出生体重与婴儿期生长速度对一年级小学生体重状态的影响

陈迪迪; 林丹; 叶佩琪; 李云; 黄俊; 温晓飒; 史慧静

doi:10.16835/j.cnki.1000-9817.2022.06.004

出生体重与婴儿期生长速度对一年级小学生体重状态的影响

doi: 10.16835/j.cnki.1000-9817.2022.06.004

陈迪迪^{1, 2},
林丹³,
叶佩琪³,
李云⁴,
黄俊⁴,
温晓飒^{1, 2, ,},
史慧静^3, ,

1.
上海市闵行区疾病预防控制中心学校卫生科，201101
2.
复旦大学公共卫生学院闵行分院
3.
复旦大学公共卫生学院妇幼与儿少卫生教研室
4.
上海市闵行区妇幼保健院儿童保健科

基金项目:

复旦-闵行康联体合作项目研究 2019FM11

闵行区自然科学研究课题 2020MHZ011

详细信息

作者简介:
陈迪迪(1989-)，女，山东枣庄人，硕士，主管医师，主要研究方向为学校卫生与青少年健康

通讯作者:
温晓飒，E-mail：xiaosasmmu@163.com

史慧静，E-mail：hjshi@fudan.edu.cn

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R 723.14 G 627.8
计量
- 文章访问数: 428
- HTML全文浏览量: 184
- PDF下载量: 46
- 被引次数: 0
出版历程
- 收稿日期: 2021-12-16
- 修回日期: 2022-01-31
- 网络出版日期: 2022-06-23
- 刊出日期: 2022-06-25

Influence of birth weight and infancy growth patterns on weight status among first-grade primary school pupils

CHEN Didi^{1, 2},
LIN Dan³,
YE Peiqi³,
LI Yun⁴,
HUANG Jun⁴,
WEN Xiaosa^{1, 2
, ,},
SHI Huijing^{3
, ,}

1.
Department of School Health, Minhang District Center for Disease Control and Prevention, Shanghai (201101), China

摘要

摘要: 目的纵向研究出生体重状态与婴儿期生长速度模式对一年级小学生体重状态的影响，为生命早期的预防和干预政策制定提供理论基础。方法针对上海市闵行区2019年入学的小学一年级新生，收集其当年学校常规体检信息，并回顾性收集其出生和产后随访信息，选取12月龄体格检查信息完整的4 434名小学生作为研究对象。采用多元线性回归模型分析婴儿期生长速度与小学一年级时体质量指数(BMI)值及其Z评分的关系，同时采用广义线性模型分析出生体重状态和婴儿期生长速度模式对小学一年级时超重和肥胖患病的影响并进行分层分析。结果纳入研究的小学生婴儿期生长速度与小学一年级BMI值及其Z评分均存在线性关系[β值(β值95%CI)=0.30(0.24~0.35)，0.12(0.10~0.15)，P值均 < 0.01]。小于、适于和大于胎龄儿人群中均出现婴儿期追赶生长的个体。出生体重状态为大于胎龄儿和婴儿期出现追赶生长是儿童小学一年级超重和肥胖患病的独立危险因素(RR=1.31~1.55，P值均 < 0.05)。分层分析显示，追赶生长会增加适于胎龄儿小学一年级超重和肥胖的患病风险[RR值(RR值95%CI)=1.74(1.42~2.14)，1.87(1.56~2.26)]，且会增加大于和小于胎龄儿小学一年级肥胖的患病风险[RR值(RR值95%CI)=3.74(1.04~13.49)，3.24(1.62~6.46)](P值均 < 0.05)。在发生婴儿期追赶生长的人群中，出生体重状态为大于胎龄会增加儿童一年级时肥胖患病的风险(RR=2.60，95%CI=1.35~5.02，P < 0.01)，但不增加超重的患病风险(P=0.13)。结论出生体重状态与婴儿期生长速度模式对小学一年级儿童的超重和肥胖患病都具有影响，建议关注大于和适于胎龄儿的生命早期生长发育并扩大婴儿期追赶生长的监测范围。
- 出生体重 /
- 生长 /
- 体重 /
- 线性模型 /
- 学生
Abstract: Objective To explore the influence of birth weight and growth patterns during infancy on overweight and obesity among first-grade primary school pupils, so as to provide a theoretical basis for the formulation of early life prevention and intervention policies. Methods In 2019, data related to routine physical examinations were collected for primary school pupils in the Minhang District of Shanghai, and information regarding birth and follow-ups was collected retrospectively. Physical examination data of 4 434 pupils at 12 months of age were obtained. A multiple linear regression model was used to analyze the relationship between growth patterns during infancy and body mass index (BMI) in the first grade of primary school. A generalized linear model was employed to analyze the relationship between birth weight and growth patterns during infancy and overweight and obesity in the first grade of primary school. A hierarchical analysis was conducted. Results A linear relationship was observed between growth patterns during infancy and BMI and the BMI Z-score of first-grade primary school pupils [β(β 95%CI)=0.30(0.24-0.35), 0.12(0.10-0.15), P < 0.01]. In addition to subjects classified as small for gestational age (SGA), catch-up growth during infancy was identified among subjects who were classified as appropriate for gestational age (AGA) and large for gestational age (LGA). LGA at birth and catch-up growth during infancy were independent risk factors for overweight and obesity among first-grade primary school children (RR=1.31-1.55, P < 0.05). The hierarchical analysis showed that catch-up growth increased the risk of overweight and obesity among first-grade primary school pupils classified as AGA [RR(RR 95%CI)=1.74(1.42-2.14), 1.87(1.56-2.26)], and increased the risk of obesity among first-grade primary school pupils classified as SGA and LGA [RR(RR 95%CI)=3.74(1.04-13.49), 3.24(1.62-6.46)](P < 0.05). Among those who exhibited catch-up growth during infancy, LGA increased the risk of obesity among first-grade primary school pupils (RR=2.60, 95%CI=1.35-5.02, P < 0.01), but not the risk of being overweight (P=0.13). Conclusion Birth weight and growth patterns during infancy have an impact on overweight and obesity among children in the first grade of primary school. It is suggested that attention should be paid to growth and physical development in early life for those classified as LGA and AGA, and catch-up growth in children should be closely monitored.
- Birth weight /
- Growth /
- Body weight /
- Linear models /
- Students
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

HTML全文

表 1 不同性别儿童人口学特征比较

Table 1. Characteristics of the children included in this study

性别	人数	本地户籍	父亲大专及以上学历^*	母亲大专及以上学历^*	孕母年龄>35岁^*	剖宫产^*	出生体重状态^*			追赶生长	一年级时超重	一年级时肥胖
性别	人数	本地户籍	父亲大专及以上学历^*	母亲大专及以上学历^*	孕母年龄>35岁^*	剖宫产^*	小于胎龄儿	适于胎龄儿	大于胎龄儿	追赶生长	一年级时超重	一年级时肥胖
男	2 363	1 479(62.59)	1 610(73.32)	1 563(71.27)	139(5.89)	1 185(50.17)	110(4.66)	2 002(84.83)	248(10.51)	681(28.82)	387(16.38)	493(20.86)
女	2 071	1 301(62.82)	1 416(72.69)	1 386(71.44)	123(5.94)	987(47.66)	110(5.32)	1 736(83.99)	221(10.69)	594(28.68)	312(15.07)	280(13.52)
χ²值		0.03	0.20	0.01	0.00	2.78		1.10		0.01	6.35	41.35
P值		0.87	0.65	0.90	0.95	0.10		0.58		0.92	0.01	< 0.01
注： ()内数字为报告率或构成比/%；*表示该项目人数有缺失数据。

下载: 导出CSV

表 2 婴儿期生长速度与小学一年级时BMI值关系的线性回归分析[β值(β值95%CI)，n=4 434]

Table 2. Association between growth rate in infancy and BMI value in first grade of primary school[β(β 95%CI), n=4 434]

因变量	性别	原始模型	模型1	模型2
BMI值	男	0.33(0.25~0.41)	0.33(0.25~0.41)	0.33(0.25~0.41)
	女	0.27(0.20~0.35)	0.27(0.20~0.35)	0.26(0.18~0.33)
	总体	0.30(0.25~0.36)	0.30(0.25~0.36)	0.30(0.24~0.35)
BMI值Z评分	男	0.13(0.10~0.16)	0.13(0.10~0.16)	0.13(0.10~0.16)
	女	0.12(0.09~0.16)	0.12(0.09~0.16)	0.12(0.08~0.15)
	总体	0.13(0.10~0.15)	0.13(0.10~0.15)	0.12(0.10~0.15)
注： P值均 < 0.01；模型1调整体检时年龄(连续变量)；模型2在模型1基础上调整户籍、父母文化程度、孕母年龄、生产方式、母乳喂养时长。

下载: 导出CSV

表 3 出生体重状态和婴儿期生长速度模式与小学一年级时超重和肥胖检出的关联

Table 3. Association of birth weight status or infant growth rate pattern with overweight and obesity in the first grade of primary school

组别	选项	人数	一年级时超重					一年级时肥胖
组别	选项	人数	检出人数	检出率/%	χ²值	P值	RR值(RR值95%CI)	检出人数	检出率/%	χ²值	P值	RR值(RR值95%CI)
婴儿期发生追赶生长	是	1 275	240	18.82	26.15	< 0.01	1.40(1.21~1.62)^**	302	23.69	48.00	< 0.01	1.55(1.36~1.77)^**
	否	3 159	459	14.53			1.00	471	14.91			1.00
出生体重状态	小于胎龄儿	220	25	11.36	15.46	< 0.01	0.68(0.46~1.01)	30	13.64	14.64	< 0.01	0.79(0.55~1.14)
	适于胎龄儿	3 738	580	15.52			1.00	633	16.93			1.00
	大于胎龄儿	469	93	19.83			1.40(1.15~1.70)^**	110	23.45			1.31(1.08~1.57)^**
注： **P < 0.01。

下载: 导出CSV

表 4 婴儿期生长速度模式和出生体重状态与小学一年级时检出超重和肥胖的分层分析

Table 4. Hierarchical analysis of infant growth rate pattern or birth weight status and overweight and obesity in the first grade of primary school

出生体重状态	婴儿期生长速度	人数	超重			肥胖
出生体重状态	婴儿期生长速度	人数	检出人数	检出率/%	RR值(RR值95%CI)	检出人数	检出率/%	RR值(RR值95%CI)
小于胎龄儿	未出现追赶生长	60	4	6.67	1.00	3	5.00	1.00
	出现追赶生长	160	21	13.13	1.75(0.53~5.80)	27	16.88	3.74(1.04~13.49)^*
适于胎龄儿	未出现追赶生长	2 666	370	13.88	1.00	377	14.14	1.00
	出现追赶生长	1 072	210	19.59	1.74(1.42~2.14)^**	256	23.88	1.87(1.56~2.26)^**
大于胎龄儿	未出现追赶生长	427	84	19.67	1.00	91	21.31	1.00
	出现追赶生长	42	9	21.43	2.04(0.81~5.18)	19	45.24	3.24(1.62~6.46)^**
注：调整性别、体检时年龄(连续变量)、户籍、父母文化程度、孕母年龄、生产方式、母乳喂养时长；P < 0.05，*P < 0.01。

下载: 导出CSV

参考文献(15)

[1]	朱丽, 张蓉, 张淑莲, 等. 中国不同胎龄新生儿出生体重曲线研制[J]. 中华儿科杂志, 2015, 53(2): 97-103. ZHU L, ZHANG R, ZHANG S L, et al. Chinese neonatal birth weight curve for different gestational age[J]. Chin J Pediatr, 2015, 53(2): 97-103.
[2]	SAG G, FAN M, SIMI F. SGA children: auxological and metabolic outcomes-the role of GH treatment[J]. J Matern Fetal Neonat Med, 2013, 26(Suppl 2): 64-67.
[3]	吴丹, 汪秀莲, 霍言言, 等. 足月小于胎龄儿婴儿期增长速率与学龄期肥胖风险的纵向队列研究[J]. 中国儿童保健杂志, 2019, 27(11): 1163-1166. doi: 10.11852/zgetbjzz2018-1752 WU D, WANG X L, HUO Y Y, et al. Longitudinal cohort study on the correlation between growth rate and obesity risk of small for gestational age infants[J]. Chin J Child Health Care, 2019, 27(11): 1163-1166. doi: 10.11852/zgetbjzz2018-1752
[4]	马冠生. 中国儿童肥胖报告[R]. 北京: 北京大学公共卫生学院, 2017. MA G S. China obesity report[R]. Beijing: People's Medical Publishing House, 2017.
[5]	MARTINSON M L, CHANG Y, HAN W, et al. Social determinants of childhood obesity in Shanghai, China: a cross-sectional child cohort survey[J]. Poster Abstracts, 2015, 386: 50. https://www.sciencedirect.com/science/article/pii/S0140673615006315
[6]	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: 中华人民共和国国家卫生和计划生育委员会, 2018. National Health and Family Planning Commission of the PRC. Screening for overweight and obesity among school-age children and adolescents: WS/T 586-2018[S]. Beijing: National Health and Family Planning Commission of the PRC, 2018.
[7]	WHO multicenter growth reference study group. WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development[R/OL].(2006-11-11)[2021-04-01].https://www.who.int/publications/i/item/924154693X.
[8]	ONG K K, AHMED M L, EMMETT P M, et al. Association between postnatal catch-up growth and obesity in childhood: prospective cohort study[J]. BMJ, 2000, 320(7240): 967-971. doi: 10.1136/bmj.320.7240.967
[9]	WHINCUP P H, KAYE S J, OWEN C G, et al. Birth weight and risk of type 2 diabetes: a systematic review[J]. JAMA, 2008, 300(24): 2886-2897. doi: 10.1001/jama.2008.886
[10]	XIA Q, CAI H, XIANG Y B, et al. Prospective cohort studies of birth weight and risk of obesity, diabetes, and hypertension in adulthood among the Chinese population[J]. J Diabetes, 2019, 11(1): 55-64. doi: 10.1111/1753-0407.12800
[11]	DONAHUE S M, KLEINMAN K P, GILLMAN M W, et al. Trends in birth weight and gestational length among singleton term births in the United States: 1990-2005[J]. Obstet Gynecol, 2010, 115(2 Pt 1): 357-364.
[12]	张勇, 李燕晖, 梁静, 等. 低出生体重早产儿1岁内体格追赶生长的纵向研究[J]. 中国妇幼健康研究, 2020, 31(4): 413-417. doi: 10.3969/j.issn.1673-5293.2020.04.001 ZHANG Y, LI Y H, LIANG J, et al. A longitudinal study on catch-upphysical growth of low birth weight preterm infants aged 1 year[J]. Chin J Woman Child Health Res, 2020, 31(4): 413-417. doi: 10.3969/j.issn.1673-5293.2020.04.001
[13]	DRUET C, STETTLER N, SHARP S, et al. Prediction of childhood obesity by infancy weight gain: an individual-level Meta-analysis[J]. Paediatr Perinat Epidemiol, 2012, 26(1): 19-26. doi: 10.1111/j.1365-3016.2011.01213.x
[14]	VICTORA C G, SIBBRITT D, HORTA B L, et al. Weight gain in childhood and body composition at 18 years of age in Brazilian males[J]. Acta Paediatr, 2007, 96(2): 296-300. doi: 10.1111/j.1651-2227.2007.00110.x
[15]	LEUNISSEN R W, KERKHOF G F, STIJNEN T, et al. Timing and tempo of first-year rapid growth in relation to cardiovascular and metabolic risk profile in early adulthood[J]. JAMA, 2009, 301(21): 2234-2242. doi: 10.1001/jama.2009.761