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.

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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)

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