Levels of 24-hour movement and associations with childhood obesity in Chinese school students
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摘要:
目的 分析中国7~18岁在校儿童青少年身体活动、视屏行为和睡眠组合达标情况与超重肥胖的相关性，为促进学校超重肥胖防控工作提供依据。 方法 使用2015年中国健康和营养调查数据，依据《加拿大儿童青少年24 h活动指南》对946名7~18岁在校儿童青少年身体活动、视屏行为和睡眠时间的达标情况进行分类，并采用Logistic回归模型分析各行为达标情况及行为组合达标情况与超重肥胖的相关性。 结果 儿童青少年超重肥胖率为21.56%；身体活动、视屏行为和睡眠达标率分别为24.84%，38.69%和57.08%，3类行为组合达标率为6.77%。校正年龄、性别、城乡和民族后，睡眠达标及睡眠与视屏行为组合达标分别与超重肥胖风险呈负相关(OR值分别为0.73，0.58，P值均 < 0.05)，但其他行为及行为组合与超重肥胖率相关性无统计学意义。 结论 儿童青少年24 h活动达标率较低，充足睡眠或有助于降低超重肥胖风险。今后研究需注意睡眠和视屏行为的潜在联合作用以及两类行为在儿童超重肥胖防控中的应用。 Abstract:Objective To analyze relationships between levels of 24-hour movement (physical activity, screen time and sleep) and childhood obesity in students aged 7-18 years. Methods This study used data from students aged 7-18 years in the 2015 China health and nutrition survey, and assessed levels of physical activity, screen time and sleep based on the Canadian 24 hour Movement Guidelines for Children and Youth. Associations between levels of 24-hour movement and childhood obesity were assessed using multivariable Logistic regression models. Results The overall rate of overweight and obesity was 21.56%. Proportions of students meeting the guidelines for physical activity, screen time, sleep and three behaviors combined were 24.84%, 38.69%, 57.08%, and 6.77%, respectively. After adjusting for age, sex, location of residence and nationality, students meeting the sleep guideline were less likely to be overweight and obese than those who did not(OR=0.73), students meeting both sleep and screen time guidelines had a lower risk in overweight and obesity than those met neither guidelines(OR=0.58)(P < 0.05). However, other behaviors and behavior combinations showed no significant associations with overweight and obesity. Conclusion Only a small proportion of students met all three 24-hour movement guidelines. Ensuring adequate sleep and limiting excessive screen time may be an important strategy for childhood obesity prevention and management. -
Key words:
- Motor activity /
- Overweight /
- Obesity /
- Growth and development /
- Regression analysis /
- Child /
- Adolescent
1) 王禹和朱蕊为并列第一作者。 -
表 1 不同组别研究对象超重肥胖检出率比较
Table 1. Overweight and obesity by participants' characteristics
组别 项目 人数 超重肥胖人数 χ2值 P值 性别 男 478 122(25.52) 8.95 0.01 女 468 82(17.52) 年龄/岁 7~12 723 157(21.72) 0.04 0.84 13~18 223 47(21.08) 居住地 城市 305 72(23.61) 1.11 0.29 农村 641 132(20.59) 民族 汉族 813 181(22.26) 1.67 0.20 少数民族 133 23(17.29) 注：()内数字为检出率/%。 
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表 2 不同组别在校儿童青少年24 h活动达标率比较
Table 2. Comparisons of proportions of participants meeting the 24-hour movement guidelines by socio-demographic characteristics
组别 项目 人数 统计值 运动时间 视屏时间 睡眠时间 组合达标数 0 1 2 3 性别 男 478 124(25.94) 194(40.59) 270(56.49) 102(21.34) 204(42.68) 132(27.62) 40(8.37) 女 468 111(23.72) 172(36.75) 270(57.69) 103(22.01) 201(42.95) 140(29.91) 24(5.13) χ2值 0.63 1.47 0.14 4.16 P值 0.43 0.23 0.71 0.25 年龄/岁 7~12 723 164(22.68) 279(38.59) 412(56.98) 166(22.96) 304(42.05) 208(28.77) 45(6.22) 13~18 223 71(31.84) 87(39.01) 128(57.40) 39(17.49) 101(45.29) 64(28.70) 19(8.52) χ2值 7.65 0.01 0.01 4.10 P值 0.01 0.91 0.91 0.25 居住地 城市 305 91(29.84) 120(39.34) 173(56.72) 60(19.67) 130(42.62) 91(29.84) 24(7.87) 农村 641 144(22.46) 246(38.38) 367(57.25) 145(22.62) 275(42.90) 181(28.24) 40(6.24) χ2值 6.01 0.08 0.02 1.83 P值 0.01 0.78 0.88 0.61 民族 汉族 813 189(23.25) 308(37.88) 470(57.81) 177(21.77) 358(44.03) 225(27.68) 53(6.52) 少数民族 133 46(34.59) 58(43.61) 70(52.63) 28(21.05) 47(35.34) 47(35.34) 11(8.27) χ2值 7.87 1.58 1.25 4.90 P值 0.01 0.21 0.26 0.18 体重状态 非超重肥胖 742 185(24.93) 296(39.89) 436(58.76) 152(20.49) 315(42.45) 223(30.05) 52(7.01) 超重肥胖 204 50(24.51) 70(34.31) 104(50.98) 53(25.98) 90(44.12) 49(24.02) 12(5.88) χ2值 0.02 2.10 3.95 4.66 P值 0.90 0.15 0.05 0.20 注：()内数字为达标率或构成比/%。
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表 3 儿童青少年24 h活动达标与超重肥胖关联的Logistic回归分析(n=946)
Table 3. Odds ratios for adiposity associated with meeting vs.not meeting the 24-hour movement guidelines(n=946)
自变量 模型1 模型2 模型3 OR值(OR值95%CI) P值 OR值(OR值95%CI) P值 OR值(OR值95%CI) P值 运动时间达标 0.98(0.68~1.40) 0.90 0.98(0.68~1.41) 0.89 0.91(0.67~1.25) 0.57 视屏时间达标 0.79(0.57~1.09) 0.15 0.77(0.56~1.07) 0.13 0.71(0.54~0.94) 0.02 睡眠时间达标 0.73(0.54~1.00) 0.05 0.73(0.53~0.99) 0.05 0.77(0.58~1.01) 0.05 组合达标数 1项 0.82(0.55~1.21) 0.32 0.81(0.54~1.20) 0.29 0.79(0.56~1.13) 0.19 2项 0.63(0.41~0.98) 0.04 0.63(0.41~0.99) 0.04 0.53(0.36~0.78) 0.01 3项 0.66(0.33~1.33) 0.25 0.62(0.30~1.26) 0.18 0.71(0.39~1.29) 0.26 身体活动和视屏行为组合 1项 0.78(0.56~1.08) 0.14 0.79(0.56~1.10) 0.16 0.65(0.49~0.88) 0.01 2项 0.87(0.52~1.44) 0.58 0.83(0.50~1.39) 0.48 0.79(0.51~1.24) 0.31 身体活动和睡眠组合 1项 0.81(0.58~1.14) 0.22 0.81(0.57~1.14) 0.22 0.78(0.58~1.05) 0.10 2项 0.69(0.41~1.15) 0.15 0.68(0.40~1.14) 0.14 0.70(0.45~1.09) 0.11 睡眠和视屏行为组合 1项 0.78(0.54~1.11) 0.16 0.76(0.53~1.09) 0.14 0.77(0.56~1.06) 0.11 2项 0.59(0.38~0.92) 0.02 0.58(0.37~0.90) 0.02 0.56(0.38~0.82) 0.01 注：对照组为未达标组。模型1，单因素模型；模型2，加入年龄、性别、城乡、民族为控制变量的多因素模型；模型3，在模型2的基础上将BMI分类变量替换为中心肥胖变量。
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