膳食环境因素对儿童青少年肥胖影响的多水平混合效应模型研究
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摘要
目的分析2011年中国12省(自治区、直辖市)膳食环境因素对7～17岁中国儿童青少年肥胖的影响。方法利用2011年"中国健康与营养调查"的膳食环境和体格测量数据,本调查采用多阶段分层整群随机抽样方法、连续3天24小时回顾法膳食调查、个人-家庭-社区的问卷调查及身高和体重测量等体格检查方法。选择相关资料完整的1416名7～17岁儿童青少年作为研究对象(男性占50.71%;7～10岁年龄组占43.50%,11～14岁37.43%,15～17岁19.07%),结合2011年国家统计年鉴中的膳食环境数据,构建三水平(省-社区-个人)肥胖与否的二分类结局Logistic随机截距混合效应模型,分析膳食环境因素对儿童青少年肥胖的影响,确定其中危险因素的特性。结果鉴于对单独构建的"省-个体"和"社区-个体"二水平的空模型进行分层的随机效应检验时P值分别为P<0.005和0.050 OBJECTIVE To analyze the influence of dietary environmental factors in 12 provinces of China on obesity among children and adolescents aged 7-17 in 2011. METHODS Based on the dietary environmental and physical examination data of China Health and Nutrition Survey 2011(Multi-stage stratified cluster random sampling method, 3 day 24 hour retrospective method, individual-household-community questionnaire survey and physical examination method such as height and weight measurement were used), 1416 children and adolescents aged 7-17(male 50.71%; the age group of 7-10 years old accounted for 43.50%, that of 11-14 years old 37.43%, and that of 15-17 years old 19.07%) with complete data were selected as the research subjects, and combined with the dietary environmental data of the corresponding provinces from National Statistical Yearbook 2011, a three-level(province-community-individual) logistic mixed effect(random intercept) model was constructed to binary outcome variables of obesity or not, the effect of dietary environments on obesity in children and adolescents was analyzed, and the characteristics of risk factors were determined. RESULTS Considering that the P values of the two-level empty model of "province-individual"and"community-individual" constructed separately were P<0.005 and 0.050
引文
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[29] MENEZES M C,COSTA B V,OLIVEIRA C D,et al.Local food environment and fruit and vegetable consumption:an ecological study [J].Prev Med Rep,2017,5:13-20.
[2] WHO.Consideration of the evidence on childhood obesity for the commission on ending childhood obesity:report of the ad hoc working group on science and evidence for ending childhood obesity [M].Geneva:WHO,2016:4-36.
[3] 常继乐,王宇.中国居民营养与健康状况监测2010—2013年综合报告 [M].北京:北京大学医学出版社,2016:87-90.
[4] 王烁,董彦会,王政和,等.1985—2014年中国7～18岁学生超重与肥胖流行趋势 [J].中华预防医学杂志,2017,51(4):300-305.
[5] LOOS R J F,RANKINEN T.Gene-diet interactions on body weight changes [J].J Am Diet Assoc,2005,105(5 Suppl 1):S29-S34.
[6] GORTMAKER S L,SWINBURN B A,LEVY D,et al.Changing the future of obesity:science,policy,and action [J].Lancet,2011,378(9793):838-847.
[7] CARMONA R H.Improving health literacy:preventing obesity with education [J].J Am Diet Assoc,2005,105(5):9-10.
[8] WHO.prioritizing areas for action in the field of population-based prevention of childhood obesity:a set of tools for member states to determine and identify priority areas for action [M].Geneva:WHO,2012:6-63.
[9] SWINBURN B.Dissecting obesogenic environments:the development and application of a framework for identifying and prioritizing environmental interventions for obesity [J].Prev Med,1999,29:563-570.
[10] ROBERTSON A,TIRADO C,LOBSTEIN T,et al.Food and health in Europe:a new basis for action [M].Copenhagen:WHO Regional Office for Europe,2004:282-297.
[11] BLACKBURN G L,WALTMAN B A.Expanding the limits of treatment:new strategic initiatives [J].J Am Diet Assoc,2005,105(5):131-135.
[12] 杨珉,李晓松.医学和公共卫生研究常用多水平统计模型 [M].北京:北京大学医学出版社,2007:69-104.
[13] 冯国双,罗凤基.医学案例统计分析与SAS应用 [M].北京:北京大学医学出版社,2014:240-257.
[14] 王志宏,张兵,王惠君,等.中国成年人红肉摄人量对体重指数、体重及超重危险性影响的多水平纵向研究 [J].中华流行病学杂志,2013,34(7):661-667.
[15] WANG Z,ZHANG B,ZHAI F,et al.Fatty and lean red meat consumption in China:differential association with Chinese abdominal obesity [J].Nutr Metab Carbiovasc Dis,2014,24(8):869-876.
[16] WANG Z,GORDON-LARSEN P,SIEGA-RIZ A M,et al.Sociodemographic disparity in the diet quality transition among Chinese adults from 1991 to 2011 [J].Eur J Clin Nutr,2016,71(4):486-493.
[17] 欧阳一非,汪云,王惠君,等.膳食胆固醇摄入量对我国成人血压值和高血压发病影响的多水平纵向研究 [J].中华高血压杂志,2017,3(25):239-246.
[18] POPKIN B M,DU S,ZHAI F,et al.Cohort Profile:The China health and nutrition survey—monitoring and understanding socio-economic and health change in China,1989-2011 [J].Int J Epidemiol,2010,39(6):1435-1440.
[19] 张兵,王惠君,杜文雯,等.队列研究的进展及其对中国健康与营养调查的启示 [J].中华预防医学杂志,2011,45(4):295-298.
[20] 国家统计局.中国统计年鉴 2011 [M].北京:中国统计出版社,2012.
[21] GUO Chunlei,ZHANG Bing,WANG Huijun,et al.A scan of obesogenic environments and a spatial Inference of obesity prevalence in Chinese children and adolescents:based on the Chinese Health and Nutrition Survey 2011 data [J].Biomed Environ Sci,2018,31(10):729-739.
[22] 中国肥胖问题工作组.中国学龄儿童青少年超重、肥胖筛查体重指数值分类标准 [J].中华流行病学杂志,2004,25(2):97-102.
[23] JONES-SMITH J,POPKIN B M.Understanding community context and adult health changes in China:development of an urbanicity scale [J].Soc Sci Med,2010,71(8):1436-1446.
[24] 中国营养学会.中国居民膳食营养素参考摄入量 [M].北京:科学出版社,2014:652-659.
[25] KINGE J M,STRAND B H,VOLLSET S E,et al.Educational inequalities in obesity and gross domestic product:evidence from 70 countries [J].J Epidemiol Commun H,2015,69(12):1141-1146.
[26] ZIENKIEWICZ E,OKONSKI M,MATUSZEWSKI L,et al.Influence of urbanization level and Gross domestic product on the prevalence of adolescent obesity in Poland [J].Ann Agr Env Med,2014,21(872203):136-142.
[27] SU C,ZHANG B,WANG Y F,et al.Epidemics of overweight and obesity among growing childhood in China between 1997 and 2009:impact of family income,dietary intake,and physical activity dynamics [J].Chinese Med J,2015,128(14):1879-1886.
[28] 陈芳芳,米杰,王天有,等.北京市儿童青少年青春期发育与肥胖相关关系的研究 [J].中国循证儿科杂志,2007,2(1):14-20.
[29] MENEZES M C,COSTA B V,OLIVEIRA C D,et al.Local food environment and fruit and vegetable consumption:an ecological study [J].Prev Med Rep,2017,5:13-20.