饮食行为身体活动和海拔高度与儿童青少年营养状况的关联

张登城; 蒋家诺; 陈力; 普布卓玛; 谭力铭; 张秀红; 杨田; 董子奇; 秦阳; 鲁震霆; 马军; 董彦会

doi:10.16835/j.cnki.1000-9817.2025246

饮食行为身体活动和海拔高度与儿童青少年营养状况的关联

doi: 10.16835/j.cnki.1000-9817.2025246

1.
北京大学公共卫生学院/北京大学儿童青少年卫生研究所, 北京 100191
2.
西藏自治区疾病预防控制中心公共卫生监测所
3.
内蒙古自治区疾病预防控制中心学校卫生科

基金项目:

国家自然科学基金青年科学基金项目 82103865

详细信息

作者简介:
张登城(1993-), 男, 重庆黔江人, 在读硕士, 主管医师, 主要研究方向为学校与儿少卫生、环境卫生

通讯作者:
董彦会, E-mail：dongyanhui@bjmu.edu.cn

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R153 R155.1 G806
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出版历程
- 收稿日期: 2025-03-26
- 修回日期: 2025-04-21
- 刊出日期: 2025-10-25

Association of dietary behaviors, physical activity and altitude with nutritional status among children and adolescents

1.
School of Public Health/Institute of Child and Adolescent Health, Peking University, Beijing 100191, China

摘要

摘要: 目的分析海拔高度与儿童青少年营养状况的关联, 并探究饮食行为及身体活动在其中的调节作用, 为因地制宜制定儿童青少年生活方式干预措施提供科学依据。方法 2023年9—11月, 采用分层整群随机抽样方法从内蒙古和西藏2个自治区抽取156 511名7~17岁儿童青少年, 通过体格检查获取身高、体重, 计算体质量指数; 通过问卷收集调查对象的社会人口学特征、饮食行为和身体活动因素, 利用高德地图获取调查对象所在学校的海拔高度。采用Logistic回归分析海拔与营养状况之间的关系, 通过引入交互项和分层分析探究饮食行为与身体活动在其中的调节作用, 并使用限制性立方样条(RCS)分析技术进行可视化。结果 2023年西藏儿童青少年消瘦、超重肥胖检出率分别为9.7%, 9.0%, 内蒙古分别为2.9%, 22.0%。Logistic回归分析结果显示, 海拔每增加1 km, 儿童青少年消瘦风险增加、超重肥胖风险降低(OR值分别为1.43, 0.19, P值均 < 0.05)。分层分析结果显示, 与海拔高度 < 1 km组的儿童青少年相比, 健康饮食组中1~ < 2和2~ < 3 km海拔与消瘦的关联均无统计学意义(OR值分别为1.22, 0.75, P值均>0.05), 海拔3~ < 4和≥4 km组与消瘦的关联均有统计学意义(OR值分别为2.25, 2.89, P值均 < 0.05);不健康饮食组的海拔高度与消瘦的关联均有统计学意义(OR=1.18~4.04, P值均 < 0.05), 与RCS分析结果一致。儿童青少年身体活动对海拔与消瘦的关联、饮食行为和身体活动对海拔与超重肥胖的关联均无调节作用(P_交互值分别为0.63, 0.10, 0.53)。结论健康饮食行为在改善儿童青少年营养状况以及消除地区间差异方面具有关键性作用, 可为相关公共卫生政策的制定与实施提供科学依据。
- 饮食习惯 /
- 运动活动 /
- 高海拔 /
- 营养状况 /
- 回归分析 /
- 儿童 /
- 青少年
Abstract: Objective To analyze the association between altitudes and nutritional status of children and adolescents, and to explore the moderating effects of dietary behaviors and physical activity, so as to provide a scientific basis for developing lifestyle interventions tailored to local conditions. Methods From September to November 2023, physical examinations and questionnaire surveys were conducted among children and adolescents aged 7-17 in two autonomous regions, Inner Mongolia and Xizang, with a final sample of 156 511 participants by the stratified cluster random sampling method. Height and weight were measured to calculate body mass index (BMI). Sociodemographic characteristics, dietary behaviors, and physical activity were collected via questionnaires, while the altitude of each participant's school was obtained using Amap. Logistic regression was performed to examine the relationship between altitudes and nutritional status. Interaction terms and stratified analyses were applied to assess the moderating effects of dietary behaviors and physical activity. Restricted cubic spline (RCS) were used for visualization. Results In 2023, the prevalence of wasting and overweight/obesity among children and adolescents in Xizang were 9.7% and 9.0%, respectively, compared to 2.9% and 22.0% in Inner Mongolia. Logistic regression analysis results showed that for every 1 km increase in altitude, the risk of wasting increased, while the risk of overweight/obesity decreased (OR=1.43, 0.19, both P < 0.05). The results of the stratified analysis showed that compared to those living at altitudes < 1 km, children and adolescents with healthy diets showed no significant association between altitudes (1- < 2 and 2- < 3 km) and wasting (OR=1.22, 0.75, both P>0.05), whereas significant associations were observed at 3- < 4 and ≥4 km altitudes (OR=2.25, 2.89, both P < 0.05). In contrast, unhealthy dietary groups showed statistically significant associations across altitudes (OR=1.18-4.04, all P < 0.05), consistent with RCS results. No moderating effects were observed for physical activity on the altitude-wasting association or for dietary behaviors and physical activity combined on the altitude-overweight/obesity association (P_interaction=0.63, 0.10, 0.53). Conclusion Healthy dietary behaviors play a critical role in improving the nutritional status of children and adolescents and reducing regional disparities, providing a scientific foundation for public health policy formulation and implementation.
- Food habits /
- Motor activity /
- Altitude /
- Nutritional status /
- Regression analysis /
- Child /
- Adolescent
注释:

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图 1 海拔高度与儿童青少年营养状况的非线性关联

Figure 1. Nonlinear association between altitudes and nutritional status among children and adolescents

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表 1 海拔高度与儿童青少年消瘦关联的Logistic回归分析[OR 值(95%CI)，n = 156 511]

Table 1. Logistic regression analysis of the association between altitudes and wasting among children and adolescents[OR(95%CI)，n = 156 511]

海拔高度/km	总体	饮食行为		身体活动
海拔高度/km	总体	不健康	健康	不足	充足
连续型	1.43(1.40~1.47)^*	1.44(1.41~1.47)^*	1.32(1.18~1.47)^*	1.43(1.40~1.47)^*	1.45(1.34~1.56)^*
分类型 < 1	1.00	1.00	1.00	1.00	1.00
1~ < 2	1.18(1.09~1.27)^*	1.18(1.09~1.27)^*	1.22(0.94~1.59)	1.15(1.07~1.25)^*	1.47(1.15~1.89)^*
2~ < 3	1.23(1.00~1.50)^*	1.28(1.03~1.59)^*	0.75(0.34~1.55)	1.18(0.95~1.47)	1.74(0.88~3.15)
3~ < 4	3.44(3.14~3.77)^*	3.48(3.17~3.83)^*	2.25(1.39~3.55)^*	3.41(3.10~3.75)^*	3.68(2.70~5.00)^*
≥4	4.00(3.66~4.37)^*	4.04(3.69~4.43)^*	2.89(1.77~4.62)^*	3.95(3.60~4.34)^*	4.55(3.32~6.22)^*
注： ^*P < 0.05；协变量包括年龄、性别、学段、家庭类型、人均GDP、民族、居住地等。

下载: 导出CSV

表 2 海拔高度与儿童青少年超重肥胖关联的Logistic回归分析[OR 值(95%CI)，n = 156 511]

Table 2. Logistic regression analysis of the association between altitudes and overweight/obesity among children and adolescents[OR (95%CI)，n = 156 511]

海拔高度/km	总体	饮食行为		身体活动
海拔高度/km	总体	不健康	健康	不足	充足
连续型	0.19(0.18~0.21)^*	0.70(0.68~0.71)^*	0.74(0.68~0.79)^*	0.70(0.68~0.71)^*	0.70(0.66~0.74)^*
分类型 < 1	1.00	1.00	1.00	1.00	1.00
1~ < 2	0.84(0.81~0.87)^*	0.84(0.81~0.87)^*	0.81(0.72~0.92)^*	0.83(0.80~0.87)^*	0.84(0.75~0.95)^*
2~ < 3	0.66(0.59~0.74)^*	0.65(0.57~0.73)^*	0.84(0.55~1.28)	0.67(0.59~0.75)^*	0.64(0.43~0.94)^*
3~ < 4	0.33(0.31~0.36)^*	0.33(0.31~0.35)^*	0.42(0.30~0.59)^*	0.33(0.31~0.36)^*	0.30(0.23~0.38)^*
≥4	0.19(0.18~0.21)^*	0.19(0.17~0.21)^*	0.22(0.14~0.33)^*	0.19(0.17~0.21)^*	0.20(0.15~0.27)^*
注： ^*P < 0.05；协变量包括年龄、性别、学段、家庭类型、人均GDP、民族、居住地等。

下载: 导出CSV

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