婴幼儿期维生素D补充与一年级小学生超重肥胖的纵向关联

叶佩琪; 林丹; 陈迪迪; 李云; 温晓飒; 黄俊; 史慧静

doi:10.16835/j.cnki.1000-9817.2022.06.005

婴幼儿期维生素D补充与一年级小学生超重肥胖的纵向关联

doi: 10.16835/j.cnki.1000-9817.2022.06.005

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

1.
复旦大学公共卫生学院妇幼与儿少卫生教研室，上海 200032
2.
上海市闵行区疾病预防控制中心学校卫生科
3.
复旦大学公共卫生学院闵行分院
4.
上海市闵行区妇幼保健院儿保科

基金项目:

上海市加强公共卫生体系建设第五轮重点学科建设项目 GWV-10.1-XK08

详细信息

作者简介:
叶佩琪(1996-)，女，浙江绍兴人，在读硕士，主要研究方向为生命早期保健与慢性病预防

通讯作者:
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 R 153.2 R 151
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- 被引次数: 0
出版历程
- 收稿日期: 2021-12-16
- 修回日期: 2022-02-02
- 网络出版日期: 2022-06-23
- 刊出日期: 2022-06-25

Longitudinal association between vitamin D supplementation in infancy and overweight or obesity among first-grade primary school pupils

YE Peiqi¹,
LIN Dan¹,
CHEN Didi^{2, 3},
LI Yun⁴,
WEN Xiaosa^{2, 3},
HUANG Jun⁴,
SHI Huijing^{1
, ,}

1.
Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai (200032), China

摘要

摘要: 目的调查婴幼儿期维生素D补充状况及其对学龄初期超重肥胖的影响，为儿童肥胖的早期预防提供新思路。方法以8 744名上海市闵行区2019年9月1日入学，且于2019年10月8日至2020年1月17日进行了常规体检的小学一年级学生为研究对象，由专业医务人员按标准的方法和仪器测量儿童的身高、体重并计算体质量指数(BMI)，以BMI界定超重肥胖，并回溯收集其出生记录与婴幼儿期维生素D补充、婴幼儿期喂养记录。采用非条件Logistic回归模型，拟合婴幼儿期维生素D补充对学龄初期超重肥胖的影响，并进一步根据出生后1，4，6月龄内是否纯母乳喂养进行分层分析。结果上海市闵行区一年级学生中，超重肥胖率为32.5%(2 843名)；出生后1，2，4，6月龄内的婴儿维生素D补充率分别为20.2%，49.7%，66.3%，72.7%，有83.2%的婴幼儿在出生后3年内补充了维生素D。出生后1月龄内补充过维生素D的婴幼儿，学龄初期发生超重肥胖的风险降低(OR=0.82, 95%CI=0.68~0.98)；分层分析结果显示，此保护作用在1，4，6月龄内为纯母乳喂养的婴儿中尤其明显[OR(95%CI)=0.76(0.61~0.97)，0.76(0.59~0.99)，0.69(0.49~0.98)，P值均 < 0.05]。结论婴幼儿期维生素D补充率有待提高，婴幼儿期维生素D补充尤其对纯母乳喂养儿有降低学龄初期超重肥胖风险的作用。
- 维生素D /
- 超重 /
- 肥胖症 /
- 回归分析 /
- 学生
Abstract: Objective To investigate the current status of vitamin D supplementation in infancy and to explore the effect of vitamin D supplementation in infancy and overweight or obesity in early school years. Methods Tollay 8 744 first-grade elementary school students in Minhang District, Shanghai, who entered school on September 1st, 2019, and had a routine physical examination in that year, were enrolled in the study. Children's height and weight were measured by medical professionals according to standard methods and instruments, and overweight or obesity was defined by BMI. Birth records, vitamin D supplementation during infancy, and feeding records during infancy were collected retrospectively. An unconditional Logistic regression model was used to evalute the effect of vitamin D supplementation in infancy on overweight or obesity in early school age. Stratified analysis was performed according to whether they were exclusively breastfed within 1, 4, 6 month of birth or not. Results The overweight or obesity rate of first grade students in Minhang District, Shanghai was 32.5%(2 843/8 744). Retracing their vitamin D supplementation during infancy, the vitamin D supplementation rates were 20.2%, 49.7%, 66.3%, and 72.7% for infants 1, 2, 4, and 6 months of age after birth, respectively, and 83.2% of infants and toddlers were supplemented within 3 years of birth. Infants who were supplemented with vitamin D within 1 month of birth had a reduced risk of overweight and obesity in early school age (OR=0.82, 95%CI=0.68-0.98), and stratified analysis showed that this protective effect was only present in infants who were exclusively breastfed at 1, 4, and 6 months of age [OR(95%CI)=0.76(0.61-0.97), 0.76(0.59-0.99), 0.69(0.49-0.98), P < 0.05]. Conclusion The rate of vitamin D supplementation in infancy needs to be improved, and vitamin D supplementation in infancy may have a protective effect on the development of overweight and obesity in exclusively breastfed children in early school years.
- Vitamin D /
- Overweight /
- Obesity /
- Regression analysis /
- Students
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

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表 1 不同组别学生超重肥胖检出率比较

Table 1. Comparison of the detection rate of overweight and obesity in different groups of students

组别	选项	人数	超重肥胖人数	χ²值	P值
性别	男	4 681	1 717(36.7)	79.70	< 0.01
	女	4 063	1 126(27.7)
分娩方式^a	阴道分娩	4 521	1 398(30.9)	10.60	< 0.01
	剖宫产	4 218	1 442(34.2)
出生体重	低出生体重儿	239	58(24.3)	52.07	< 0.01
	正常	7 903	2 514(31.8)
	巨大儿	602	271(45.0)
父亲文化程度^a	初中及以下	1 147	458(39.9)	66.88	< 0.01
	高中或中专	1 363	513(37.6)
	大专及大专以上	5 525	1 634(29.6)
母亲文化程度^a	初中及以下	1 289	507(39.3)	71.53	< 0.01
	高中或中专	1 372	520(37.9)
	大专及大专以上	5 344	1 563(29.2)
6个月内纯母乳喂养	是	1 939	616(31.8)	0.63	0.43
	否	6 805	2 227(32.7)
注： a表示数据有缺失；()内数字为检出率/%。

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表 2 上海市闵行区一年级小学生婴幼儿期维生素D补充情况及其与超重肥胖的关联

Table 2. Vitamin D supplementation during infancy and its association with overweight or obesity among first grade primary students in Minhang District, Shanghai

组别	选项	人数	超重肥胖人数	超重肥胖检出率/%	OR值(OR值95%CI)	调整OR值(OR值95%CI)
1月龄内是否补充维生素D	是	1 762	529	30.0	0.87(0.77~0.97)^*	0.82(0.68~0.98)^*
	否	6 982	2 314	33.1	1.00	1.00
2月龄内是否补充维生素D	是	4 347	1 377	31.7	0.93(0.85~1.01)	1.00(0.88~1.15)
	否	4 397	1 466	33.3	1.00	1.00
4月龄内是否补充维生素D	是	5 794	1 881	32.5	0.99(0.90~1.09)	1.04(0.92~1.19)
	否	2 950	962	32.6	1.00	1.00
6月龄内是否补充维生素D	是	6 361	2 043	32.1	0.94(0.85~1.04)	1.00(0.88~1.14)
	否	2 383	800	33.6	1.00	1.00
3岁内是否补充维生素D	是	7 278	2 311	31.8	0.82(0.73~0.92)^**	0.89(0.77~1.03)
	否	1 466	532	36.3	1.00	1.00
注：调整婴儿性别、出生体重、分娩方式、父亲文化程度、母亲文化程度；P < 0.05，*P < 0.01。

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表 3 婴幼儿期维生素D补充与喂养方式对一年级小学生超重肥胖的交互作用

Table 3. Interaction between vitamin D supplementation and feeding practices in infancy and first grade primary students' overweight or obesity

母乳喂养方式	时间	1月龄内补充维生素D					1月龄内未补充维生素D
母乳喂养方式	时间	人数	超重肥胖人数	超重肥胖率/%	OR值(OR值95%CI)	调整OR值(OR值95%CI)	人数	超重肥胖人数	超重肥胖率/%
纯母乳	1月龄内	891	253	28.4	0.80(0.68~0.94)^**	0.76(0.61~0.97)^*	2 800	929	33.2
	4月龄内	708	205	29.0	0.81(0.67~0.97)^*	0.76(0.59~0.99)^*	2 230	748	33.5
	6月龄内	434	121	27.9	0.79(0.62~0.99)^*	0.69(0.49~0.98)^*	1 505	495	32.9
非纯母乳	1月龄内	871	276	31.7	0.94(0.80~1.10)	0.89(0.66~1.19)	4 182	1 385	33.1
	4月龄内	1 054	324	30.7	0.90(0.78~1.04)	0.79(0.62~1.02)	4 752	1 566	33.0
	6月龄内	1 328	408	30.7	0.89(0.78~1.02)	0.90(0.73~1.12)	5 477	1 819	33.2
注：自变量均以1月龄未补充维生素D为参照；P < 0.05；*P < 0.01。

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