肥胖持续状态对学龄儿童肺功能的影响

丁佳韵; 张博雅; 戴一鸣; 王铮; 郭剑秋; 段志萍; 张沁雨; 齐小娟; 邬春华; 张济明; 周志俊

doi:10.16835/j.cnki.1000-9817.2024107

肥胖持续状态对学龄儿童肺功能的影响

doi: 10.16835/j.cnki.1000-9817.2024107

1.
复旦大学公共卫生学院/教育部公共卫生安全重点实验室，上海 200032
2.
浙江省疾病预防控制中心营养与食品安全所

基金项目:

国家自然科学基金项目 82373533

国家自然科学基金项目 82073501

国家自然科学基金项目 81611130087

详细信息

作者简介:
丁佳韵(1999-)，女，山东寿光人，在读硕士，主要研究方向为环境与儿童健康

通讯作者:
周志俊，E-mail：zjzhou@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: R723.14 R179 Q471
计量
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- 被引次数: 0
出版历程
- 收稿日期: 2023-12-28
- 修回日期: 2024-01-22
- 网络出版日期: 2024-04-25
- 刊出日期: 2024-04-25

Effectss of persistent obesity on lung function in school-age children

1.
School of Public Health/Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai (200032), China

摘要

摘要: 目的了解肥胖持续状态对儿童肺功能的影响，为采取干预措施提高肥胖学龄儿童的肺功能提供参考。方法以2009年江苏省盐城市射阳小型出生队列中参与7岁(2016年)和10岁(2019年)随访的335名儿童为研究对象，测量儿童的身高、体重和肺功能指标；根据世界卫生组织标准，即使用性别、年龄校正体质量指数，得到体质量指数Z评分，以此判断儿童7和10岁时的肥胖状态，并将其分为持续非肥胖、肥胖恢复、新发肥胖以及持续肥胖组。使用全球肺功能行动推荐的肺功能预测方程标化儿童肺功能指标；比较不同肥胖组间儿童肺功能指标的差异，并采用广义估计方程纵向分析儿童肥胖与肺功能之间的关联。结果 7和10岁时儿童的肥胖检出率分别为9.0%和16.1%，新发肥胖组和持续肥胖组的比例均为8.1%。7岁时儿童第1 s用力呼气容积(FEV₁)和用力呼气容积(FVC)分别为(1 269.90±202.70)(1 415.70±230.00)mL，10岁时分别为(1 440.80±403.20)(1 555.60±517.60)mL。横断面分析结果显示，7岁时肥胖儿童用力呼出75%肺活量时的瞬间流量(FEF₇₅)(β=-0.52，95%CI=-0.96~-0.07)和最大呼气中期流量(MMEF)(β=-0.45，95%CI=-0.89~-0.00)低于非肥胖儿童(P值均<0.05)；纵向分析结果显示，肥胖儿童较非肥胖儿童各项肺功能指标均降低，其中FEV₁的差异有统计学意义(β=-0.44，95%CI=-0.85~-0.02，P<0.05)。不同肥胖状态变化分组中，儿童总体肺功能指标差异均无统计学意义(P值均>0.05)；但性别分层后显示，新发肥胖女童10岁时FEV₁/FVC降低(β=-1.76，95%CI=-3.13~-0.38)，持续肥胖女童10岁时MMEF显著降低(β=-1.44，95%CI=-2.79~-0.09)(P值均<0.05)。结论肥胖可能导致学龄儿童肺功能指标降低，新发肥胖和持续肥胖状态对女童肺功能指标的影响更为显著。
- 肥胖症 /
- 肺 /
- 生长和发育 /
- 儿童
Abstract: Objective To analyze the impact of persistent obesity on their lung function, so as to offer insights for implementing intervention measures to increase lung function in obese school-age children. Methods A total of 335 children from the Sheyang Mini Birth Cohort established in 2009 in Yancheng City, Jiangsu Province, who participated in the follow-up at the ages of 7 years (2016) and 10 years (2019), were selected as the study participants. Physical measurements including height, weight, and lung function were recorded. According to the World Health Organization standard, that is, gender- and age-specific to correct the body mass index to calculate the body mass index Z score, was used to evaluate the obesity status of children at the age of 7 and 10. Children were divided into four groups, including sustained non-obesity group, restored obesity group, newly classified obesity group, and persistent obesity group. Meanwhile, the lung function prediction equations recommended by the Global Lung Function Initiative were used to standardize the lung function indexes of children. Pulmonary function differences among these groups were examined, and the relationship between childhood obesity and pulmonary function was longitudinally analyzed using generalized estimating equations. Results The prevalence of obesity were 9.0% and 16.1% at the age of 7 and 10 years, respectively. The proportion of both newly classified and persistent obesity group were 8.1%, respectively. The forced expiratory volume in one second (FEV₁) and forced vital capacity (FVC) were (1 269.90±202.70) and (1 415.70±230.00) mL, respectively, at the age of 7 years. FEV₁ and FVC at the age of 10 years were (1 440.80±403.20) and (1 555.60±517.60) mL, respectively. Cross-sectional analysis at age 7 showed that forced expiratory flow at 75% vital capacity (FEF₇₅) (β=-0.52, 95%CI=-0.96-0.07) and maximal mid-expiratary flow (MMEF) (β=-0.45, 95%CI=-0.89-0.00) were significantly lower in obese children compared to their non-obese peers (P<0.05). Longitudinal analysis indicated that obese children had lower levels of lung pulmonary function, with a statistically significant difference in FEV₁ (β=-0.44, 95%CI=-0.85-0.02, P<0.05). There was no significant difference among the various obesity groups (P>0.05), while gender-stratified results revealed significant reductions in FEV₁/FVC in newly classified obese girls at age 10 years (β=-1.76, 95%CI=-3.13-0.38) and in MMEF in persistently obese girls at age 10 years (β=-1.44, 95%CI=-2.79-0.09) (P<0.05). Conclusion Obesity may contribute to reduced lung function levels in school-aged children, with newly classified and persistent obesity having more pronounced effects on lung function in girls.
- Obesity /
- Lung /
- Growth and development /
- Child
注释:

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表 1 不同组别儿童肥胖检出率比较

Table 1. Comparison of obesity rates among children in different groups

组别	选项	人数	统计值	7岁	10岁
性别	男	187		24(12.8)	46(24.6)
	女	148		6(4.1)	8(5.4)
			χ²值	7.81	22.51
			P值	< 0.01	< 0.01
居住地	城镇	179		22(12.3)	35(19.6)
	农村	156		8(5.1)	19(12.2)
			χ²值	5.24	3.35
			P值	0.03	0.08
家庭受教育	< 9	170		15(8.8)	29(17.1)
年限	≥9	165		15(9.1)	25(15.2)
			χ²值	0.01	0.23
			P值	0.93	0.64
注：家庭受教育年限为父母学历较高者受教育年限；()内数字为检出率/%。

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表 2 7和10岁儿童肺功能指标[M(P₂₅, P₇₅)]

Table 2. Lung function indicators in children aged 7 and 10 years[M(P₂₅, P₇₅)]

年龄/岁	FEV₁/mL^a	FEV₁ Z分	FVC/mL^a	FVC Z分	FEV₁与FVC比值/%^a	FEV₁/FVC Z分	FEF₇₅ Z分	MMEF Z分
7	1 269.90±202.70	-0.92(-1.57, -0.28)	1 415.70±230.00	-0.11(-0.88, 0.71)	89.50±9.40	-0.20(-1.04, 0.71)	-0.53(-1.18, 0.40)	0.02(-0.70, 0.77)
10	1 440.80±403.20	-2.16(-3.40, -1.32)	1 555.60±517.60	-1.94(-3.22, -0.88)	94.80±11.40	2.07(1.19, 2.31)	-0.11(-1.12, 0.84)	0.93(0, 1.86)
注： a数据符合正态分布，用(x±s)描述。

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表 3 儿童7及10岁肥胖状态与肺功能指标的横断面关联分析[β值(95%CI)，n=335]

Table 3. Cross-sectional associations between obesity status and lung function in children aged 7 and 10 years[β(95%CI), n=335]

因变量	7岁	10岁
FEV₁ Z分	-0.08(-0.50~0.34)	-0.24(-0.74~0.25)
FVC Z分	0.02(-0.43~0.47)	-0.13(-0.76~0.50)
FEV₁/FVC Z分	-0.35(-0.81~0.11)	-0.21(-0.72~0.30)
FEF₇₅ Z分	-0.52(-0.96~-0.07)^*	-0.20(-0.60~0.20)
MMEF Z分	-0.45(-0.89~-0.00)^*	-0.20(-0.63~0.23)
注：自变量以非肥胖儿童为参照；*P<0.05。

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表 4 儿童7岁至10岁肥胖状态变化与10岁时肺功能指标关联分析[β值(95%CI)]

Table 4. Associations of changes in obesity status between the ages of 7 and 10 years with lung function at 10 years of age[β(95%CI)]

性别	自变量	FEV₁ Z分	FVC Z分	FEV₁/FVC Z分	FEF₇₅ Z分	MMEF Z分
男	新发肥胖	-0.25(-1.01~0.52)	-0.21(-1.16~0.73)	-0.17(-0.98~0.65)	0.18(-0.45~0.80)	0.19(-0.46~0.84)
(n=187)	持续肥胖	-0.00(-0.76~0.76)	0.03(-0.91~0.97)	0.05(-0.77~0.86)	-0.13(-0.76~0.49)	-0.05(-0.70~0.60)
	肥胖恢复	-1.93(-5.23~1.38)	-2.54(-6.63~1.56)	1.93(-1.61~5.47)	0.99(-1.70~3.69)	0.93(-1.88~3.73)
女	新发肥胖	-0.19(-1.59~1.22)	0.89(-1.03~2.82)	-1.76(-3.13~-0.38)^*	-0.56(-1.77~0.58)	-0.33(-1.67~1.00)
(n=148)	持续肥胖	-1.29(-2.71~0.13)	-1.66(-3.60~0.28)	-0.03(-1.42~1.36)	-1.06(-2.24~0.13)	-1.44(-2.79~-0.09)^*
	肥胖恢复	1.08(-0.94~3.10)	1.11(-1.66~3.87)	0.67(-1.31~2.65)	0.65(-1.04~2.34)	-0.33(-1.67~1.00)
总体	新发肥胖	-0.35(-1.00~0.30)	-0.04(-0.86~0.78)	-0.23(-0.91~0.44)	0.35(-0.21~0.91)	0.13(-0.44~0.70)
(n=335)	持续肥胖	-0.40(-1.06~0.25)	-0.27(-1.10~0.56)	0.07(-0.61~0.75)	-0.07(-0.63~0.50)	-0.27(-0.85~0.31)
	肥胖恢复	0.08(-1.76~1.93)	-0.29(-2.63~2.05)	1.07(-0.84~2.98)	0.35(-1.24~1.94)	0.63(-1.00~2.25)
注：自变量以持续非肥胖为参照；*P<0.05。

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表 5 儿童肥胖状况与肺功能指标的广义估计方程分析[β值(95%CI)]

Table 5. Generalized estimating equation analysis of obesity status and lung function in children[β(95%CI)]

因变量	总体(n=335)	男(n=187)	女(n=148)
FEV₁ Z分	-0.44(-0.85~-0.02)^*	-0.35(-0.85~0.14)	-0.53(-1.20~0.14)
FVC Z分	-0.32(-0.78~0.13)	-0.22(-0.76~0.31)	-0.49(-1.35~0.37)
FEV₁/FVC Z分	-0.07(-0.50~0.36)	-0.05(-0.55~0.45)	-0.27(-1.25~0.71)
FEF₇₅ Z分	-0.14(-0.50~0.22)	-0.09(-0.53~0.35)	-0.31(-0.80~0.18)
MMEF Z分	-0.22(-0.56~0.13)	-0.11(-0.52~0.30)	-0.52(-1.13~0.10)
注：自变量以非肥胖儿童为参照；*P<0.05。

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