广东省广州市13802例6~36月龄儿童出生节气与体格发育不良关系研究

Association between birth solar terms and physical mal-development among 13802 children aged 6~36 months in Guangzhou,Guangdong Province

目的研究广东省广州市部分6~36月龄儿童出生节气与体格发育不良之间的关系,为儿童健康管理及儿童公共卫生服务政策的制定提供参考依据。方法采取回顾性调查方法,选取2018年6月至2019年12月在广州市某区各社区卫生服务中心接受基本公共卫生服务的13802名6~36月龄儿童作为研究对象。根据世界卫生组织2006年发布的0~5岁儿童生长标准,对其生长发育状况进行评估。采用圆形分布法检验体格发育不良的节气分布特征。结果在一个自然年中,出生节气从立春开始,儿童体格发育不良检出率逐渐下降,在夏季达到最低,以芒种时节为最低点(低体重检出率1.68%,生长迟缓检出率1.01%,消瘦检出率0.84%)。从出生节气白露后,儿童体格发育不良检出率开始逐渐升高,低体重和生长迟缓峰值(分别5.82%和4.74%)位于霜降与小雪之间,消瘦检出率峰值(3.84%)位于小雪与小寒之间。冬季出生儿童发育不良检出率最高(低体重、生长迟缓和消瘦检出平均角ɑ分别为298.61°、300.27°和292.42°,P<0.05),且生长迟缓和低体重检出率上升幅度明显;与冬季出生儿童相比,夏季出生儿童发生低体重(OR=0.471,95%CI:0.365~0.609)、生长迟缓(OR=0.631,95%CI:0.486~0.819)和消瘦(OR=0.471,95%CI:0.345~0.643)的风险较低;秋季出生儿童发生低体重(OR=0.625,95%CI:0.496~0.787)和生长迟缓(OR=0.682,95%CI:0.531~0.878)的风险也相对较低;春季出生儿童低体重、生长迟缓和消瘦检出率与冬季出生儿童的差异无统计学意义(P>0.05)。6月龄时,与冬季出生儿童相比,夏季出生儿童发生低体重(OR=0.440,95%CI:0.293~0.659)、生长迟缓(OR=0.466,95%CI:0.306~0.709)、消瘦(OR=0.351,95%CI:0.190~0.648)的风险较低,秋季出生儿童发生生长迟缓(OR=0.693,95%CI:0.487~0.987)的风险较低;18月龄时,与冬季出生儿童相比,夏季出生儿童发生低体重(OR=0.464,95%CI:0.314~0.686)、生长迟缓(OR=0.594,95%CI:0.402~0.877)和消瘦(OR=0.496,95%CI:0.307~0.802)的风险较低,秋季出生儿童发生低体重(OR=0.554,95%CI:0.386~0.794)的风险较低;30月龄时,冬季出生儿童低体重、生长迟缓、消瘦检出率与其他季节差异无统计学意义(P>0.05)。结论广东省广州市儿童的生长发育状况与出生时的节气有关,其中6月龄和18月龄儿童受影响较明显,30月龄儿童受影响不明显,提示出生节气对儿童生长发育的影响可能仅限于生命早期。

Objective To study the association between birth solar term and physical mal-development among children aged 6~36 months in Guangzhou,so as to provide evidence for children's health management and public health service policy making.Methods A retrospective survey method was used to recruit 13802 children aged 6~36 months who received basic public health services in every community health service centers in a district of Guangzhou from June 2018 to December 2019 as research subjects.Growth and development status of the subjects were assessed based on the growth criteria for children aged 0~5 years issued by the World Health Organization in 2006.Circular distribution was used to test the distribution characteristics of solar terms with physical mal-development.Result The birth solar term started from beginning of spring within a natural year.The detection rates of children’s physical dysplasia decreased gradually,reaching the lowest in summer,and the lowest point at Grain in Ear(low birth weight was 1.68%,stunting was 1.01%,and wasting was 0.84%).From the birth of the solar term after Dew,the detection rates of physical dysplasia increased gradually,and the peak of low weight and stunting(5.82%and 4.74%,respectively)were between Frost and Light Snow,while the peak detection rate of wasting(3.84%)was between Light Snow and Minor Cold.The highest detection rates of physical dysplasia were among winter births(mean angleɑfor low weight,stunting and wasting was 298.61°,300.27°and 292.42°,respectively,P<0.05),and the detection rates of low weight and stunting increased significantly.Compared with children born in winter,children born in summer were at lower risk of low weight(OR=0.471,95%CI:0.365~0.609),stunting(OR=0.631,95%CI:0.486~0.819)and wasting(OR=0.471,95%CI:0.345~0.643);children born in autumn also had a relatively low risk of low weight(OR=0.625,95%CI:0.496~0.787)and stunting(OR=0.682,95%CI:0.531~0.878).And,there was no significant differences in the detection rates of low weight,stunting and wasting between children born in spring and winter(P>0.05).At the age of 6 months,compared with children born in winter,children born in summer were at lower risk of low weight(OR=0.440,95%CI:0.293~0.659),stunting(OR=0.466,95%CI:0.306~0.709)and wasting(OR=0.351,95%CI:0.190~0.648),and children born in autumn had a lower risk of stunting(OR=0.693,95%CI:0.487~0.987).At the age of 18 months,children born in summer were at lower risk of low weight(OR=0.464,95%CI:0.314~0.686),stunting(OR=0.594,95%CI:0.402~0.877)and wasting(OR=0.496,95%CI:0.307~0.802),and children born in autumn had a lower risk of low weight(OR=0.554,95%CI:0.386~0.794)than children born in winter.At the age of 30 month,the differences of low weight,stunting and wasting detection rates between winter born children and the other seasons’were not significant(P>0.05).Conclusion The growth and development of children in Guangzhou is associated with birth solar terms,among which the children of 6 months and 18 months are greatly affected,while those of 30 months are not affected significantly,suggesting that the influence of birth solar terms on growth and development may be limited to early life.