中华预防医学杂志    2017年09期 超重肥胖与青少年青春发动时相的关联及性别差异研究    PDF     文章点击量:154    
中华预防医学杂志2017年09期
中华医学会主办。
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文章信息

许媛媛 孙丽 郭欣 张静 娄晓民 王宏 陶芳标
XuYuanyuan,SunLi,GuoXin,ZhangJing,LouXiaomin,WangHong,TaoFangbiao
超重肥胖与青少年青春发动时相的关联及性别差异研究
Associations between overweight-obesity and puberty timing in children with different genders in China
中华预防医学杂志, 2017,51(9)
http://dx.doi.org/10.3760/cma.j.issn.0253-9624.2017.09.004

文章历史

投稿日期: 2017-04-17
上一篇:中国3个城市中学生童年期不良经历和社会支持与身心亚健康状态的关联研究
下一篇:脂肪重积聚提前与女童青春期发育的关联研究
超重肥胖与青少年青春发动时相的关联及性别差异研究
许媛媛 孙丽 郭欣 张静 娄晓民 王宏 陶芳标     
许媛媛 230032 合肥,安徽医科大学公共卫生学院儿少卫生与妇幼保健学系人口健康与优生安徽省重点实验室
孙丽 230032 合肥,安徽医科大学公共卫生学院儿少卫生与妇幼保健学系人口健康与优生安徽省重点实验室
郭欣 北京市疾病预防控制中心学校卫生所
张静 沈阳市沈北新区中小学卫生保健所
娄晓民 郑州大学公共卫生学院
王宏 重庆医科大学公共卫生与管理学院
陶芳标 230032 合肥,安徽医科大学公共卫生学院儿少卫生与妇幼保健学系人口健康与优生安徽省重点实验室
摘要: 目的  探讨超重肥胖与青少年青春发动时相提前和延迟的关联及性别差异。方法  于2014年10—12月,在沈阳市沈北新区、北京市延庆区、郑州市二七区和重庆市九龙坡区采用立意抽样,选取二、三、初一、初二年级女生,三、四、初一、初二年级男生为调查对象。收集人口学特征,采用青春发育量表评价青春期发育。共调查了6 701名中学生,收回有效问卷6 137份。采用多项式logistic回归模型分析超重肥胖与男女生青春期发育的关联。结果  小学男女生超重肥胖检出率分别为34.8%(522/1 499)、24.2%(341/1 409),中学男女生超重肥胖的检出率分别为31.3%(591/1 658)、21.8%(342/1 571)。小学男女生青春发育提前检出率分别为15.0%(225/1 499)和14.2%(200/1 409),中学男女生青春发育延迟检出率分别为14.3%(237/1 658)和14.9%(234/1 571)。调整地区、年龄、是否独生子女、家庭经济状况和父母文化程度后,与正常体重相比,小学女生超重肥胖与青春发育提前呈正向关联(OR=2.16,95%CI:1.56~2.99),中学女生超重肥胖与青春发育延迟呈负向关联(OR=0.54,95%CI:0.36~0.80),P值均<0.05。与正常体重相比,小学和中学男生超重肥胖与青春发动时相关联均无统计学意义,OR(95%CI)值分别为1.08(0.80~1.45)和0.93(0.69~1.27)(P值均>0.05)。结论  小学女生超重肥胖与青春发育提前呈正向关联,中学女生超重肥胖与青春发育延迟呈负向关联;但在男生中并未发现这种关联。
关键词 :超重;肥胖症;青春期发育;性别差异
Associations between overweight-obesity and puberty timing in children with different genders in China
XuYuanyuan,SunLi,GuoXin,ZhangJing,LouXiaomin,WangHong,TaoFangbiao     
Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei 230032, China
Corresponding author: Tao Fangbiao, Email: fbtao@126.com
Abstract:Objective  To understand the associations between overweight-obesity and puberty timing in children with different genders.Methods  The girls in grade 2, 3, 7, 8 and boys in grade 3, 4, 7, 8 were recruited from primary and middle schools in North new area of Shenyang, Yanqing district of Beijing, Erqi district of Zhengzhou and Jiulongpo district of Chongqing by purposive sampling method between October and December 2014, respectively. The information of demographic characteristics of the respondents were collected and the pubertal development status was evaluated by Pubertal Development Scale (PDS). A total of 6 701 students were recruited; 6 137 out of which were valid with complete questionnaires. The associations between overweight-obesity and puberty timing were estimated by multivariate logistic regression analysis.Results  The prevalence of overweight-obesity in primary schools were 34.8% (522/1 499) among boys and 24.2% (341/1 409) among girls, respectively. The prevalence of overweight-obesity in middle schools were 31.3% (591/1 658) among boys and 21.8% (342/1 571) among girls, respectively. The prevalence of premature puberty in primary schools were 15.0% (225/1 499) among boys and 14.2% (200/1 409) among girls, respectively. The prevalence of delayed puberty in middle schools were 14.3% (237/1 658) among boys and 14.9% (234/1 571) among girls, respectively. After adjusting the effects of region, age, one-child, family income and the parents' educational levels, multivariate logistic regression analysis showed that overweight-obesity had significantly positive association with premature puberty (OR=2.16, 95%CI: 1.56-2.99) among girls in primary schools, and significantly negative association with delayed puberty (OR=0.54, 95%CI: 0.36-0.80) among girls in middle schools when compared with students with normal weights, both P values were <0.05. There was no significant associations among boys in primary and middle schools between overweight-obesity and puberty timing, and the corresponding OR(95%CI) were 1.08(0.80-1.45) and 0.93(0.69-1.27) respectively, both P values >0.05.Conclusion  There was significantly positive association between overweight-obesity and premature puberty among girls, and significantly negative association with delayed puberty among girls in middle schools; but the association was not found among boys.
Key words :Overweight;Obesity;Adolescent development;Gender differences
全文

伴随世界范围内的儿童超重肥胖的流行[1],超重肥胖对儿童青春发动时相的影响引起了越来越多的关注。多项研究表明,高BMI的女童可能月经初潮更早[2,3,4],提示BMI与女童的青春发动时相之间存在关联。但是,男童肥胖与青春发动时相的关联尚不明确,且存在争议[5]。目前我国儿童肥胖与青春发动时相关联的大型流行病学调查尚处起步阶段,需要更多的全国性协作研究来补充和完善[6]。本研究旨在通过开展全国性协作研究,探讨超重肥胖与男女童青春发动时相之间的关系。

对象与方法  

一、对象  于2014年10—12月,采用立意抽样在沈阳市沈北新区、北京市延庆区、郑州市二七区和重庆市九龙坡区开展调查,学校和调查对象的纳入标准:(1)普通小学和中学;(2)小学男生来自三、四年级,女生来自二、三年级;(3)中学男女生均来自初一、初二年级;(4)每个年级男女学生各200名;(5)年级学生不足男女各200名的学校增加1所同类学校;(6)以班级为单位整群选取直至满足每个年级男女学生达200名的要求。最后在沈阳选取小学和中学各1所;北京小学2所、中学3所;郑州小学2所、中学1所;重庆小学和中学各2所。4个地区共调查了6 701名学生,收回有效问卷6 137份。所有调查对象的监护人均签署了知情同意书;本研究通过了安徽医科大学生物医学伦理委员会审批(批号:20131402)。

二、调查内容与方法  

1.基本情况:  二、三年级学生采用父母问卷,四年级及以上采用自填问卷。收集调查对象的人口学特征,包括年龄、性别、是否独生子女、家庭经济状况、父母文化程度等。

2.青春期发育的评价:  采用Petersen等[7]编制的青春发育量表(Puberty Development Scale, PDS),该量表在中国儿童中广泛应用[8,9],且适用于中国青少年人群[10]。二、三年级采用父母量表,四年级及以上采用自评量表。内容包括男女生身高突增、体毛(腋毛、阴毛)生长状况、皮肤改变状况3项;另外女童评价乳房发育和月经初潮状况,男童评价变声和胡须生长状况。除月经是否来潮外,其余项目进行1~4级评分,"尚未开始"(1分)、"刚刚起步"(2分)、"肯定开始"(3分)、"似乎完成"(4分),月经初潮按"已经来潮"(4分)、"尚未来潮"(1分),所有条目相加后除以条目数得到PDS均分。将不同年龄PDS得分>+s界定为青春发育提前组,PDS得分≤+ s为非提前组,PDS得分<+s为青春发育延迟组,PDS得分≥- s为非延迟组[11]

3.超重肥胖的判定标准:  按照《2014年全国学生体质健康调研工作手册》的要求进行身高、体重指标的测量,计算BMI。按照中国肥胖问题工作组[12]推荐的中国学龄儿童青少年超重肥胖筛查BMI分类标准评定超重肥胖。

三、质量控制  调查前对所有调查人员进行培训,并发放具体实施方案和调查流程,包括问卷的填写和体格发育指标测量等。调查中由现场质量控制人员监督,核查资料并及时纠正错误,确保将资料准确、详尽收集和记录。

四、统计学分析  采用Epidata 3.1软件进行数据录入,运用SPSS 13.0软件进行统计学分析。采用χ2检验比较正常和超重肥胖学生青春发动时相状况的差异;采用多项式logistic回归模型,调整地区、年龄、是否独生子女、家庭经济状况和父母文化程度等混杂因素,分析超重肥胖对生青春期发育的影响。以P<0.05为有统计学意义。

结果  

1.基本情况:  6 137名调查对象年龄为(11.17±2.46)岁,范围为6~17岁;男生3 157名,女生2 980名;小学2~3年级女生1 409名,3~4年级男生1 499名;初一、二年级女生1 571名,男生1 658名。小学男女生超重肥胖检出率分别为34.8%、24.2%,中学男女生超重肥胖的检出率分别为31.3%、21.8%。小学男女生青春发育提前检出率分别为15.0%和14.2%,中学男女生青春发育延迟检出率分别为14.3%和14.9%。详见表1

表1中小学生超重肥胖检出情况及青春发动时相分布状况

2.正常体重与超重肥胖中小学生青春发动时相比较:  小学女生超重肥胖组青春发育提前检出率高于正常体重组,中学女生超重肥胖组青春发育延迟检出率低于正常肥胖组,P值均<0.01。正常体重与超重肥胖男生青春发动时相差异无统计学意义(P值均>0.05)。详见表2

表2正常体重与超重肥胖中小学生青春发动时相比较

3.超重肥胖与青春发育提前关系的多项式logistic回归模型分析:  调整地区、年龄、是否独生子女、家庭经济状况和父母文化程度等混杂因素,与正常体重相比,小学女生超重肥胖与青春发育提前呈正向关联(OR=2.16,95%CI:1.56~2.99),中学女生超重肥胖与青春发育延迟呈负向关联(OR=0.54,95%CI:0.36~0.80),P值均<0.05。与正常体重相比,小学和中学男生超重肥胖与青春发动时相关联均无统计学意义,OR(95%CI)值分别为1.08(0.80~1.45)和0.93(0.69~1.27)(P值均>0.05)。

讨论  本研究中,超重肥胖与青春发动时相的关联存在性别差异。超重肥胖与小学组女生青春发动时相提前呈正向关联,与国内外相关研究结果一致[12,13,14,15];超重肥胖与女生青春发动时相延迟呈负向关联;但并未发现在男生中存在类似的相关性,这符合目前两者关系尚不明确、存在争议的观点。有研究认为,男生和女生一样存在类似的相关性,超重肥胖与青春发动时相呈正向关联[14,15,16,17,18,19,20];但是另有研究认为,超重肥胖的男生更易青春发动时相延迟[16,17,18,19,20,21]。这可能是由于BMI轻度增加(超重)与青春期发育提前有关,而BMI高度增加(肥胖)与青春期发育延迟有关[22],即超重肥胖与青春期间存在非线性的关系。
        目前青春发育时相的评价方法分为客观和主观青春发育时相,前者采用青春期第二性征发育指标,后者称为阶段标化的青春期发育时相PDS量表,本研究采用后者,该量表在中国儿童中应用广泛[8,9],有研究表明两种评价方法一致性较高[23],适用于中国青少年人群[10]
        超重肥胖与男女生青春发动时相的关联机制,可能是因为肥胖作为中枢性青春发动时相的守门人,会导致促性腺激素释放激素脉冲发生器的过早激活[24]。肥胖影响青春发育的调节因素可能是瘦素,直接影响促性腺激素的分泌[25]。另外,也可通过与肥胖有关的高胰岛素血症/胰岛素抵抗来解释。胰岛素水平的增加通过作用于肾上腺和性腺刺激性类固醇激素的产生。雄激素水平增加,反过来通过外周和/或中枢性作用于下丘脑垂体轴,从而促进青春期发育[24]。肥胖这两个已知效应导致其与男女生青春发动时相的关联存在性别差异。
        综上所述,超重肥胖对青春发动时相的影响可能存在性别差异,超重肥胖对女生青春发动时相的影响较大。但是,横断面调查不能进行因果推断,两者的关联及其性别差异仍需进一步的研究验证。

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