LEI C Q, et al. Recent trends in waist circumference and central obesity in Chinese children and adolescence during 1993-2015[J]. Chin J Sch Health, 2020, 41(6): 897-900. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2020.06.026
[15]	严明明, 罗淑颖, 张耀东. 郑州市城区7~15岁儿童青少年中心性肥胖流行现况[J]. 中国儿童保健杂志, 2022, 30(9): 1000-1004. https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO202209015.htm YANG M M, LUO S Y, ZHANG Y D. Prevalence of abdominal obesity among children and adolescents aged 7 to 15 years in Zhengzhou[J]. Chin J Health Care, 2022, 30(9): 1000-1004. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO202209015.htm
[16]	王志如, 李惟怡, 姜红如, 等. 中国四省7-17岁儿童青少年心血管代谢性危险因素的流行特征[J]. 中华流行病学杂志, 2023, 44(4): 592-597. doi: 10.3760/cma.j.cn112338-20220927-00814 WANG Z R, LI W Y, JIANG H R, et al. Epidemiological characteristics of cardio-metabolic risk factors among children and adolescents aged 7-17 years in 4 provinces of China[J]. Chin J Epidemiol, 2023, 44(4): 592-597. (in Chinese) doi: 10.3760/cma.j.cn112338-20220927-00814
[17]	丁文清, 董虹孛, 米杰. 中国儿童青少年血脂异常流行现状Meta分析[J]. 中华流行病学杂志, 2015, 36(1): 71-77. doi: 10.3760/cma.j.issn.0254-6450.2015.01.017 DING W Q, DONG H B, MI J. Prevalence of dyslipidemia in Chinese children and adolescents: a Meta-analysis[J]. Chin J Epidemiol, 2015, 36(1): 71-77. (in Chinese) doi: 10.3760/cma.j.issn.0254-6450.2015.01.017
[18]	李戈, 王冬梅, 李玉, 等. 北京地区超重及肥胖儿童脂代谢异常与血清视黄醇结合蛋白4水平的关系[J]. 中华糖尿病杂志, 2020, 12(9): 685-690. LI G, WANG D M, LI Y, et al. Association between retinol binding protein 4 levels and dyslipidemia in overweight and obese children and adolescents[J]. Chin J Diabetes Mellitus, 2020, 12(9): 685-690. (in Chinese)
[19]	候亚萍, 李智贤, 羊柳, 等. 儿童期腹型肥胖对成年期腹型肥胖的影响[J]. 中华流行病学杂志, 2020, 41(3): 385-388. doi: 10.3760/cma.j.issn.0254-6450.2020.03.020 HOU Y P, LI Z X, YANG L, et al. Effect of abdominal obesity in childhood on abdominal obesity in adulthood[J]. Chin J Epidemiol, 2020, 41(3): 385-388. (in Chinese) doi: 10.3760/cma.j.issn.0254-6450.2020.03.020
[20]	王政和, 邹志勇, 阳益德, 等. 2012年中国7省份6~17岁儿童青少年血脂异常流行情况及相关因素分析[J]. 中华预防医学杂志, 2018, 52(8): 798-801. doi: 10.3760/cma.j.issn.0253-9624.2018.08.005 WANG Z H, ZOU Z Y, YANG Y D, et al. The epidemiological characteristics and related factors of dyslipidemia among children and adolescents aged 6-17 years from 7 provinces in China, 2012[J]. Chin J Prev Med, 2018, 52(8): 798-801. (in Chinese) doi: 10.3760/cma.j.issn.0253-9624.2018.08.005
[21]	刘军廷, 么鸿雁, 于石成, 等. 中国六省学龄儿童体重指数、体脂百分比评价肥胖与心血管代谢危险因素的相关性[J]. 中国儿童保健杂志, 2022, 30(5): 469-474. https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO202205002.htm LIU J T, YAO H Y, YU S C, et al. Association of obesity classified by body mass index and fat mass percentage with cardiometabolic risk factors among school-age children in 6 provinces, China[J]. Chin J Child Health Care, 2022, 30(5): 469-474. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO202205002.htm
[22]	MAFFETONE P B, RIVERA-DOMINGUEZ I, LAURSEN P B, et al. Overfat adults and children in developed countries: the public health importance of identifying excess body fat[J]. Front Public Health, 2017, 24(5): 190.