含糖饮料摄入模式与儿童肥胖关联的纵向研究

徐玉祥; 江伟康; 赵莉; 熊静远; 苏普玉; 万宇辉; 方姣; 成果; 孙莹

doi:10.16835/j.cnki.1000-9817.2021.04.007

含糖饮料摄入模式与儿童肥胖关联的纵向研究

doi: 10.16835/j.cnki.1000-9817.2021.04.007

徐玉祥¹,
江伟康²,
赵莉³,
熊静远³,
苏普玉^{1, 4},
万宇辉^{1, 4},
方姣¹,
成果^5, ,,
孙莹^{1, 4, ,}

1.
安徽医科大学公共卫生学院，合肥 230032
2.
蚌埠市怀远县白莲坡镇中心小学柴沟分校
3.
四川大学华西公共卫生学院
4.
出生人口健康教育部重点实验室/人口健康与优生安徽省重点实验室
5.
四川大学华西第二医院西部妇幼医学研究院

基金项目:

国家自然科学基金项目 81872638

详细信息

作者简介:
徐玉祥(1996-)，男，安徽天长人，在读硕士，主要研究方向为儿童青少年卫生

通讯作者:
成果，E-mail：ehw_cheng@126.com

孙莹，E-mail：yingsun@ahmu.edu.cn

中图分类号: R 153.2 R 723.14
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- 被引次数: 0
出版历程
- 收稿日期: 2021-01-22
- 修回日期: 2021-03-04
- 网络出版日期: 2021-04-16
- 刊出日期: 2021-04-25

A cohort study on the association between sugar-sweetened beverage intake and childhood obesity using a group-based trajectory model

XU Yuxiang¹,
JIANG Weikang²,
ZHAO Li³,
XIONG Jingyuan³,
SU Puyu^{1, 4},
WAN Yuhui^{1, 4},
FANG Jiao¹,
CHENG Guo^{5
, ,},
SUN Ying^{1, 4
, ,}

1.
School of Public Health, Anhui Medical University, Hefei(230032), China

摘要

摘要: 目的探讨童年期不同含糖饮料(sugar-sweetened beverages，SSBs)摄入模式对儿童肥胖的影响，旨在为预防和控制儿童超重或肥胖提供新的流行病学证据。方法采用方便抽样方法，于2016年在安徽省蚌埠市2所小学建立儿童随访队列，每年随访1次，共随访3次。基线有1 263名儿童参加调查，3次随访后最终有997名儿童纳入分析。通过自编父母问卷和学生问卷获得儿童基本信息及每日SSBs消费情况，应用群组轨迹模型(group-based trajectory modelling，GBTM)拟合童年期SSBs摄入模式发展轨迹，采用多元线性回归模型分析不同SSBs摄入模式与儿童肥胖的关联。结果 GBTM拟合4种童年期SSBs摄入模式发展轨迹，分别命名为SSBs摄入持续较低组(822名)、先升后降组(20名)、渐降组(106名)和渐增组(49名)。SSBs摄入先升后降组和渐增组儿童基线及3次随访时的体质量指数(BMI)均高于持续较低组(F值分别为6.26，5.90，5.99和5.87，P值均＜0.01)。SSBs摄入模式与儿童BMI的关联存在性别差异。调整儿童基线BMI、父母BMI、肥胖遗传风险评分和体力活动等混杂因素后，在女童中，相比于SSBs摄入持续较低组，SSBs摄入渐增组女童第3次随访时BMI增加(B=1.20，95%CI=0.25~2.15，P=0.01)；在男童中，未发现4组SSBs摄入模式与BMI关联存在统计学意义(P值均＞0.05)。结论儿童SSBs摄入模式与肥胖关联存在性别差异，SSBs摄入水平较高的女童肥胖风险显著增加。未来需更多研究探讨性别差异的生理机制，为儿童肥胖预防及干预措施的制定提供理论依据。
- 碳水化合物 /
- 饮料 /
- 摄食行为 /
- 肥胖症 /
- 回归分析 /
- 儿童
Abstract: Objective To evaluate the development trajectory of sugar-sweetened beverage (SSB) intake in childhood, and to explore the influence of different SSB intake patterns on childhood obesity. Methods In 2016, a follow-up cohort study was carried out in two primary schools in Bengbu, Anhui Province. Three annual follow-ups were conducted in 1 263 children at baseline, and 997 children were included in the final analysis. Parental and student questionnaires were used to obtain basic information related to the children's consumption of SSBs. A group-based trajectory model (GBTM) was applied to classify the development trajectory of SSB intake patterns in childhood. Multiple linear regression analyses were performed to assess the correlation between different SSB intake patterns and childhood obesity. Results GBTM identified four childhood SSB intake patterns, namely, the "persistently-low group (n=822), "decreasing-after-increasing" group (n=20), "gradually-decreasing" group (n=106), and "increasing" group (n=49). In the decreasing-after-increasing group and the gradually-decreasing group, baseline BMI levels and BMI levels obtained at the three follow-ups were significantly higher than those observed in the persistently-low group (F=6.26, 5.90, 5.99, 5.87, P < 0.01). There were sex differences in the association between SSB intake patterns and the children's BMI levels. Among girls, after adjusting for confounding factors, the gradually-decreasing group increased by 1.20 kg/m²(B=1.20, 95%CI=0.25-2.15, P=0.01) when compared with the persistently low group at the third follow-up. Among boys, no statistically significant association was found between SSB intake patterns and BMI levels (P>0.05). Conclusion Sex differences were observed with respect to the association between SSB intake patterns and obesity in children. Girls with a higher SSB intake had a significantly increased risk of obesity. Further studies are needed to explore the physiological mechanisms underlying sex differences, to provide the theoretical basis for developing intervention programs to prevent childhood obesity.
- Carbohydrates /
- Beverages /
- Feeding behavior /
- Obesity /
- Regression analysis /
- Child

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图 1 童年期含糖饮料摄入模式发展轨迹

Figure 1. Development trajectory of sugar-sweetened beverages intake pattern in childhood

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表 1 不同人口统计学特征儿童童年期含糖饮料摄入模式分布比较

Table 1. Distribution of different demographic variables among children in different groups of sugar-sweetened beverages intake pattern during childhood

人口统计学指标	选项	人数	持续较低组	先升后降组	渐降组	渐增组	χ²值
性别	男	418	326(77.99)	12(2.87)	50(11.96)	30(7.18)	13.11^*
	女	579	496(85.66)	8(1.38)	56(9.68)	19(3.28)
家庭月收入/元	＜10 000	187	150(80.22)	3(1.60)	21(11.23)	13(6.95)	3.79
	10 000~15 000	630	519(82.38)	15(2.38)	67(10.64)	29(4.60)
	＞15 000	180	153(85.00)	2(1.11)	18(10.00)	7(3.89)
父亲文化程度	高中及以下	490	385(78.57)	11(2.24)	66(13.47)	28(5.72)	8.61^*
	大专	292	250(85.62)	5(1.71)	23(7.88)	14(4.79)
	本科及以上	215	187(86.97)	4(1.86)	17(7.91)	7(3.26)
母亲文化程度	高中及以下	585	466(79.66)	12(2.05)	72(12.31)	35(5.98)	8.36^*
	大专	267	229(85.77)	4(1.50)	24(8.99)	10(3.74)
	大学及以上	145	127(87.58)	4(2.76)	10(6.90)	4(2.76)
注： ()内数字为构成比/%；*P < 0.05;父母文化程度为趋势性χ²检验。

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表 2 不同含糖饮料摄入组儿童各特征比较(x±s)

Table 2. Comparison of children's characteristics in different sugar-sweetened beverages intake groups(x±s)

组别	人数	年龄 (T3)/岁	BMI/(kg·m^-2)				睡眠时长 (T3)/h	家庭逆境数量(T3)	童年期不良经历数量(T3)
组别	人数	年龄 (T3)/岁	T0	T1	T2	T3	睡眠时长 (T3)/h	家庭逆境数量(T3)	童年期不良经历数量(T3)
持续较低组	822	11.01±0.80	17.85±2.91	18.47±3.22	18.66±3.54	19.62±3.87	9.00±0.71	0.41±0.83	1.79±2.13
先升后降组	20	11.00±0.35	19.58±4.23	20.28±4.32	20.25±4.58	21.46±5.18	8.96±0.80	0.61±0.94	2.22±2.19
渐降组	106	10.97±0.44	17.83±2.56	18.58±2.83	18.91±3.11	19.83±3.38	8.92±0.82	0.26±0.56	1.84±1.92
渐增组	49	11.11±0.36	19.38±3.48	20.13±3.80	20.64±3.89	21.73±4.16	8.65±0.58	0.41±0.88	1.54±1.62
F值		0.43	6.26^**	5.90^*	5.99^**	5.87*	3.92^*	1.83	1.53
注： P < 0.05，*P < 0.01。

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表 3 不同含糖饮料摄入模式及协变量指标与男女童BMI关联的多元线性回归分析[B值(B值95%CI)]

Table 3. Multiple linear regression analysis of the association between different groups of sugary-sweetened beverages intake pattern, covariate indexes and BMI of boys and girls [B(B 95%CI)]

自变量	男童(n=418)	女童(n=579)
含糖饮料摄入模式
先升后降组	-0.23(-1.58~1.12)	-0.37(-1.78~1.04)
渐降组	0.39(-0.33~1.12)	-0.06(-0.61~0.50)
渐增组	-0.17(-1.20~0.85)	1.20(0.25~2.15)^*
儿童BMI(T0)	1.11(1.02~1.19)	1.07(1.01~1.13)^**
父亲BMI	0.05(-0.03~0.14)	0.04(-0.02~0.10)
母亲BMI	0.09(-0.01~0.19)	0.14(0.08~0.21)^**
出生体重	-0.35(-0.90~0.19)	0.09(-0.27~0.46)
喂养方式	0.17(-0.15~0.49)	-0.06(-0.28~0.16)
家庭月收入	-0.14(-0.40~0.13)	-0.10(-0.26~0.06)
肥胖遗传风险评分	-0.25(-0.74~0.24)	-0.23(-0.56~0.11)
睡眠时长(T3)	-0.03(-0.37~0.30)	-0.13(-0.37~0.12)
体力活动(T3)	-0.24(-0.14~0.09)	-0.08(-0.16~0.01)
家庭逆境数量(T3)	-0.05(-0.37~0.26)	-0.12(-0.35~0.12)
童年期不良经历	-0.04(-0.16~0.09)	0.05(-0.04~0.15)
数量(T3)
注： P < 0.05，*P < 0.01。

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