摘要
目的调查分析兰州市城区3-6岁儿童2001-2011年的体检资料,从而研究该人群较长期(11年)的生长发育变化趋势,找出依然存在的或新出现的影响其机能发挥的突出体格发育障碍,为制定促进该人群健康成长的区域性和国内策略提供指导依据。
方法根据兰州市地理、社会功能区特征、参考幼儿园公私立等性质,采用分层随机整群抽样的方法,在兰州市城区不同功能区随机抽取3个以上幼儿园(至少包括办学条件较好、中等、较差的幼儿园各一个),共选取67所幼儿园儿童为调查对象。以身高、体重及身体质量指数(BMI)为主要指标分析其变化趋势。以年龄别身高Z评分(HAZ)、年龄别体重Z评分(WAZ)和身高别体重Z评分(WHZ)三项指标筛查其生长迟缓、低体重、超重、消瘦和肥胖检出情况并分析变化趋势。对体检资料同时进行横向(同一年龄组)及纵向(随年龄增长)的体格发育情况比较分析,并与2005年九市城区七岁以下儿童生长水平进行比较。
结果12001～2011年间身高、体重变化情况
1.1纵向分析发现,该人群男女身高、体重总体上随年龄增长而增长,符合儿童一般生长发育规律。
1.2横向比较发现,该人群各年龄组男女身高、体重增幅均较明显(P<0.05),且男童(1.7cm,2.3kg)快于女童(1.2cm,0.7kg)(P<0.05),表现出明显的性别、年龄差异。
其中,3岁组男童身高、体重与年份均存在线性正相关关系(rs=0.612,P<0.05；rs=0.776,P<0.05),身高平均增长速度为0.19%,体重平均增长速度为0.49%；女童只有身高与年份存在线性正相关关系(rs=0.630,P<0.05),平均增长速度为0.07%。
4岁组只有男童体重与年份存在线性正相关关系(rs=0.722,P<0.05),平均增长速度为0.44%。
5岁组男童身高、体重与年份均存在线性正相关关系(rs=0.606,P<0.05；rs=0.719,P<0.05),平均增长速度分别为0.13%和0.65%。
6-7岁组男童身高、体重与年份均存在线性正相关关系(rs=0.647,P<0.05：rs=0.700,P<0.05),平均增长速度分别为0.03%和1.14%。
22001～2011年间BMI P50变化情况
横向比较,各年龄组儿童BMI P50与年份无相关性。纵向比较有随年龄增加逐渐减小的趋势,身高的增速快于体重。
32001～2011年间Z评分情况
3.1调查对象11年间Z评分情况进行比较,各年龄组Z评分均有统计学差异(P<0.05)。
其中,3岁和4岁组儿童HAZ评分与年份均存在线性正相关关系(rs=0.766,P<0.05；rs=0.725,P<0.05),平均增长速度分别为7.96%和1.90%；3-6岁组儿童HAZ评分亦与年份存在线性正相关关系(rs=0.693,P<0.05),平均增长速度为3.98%。
3.2Z评分判断营养不良和超重、肥胖检出情况
横向比较：11年间调查对象各年龄组超重检出率及各年龄组(除3岁组)肥胖检出率在各年份间差异有统计学意义(P<0.05),并呈逐渐增加的趋势；各年龄组生长迟缓及消瘦检出率差异均有统计学意义(P<0.05)；3岁组和4岁组儿童低体重检出率差异无统计学意义(P>0.05),而5岁组和6-7岁组差异均有统计学意义(P<0.05)
纵向比较：11年间(除2001年)调查对象超重检出率各年龄组间比较均有统计学差异(P<0.05),且随年龄增长检出率呈逐渐减小的趋势；而肥胖检出率各年龄组间比较差异均无统计学意义(P>0.05)；2002、2008、2009、2011年的低体重检出率以及2006、2007年的消瘦检出率各年龄组间比较有统计学差异(P<0.05),其余各年份的低体重和消瘦检出率不同年龄组间比较差异均无统计学意义(P>0.05)；11年间,调查对象生长迟缓检出率各年龄组间比较2003、2004、2005、2010年差异无统计学意义(P>0.05),其余各年份的生长迟缓检出率各年龄组间比较均有统计学差异(P<0.05)。其中,3岁组儿童低体重与年份存在线性负相关关系(rs=-0.612,P<0.05),平均下降速度为11.34%；5岁组儿童超重、肥胖与年份均存在线性正相关关系,(rs=0.880,P<0.05；rs=0.725,P<0.05),平均增长速度分别为5.38%和4.60%。
结论整体而言该人群近十年来生长发育变化明显,呈现快速增长趋势,体格发育中存在的传统问题如：生长迟缓、低体重、消瘦等在逐渐改善。但也出现与其他地域人群类似如超重、肥胖等新的体格发育障碍问题,即营养不良与营养过剩并存。提示在制定与实施针对该人群成长的区域性和国内健康促进策略中,应在注重营养不良问题改善的同时高度关注营养过剩的体格发育障碍问题,托幼机构与家庭要着力培养儿童良好的生活习惯,注意膳食营养均衡和适当增加儿童户外活动时间,同时强化社会性健康教育,从社会、家庭、托幼机构等多方面关注儿童成长。
Objective To investigate the physical data of3to6years old preschool children in urban areas of Lanzhou from2001to2011and study the physical growth trend of this group in a longer period (11years); to find out existing and newly emerged risky factors that can influence the physical growth and therefore provide scientific guidance for making regional and domestic policy to improve this group's health.
Method Children from67kindergartens in total located in different functional urban areas of Lanzhou were chosen as study objects using stratified cluster sampling method. Each area included at least3kindergartens at random, including good, fair, inferior ones respectively. Height, weight and body mass index (BMI) were studied. And the changes of this group's growth retardation, emaciation, underweight, overweight and obesity were then screened respectively according to Z scores, namely, height for age (WAZ), weight for age (HAZ), weight for height (WHZ). Physical data were studied by horizontal (of the same age), together with vertical (of different ages) analysis, then compared with the physical growth level of children under7years old living in urban areas of nine cities of China in2005.
Results1The changes of height and weight of3-6years old children in urban areas of Lanzhou from2001-2011.
1.1According to the vertical analysis, the height and weight of this group increased by age, which was in accordance with the physical growth trend of children.
1.2According to the horizontal analysis, the increasing rates of height and weight of this groups were significantly different (P<0.05), and that of boys (1.7cm,2.3kg) higher than girls (1.2cm,0.7kg)(P<0.05), showing significant difference of gender and age.
In groups of3years old, the height and weight of boys were in linear positive correlation with ages (rs=0.612,P<0.05; rs=0.776,P<0.05), with an average increasing rate of0.19%for height and0.49%for weight. Meanwhile, only the height of girls was in linear positive correlation with ages (rs=0.630,P<0.05), with an average increasing rate of0.07%.
In groups of4years old, only the weight of boys was in linear positive correlation with ages (rs=0.722,P<0.05), with an average increasing rate of0.44%.
In groups of5years old, the height and weight of boys were in linear positive correlation with ages (rs=0.606,P<0.05; rs=0.70,P<0.05), with an average increasing rate of0.13%for height and0.65%for weight.
In groups of6-7years old, the height and weight of boys were in linear positive correlation with ages (rs=0.647,P<0.05; r,=0.700,P<0.05), with an average increasing rate of0.03%for height and1.14%for weight.
2The changes of BMI P50from2001to2011
According to the horizontal analysis, the BMI P50showed no correlation with age. According to the vertical analysis, the BMI P50decreased with age, with a higher increasing rate of height than weight.
3The Z scores from2001-2011
3.1The Z scores were significantly different (P<0.05), during these11years.
In groups of3years old and4years old, the HAZ scores were in linear positive correlation with ages (rs=0.166,P=0.006; rs=0.725,P=0.012), with an average increasing rate of7.96%and1.90%. In groups of3-6years old, the HAZ scores were also in linear positive correlation with ages (rs=0.693, P=0.018), with an average increasing rate of3.98%.
3.2The relevance ratio of malnutrition, overweight and obesity according to Z scores
According to the horizontal analysis, the relevance ratios of overweight and obesity of each group, except for group of3years old, were significantly different (P<0.05) during these11years, with an increasing rate each year. The relevance ratios of growth retardation and emaciation were also significantly different (P<0.05). In groups of3years old and4years old, the relevance ratio of low weight had no significant difference (P>0.05), however, that of5years old and6-7years old showed significant differences (P<0.05).
According to vertical analysis, the relevance ratios of overweight among groups were significantly different (P<0.05) during these11years, with a decreasing trend each year. However, the relevance ratios of obesity showed no significant difference (P>0.05). The relevance ratios of low weight in2002,2008,2009,2011and that of emaciation in2006,2007were significantly different (P<0.05). Those in other years showed no significant differences (P>0.05). The relevance ratios of growth retardation in2003,2004,2005and2010had no significant differences (P>0.05), while those in other years showed significant differences (P<0.05). In groups of3years old children, the low weight was in linear negative correlation with ages (rs=-0.612,P<0.05), with an average decreasing rate of11.34%. In groups of5years old children, the overweight and obesity were in linear positive correlation with ages, with an average increasing rate of5.38%and4.60%, respectively.
Conclusions During these recent10years, the physical growth level of preschool children in urban areas of Lanzhou was increasing rapidly. However, malnutrition and over-nutrition also surged as a dual problem in this group. In response, while children's good living habits being prompted, kindergartens should pay more attention to the nutrition balance of children's diet and increase their outdoor activities. Meanwhile, public health education should also be emphasized among societies, families and kindergartens to take care of children's physical growth.
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