5岁前6个时点的身高、体重数据对5岁时肥胖和正常男童影响的回顾性队列研究

Effects of height and weight at six time points before 5 years of age on obese and normal boys at the age of 5: A retrospective cohort study

目的比较5岁时肥胖和正常男童在0~5岁期间的体格发育情况,为早期识别及预防肥胖提供依据。方法儿童肥胖诊断采用WHO 2006年5~19岁儿童BMI标准,BMI≥均数((x^-))+1个标准差(SD)为超重,≥x^-+2SD为肥胖,<x^--2SD为营养不良,余为正常。同时符合以下条件儿童纳入分析:①2008年1月至2020年1月到重庆市妇幼保健院儿童保健科做体格测量时5岁的男童;②6、12、18、24、36、48和60月龄均行体格测量。5岁时达到儿童肥胖诊断标准者,排除内分泌疾病、药物、肿瘤引起的继发性肥胖。Z-score的计算公式=(儿童观察值-同年龄同性别儿童均值)/SD。结果研究期间符合本文纳入标准第1条的肥胖男童104例,正常男童864名;进入本文分析的肥胖男童58名,正常男童303名。符合本文纳入标准第1条的肥胖和正常男童与纳入分析的肥胖和正常男童在身高、体重和BMI差异均无统计学意义。肥胖男童的年龄别体重Z评分(WAZ)、年龄别体重指数Z评分(BMIZ)的均值从6月龄起持续高于正常男童,18月龄后差异有统计学意义;肥胖男童的年龄别身高的Z评分(HAZ)均值在18月龄后开始持续高于正常男童,36月龄后差异有统计学意义。肥胖男童ΔWt均数持续高于正常男童,12~18月龄之后的体重增加速度差异有统计学意义。肥胖男童ΔHt均数在12~18月龄后持续高于正常男童,在12~18月龄至36~48月龄较正常男童身高增加差异有统计学意义。肥胖男童ΔBMI均6~12月龄至24~36月龄组持续低于正常男童,36~48月龄和48~60月龄高于正常男童,18~24月龄以后差异有统计学意义。结论预防男童肥胖应在2岁前,12~18月龄是干预的第一个关键期。肥胖男童在短期内出现身高更高、身高增长加速,但48月龄后身高增长速度无优势。

Objective:To compare the physical development of obese and normal boys aged from 0 to 5 years old to provide a basis for early identification and prevention of obesity.Methods:The diagnosis of childhood obesity was made using the WHO BMI standard of 2006 for children aged from 5 to 19 years old that BMI of(x^-)+SD,x^-+2SD,x^--2SD were defined as excess weight,obesity and malnutrition respectively.The children included in the analysis should meet the following three criteria at the same time:a.a 5-year-old boy who came to the Child Healthy Department of Chongqing Health Center for Women and Children for physical measurements from January 2008 to January 2020;b.taking physical measurements at all of the time points of 6,12,18,24,36,48 and 60 months;c.those meeting the diagnostic criteria at the age of 5 without secondary obesity caused by endocrine diseases,drugs and tumors.The calculation formula of Z-score=(children observation value-mean of children of the same age and same sex)/standard deviation(SD).Results:There were 104 obese boys and 864 normal boys meeting the first inclusion criterion.Among them,58 obese boys and 303 normal boys who met all of the three criteria were included in the analysis.The mean WAZ and BMIZ of the obese group were higher than that of the normal group from the age of 6 months,and the difference was statistically significant after the age of 18 months.The mean HAZ of the obese group continued to be higher than that of the normal group after the age of 18 months,and the difference was statistically significant after the age of 36 months.The meanΔWt of the obese boys was consistently higher than that of the normal boys,and there was a statistically significant difference in the rate of weight gain after the age of 12 to 18 months.The mean ofΔHt in obese boys continued to be higher than that of normal boys after the age of 12 to 18 months,and there was a statistically significant difference in height increase between the age of 12 to 18 months and 36 to 48 months.Absolute mean value ofΔBMI of the obese boys from 6 to 12 months to 24 to 36 months were consistently lower than that of the normal boys,while those in the 36 to 48 months and 48 to 60 months were higher than that of the normal boy group.The difference ofΔBMI after 18 to 24 months was statistically significant.Conclusion:The prevention of childhood obesity should be before the age of 2 years and the age of 12 to 18 months was the first critical period.Obese children showed higher height and faster height growth in a short period of time,but there was no advantage in height growth after the age of 48 months.