室外夜间人工光暴露与中国9~18岁儿童青少年超重肥胖的关联

doi:10.19723/j.issn.1671-167X.2023.03.006

摘要/Abstract

摘要：

目的: 分析中国9~18岁儿童青少年室外夜间人工光(artificial light at night, ALAN)暴露与超重肥胖之间的关联。方法: 使用2019年11月至2020年11月开展的中国八省市5 540名9~18岁儿童青少年随访数据，根据学校地址确定经纬度，通过最近邻法提取116所学校所在位置的月平均夜光辐亮度，获得各学校的室外ALAN暴露平均值[单位为nW/(cm²·sr)]。超重肥胖结局指标共包含四项：基线超重肥胖、持续性超重肥胖、超重肥胖加重和超重肥胖发病。使用混合效应Logistic回归探究ALAN暴露水平(按照五分位数分为Q1~Q5组)和基线超重肥胖、持续性超重肥胖、超重肥胖加重和超重肥胖发病的关联，并使用自然三次样条函数探究ALAN暴露(连续型变量)与结局之间的暴露反应关系。结果: 儿童青少年基线超重肥胖、持续性超重肥胖、超重肥胖加重患病率及超重肥胖发病率分别为21.6%、16.3%、2.9%、12.8%。与ALAN暴露处于Q1组的儿童青少年相比，当ALAN暴露水平达到Q4或Q5时，ALAN暴露与基线超重肥胖关联的OR值才具有统计学意义，分别为1.90 (95%CI: 1.26~2.86)和1.77 (95%CI: 1.11~2.83)。与基线超重肥胖的结果类似，当ALAN暴露水平达到Q4或Q5时，其与持续性超重肥胖关联的OR值分别为1.89 (95%CI: 1.20~2.99)和1.82 (95%CI: 1.08~3.06)，但ALAN与超重肥胖加重和超重肥胖发病之间关联的效应值均无统计学意义。拟合自然三次样条函数显示，ALAN暴露水平与持续性超重肥胖之间存在非线性趋势。结论: ALAN与儿童青少年肥胖存在正向关联，ALAN对儿童青少年超重肥胖的促进更倾向于累积效应而非即时效应，未来在关注儿童青少年常见的超重肥胖危险因素的同时，需要改善致超重肥胖人群的夜间光暴露环境。

关键词: 夜间人工光, 超重, 肥胖, 儿童, 青少年

Abstract:

Objective: To analyze the association between outdoor artificial light-at-night (ALAN) exposure and overweight and obesity among children and adolescents aged 9 to 18 years in China. Methods: Using follow-up data of 5 540 children and adolescents aged 9 to 18 years conducted from November 2019 to November 2020 in eight provinces of China, latitude and longitude were determined based on school addresses, and the mean monthly average nighttime irradiance at the location of 116 schools was extracted by the nearest neighbor method to obtain the mean outdoor ALAN exposure [unit: nW/(cm²·sr)] for each school. Four indicators of overweight and obesity outcomes were included: Baseline overweight and obesity, persistent overweight and obesity, overweight and obesity progression and overweight and obesity incidence. Mixed effects Logistic regression was used to explore the association between ALAN exposure levels (divided into quintiles Q1-Q5) and baseline overweight and obesity, persistent overweight and obesity, overweight and obesity progression and overweight and obesity incidence. In addition, a natural cubic spline function was used to explore the exposure response association between ALAN exposure (a continuous variable) and the outcomes. Results: The prevalence of baseline overweight and obesity, persistent overweight and obesity, overweight and obesity progression and overweight and obesity incidence among the children and adolescents in this study were 21.6%, 16.3%, 2.9% and 12.8%, respectively. The OR value for the association between ALAN exposure and baseline overweight and obesity was statistically significant when ALAN exposure levels reached Q4 or Q5, 1.90 (95%CI: 1.26-2.86) and 1.77 (95%CI: 1.11-2.83), respectively, compared with the children and adolescents in the Q1 group of ALAN exposure. Similar to the results for baseline overweight and obesity, the OR values for the association with persistent overweight and obesity were 1.89 (95%CI: 1.20-2.99) and 1.82 (95%CI: 1.08-3.06) when ALAN exposure levels reached Q4 or Q5, respectively, but none of the OR values for the association between ALAN and overweight and obesity progression and overweight and obesity incidence were statistically significant. Fitting a natural cubic spline function showed a non-linear trend between ALAN exposure and persistent overweight and obesity. Conclusion: There is a positive association between ALAN exposure and overweight and obesity in children and adolescents, and the promotion of overweight obesity in children and adolescents by ALAN tends to have a cumulative effect rather than an immediate effect. In the future, while focusing on the common risk factors for overweight and obesity in children and adolescents, there is a need to improve the overweight and obesity-causing nighttime light exposure environment.

Key words: Artificial light-at-night, Overweight, Obesity, Children, Adolescents

中图分类号:

R179

党佳佳,蔡珊,钟盼亮,王雅琪,刘云飞,师嫡,陈子玥,张依航,胡佩瑾,李晶,马军,宋逸. 室外夜间人工光暴露与中国9~18岁儿童青少年超重肥胖的关联[J]. 北京大学学报（医学版）, 2023, 55(3): 421-428.

Jia-jia DANG,Shan CAI,Pan-liang ZHONG,Ya-qi WANG,Yun-fei LIU,Di SHI,Zi-yue CHEN,Yi-hang ZHANG,Pei-jin HU,Jing LI,Jun MA,Yi SONG. Association of outdoor artificial light at night exposure with overweight and obesity among children and adolescents aged 9 to 18 years in China[J]. Journal of Peking University (Health Sciences), 2023, 55(3): 421-428.

图/表 4

表1

表2

图1

图2

参考文献 37

1	World Health Organization.Obesity: Preventing and managing the global epidemic. Report of a WHO consultation[J].World Health Organ Tech Rep Ser,2000,894,1-253.
2	Prospective Studies Collaborationm,WhitlockG,LewingtonS,et al.Body-mass index and cause-specific mortality in 900 000 adults: Collaborative analyses of 57 prospective studies[J].Lancet,2009,373(9669):1083-1096. doi: 10.1016/S0140-6736(09)60318-4
3	PischonT,BoeingH,HoffmannK,et al.General and abdominal adiposity and risk of death in Europe[J].N Engl J Med,2008,359(20):2105-2120. doi: 10.1056/NEJMoa0801891
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	LuoD,SongY.Socio-economic inequalities in child growth: Identifying orientation and forward-looking layout[J].Lancet Reg Health West Pac,2022,21,100412. doi: 10.1016/j.lanwpc.2022.100412
6	GBD 2015 Obesity Collaborators,AfshinA,ForouzanfarMH,et al.Health effects of overweight and obesity in 195 countries over 25 years[J].N Engl J Med,2017,377(1):13-27. doi: 10.1056/NEJMoa1614362
7	WangY,ZhaoL,GaoL,et al.Health policy and public health implications of obesity in China[J].Lancet Diabetes Endocrinol,2021,9(7):446-461. doi: 10.1016/S2213-8587(21)00118-2
8	PanX,WangL,PanA.Epidemiology and determinants of obesity in China[J].Lancet Diabetes Endocrinol,2021,9(6):373-392. doi: 10.1016/S2213-8587(21)00045-0
9	GastonKJ,VisserME,HolkerF.The biological impacts of artificial light at night: The research challenge[J].Philos Trans R Soc Lond B Biol Sci,2015,370(1667):20140133. doi: 10.1098/rstb.2014.0133
10	ZubidatAE,HaimA.Artificial light-at-night: A novel lifestyle risk factor for metabolic disorder and cancer morbidity[J].J Basic Clin Physiol Pharmacol,2017,28(4):295-313.
11	MchillAW,MelansonEL,HigginsJ,et al.Impact of circadian misalignment on energy metabolism during simulated nightshift work[J].Proc Natl Acad Sci USA,2014,111(48):17302-17307. doi: 10.1073/pnas.1412021111
12	HansenAB,StaynerL,HansenJ,et al.Night shift work and incidence of diabetes in the Danish nurse cohort[J].Occup Environ Med,2016,73(4):262-268. doi: 10.1136/oemed-2015-103342
13	LunnRM,BlaskDE,CooganAN,et al.Health consequences of electric lighting practices in the modern world: A report on the National Toxicology Program' s workshop on shift work at night, artificial light at night, and circadian disruption[J].Sci Total Environ,2017,607/608,1073-1084. doi: 10.1016/j.scitotenv.2017.07.056
14	FonkenLK,NelsonRJ.The effects of light at night on circadian clocks and metabolism[J].Endocr Rev,2014,35(4):648-670. doi: 10.1210/er.2013-1051
15	ChoY,RyuSH,LeeBR,et al.Effects of artificial light at night on human health: A literature review of observational and experimental studies applied to exposure assessment[J].Chronobiol Int,2015,32(9):1294-1310. doi: 10.3109/07420528.2015.1073158
16	RybnikovaNA,HaimA,PortnovBA.Does artificial light-at-night exposure contribute to the worldwide obesity pandemic?[J].Int J Obes (Lond),2016,40(5):815-823. doi: 10.1038/ijo.2015.255
17	KooYS,SongJY,JooEY,et al.Outdoor artificial light at night, obesity, and sleep health: Cross-sectional analysis in the KoGES study[J].Chronobiol Int,2016,33(3):301-314. doi: 10.3109/07420528.2016.1143480
18	AbayKA,AmareM.Night light intensity and women's body weight: Evidence from Nigeria[J].Econ Hum Biol,2018,31,238-248. doi: 10.1016/j.ehb.2018.09.001
19	ZhangD,JonesRR,Powell-WileyTM,et al.A large prospective investigation of outdoor light at night and obesity in the NIH-AARP diet and health study[J].Environ Health,2020,19(1):74. doi: 10.1186/s12940-020-00628-4
20	CrowleySJ,CainSW,BurnsAC,et al.Increased sensitivity of the circadian system to light in early/mid-puberty[J].J Clin Endocrinol Metab,2015,100(11):4067-4073. doi: 10.1210/jc.2015-2775
21	HiguchiS,NagafuchiY,LeeSI,et al.Influence of light at night on melatonin suppression in children[J].J Clin Endocrinol Metab,2014,99(9):3298-3303. doi: 10.1210/jc.2014-1629
22	LinLZ,ZengXW,DebB,et al.Outdoor light at night, overweight, and obesity in school-aged children and adolescents[J].Environ Pollut,2022,305,119306. doi: 10.1016/j.envpol.2022.119306
23	ShiD,MaN,LiuY,et al.Secular trend and urban-rural disparity for age at spermarche among Chinese Han boys from 1995 to 2019[J].Acta Paediatr,2023,112(3):529-536. doi: 10.1111/apa.16636
24	仲晓雅, 闫庆武, 李桂娥. 中国长时间序列夜间灯光数据集(2000—2020)[J/OL]. 全球变化数据仓储电子杂志(中英文). 2022, 9 (2022-09-25)[2022-11-05]. https://doi.org/10.3974/geodb.2022.06.01.V1.
25	ChenJ,GaoM,ChengS,et al.Global 1 km×1 km gridded revised real gross domestic product and electricity consumption during 1992—2019 based on calibrated nighttime light data[J].Sci Data,2022,9(1):202. doi: 10.1038/s41597-022-01322-5
26	中华人民共和国国家卫生健康委员会. 学龄儿童青少年超重与肥胖筛查: WS/T 586—2018[S]. 北京: 中华人民共和国国家卫生健康委员会, 2018: 1-3.
27	KellyAS,BarlowSE,RaoG,et al.Severe obesity in children and adolescents: Identification, associated health risks, and treatment approaches: A scientific statement from the American Heart Association[J].Circulation,2013,128(15):1689-1712. doi: 10.1161/CIR.0b013e3182a5cfb3
28	PaksarianD,RudolphKE,StappEK,et al.Association of outdoor artificial light at night with mental disorders and sleep patterns among US adolescents[J].JAMA Psychiatry,2020,77(12):1266-1275. doi: 10.1001/jamapsychiatry.2020.1935
29	SunS,CaoW,GeY,et al.Outdoor light at night and risk of coronary heart disease among older adults: A prospective cohort study[J].Eur Heart J,2021,42(8):822-830. doi: 10.1093/eurheartj/ehaa846
30	DangJ,ShiD,LiX,et al.Artificial light-at-night exposure and overweight and obesity across GDP levels among Chinese children and adolescents[J].Nutrients,2023,15(4):939. doi: 10.3390/nu15040939
31	LeeH,HickenMT.Cumulative social risk and racial/ethnic disparities in obesity during the transition to adulthood[J].J Health Care Poor Underserved,2013,24(2):907-927. doi: 10.1353/hpu.2013.0090
32	GuangleiW,NgarambeJ,KimG.A comparative study on current outdoor lighting policies in China and Korea: A step toward a sustainable nighttime environment[J].Sustainability,2019,11(14):3989. doi: 10.3390/su11143989
33	ObayashiK,YamagamiY,TatsumiS,et al.Indoor light pollution and progression of carotid atherosclerosis: A longitudinal study of the HEIJO-KYO cohort[J].Environ Int,2019,133(PtB):105184.
34	XuY,HuangY,ZhouY,et al.Association between bedroom light exposure at night and allostatic load among Chinese young adults[J].Environ Pollut,2022,308,119671.
35	中华人民共和国教育部. 教育部办公厅关于进一步做好普通中小学招生入学工作的通知[EB/OL]. (2022-03-29)[2023-01-05]. http://www.gov.cn/zhengce/zhengceku/2022-04/01/content_5682919.htm.
36	刘静,解光穆.基于中小学生视角的学校布局调整的实证分析与建议: 以宁夏回族自治区为例[J].现代中小学教育,2014,30(1):5-10.
37	中华人民共和国教育部. 教育部介绍基础教育热点难点治理情况[EB/OL]. (2019-11-15)[2023-4-8]. http://www.moe.gov.cn/jyb_xwfb/xw_fbh/moe_2606/2019/tqh20191114/mtbd/201911/t20191115_408319.html.

Metrics

Viewed

Full text

Abstract

Cited

Shared

Discussed

Characteristics	Total (n = 5 540)	Boys (n = 2 760)	Girls (n = 2 780)	Z/χ²	P
Age/years, M (IQR)	13.00 (5.00)	13.00 (5.00)	13.00 (5.00)	-0.472^a	0.637
Residence, n (%)				8.985	0.003
Urban	2 998 (54.1)	1 438 (52.1)	1 560 (56.1)
Rural	2 542 (45.9)	1 322 (47.9)	1 220 (43.9)
Only-child status, n (%)				35.028	< 0.001
Only-child	1 982 (35.8)	1 093 (39.6)	889 (32.0)
Non-only-child	3 558 (64.2)	1 667 (60.4)	1 891 (68.0)
Paternal education background, n (%)				0.505	0.447
Lower secondary or below	2 654 (47.9)	1 309 (47.4)	1 345 (48.4)
Upper secondary or above	2 886 (52.1)	1 451 (52.6)	1 435 (51.6)
Maternal education background, n (%)				0.467	0.494
Lower secondary or below	2 883 (52.0)	1 449 (52.5)	1 434 (51.6)
Upper secondary or above	2 657 (48.0)	1 311 (47.5)	1 346 (48.4)
Height/cm, M (IQR)	155.00 (20.20)	158.30 (25.90)	153.70 (15.40)	-14.053^a	< 0.001
Weight/kg, M (IQR)	46.00 (19.15)	47.95 (22.65)	45.00 (16.50)	-9.391^a	< 0.001
BMI/(kg/m²), M (IQR)	18.82 (4.58)	18.89 (4.73)	18.75 (4.44)	-2.120^a	0.034
Baseline overweight and obesity, n (%)	1 194 (21.6)	696 (25.2)	498 (17.9)	43.698	< 0.001
Persistent overweight and obesity, n (%)	905 (16.3)	563 (20.4)	342 (12.3)	66.428	< 0.001
Overweight and obesity progression, n (%)	162 (2.9)	107 (3.9)	55 (2.0)	17.583	< 0.001
Overweight and obesity incidence, n (%)	506 (12.8)	264 (14.5)	242 (11.4)	8.547	0.003
ALAN/[nW/(cm²·sr)], n (%)				6.154	0.188
Q1	1 148 (20.7)	596 (21.6)	552 (19.9)
Q2	1 081 (19.5)	511 (18.5)	570 (20.5)
Q3	1 019 (18.4)	497 (18.0)	522 (18.8)
Q4	1 212 (21.9)	620 (22.5)	592 (21.3)
Q5	1 080 (19.5)	536 (19.4)	544 (19.6)

Subgroups	Overweight and obesity in 2019	Overweight and obesity in 2020	Persistent overweight and obesity	Overweight and obesity progression	Overweight and obesity incidence
Total, n (%)	1 194 (21.6)	1 447 (26.1)	905 (16.3)	162 (2.9)	506 (12.8)
Residence, n (%)
Urban	688 (22.9)	813 (27.1)	510 (17.0)	94 (3.1)	284 (13.4)
Rural	506 (19.9)	634 (24.9)	395 (15.5)	68 (2.7)	222 (12.2)
χ²	7.534	3.379	2.182	1.027	1.320
P	0.006	0.066	0.140	0.311	0.251
Gender, n (%)
Boys	696 (25.2)	854 (30.9)	563 (20.4)	107 (3.9)	264 (14.5)
Girls	498 (17.9)	593 (21.3)	342 (12.3)	55 (2.0)	242 (11.4)
χ²	43.698	66.298	66.428	17.583	8.547
P	< 0.001	< 0.001	< 0.001	< 0.001	0.003
Age group, n (%)
9-12 years	640 (24.3)	803 (30.5)	511 (19.4)	106 (4.0)	268 (15.0)
13-15 years	353 (20.4)	412 (23.8)	257 (14.8)	36 (2.1)	145 (11.5)
16-18 years	201 (17.1)	232 (19.7)	137 (11.7)	20 (1.7)	93 (10.4)
χ²	27.076	55.044	39.613	19.400	13.066
P	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001
Area, n (%)
Shanghai	104 (29.0)	105 (29.2)	83 (23.1)	6 (1.7)	21 (8.9)
Fujian	222 (25.1)	269 (30.5)	199 (22.5)	33 (3.7)	68 (11.5)
Shanxi	150 (22.2)	282 (41.7)	112 (16.5)	23 (3.4)	153 (31.0)
Henan	72 (23.9)	88 (29.2)	54 (17.9)	11 (3.7)	29 (14.1)
Hunan	42 (12.7)	60 (18.1)	31 (9.3)	5 (1.5)	24 (9.2)
Gansu	193 (24.4)	165 (20.9)	100 (12.6)	19 (2.4)	64 (11.5)
Chongqing	216 (22.2)	248 (25.5)	176 (18.1)	39 (4.0)	72 (10.3)
Guangxi	195 (15.9)	230 (18.8)	150 (12.3)	26 (2.1)	75 (8.3)

[1]	崔孟杰,马奇,陈曼曼,马涛,王鑫鑫,刘婕妤,张奕,陈力,蒋家诺,袁雯,郭桐君,董彦会,马军,星一. 不同生长模式与7~17岁儿童青少年代谢综合征的关系[J]. 北京大学学报（医学版）, 2023, 55(3): 415-420.
[2]	弭小艺,侯杉杉,付子苑,周末,李昕璇,孟召学,蒋华芳,周虹. 中文版童年不良经历问卷在学龄前儿童父母中应用的信效度评价[J]. 北京大学学报（医学版）, 2023, 55(3): 408-414.
[3]	陈敬,肖伍才,单蕊,宋洁云,刘峥. DRD2基因rs2587552多态性对儿童肥胖干预效果的影响：一项前瞻性、平行对照试验[J]. 北京大学学报（医学版）, 2023, 55(3): 436-441.
[4]	郑丹枫,李君禹,李佳曦,张英爽,钟延丰,于淼. 青少年特发性脊柱侧凸椎旁肌的病理特征[J]. 北京大学学报（医学版）, 2023, 55(2): 283-291.
[5]	李辉,高阳旭,王书磊,姚红新. 恶性肿瘤患儿完全植入式静脉输液港手术并发症[J]. 北京大学学报（医学版）, 2022, 54(6): 1167-1171.
[6]	崔雅茜,杜军保,张清友,廖莹,刘平,王瑜丽,齐建光,闫辉,徐文瑞,刘雪芹,孙燕,孙楚凡,张春雨,陈永红,金红芳. 儿童直立不耐受和坐位不耐受的疾病谱及治疗方式十年回顾[J]. 北京大学学报（医学版）, 2022, 54(5): 954-960.
[7]	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.
[8]	刘京,陆爱东,左英熹,吴珺,黄志卓,贾月萍,丁明明,张乐萍,秦炯. 儿童急性淋巴细胞白血病合并癫痫发作75例临床特征和预后分析[J]. 北京大学学报（医学版）, 2022, 54(5): 948-953.
[9]	杜燕燕,王健,贺兰,季丽娜,徐樨巍. 儿童川崎病合并轻微脑炎/脑病伴可逆性胼胝体压部病变综合征1例并文献复习[J]. 北京大学学报（医学版）, 2022, 54(4): 756-761.
[10]	钱婧,魏友加,程毅菁,张奕,彭博,朱春梅. 儿童坏死性肺炎临床特征及危险因素分析[J]. 北京大学学报（医学版）, 2022, 54(3): 541-547.
[11]	刘云飞,党佳佳,钟盼亮,马宁,师嫡,宋逸. 1990—2019年中国5~24岁人群伤害死亡率分析[J]. 北京大学学报（医学版）, 2022, 54(3): 498-504.
[12]	闫辉,逄璐,李雪迎,杨文双,蒋世菊,刘平,闫存玲. 单中心就诊2~18岁儿童胆固醇水平异常发生率及病因分析[J]. 北京大学学报（医学版）, 2022, 54(2): 217-221.
[13]	张宏,董继元,王建军,范临夏,曲强,刘洋. 兰州市臭氧对儿童哮喘的短期影响及其季节性差异[J]. 北京大学学报（医学版）, 2022, 54(2): 227-235.
[14]	冯莎蔚,国慧,王勇,赵一姣,刘鹤. 乳牙数字化参考牙冠模型的初步构建[J]. 北京大学学报（医学版）, 2022, 54(2): 327-334.
[15]	王子靖,李在玲. 有幽门螺杆菌感染家族史儿童胃部菌群的特点[J]. 北京大学学报（医学版）, 2021, 53(6): 1115-1121.