Influence of birthweight and delivery mode on obesity among primary school students in Guangzhou
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摘要:
目的 探讨出生体重及分娩方式对小学生超重肥胖和腹型肥胖的影响，为预防儿童肥胖提供依据。 方法 依托广州市中小学生常规体检，采用分层整群抽样方法，抽取3所小学3 361名学生，对学生及家长进行问卷调查。应用Logistic回归模型分析分娩方式、出生体重与学生超重肥胖和腹型肥胖的关系。应用相乘交互项和Delta法探讨交互作用。 结果 广州市小学生的超重肥胖率为21.33%，腹型肥胖率为12.08%。多因素Logistic分析表明，与顺产的学生相比，经剖宫产者的超重肥胖风险增加了44%(OR=1.44，95%CI=1.16~1.80)；高出生体重的学生超重肥胖风险较正常体重者增加62%(OR=1.62，95%CI=1.09~2.42)。调整多因素后，未观察到出生体重和出生方式与学生腹型肥胖之间的关联性(P值均>0.05)。经剖宫产出生与父母肥胖对学生的超重肥胖(RERI=0.33，95%CI=0.02~0.65)和腹型肥胖(RERI=0.39，95%CI=0.12~0.65)存在相加交互作用。 结论 剖宫产及高出生体重与小学生超重肥胖风险增高有关联。剖宫产出生方式与父母肥胖可能协同促进儿童肥胖发生。 Abstract:Objective To explore the influence of birthweight and delivery mode on overweight/obesity and abdominal obesity in primary school students, and to provide evidence for childhood obesity prevention. Methods After physical examination, questionnaire survey was conducted among 3 361 students and their parents from 3 primary schools in Guangzhou selected through stratified clustering sampling. Information about birthweight and delivery mode was collected. Logistic regression model was used to analyze the association of birthweight and delivery mode with overweight/obesity and abdominal obesity. The multiplicative interaction term and the Delta method was used to explore the potential interaction. Results The prevalence rate of overweight and obesity for primary school students was 21.33%, and the rate of abdominal obesity was 12.08%. Multivariate Logistic regression analysis showed that delivery by cesarean section was associated with 44% increased risk of overweight/obesity(OR=1.44, 95%CI=1.16-1.80), as compared to vaginal delivery. Higher birthweight was linked to increased risk of overweight/obesity(OR=1.62, 95%CI=1.09-2.42). There was no significant association of birth weight and delivery mode with abdominal obesity in multivariate analysis(P>0.05). Additionally, a positive additive interaction was seen between delivery mode and parental obesity for students' risk of overweight/obesity(RERI=0.33, 95%CI=0.02-0.65), as well as for the risk of abdominal obesity(RERI=0.39, 95%CI=0.12-0.65). Conclusion Cesarean section delivery and higher birthweight are linked to increased risk of overweight and obesity in primary school students. The synergistic effect of cesarean section and parental obesity may increase the risk of childhood obesity. -
Key words:
- Birth weight /
- Obesity /
- Parturition /
- Regression analysis /
- Students
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表 1 不同组别小学生超重肥胖及腹型肥胖检出率比较
Table 1. Comparison of the detection rates of overweight, obesity and abdominal obesity among primary school students in different groups
组别 人数 超重肥胖 腹型肥胖 检出人数 χ2值 P值 检出人数 χ2值 P值 性别 男 1 786 482(26.99) 72.62 <0.01 308(17.25) 95.75 <0.01 女 1 575 235(14.92) 98(6.22) 年级 一~三 1 870 378(20.21) 3.15 0.08 196(10.48) 10.14 <0.01 四~六 1 491 339(22.74) 210(14.08) 视屏时间/(h·d-1) ≤1 2 434 523(21.49) 0.13 0.72 281(11.64) 0.35 0.55 >1 927 194(20.93) 117(12.73) 中高强度运动/(h·d-1) <1 1 416 280(19.77) 1.30 0.25 156(11.02) 2.28 0.13 ≥1 845 184(21.78) 111(13.14) 父母肥胖 否 2 060 366(17.77) 40.32 <0.01 208(10.10) 19.70 <0.01 是 1 301 351(26.98) 198(15.22) 父母文化程度 中学及以下 681 143(21.00) 1.96 0.38 103(15.12) 15.79 <0.01 高中或中专 571 133(23.29) 84(14.71) 大专及以上 2 075 431(20.77) 214(10.31) 家庭年收入/万元 <10 693 137(19.77) 1.31 0.52 93(13.42) 7.55 0.02 10~ 950 206(21.68) 130(13.68) ≥20 1 520 329(21.64) 158(10.39) 注：部分变量有缺失；( )内数字为检出率/%。 
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表 2 出生体重及分娩方式与小学生超重肥胖的关联分析
Table 2. Correlation of birth weight and delivery modes with overweight and obesity in primary school students
自变量 一至三年级 四至六年级 合计 人数 超重肥胖人数 超重肥胖检出率/% 调整OR值(OR值95%CI) 人数 超重肥胖人数 超重肥胖检出率/% 调整OR值(OR值95%CI) 人数 超重肥胖人数 超重肥胖检出率/% 调整OR值(OR值95%CI) 分娩方式 顺产 1 031 179 17.36 1.00 853 175 20.52 1.00 1 884 354 18.79 1.00 剖宫产 798 190 23.81 1.69(1.25~2.29)* 614 157 25.57 1.15(0.82~1.60) 1 412 347 24.58 1.44(1.16~1.80)* 出生体重 低 111 324 19.42 0.74(0.35~1.54) 90 16 17.78 0.94(0.46~1.93) 201 35 17.41 0.83(0.50~1.38) 正常 1 668 19 17.12 1.00 1 278 285 22.30 1.00 2 946 612 20.77 1.00 高 91 32 35.16 1.91(1.02~3.59)* 123 38 30.89 1.47(0.87~2.46) 214 70 32.71 1.62(1.09~2.42)* 注： *P<0.05；部分变量有缺失。
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表 3 出生体重及分娩方式与小学生腹型肥胖的关联分析
Table 3. Correlation of birth weight and delivery modes with abdominal obesity in primary school students
自变量 一至三年级 四至六年级 合计 人数 腹型肥胖人数 腹型肥胖检出率/% 调整OR值(OR值95%CI) 人数 腹型肥胖人数 腹型肥胖检出率/% 调整OR值(OR值95%CI) 人数 腹型肥胖人数 腹型肥胖检出率/% 调整OR值(OR值95%CI) 出生方式 顺产 1 031 92 8.92 1.00 853 106 12.43 1.00 1 884 198 10.51 1.00 剖宫产 798 101 12.66 0.97(0.56~1.69) 614 100 16.29 1.64(0.90~3.00) 1 412 201 14.24 1.24(0.83~1.85) 出生体重 低 111 13 11.71 1.30(0.31~5.43) 90 10 11.11 1.00(0.27~3.68) 201 23 11.44 1.18(0.46~3.03) 正常 1 668 168 10.07 1.00 1 278 175 13.69 1.00 2 946 343 11.64 1.00 高 91 15 16.48 0.76(0.26~2.21) 123 25 20.33 0.88(0.38~2.08) 214 40 18.69 0.87(0.45~1.68) 注：调整了性别、年龄、父母文化程度、家庭收入、BMI、父母肥胖、视屏时间和中高等强度活动时间；部分变量有缺失。
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表 4 分娩方式与视屏时间、身体活动、父母肥胖对小学生超重肥胖的交互作用分析
Table 4. Impact of interaction between delivery modes with screen time, physical activity, and parental obesity on overweight and obesity among primary school students
分娩方式 视屏时间、身体活动与父母肥胖 人数 超重肥胖人数 调整OR值(OR值95%CI) 剖宫产 中高强度运动时间/(h·d-1) 否 ≥1 485 92 1.00 <1 773 131 0.95(0.70~1.29) 是 ≥1 348 89 1.53(1.10~2.14)* <1 617 141 1.37(1.01~1.86)* 剖宫产 视屏时间/(h·d-1) 否 ≤1 153 32 1.00 >1 1 731 322 0.92(0.61~1.39) 是 ≤1 105 23 1.13(0.61~2.08) >1 1 307 324 1.33(0.88~2.02) 剖宫产 父母肥胖 否 否 1 199 191 1.00 是 8 115 163 1.33(1.05~1.68)* 是 否 690 162 1.62(1.28~2.05)* 是 597 184 2.34(1.85~2.96)* 注： *P<0.05；调整了性别、年龄、父母文化程度、家庭收入等因素；部分变量有缺失。
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表 5 出生体重与视屏时间、身体活动、父母肥胖对小学生超重肥胖的交互作用分析
Table 5. Impact of interaction between students' birth weight with screen time, physical activity, and parental obesity on overweight and obesity among primary school students
出生体重 视屏时间、身体活动与父母肥胖 人数 超重肥胖人数 调整OR值(OR值95%CI) 高出生体重 中高强度运动时间/(h·d-1) 否 ≥1 774 162 1.00 <1 1 344 255 0.94(0.75~1.19) 是 ≥1 71 21 1.42(0.82~2.45) <1 72 23 1.68(0.99~2.87) 高出生体重 视屏时间/(h·d-1) 否 ≤1 2 296 474 1.00 >1 851 168 0.90(0.74~1.11) 是 ≤1 138 44 1.62(1.11~2.37)* >1 76 26 1.72(1.05~2.83)* 高出生体重 父母肥胖 否 否 1 935 329 1.00 是 125 33 1.56(1.02~2.38)* 是 否 1 212 313 1.69(1.42~2.02)* 是 89 37 3.14(2.01~4.89)* 注：*P<0.05；调整了性别、年龄、父母文化程度、家庭收入等因素。
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表 6 分娩方式与视屏时间、身体活动、父母肥胖对小学生腹型肥胖的交互作用分析
Table 6. Impact of interaction between delivery modes with screen time, physical activity, and parental obesity on abdominal obesity in primary school students
分娩方式 视屏时间、身体活动与父母肥胖 人数 腹型肥胖人数 调整OR值(OR值95%CI) 剖宫产 身体活动时间/(h·d-1) 否 ≥1 485 51 1.00 <1 773 74 1.09(0.74~1.61) 是 ≥1 348 57 1.76(1.17~2.66)* <1 617 76 1.41(0.95~2.08) 剖宫产 视屏时间/(h·d-1) 否 ≤1 153 21 1.00 >1 1 731 172 0.91(0.66~1.25) 是 ≤1 105 16 1.28(0.86~1.91) >1 1 307 182 1.38(1.00~1.91)* 剖宫产 父母肥胖 否 否 1 199 110 1.00 是 8 115 86 1.19(0.88~1.60) 是 否 690 83 1.33(0.98~1.80) 是 597 112 2.26(1.70~3.02)* 注： *P<0.05；调整了性别、年龄、父母文化程度、家庭收入等因素。
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表 7 出生体重与视屏时间、身体活动、父母肥胖对小学生腹型肥胖的交互作用分析
Table 7. qImpact of interaction between students' birth weight with screen time, physical activity, and parental obesity on abdominal obesity in primary school students
出生体重 视屏时间、身体活动与父母肥胖 人数 腹型肥胖人数 调整OR值(OR值95%CI) 高出生体重 身体活动时间/(h·d-1) 否 ≥1 774 96 1.00 <1 1 344 141 0.96(0.72~1.29) 是 ≥1 71 14 1.44(0.76~2.71) <1 72 12 1.36(0.70~2.64) 高出生体重 视屏时间/(h·d-1) 否 ≤1 2 296 258 1.00 >1 851 101 0.96(0.75~1.24) 是 ≤1 138 22 1.30(0.81~2.09) >1 76 16 1.59(0.89~2.84) 高出生体重 父母肥胖 否 否 1 935 183 1.00 是 125 18 1.27(0.75~2.16) 是 否 1 212 176 1.60(1.28~2.00)* 是 89 20 2.49(1.47~4.19)* 注： *P<0.05；调整了性别、年龄、父母文化程度、家庭收入等因素。
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