Relationship between dietary fruit intake and overweight and obesity in children
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摘要:
目的 探讨儿童水果摄入量与超重肥胖患病风险的关系，为儿童肥胖的防控提供流行病学依据。 方法 于2014年9—11月在重庆市采用分层整群抽样的方法，选取重庆农村1个县的2所小学共6 369名6~12岁儿童进行体格检查和问卷调查，并于2019年3—5月对基线一至二年级的儿童(1 814名)进行随访，分析比较不同水果摄入量与儿童超重肥胖患病率的关系。 结果 将基线调查的6 369名儿童按照水果摄入量百分位数分为3个组Q1(＜P33.3，水果摄入量＜100 g/d)，Q2(P33.3~P66.7，水果摄入量为100.0~214.3 g/d)和Q3(＞P66.7，水果摄入量＞214.3 g/d)。基线调查，Q2组的儿童体重、体质量指数(BMI)更低，Q1组儿童的超重肥胖患病率最高(32.03%)；按照性别分组后，Q2组男童的超重肥胖患病率最低(31.94%)(P值均＜0.05)。随访调查，3组儿童身高、体重、BMI的变化差异均无统计学意义(P值均＞0.05)，但Q2组的儿童肥胖患病率最低，为5.07%(P＜0.05)。与Q2组的儿童比较，基线调查Q1组的儿童患肥胖的风险增加(OR=1.41，95%CI=1.10~1.81，P＜0.05)，随访调查Q3组的儿童患肥胖的风险增加(RR=1.83，95%CI=1.21~2.75，P＜0.05)。 结论 水果摄入量较高或较低均可能是儿童超重肥胖的危险因素。儿童适当摄入水果，可以预防肥胖的发生。 Abstract:Objective To explore the relationship between fruit intake and the risk of overweight with obesity in children, so as to provide references for the prevention of childhood obesity. Methods From September to November 2014, a stratified cluster sampling method was used to select 6 369 children aged 6-12 from two elementary schools of a country in rural Chongqing for physical examinations and questionnaire surveys, and 1 814 children in grades 1-2 at baseline were followed up from March to May 2019. The relationship between fruit intake and the prevalence of overweight and obesity was analyzed. Results According to the percentile of fruit intake, the 6 369 children at baseline were assigned to three groups: Q1 (< P33.3, fruit intake < 100 g/d), Q2 (P33.3-P66.7, fruit intake: 100-214.3 g/d), and Q3 (> P66.7, fruit intake > 214.3 g/d). For the baseline survey results, children in the Q2 group had a lower weight and Body Mass Index (BMI) (P < 0.05); the prevalence of overweight and obesity among children in the Q1 group was the highest (32.03%), and the prevalence of overweight and obesity among boys in the Q2 group was the lowest (31.94%) after gender stratification (P < 0.05). The follow-up survey results showed no significant differences between the three groups in terms of changes in height, weight, and BMI (P > 0.05); but the prevalence of obesity among youth in the Q2 group was the lowest (5.07%, P < 0.05). Compared with youth in the Q2 group, the risk of obesity was higher among those in the Q1 group at baseline survey (OR=1.41, 95%CI=1.10-1.81, P < 0.05), and was higher among those in the Q3 group at follow-up survey (RR=1.83, 95%CI=1.21-2.75, P < 0.05). Conclusion Deviating from moderate fruit intake may increase the likelihood of overweight and obesity in children, and it is recommended that children are encouraged to consume fruits as part of a well-balanced diet to prevent the occurrence of obesity. -
Key words:
- Diet /
- Fruit /
- Overweight /
- Obesity /
- Regression analysis /
- Child
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表 1 不同水果摄入量儿童的基本特征分布
Table 1. General characteristics of children with different fruit intake
组别 人数 年龄/岁 性别 每周学校运动时间/min* 每周在家运动时间/min* 每周总运动时间/min* 6~10 ＞10 男生 女生 ≤100 ＞100 ≤55 ＞55 ≤150 ＞150 Q1 2 014 1 510(74.98) 504(25.02) 1 053(52.28) 961(47.72) 1 153(57.59) 849(42.41) 1 351(67.45) 652(32.55) 1 131(56.63) 866(43.37) Q2 2 264 1 781(78.67) 483(21.33) 1 174(51.86) 1 090(48.14) 1 260(55.85) 996(44.15) 1 563(69.25) 694(30.75) 1 245(55.24) 1 009(44.76) Q3 2 091 1 526(72.98) 565(27.02) 1 059(50.65) 1 032(49.35) 1 096(52.67) 985(47.33) 1 348(64.71) 735(35.29) 1 071(51.54) 1 007(48.46) χ2值 19.76 1.20 11.70 11.73 14.26 P值 ＜0.01 0.55 0.01 0.01 ＜0.01 注：()内数字为构成比/%；*数据有缺失值。 
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表 2 不同水果摄入量水平儿童各肥胖指标比较(x±s)
Table 2. Comparison of obesity indicators in children with different fruit intake (x±s)
组别 人数 身高/cm 体重/kg BMI/ (kg·m-2) BMI-Z 腰围/cm TC/ (mmol·L-1) TG/ (mmol·L-1) HDL-C/ (mmol·L-1) LDL-C/ (mmol·L-1) Q1 2 014 134.52±11.65 32.06±9.84 17.32±3.09 0.06±1.12 57.56±8.61 4.14±0.62 1.08±0.57 1.35±0.27 2.39±0.56 Q2 2 264 133.96±11.58 31.30±9.46 17.09±2.91 0.01±1.10 57.03±8.17 4.09±0.64 1.00±0.51 1.35±0.28 2.35±0.61 Q3 2 091 135.64±11.57 32.26±9.15 17.22±2.80 0.01±1.08 57.52±7.95 4.07±0.61 1.00±0.57 1.35±0.28 2.31±0.56 F值 11.63 6.25 3.15 1.49 2.88 1.32 2.12 0.00 1.65 P值 ＜0.01 ＜0.01 0.05 0.23 0.06 0.27 0.12 1.00 0.19
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表 3 不同年龄性别儿童不同水果摄入量的超重肥胖患病率比较
Table 3. Comparison of the prevalence of overweight and obesity among children with different fruit intake by age and sex
组别 选项 Q1 Q2 Q3 χ2值 P值 人数 超重肥胖人数 人数 超重肥胖人数 人数 超重肥胖人数 年龄/岁 6~10 1 510 468(30.99) 1 781 506(28.41) 1 526 438(28.70) 3.03 0.22 ＞10 504 177(35.12) 483 152(31.47) 565 161(28.50) 5.41 0.07 性别 男 1 053 387(36.75) 1 174 375(31.94) 1 059 345(32.58) 6.61 0.04 女 961 258(26.85) 1 090 283(25.96) 1 032 254(24.61) 1.33 0.52 合计 2 014 645(32.03) 2 264 658(29.07) 2 091 599(28.65) 6.67 0.02 注：()内数字为患病率/%。
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表 4 基线和随访期不同水果摄入水平儿童超重肥胖相关指标比较(x±s)
Table 4. Comparison of overweight and obesity indicators in children with different fruit intake at baseline and follow-up(x±s)
年份 组别 人数 统计值 身高/cm 体重/kg BMI/(kg·m-2) 2014 Q1 673 122.82±5.80 24.39±4.58 16.10±2.31 Q2 783 122.91±6.11 24.39±5.19 16.05±2.44 Q3 548 122.55±5.85 24.20±4.58 16.01±2.31 F值 0.42 0.22 0.15 P值 0.66 0.81 0.86 2019 Q1 557 151.61±8.01 44.07±11.24 18.98±3.65 Q2 789 150.83±7.53 43.23±10.17 18.86±3.51 Q3 468 149.95±8.23 42.66±10.29 18.87±3.96 F值 4.50 1.87 0.16 P值 0.01 0.15 0.85 变化值 Q1 557 28.81±8.23 19.71±10.89 2.90±3.84 Q2 789 28.03±8.09 19.02±10.20 2.89±3.84 Q3 468 27.45±9.15 19.11±10.63 2.89±4.44 F值 2.69 1.29 0.00 P值 0.07 0.28 1.00
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表 5 基线和随访期不同水果摄入水平儿童超重肥胖患病率比较
Table 5. Comparison of prevalence of overweight and obesity in children with different fruit intake at baseline and follow-up
年份 组别 人数 统计值 超重肥胖 肥胖 2014 Q1 673 185(27.49) 51(7.58) Q2 783 227(28.99) 53(6.77) Q3 548 159(29.01) 44(8.03) χ2值 0.50 0.80 P值 0.78 0.67 2019 Q1 557 96(17.24) 42(7.54) Q2 789 127(16.10) 40(5.07) Q3 468 88(18.80) 44(9.40) χ2值 1.55 8.95 P值 0.82 0.01 注：()内数字为患病率/%。
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表 6 儿童肥胖与水果摄入量的Logistic回归分析(n=6 369)
Table 6. Logistic regression analysis between children with obesity and fruit intake (n=6 369)
模型 自变量 β值 标准误 OR值(95%CI) P值 模型1 Q1 0.35 0.12 1.42(1.13~1.79) ＜0.01 Q3 0.10 0.12 1.10(0.87~1.40) 0.42 模型2 Q1 0.34 0.12 1.40(1.11~1.77) 0.01 Q3 0.08 0.12 1.08(0.85~1.37) 0.53 模型3 Q1 0.35 0.13 1.41(1.10~1.81) 0.01 Q3 0.08 0.13 1.08(0.85~1.39) 0.53 注：模型1，未校正模型；模型2，调整年龄、性别；模型3，调整年龄、性别、父母亲职业、父母亲肥胖、收入、母亲妊娠高血压、妊娠糖尿病、出生体重、体育活动时间、谷薯类、新鲜蔬菜、红肉、禽肉、鱼虾贝类、蛋类、牛奶、豆类食品、坚果类、菌藻类食物、食用油、咸菜、营养补充剂、含糖饮料；自变量均以Q2为参照，因变量以非肥胖为参照。
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表 7 儿童水果摄入水平与肥胖的关联性(n=1 814)
Table 7. Relationship between fruit intake and obesity in children (n=1 814)
模型 自变量 β值 标准误 RR值(95%CI) P值 模型1 Q1 0.40 0.21 1.49(0.98~2.26) 0.06 Q3 0.62 0.21 1.85(1.23~2.80) ＜0.01 模型2 Q1 0.42 0.22 1.51(0.99~2.32) 0.06 Q3 0.62 0.21 1.86(1.23~2.83) ＜0.01 模型3 Q1 0.26 0.22 1.30(0.85~1.97) 0.23 Q3 0.60 0.21 1.83(1.21~2.75) ＜0.01 注：模型1，未校正模型；模型2，调整年龄、性别；模型3，调整年龄、性别、父母文化程度、家庭收入、家族肥胖史、出生体重、体育活动时间；自变量均以Q2为参照，因变量以非肥胖为参照。
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