甘肃省中小学生超重肥胖与睡眠时长现状及相关性

李艺璇; 陈发青; 张静; 张丑吉

doi:10.16835/j.cnki.1000-9817.2024026

甘肃省中小学生超重肥胖与睡眠时长现状及相关性

doi: 10.16835/j.cnki.1000-9817.2024026

甘肃省疾病预防控制中心社区卫生与慢性非传染性疾病防制科，兰州 730020

基金项目:

国家自然科学基金项目 81760147

详细信息

作者简介:
李艺璇(1994- )，女，甘肃永昌人，硕士，公共卫生医师，主要从事慢性病、儿童青少年健康与伤害预防控制方面工作

通讯作者:
张丑吉，E-mail: zcj4672362@163.com

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R179 R723.14 Q428
计量
- 文章访问数: 417
- HTML全文浏览量: 192
- PDF下载量: 72
- 被引次数: 0
出版历程
- 收稿日期: 2023-10-16
- 修回日期: 2023-11-23
- 网络出版日期: 2024-02-01
- 刊出日期: 2024-01-25

Prevalence of overweight and obesity and their associations with sleep duration among primary and secondary school students in Gansu Province

Community Health and Chronic Non-communicable Disease Control Department, Gansu Province Center for Disease Control and Prevention, Lanzhou (730020), Gansu Province, China

摘要

摘要: 目的分析甘肃省6~17岁学生的超重率和肥胖率，并评估其与睡眠时长的关系，以便制定相应的防控策略和干预措施。方法采用多阶段分层整群随机抽样方法，于2022年5—7月抽取甘肃省2个监测点，对2 172名6~17岁学生进行问卷调查和体格检查。采用χ²检验对超重肥胖检出率和睡眠时长构成进行组间差异分析，采用Logistic回归模型对超重肥胖和睡眠时长进行关联性分析。结果甘肃省监测点中小学生的超重率和肥胖率分别为10.45%和6.86%，平均睡眠时长为(8.28±1.66)h/d。16~17岁高中生和睡眠时长<8 h/d的中小学生超重检出率高(χ²值分别为12.51，19.32，14.96)，男生和非住校生的肥胖检出率高(χ²值分别为5.89，9.59)(P值均<0.05)。无论男生还是女生，小学生的超重率和肥胖率均随着睡眠时长的减少而增加(χ²值分别为38.84，9.80，19.61，41.60，P值均<0.05)；总人群中，女生不同睡眠时长的肥胖率均低于男生(睡眠时长<8 h/d：6.07%，11.11%；8~<9 h/d：5.76%，6.09%；9~<10 h/d：6.02%，8.19%；≥10 h/d：4.04%，6.90%)。多因素Logistic回归分析结果显示，小学生和高中生睡眠时长短与超重肥胖的发生风险正性相关，高中生睡眠时长与超重肥胖发生风险呈负性相关(睡眠时长8~<9 h/d：OR_小学生=1.89；9~<10 h/d：OR_小学生=1.54；8~<9 h/d：OR_高中生=0.30；P值均<0.05)。结论睡眠不足是甘肃省监测点中小学生超重肥胖的相关因素。应针对不同人群制定相应的预防策略和干预措施，保证充足的睡眠时长，降低中小学生超重肥胖的发生风险。
- 睡眠 /
- 超重 /
- 肥胖症 /
- 学生 /
- 回归分析
Abstract: Objective To investigate the prevalence of overweight/obesity and its associations with sleep duration among children and adolescents aged 6-17 in Gansu Province, so as to formulate tailored prevention and control strategies and intervention measures. Methods Using a multi-stage stratified cluster random sampling method, a questionnaire survey and physical examination were conducted among 2 172 students aged 6-17 from 2 monitoring points in Gansu Province from May to July 2022. Using Chi-square test to analyze the inter group differences in the detection rates of overweight and obesity and the composition of sleep duration, and using Logistic regression model to analyze the correlation between overweight and obesity and sleep duration. Results The prevalence of overweight and obesity were 10.45% and 6.86%, respectively. The average sleep duration was (8.28±1.66)h/d. The detection rate of overweight was high among high school students aged 16-17 and those with sleep duration<8 h/d (χ²=12.51, 19.32, 14.96), while the detection rate of obesity was high among male and non residential students (χ²=5.89, 9.59)(P<0.05). For both boys and girls, the rates of overweight and obesity among primary school students increased with the decrease in sleep duration (χ²=38.84, 9.80, 19.61, 41.60, P<0.05). The rates of obesity in boys were higher than girls across varying sleep durations among the general population (sleep duration<8 h/d: 6.07%, 11.11%, 8~<9 h/d: 5.76%, 6.09%, 9~<10 h/d: 6.02%, 8.19%, ≥10 h/d: 4.04%, 6.90%). Multivariate Logistic regression analysis showed that insufficient sleep duration among primary school students was positively associated with the risk of overweight and obesity, and adequate sleep duration among high school students was negatively associated with the risk of overweight and obesity (sleep duration 8~<9 h/d: OR_{primary school students}=1.89, 9~<10 h/d: OR_{primary school students}=1.54, 8~<9 h/d: OR_{high school students}=0.30, P<0.05). Conclusions Insufficient sleep is a risk factor for overweight and obesity among primary and secondary school students at monitoring sites in Gansu Province. Prevention strategies and interventions should be developed for different populations to ensure adequate sleep duration and reduce the risk of overweight and obesity among primary and secondary school students.
- Sleep /
- Overweight /
- Obesity /
- Students /
- Regression analysis
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 不同组别学生超重肥胖检出率比较

Table 1. Comparison of detection rates of overweight and obesity among students in different groups

特征	选项	人数	超重			肥胖
特征	选项	人数	检出人数	χ²值	P值	检出人数	χ²值	P值
性别	男	1 031	104(10.09)	0.28	0.60	85(8.24)	5.89	0.02
	女	1 141	123(10.78)			64(5.61)
年龄/岁	6~12	1 066	91(8.54)	12.51	<0.01	74(6.94)	2.22	0.33
	13~15	622	66(10.61)			36(5.79)
	16~17	484	70(14.46)			39(8.06)
学段	小学	1 055	88(8.34)	19.32	<0.01	74(7.01)	2.24	0.33
	初中	569	55(9.67)			32(5.62)
	高中	548	84(15.33)			43(7.85)
睡眠时长/	<8	749	99(13.22)	14.96	<0.01	60(8.01)	3.50	0.32
(h·d^-1)	8~<9	421	47(11.16)			25(5.94)
	9~<10	547	52(9.51)			39(7.13)
	≥10	455	29(6.37)			25(5.49)
是否住校	是	501	56(11.18)	0.37	0.55	19(3.79)	9.59	<0.01
	否	1 671	171(10.23)			130(7.78)
注： ( )内数字为检出率/%。

下载: 导出CSV

表 2 不同组别学生静坐和活动时间比较(x±s，h/d)

Table 2. Comparison of time of sitting and activity among different groups of students (x±s, h/d)

组别	人数	静坐	高等强度活动	中等强度活动
正常	1 796	8.46±3.15	1.11±1.14	2.11±1.34
超重	227	8.83±3.71	1.09±1.06	1.84±1.38
肥胖	149	8.57±3.62	1.13±1.05	1.94±1.37
F值		2.69	0.49	15.17
P值		0.26	0.78	<0.01
注：( )内数字为检出率/%。

下载: 导出CSV

表 3 不同组别6~17岁学生的睡眠时长分布比较

Table 3. Comparison of sleep duration composition among students aged 6-17 years in different groups

特征	选项	人数	<8 h/d	8~<9 h/d	9~<10 h/d	≥10 h/d	χ²值	P值
性别	男	1 031	288(27.93)	230(22.31)	281(27.26)	232(22.50)	38.69	<0.01
	女	1 141	461(40.40)	191(16.74)	266(23.31)	223(19.54)
年龄/岁	6~12	1 066	24(2.25)	177(16.60)	439(41.18)	426(39.96)	1 600.00	<0.01
	13~15	622	274(44.05)	218(35.05)	103(16.56)	27(4.34)
	16~17	484	451(93.18)	26(5.37)	5(1.03)	2(0.41)
学段	小学	1 055	21(1.99)	166(15.73)	441(41.80)	427(40.47)	1 800.00	<0.01
	初中	569	202(35.50)	235(41.30)	105(18.45)	27(4.75)
	高中	548	526(95.99)	20(3.65)	1(0.18)	1(0.18)
体重状态	正常	1 796	590(32.85)	349(19.43)	456(25.39)	401(22.33)	19.71	<0.01
	超重	227	99(43.61)	47(20.70)	52(22.91)	29(12.78)
	肥胖	149	60(40.27)	25(16.78)	39(26.17)	25(16.78)
是否住校	是	501	285(56.89)	114(22.75)	51(10.18)	51(10.18)	192.85	<0.01
	否	1 671	464(27.77)	307(18.37)	496(29.68)	404(24.18)
注： ( )内数字为构成比/%。

下载: 导出CSV

表 4 各学段不同睡眠时长学生超重率和肥胖率比较

Table 4. Comparison of overweight and obesity rates among children and adolescents of different sleep durations with each stage of study

学段	睡眠时长/ (h·d^-1)	统计值	男生			女生
学段	睡眠时长/ (h·d^-1)	统计值	人数	超重	肥胖	人数	超重	肥胖
小学	<8		16	0	2(12.50)	5	0	0
	8~<9		93	13(13.98)	11(11.83)	73	8(10.96)	6(8.22)
	9~<10		230	25(10.87)	20(8.70)	211	16(7.58)	13(6.16)
	≥10		216	16(7.41)	15(6.94)	211	10(4.74)	7(3.32)
		χ_趋²值		38.84	9.80		19.61	41.60
		P值		<0.01	<0.01		<0.01	<0.01
初中	<8		73	3(4.11)	4(5.48)	129	14(10.85)	12(9.30)
	8~<9		125	8(6.40)	2(1.60)	110	17(15.45)	5(4.55)
	9~<10		51	5(9.80)	3(5.88)	54	6(11.11)	3(5.56)
	≥10		15	2(13.33)	1(6.67)	12	0	2(16.67)
		χ_趋²值		1.93	13.59		16.74	10.27
		P值		0.07	<0.01		<0.01	<0.01
高中	<8		199	31(15.58)	26(13.07)	327	51(15.60)	16(4.89)
	8~<9		12	0	1(8.33)	8	1(12.50)	0
	9~<10		0	0	0	1	0	0
	≥10		1	1(100.00)	0	0	0	0
		χ_趋²值		2.82	2.79		2.89	0.43
		P值		0.99	0.97		0.99	0.51
总体	<8		288	34(11.81)	32(11.11)	461	65(14.10)	28(6.07)
	8~<9		230	21(9.13)	14(6.09)	191	26(13.61)	11(5.76)
	9~<10		281	30(10.68)	23(8.19)	266	22(8.27)	16(6.02)
	≥10		232	19(8.19)	16(6.90)	223	10(4.48)	9(4.04)
		χ_趋²值		28.70	11.78		16.65	30.49
		P值		<0.01	<0.01		0.04	<0.01
注： ( )内数字为检出率/%。

下载: 导出CSV

表 5 不同学段超重肥胖与睡眠时长的关联性

Table 5. Correlation between overweight and obesity and sleep duration among students with different stage of study

学段	选项/ (h·d^-1)	模型1		模型2
学段	选项/ (h·d^-1)	OR值(95%CI)	P值	OR值(95%CI)	P值
小学	<8	0.83(0.19~3.68)	0.81	0.68(0.15~3.06)	0.61
(n=1 055)	8~<9	2.34(1.46~3.75)	<0.01	1.89(1.14~3.14)	0.01
	9~<10	1.59(1.08~2.35)	0.02	1.54(1.02~2.31)	0.04
	≥10	1.00		1.00
初中	<8	1.01(0.53~1.91)	0.97	0.94(0.48~1.82)	0.85
(n=569)	8~<9	0.82(0.43~1.55)	0.53	0.87(0.45~1.67)	0.68
	9~<10	1.00		1.00
	≥10	1.18(0.39~3.54)	0.77	1.23(0.40~3.76)	0.72
高中	<8	1.00		1.00
(n=548)	8~<9	0.36(0.08~1.57)	0.29	0.30(0.10~0.93)	0.04
	9~<10	—	—	—	—
	≥10	—	—	—	—
合计	<8	1.00		1.00
(n=2 172)	8~<9	0.76(0.56~1.04)	0.09	0.71(0.51~1.01)	0.06
	9~<10	0.74(0.56~0.98)	0.04	0.65(0.47~0.91)	0.01
	≥10	0.50(0.36~0.70)	<0.01	0.43(0.30~0.63)	<0.01
注：模型1未调整混杂因素，模型2调整年龄、性别、静坐时间、高等强度活动时间、中等强度活动时间和是否住校。

下载: 导出CSV

参考文献(25)

[1]	NCD Risk Factor Collaboration (NCD-RISC). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2 416 population-based measurement studies in 128.9 million children, adolescents, and adults[J]. Lancet, 2017, 390(10113): 2627-2642. doi: 10.1016/S0140-6736(17)32129-3
[2]	LOBSTEIN T, JACKSON-LEACH R, MOODIE M L, et al. Child and adolescent obesity: part of a bigger picture[J]. Lancet, 2015, 385(9986): 2510-2520. doi: 10.1016/S0140-6736(14)61746-3
[3]	马冠生, 米杰, 马军. 中国儿童肥胖报告[M]. 北京: 人民卫生出版社, 2017. MA G S, MI J, MA J. Report on childhood obesity in China[M]. Beijing: People's Medical Publishing House, 2017. (in Chinese)
[4]	中华人民共和国国家卫生健康委疾病预防控制局. 中国居民营养与慢性病状况报告(2020年)[M]. 北京: 人民卫生出版社, 2020. Bureau of Disease Control and Prevention, National Health Commission of the PRC. Report on nutrition and chronic diseases in China (2020)[M]. Beijing: People's Medical Publishing House, 2020. (in Chinese)
[5]	中华人民共和国国家卫生健康委疾病预防控制局. 中国居民营养与慢性病状况报告(2002年)[M]. 北京: 人民卫生出版社, 2002. Bureau of Disease Control and Prevention, National Health Commission of the PRC. Report on nutrition and chronic diseases in China (2002)[M]. Beijing: People's Medical Publishing House, 2002. (in Chinese)
[6]	SALAM R A, PADHANI Z A, DAS J K, et al. Effects of lifestyle modification interventions to prevent and manage child and adolescent obesity: a systematic review and Meta-analysis[J]. Nutrients, 2020, 12(8): 2208-2230. doi: 10.3390/nu12082208
[7]	LIANG J H, ZHAO Y, CHEN Y C, et al. Face-to-face physical activity incorporated into dietary intervention for overweight/obesity in children and adolescents: a Bayesian network Meta-analysis[J]. BMC Med, 2022, 20(1): 325-338. doi: 10.1186/s12916-022-02462-6
[8]	MAHUMUD R A, SAHLE B W, OWUSU-ADDO E, et al. Association of dietary intake, physical activity, and sedentary behaviours with overweight and obesity among 282, 213 adolescents in 89 low and middle income to high-income countries[J]. Int J Obes (Lond), 2021, 45(11): 2404-2418. doi: 10.1038/s41366-021-00908-0
[9]	王一然, 黄晓培, 严惠, 等. 河南省7~18岁儿童青少年睡眠时长与超重肥胖的关联[J]. 中华疾病控制杂志, 2021, 25(3): 306-310, 358. WANG Y R, HUANG X P, YAN H, et al. Correlation between sleep duration and overweight/obesity among children and adolescents aged 7-18 in Henan Province[J]. Chin J Dis Control Prev, 2021, 25(3): 306-310, 358. (in Chinese)
[10]	龚清海, 李辉, 王锋, 等. 宁波市青少年睡眠与超重肥胖的相关性[J]. 中国学校卫生, 2017, 38(10): 1493-1495, 1499. doi: 10.16835/j.cnki.1000-9817.2017.10.016 GONG Q H, LI H, WANG F, et al. Relations between sleep duration and obesity/overweight among adolescents in Ningbo[J]. Chin J Sch Health, 2017, 38(10): 1493-1495, 1499. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2017.10.016
[11]	李艳辉, 陶然, 高迪, 等. 我国儿童青少年睡眠不足与肥胖的关联性研究[J]. 中华流行病学杂志, 2020, 41(6): 845-849. LI Y H, TAO R, GAO D, et al. A study on the relationship between insufficient sleep and obesity among children and adolescents in China[J]. Chin J Epidemiol, 2020, 41(6): 845-849. (in Chinese)
[12]	FAN J, DING C, GONG W, et al. Association of sleep duration and overweight/obesity among children in China[J]. Int J Environ Res Public Health, 2020, 17(6): 1962-1970. doi: 10.3390/ijerph17061962
[13]	HAN S H, YEE J Y, PYO J S. Impact of short sleep duration on the incidence of obesity and overweight among children and adolescents[J]. Medicina (Kaunas), 2022, 58(8): 1037-1045. doi: 10.3390/medicina58081037
[14]	杨连建, 刁华, 李婷, 等. 重庆沙坪坝中小学生睡眠时间与超重肥胖的相关性分析[J]. 现代预防医学, 2020, 47(11): 1980-1984. YANG L J, DIAO H, LI T, et al. Correlation between sleep duration and overweight-obesity among primary and middle school students, Shapingba, Chongqing[J]. Mod Prev Med, 2020, 47(11): 1980-1984. (in Chinese)
[15]	中华人民共和国国家卫生和和计划生育委员会. 学龄儿童青少年超重与肥胖筛查: WS/T 586—2018[S]. 2018-08-01. 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]. 2018-08-01. (in Chinese)
[16]	中华人民共和国卫生部, 国家标准化管理委员会. 中小学生一日学习时间卫生要求: GB/T 17223—2012[S]. 2012-12-21. Ministry of Health of the PRC, Standardization Administration. Health requirements of daily learning time for secondary and elementary school students: GB/T 17223-2012[S]. 2012-12-21. (in Chinese)
[17]	中华人民共和国国家卫生和计划生育委员会. 人群健康监测人体测量方法: WS/T 424—2013[S]. 北京: 中国标准出版社, 2013. National Health and Family Planning Commission of the PRC. Anthropometric measurements method in health surveillance: WS/T 424-2013[S]. Beijing: Standards Press of China, 2013. (in Chinese)
[18]	宋超, 宫伟彦, 丁彩翠, 等. 中国2010—2012年6~17岁儿童青少年睡眠状况[J]. 中国学校卫生, 2017, 38(9): 1288-1290. doi: 10.16835/j.cnki.1000-9817.2017.09.003 SONG C, GONG W Y, DING C C, et al. Sleep duration among Chinese children and adolescents aged 6-17 years old[J]. Chin J Sch Health, 2017, 38(9): 1288-1290. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2017.09.003
[19]	黄若楠, 林琼芬, 吕娴佳, 等. 广州市5 781名中学生睡眠质量现状及影响因素分析[J]. 中国校医, 2018, 32(7): 518-521. HUANG R N, LIN Q F, LYU X J, et al. Sleep quality and influencing factors of 5 781 middle school students in Guangzhou City[J]. Chin J School Doctor, 2018, 32(7): 518-521. (in Chinese)
[20]	敖丽萍, 梁健平, 邓嘉茹, 等. 广州市城区初一学生睡眠不足现状及影响因素[J]. 中国学校卫生, 2018, 39(12): 1770-1772, 1778. doi: 10.16835/j.cnki.1000-9817.2018.12.003 AO L P, LIANG J P, DENG J R, et al. Prevalence and influencing factors of sleep deprivation among seventh grade students in urban areas of Guangzhou[J]. Chin J Sch Health, 2018, 39(12): 1770-1772, 1778. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2018.12.003
[21]	LYTLE LA, PASCH KE, FARBAKHSH K. The relationship between sleep and weight in a sample of adolescents[J]. Obesity (Silver Spring), 2011, 19(2): 324-331. doi: 10.1038/oby.2010.242
[22]	刘宏, 常利涛, 吕慧, 等. 云南儿童青少年睡眠时间与超重肥胖的关系[J]. 中国学校卫生, 2015, 36(10): 1534-1536, 1539. http://www.cjsh.org.cn/article/id/zgxxws201510027 LIU H, CHANG L T, LYU H, et al. Sleep duration and obesity in children and adolescents[J]. Chin J Sch Health, 2015, 36(10): 1534-1536, 1539. (in Chinese) http://www.cjsh.org.cn/article/id/zgxxws201510027
[23]	PELTZER K, PENGPID S. Sleep duration, sleep quality, body mass index, and waist circumference among young adults from 24 low- and middle-income and two high-income countries[J]. Int J Environ Res Public Health, 2017, 14(6): 566-577. doi: 10.3390/ijerph14060566
[24]	ST-ONGE M P, WOLFE S, SY M, et al. Sleep restriction increases the neuronal response to unhealthy food in normal-weight individuals[J]. Int J Obes (Lond), 2014, 38(3): 411-416. doi: 10.1038/ijo.2013.114
[25]	TAVERAS E M, RIFAS-SHIMAN S L, BUB K L, et al. Prospective study of insufficient sleep and neurobehavioral functioning among school-age children[J]. Acad Pediatr, 2017, 17(6): 625-632. doi: 10.1016/j.acap.2017.02.001