全国0～6岁儿童单纯性肥胖流行病学研究

National epidemiological survey on childhood obesity, 2006

目的本研究旨在了解自1996年第二次全国儿童期单纯肥胖症流行学研究后10年来我国儿童期单纯肥胖症的发展特征和趋势；复核本工作组研究初期所确定的工作假设和所选择的指示参数的科学效应；修订本工作组所制定的中国儿童单纯肥胖症控制方案的科学性和可操作性。方法选择沈阳、济南、青岛、郑州、长沙、重庆、西安、成都、深圳、海口、文昌11个城市，采取随机整群抽样的方法，共调查0～6岁儿童84766名，代表人口1414220名儿童。儿童肥胖的判定标准为世界卫生组织（WHO）身高标准体重值，采用标准差计分法（Z—xcore），体重高于中位数1个标准差为超重、高于2个标准差为肥胖。测量体重、身长／身高、3岁以上儿童的腰围、臀围、大腿围及血压。计数、计量数据分别采用X^2检验和t检验进行分析，显著性检验水平为0．05。结果（1）本次调查0～6岁儿童肥胖、超重总检出率分别为7．2％、19．8％，其中男童肥胖、超重检出率分别为8．9％、22．2％，女童肥胖、超重检出率分别为5．3％、17．0％。较1996年分别增长了3．6、4．7倍，年均增长速度分别为156％和52％。肥胖、超重检出率北部高于西部，中南部居中；男童高于女童。肥胖、超重比仍处于高危水平。（2）出生后1个月儿童的平均体块指数（BMI）值〉16．5，于1个月时BMI均值达最高（17．8），之后逐渐降低，5．5岁时降至最低点（平均值15．7），然后随年龄上升，但最高BMI均值未超过18。（3）本次调查中，脂肪重聚年龄为5．5岁，较1996年后移半年。出生后前半年的脂肪重聚比（ARR1）为0．56，出生后半年（ARR2）为0．97，均处于可接受水平，且明显低于10年前的水平。（4）西部地区儿童由于身高不足，可以出现“假性超重”。这既掩盖了早期线性生长不足和营养不良，又掩盖了可能产生的肥胖。（5）本次调查肥胖儿童血压高于第95百分位数的比例高达12．9％，其腰臀比大于本工作组设置的1．0的危险警戒水平者占17．2％。（6）本工作组所设立的BMI参照值及肥胖筛查界值点、脂肪重聚比／年龄等参照值及界值点、腰臀比参照值及界值点等指示参数在现场筛查和指示健康危险因素等方面是适宜、科学、实用的。结论近10年儿童期单纯肥胖症检出率和肥胖儿童高血压率增加明显，且存在心血管高危状态，应加强儿童期单纯肥胖症的早期预防控制。

Objective The purpose of the 3rd national survey on childhood obesity was conducted not only to understand the present status and trends of childhood obesity in China since the last survey conducted 10 years ago, but also to reveal the health status of preschool children at nutrition transit period and to evaluate the efficacy and sensitivity of cited reference population, criteria and cut-off point of body mass index （ BMI）, adiposity rebound age, waist/hip ratio and other parameters relevant to the diagnosis of obesity made by the national task force on childhood obesity of China （NTFCOC）. Methods A total of 84,766 children aged 0-7 years were recruited in the survey by the random cluster sampling which represented a 1,414,220 children＇s population from 11 cities covered north, central, south and west regions of China. The criteria of screening overweight/obesity was more than 1 Z-score/2 Z-score of the medium of reference value of weight for height made by WHO. Length- height/weight for all subjects and waist/hip/ thigh circumference and blood pressure data for children 3-6 years of age were measured. The prevalence of overweight and obesity, overweight-obesity ratio, adiposity rebound age and BMI were calculated. The enumeration and measurement data were statistically managed by chi-square test and T-test, respectively using SPSS version 12.0 and the significance level was 0. 05. Results （ 1 ） The prevalence of obesity and overweight was 7.2% and 19.8% for all;8.9% and 22.2% for boys, and 5.3% and 17.0% for girls,respectively, which is 3.6/4. 7 times higher than that of 1996 respectively, the annual increase rate of obesity and overweight was in average 156% and 52%, respectively. The distribution pattern of prevalence of overweight and obesity in geographic areas and gender was that the northern regions had higher prevalence than the west and the central regions and the prevalence in boys was higher than in girls. The obesity/ overweight ratio （OOR） was still at a high risk level. （2） BMI at 1 month after birth was higher than 16.5, then increased to the top of 17.8 at 1 year of age and decreased to the bottom of 15.7 at 5.5 years of age and increased a little since then. It was never higher than 18 of diagnosis point of obesity during the preschool age period. （3） The adiposity rebound age was 5.5 years of age in this study and delayed half a year as compared with that seen in 1999. The adiposity rebound ratio at first half year after birth （ARR1） was 0. 56 and 0. 97 at second half year after birth （ARR2） which is an acceptable level according to the cut-off point made by NTFCOC and lower than the level obtained 10 years ago. （4） The pseudo-overweight phenomenon can be seen in the western regions which was derived from linear growth retardation and showed that both the malnutrition and obesity are a health problem in the poverty and maintain area of the western regions. （5） The 12. 9% of obese children who＇s blood pressure was higher than 95th percentile of reference value and 17.2% of them had a waist/hip ratio higher than 1.0 which is a warning point for the risk factor of CHD made by the NTFCOC. （6） The data showed that all the reference population and it＇s cut-off point for BMI, adiposity rebound age/ratio, waist/hip ratio etc. made by NTFCOC is valuable, reliable and practicable. Conclusion The prevalence of childhood obesity and high blood pressure in obese children has been increased sharply during the recent 10 years, which is a out of control and a severe hazard to obese children. The early prevention and management of childhood obesity is urgently needed.