青春期启动提前与儿童肥胖类型的关联研究: 基于横断面调查和队列调查

doi:10.19723/j.issn.1671-167X.2022.05.025

北京大学学报（医学版） ›› 2022, Vol. 54 ›› Issue (5): 961-970. doi: 10.19723/j.issn.1671-167X.2022.05.025

青春期启动提前与儿童肥胖类型的关联研究: 基于横断面调查和队列调查

马涛¹,李艳辉¹,陈曼曼¹,马莹¹,高迪¹,陈力¹,马奇¹,张奕¹,刘婕妤¹,王鑫鑫²,董彦会¹,马军^1,*()

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. 宁夏医科大学公共卫生与管理学院, 银川 750004

收稿日期:2022-06-13 出版日期:2022-10-18 发布日期:2022-10-14
通讯作者: 马军 E-mail:majunt@bjmu.edu.cn
作者简介:马军，北京大学儿童青少年卫生研究所所长，北京大学长聘教授，博士生导师；主要从事儿童青少年生长发育及其影响因素、成年期疾病早期预防及学校卫生管理等方面的研究，主持和参与了包括GB 40070—2021《儿童青少年学习用品近视防控卫生要求》在内的17项全国儿童青少年健康相关标准的制定，出版教学书籍13部。现任中国疾病预防控制中心学校/儿少卫生中心主任，国家卫生健康标准委员会学校卫生专业委员会主任委员，中华预防医学会儿少卫生分会主任委员，全国公共卫生与预防医学名词编写委员会儿少与学校卫生名词编写与审定委员会主任，全国学生体质与健康调研组副组长，教育部首届全国中小学健康教育教学指导委员会主任委员等社会工作和学术兼职，并曾受邀作为健康中国行动专家咨询委员会首批委员、国家儿童青少年视力健康管理专家咨询委员会委员，为儿童青少年卫生促进工作提供政策支持。承担包括卫生行业科研专项、国家自然科学基金、国家卫生健康委员会和教育委托科研项目等80余项，作为第一作者或通信作者发表论文300余篇，包括BMJ、Circulation、Lancet Diabetes and Endocrinology、Lancet Global Health、JAMA Pediatrics等国际顶尖学术期刊，曾先后获得宋庆龄儿科医学奖和中华预防医学会科学技术奖一等奖和三等奖等，研究成果在儿童青少年卫生领域产生了重要影响
基金资助:
国家自然科学基金(81673192);卫生部卫生行业科研专项(201202010)

Associations between early onset of puberty and obesity types in children: Based on both the cross-sectional study and cohort study

Tao MA¹,Yan-hui LI¹,Man-man CHEN¹,Ying MA¹,Di GAO¹,Li CHEN¹,Qi MA¹,Yi ZHANG¹,Jie-yu LIU¹,Xin-xin WANG²,Yan-hui DONG¹,Jun MA^1,*()

1. Institute of Child and Adolescent Health, Peking University School of Public Health, Beijing 100191, China
2. School of Public Health and Management, Ningxia Medical University, Yinchuan 750004, China

Received:2022-06-13 Online:2022-10-18 Published:2022-10-14
Contact: Jun MA E-mail:majunt@bjmu.edu.cn
Supported by:
the National Natural Science Foundation of China(81673192);the Research Special Fund for Public Welfare Industry of Health of the Ministry of Health of China(201202010)

摘要/Abstract

摘要：

目的: 青春期启动及其提前与儿童肥胖的关联一直存在争议，本研究通过将大样本横断面调查数据与长期纵向队列数据相结合，探索并分析青春期启动提前与儿童不同肥胖类型的关联，为进一步明确青春期启动提前的健康危害和肥胖防控提供线索。方法: 研究资料来源于中国7个省(自治区、直辖市)横断面调查数据和厦门市青少年青春期发育队列数据，先通过对横断面数据进行Logistic回归分析发现青春期启动与肥胖的关联，然后使用泊松回归(Poisson regression)分析青春期启动提前与各类型肥胖风险之间的关联。结果: 横断面调查和队列调查研究分别纳入儿童43 137人和1 266人，横断面研究发现，女生青春期启动提前与单纯性肥胖、中心性肥胖和复合型肥胖均呈正相关关系，OR值(95%CI)分别为1.86(1.42~2.44)、1.95(1.65~2.32)和1.86(1.41~2.45)，男生未发现显著关联。通过研究队列数据发现，在女生中，与青春期启动未提前组相比，提前组发生单纯性肥胖的风险为6.00倍[RR (95%CI)：6.00 (1.07~33.60)]，发生中心性肥胖的风险为3.30倍[RR (95%CI)：3.30 (1.22~8.92)]，发生复合型肥胖的风险为5.76倍[RR (95%CI)：5.76 (1.03~32.30)]，而在男生中未发现青春期启动提前与肥胖存在关联。结论: 同时基于横断面调查和纵向队列调查证实，女生青春期启动提前可能增加单纯性肥胖、中心性肥胖和复合型肥胖的发生风险，而在男生中未发现青春期启动提前与肥胖存在显著关联。

关键词: 儿童肥胖, 青春期, , 横断面研究, 队列研究

Abstract:

Objective: To explore and analyze the relationship between early onset of puberty and different types of obesity in children, by combining large sample cross-sectional survey data with long-term longitudinal cohort data, so as to provide clues for further clarifying the health hazards of early onset of puberty and obesity prevention and control. Methods: The research data were from the cross-sectional survey data of seven provinces(autonomous regions, municipalities) in China and the cohort data of adolescent development in Xiamen. The study first found the association between early onset of puberty and obesity by Logistic regression on the cross-sectional data, and then used Poisson regression to analyze the association between early puberty initiation and various types of obesity risk. Results: In the study, 43 137 and 1 266 children were included in the cross-sectional survey and cohort survey respectively. The cross-sectional study found that among the girls aged 10-13 years, compared with the girls of the same age who did not start puberty, the body mass index (BMI)-Z score of the girls in the puberty start group was 0.5-0.8 higher, and the waist circumference Z score was 0.4-0.7 higher, and the risk of various types of obesity was higher. At the same time, the early onset of puberty was positively correlated with simple obesity, central obesity and compound obesity, the OR (95%CI) were 1.86 (1.42-2.44), 1.95 (1.65-2.32) and 1.86 (1.41-2.45), respectively. No significant association was found in boys. According to the cohort data, in girls, the risk of simple obesity was 6.00 times [RR (95%CI): 6.00 (1.07-33.60)], the risk of central obesity was 3.30 times [RR (95%CI): 3.30 (1.22-8.92)], and the risk of compound obesity was 5.76 times [RR (95%CI): 5.76 (1.03-32.30)], compared with the group without early puberty initiation, while no association between early puberty initiation and obesity was found in boys. Conclusion: Based on the cross-sectional survey and longitudinal cohort survey, it is confirmed that the early onset of puberty in girls may increase the risk of simple obesity, central obesity and compound obesity, while there is no significant correlation between puberty onset and obesity in boys.

Key words: Pediatric obesity, Puberty, Children, Cross-sectional studies, Cohort studies

中图分类号:

R723.14

马涛,李艳辉,陈曼曼,马莹,高迪,陈力,马奇,张奕,刘婕妤,王鑫鑫,董彦会,马军. 青春期启动提前与儿童肥胖类型的关联研究: 基于横断面调查和队列调查[J]. 北京大学学报（医学版）, 2022, 54(5): 961-970.

Tao MA,Yan-hui LI,Man-man CHEN,Ying MA,Di GAO,Li CHEN,Qi MA,Yi ZHANG,Jie-yu LIU,Xin-xin WANG,Yan-hui DONG,Jun MA. Associations between early onset of puberty and obesity types in children: Based on both the cross-sectional study and cohort study[J]. Journal of Peking University (Health Sciences), 2022, 54(5): 961-970.

图/表 6

图1

表1

研究对象基本情况"

Subjects	Cross-sectional data of seven provinces (autonomous regions, municipalities) in China			Last follow-up data of Xiamen cohort
Subjects	Boys	Girls	P value	Boys	Girls	P value
Sample size, n (%)	21 094 (48.9)	22 043 (51.1)		613 (48.4)	653 (51.6)
Age group, n (%)			< 0.001			< 0.001
6-12 years	13 206 (62.6)	12 710 (57.7)		456 (74.4)	651 (99.7)
13-15 years	5 093 (24.1)	5 965 (27.1)		157 (25.6)	2 (0.3)
16-18 years	2 795 (13.3)	3 368 (15.3)
Residence area, n (%)			< 0.001
Urban	11 446 (54.3)	12 935 (58.7)		613 (48.4)	653 (51.6)
Rural	9 648 (45.7)	9 108 (41.3)
Simple obesity, n (%)			< 0.001	126 (20.5)	27 (4.1)	< 0.001
Yes	16 064 (76.6)	16 719 (76.3)		487 (79.4)	626 (95.9)
No	3 370 (16.0)	1 910 (8.7)
Central obesity, n (%)			0.369			< 0.001
Yes	17 971 (85.3)	20 210 (91.8)		173 (28.2)	54 (8.3)
No	4 896 (23.4)	5 201 (23.7)		440 (71.8)	599 (91.7)
Compound obesity, n (%)			< 0.001			< 0.001
Yes	0 (0)	10 908 (49.5)		120 (19.6)	26 (4.0)
No	3 094 (14.7)	1 816 (8.2)		493 (80.4)	627 (96.0)
Puberty onset, n (%)			< 0.001			0.011
Yes	5 605 (26.6)	10 908 (49.5)		531 (86.6)	595 (91.1)
No	15 489 (73.4)	11 135 (50.5)		82 (13.4)	58 (8.9)
Breast-feeding, n (%)			0.016			0.470
Yes	5 241 (32.9)	5 247 (31.6)		189 (34.9)	75 (32.2)
No	0 (0)	0 (0)		353 (65.1)	158 (67.8)
BMI, ${\bar x}$±s	19.29±4.10	18.63±3.62	< 0.001	20.44±3.78	16.91±2.64	< 0.001
WC, ${\bar x}$±s	67.56±11.70	65.12±9.64	< 0.001	70.11±10.71	58.91±6.78	< 0.001
BMI-Z, ${\bar x}$±s	0.42±1.42	0.00±1.14	< 0.001	0.79±1.33	-0.44±1.18	< 0.001
WC-Z, ${\bar x}$±s	0.32±1.03	0.20±1.01	< 0.001	0.42±0.99	-0.44±0.79	< 0.001
Fruit and vegetable intake/(portions/day), ${\bar x}$±s	3.17±2.19	3.17±2.06	0.994	3.23±2.34	3.42±2.34	0.155
Meat intake/(portions/day), ${\bar x}$±s	1.36±1.38	1.05±1.10	< 0.001	1.12±0.89	1.05±0.74	0.177
Moderate and high intensity exercise/(h/d), ${\bar x}$±s	1.20±1.48	0.94±1.22	< 0.001	1.04±0.99	0.88±0.92	0.005
Puberty onset age/years, M (P₂₅, P₇₅)	13.08 (12.33, 13.92)	12.25 (11.58, 12.92)	< 0.001	11.10 (10.41, 11.58)	9.65 [8.95, 10.38]	< 0.001

表1

表2

表3

7个省(自治区、直辖市)横断面调查中10~18岁学生青春期启动与肥胖类型的关联*"

Age group	Obesity type	Boys			Girls
Age group	Obesity type	Adolescent, n (%)	Preadolescent, n (%)	OR (95%CI)	Adolescent, n (%)	Preadolescent, n (%)	OR (95%CI)
10 years-	Non obesity						Ref.
	Simple obesity				22 (21.8)	209 (10.4)	2.39 (1.46-3.92)
	Central obesity				48 (47.5)	522 (26.1)	2.56 (1.71-3.83)
	Compound obesity				21 (20.8)	202 (10.1)	2.34 (1.42-3.87)
11 years-	Non obesity						Ref.
	Simple obesity				19 (16.4)	37 (8.1)	2.22 (1.23-4.03)
	Central obesity				39 (33.6)	96 (21.1)	1.89 (1.21-2.95)
	Compound obesity				17 (14.7)	36 (7.9)	2.01 (1.08-3.72)
12 years-	Non obesity			Ref.			Ref.
	Simple obesity	36 (13.2)	287 (15.6)	0.82 (0.57-1.20)	204 (11.6)	39 (4.6)	2.72 (1.91-3.87)
	Central obesity	70 (25.8)	497 (27.1)	0.94 (0.70-1.26)	493 (28.1)	96 (11.4)	3.05 (2.41-3.87)
	Compound obesity	36 (13.2)	282 (15.3)	0.84 (0.58-1.22)	191 (10.8)	38 (4.5)	2.60 (1.82-3.72)
13 years-	Non obesity			Ref.			Ref.
	Simple obesity	123 (14.6)	239 (14.0)	1.04 (0.83-1.32)	196 (7.7)	8 (2.3)	3.63 (1.78-7.43)
	Central obesity	212 (25.3)	403 (23.9)	1.08 (0.89-1.31)	658 (26.0)	34 (9.6)	3.30 (2.30-4.76)
	Compound obesity	116 (13.8)	226 (13.3)	1.04 (0.82-1.33)	192 (7.6)	8 (2.3)	3.55 (1.74-7.27)
14 years-	Non obesity			Ref.			Ref.
	Simple obesity	43 (9.8)	33 (9.2)	1.07 (0.67-1.73)	44 (5.6)	1 (2.1)	2.72 (0.37-20.16)
	Central obesity	85 (19.4)	66 (18.5)	1.06 (0.74-1.51)	171 (21.8)	4 (8.5)	2.99 (1.06-8.44)
	Compound obesity	42 (9.6)	30 (8.3)	1.16 (0.71-1.90)	43 (5.4)	1 (2.1)	2.65 (0.36-19.69)
15 years-	Non obesity			Ref.
	Simple obesity	150 (10.2)	31 (11.4)	0.88 (0.59-1.33)
	Central obesity	326 (22.2)	68 (25.1)	0.85 (0.63-1.15)
	Compound obesity	149 (10.1)	31 (11.4)	0.88 (0.58-1.32)
16 years-	Non obesity			Ref.
	Simple obesity	186 (9.9)	27 (13.4)	0.71 (0.46-1.09)
	Central obesity	409 (21.9)	48 (24.1)	0.88 (0.63-1.24)
	Compound obesity	180 (9.6)	26 (12.9)	0.71 (0.46-1.11)
17 years-	Non obesity			Ref.
	Simple obesity	62 (9.4)	4 (7.0)	1.38 (0.48-3.94)
	Central obesity	134 (20.6)	10 (17.5)	1.22 (0.60-2.48)
	Compound obesity	59 (9.0)	4 (7.0)	1.31 (0.46-3.75)

表3

表4

表5

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Age group	Boys		Girls
Age group	BMI-Z	WC-Z	BMI-Z	WC-Z
10 years-
Puberty started			0.7±1.1	0.7±1.0
Puberty does not start			0.1±1.2	0.2±1.0
P value			< 0.001	< 0.001
11 years-
Puberty started			0.6±1.0	0.5±0.9
Puberty does not start			-0.1±1.3	0.1±1.0
P value			< 0.001	< 0.001
12 years-
Puberty started	0.6±1.2	0.4±1.0	0.3±1.1	0.4±1.0
Puberty does not start	0.5±1.4	0.3±1.0	-0.5±1.2	-0.3±0.9
P value	0.151	0.446	< 0.001	< 0.001
13 years-
Puberty started	0.5±1.3	0.4±1.0	0.1±1.1	0.3±1.0
Puberty does not start	0.4±1.4	0.3±1.0	-0.7±1.2	-0.3±0.9
P value	0.056	0.014	< 0.001	< 0.001
14 years-
Puberty started	0.1±1.3	0.4±1.1	-0.1±1.0	0.2±1.0
Puberty does not start	0.0±1.3	0.2±1.1	-0.6±1.0	-0.3±1.0
P value	0.368	0.080	< 0.001	0.001
15 years-
Puberty started	0.0±1.3	0.4±1.1
Puberty does not start	0.1±1.4	0.3±1.1
P value	0.732	0.703
16 years-
Puberty started	0.0±1.3	0.3±1.0
Puberty does not start	0.0±1.4	0.4±1.1
P value	0.525	0.323
17 years-
Puberty started	-0.2±1.3	0.3±1.1
Puberty does not start	-0.2±1.3	0.3±1.2
P value	0.950	0.944

Obesity type	Early onset of puberty	Boys, OR (95%CI)		Girls, OR (95%CI)
Obesity type	Early onset of puberty	Unadjusted	Adjusted^*	Unadjusted	Adjusted^*
Simple obesity	No	0 (reference)	0 (reference)	0 (reference)	0 (reference)
Simple obesity	Yes	1.41 (1.08-1.83)	1.32 (0.94-1.86)	1.91 (1.56-2.33)	1.86 (1.42-2.44)
Central obesity	No	0 (reference)	0 (reference)	0 (reference)	0 (reference)
Central obesity	Yes	1.10 (0.90-1.34)	1.07 (0.83-1.39)	1.91 (1.68-2.17)	1.95 (1.65-2.32)
Compound obesity	No	0 (reference)	0 (reference)	0 (reference)	0 (reference)
Compound obesity	Yes	1.38 (1.06-1.81)	1.27 (0.90-1.80)	1.87 (1.52-2.29)	1.86 (1.41-2.45)

Obesity type		Early onset of puberty	n/N	Unadjusted relative risk (95%CI)	Adjusted relative risk (95%CI)^*
Boys	Simple obesity	No	26/459	0 (reference)	0 (reference)
	Simple obesity	Yes	4/38	1.83 (0.65-5.16)	1.82 (0.61-5.49)
	Central obesity	No	22/401	0 (reference)	0 (reference)
	Central obesity	Yes	4/55	1.30 (0.47-3.59)	1.29 (0.45-3.69)
	Compound obesity	No	28/482	0 (reference)	0 (reference)
	Compound obesity	Yes	4/33	2.08 (0.73-5.92)	2.38 (0.77-7.38)
Girls	Simple obesity	No	113/613	0 (reference)	0 (reference)
	Simple obesity	Yes	5/8	7.10 (1.70-29.73)	6.00 (1.07-33.60)
	Central obesity	No	104/587	0 (reference)	0 (reference)
	Central obesity	Yes	10/24	3.11 (1.38-7.01)	3.30 (1.22-8.92)
	Compound obesity	No	118/619	0 (reference)	0 (reference)
	Compound obesity	Yes	5/8	6.83 (1.63-28.58)	5.76 (1.03-32.30)

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青春期启动提前与儿童肥胖类型的关联研究: 基于横断面调查和队列调查

Associations between early onset of puberty and obesity types in children: Based on both the cross-sectional study and cohort study

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