Veugelers Paul J, Fitzgerald Angela L
Department of Public Health Sciences, University of Alberta, Edmonton, Alta.
CMAJ. 2005 Sep 13;173(6):607-13. doi: 10.1503/cmaj.050445.
Increases in childhood overweight and obesity have become an important public health problem in industrialized nations. Preventive public health action is required, but more research of risk factors is required before evidence-based initiatives can be developed and targeted effectively. We investigated the association between childhood overweight and obesity and risk factors relating to dietary habits, activities, parents and schools.
In 2003 we surveyed grade 5 students and their parents and school principals in Nova Scotia. We measured height and weight and assessed dietary habits (using Harvard's Youth/Adolescent Food Frequency Questionnaire), physical and sedentary activities, and parental and school-based risk factors. We estimated neighbourhood income by averaging, per school, the postal-code level means of household income of residential addresses of children attending that school. We used multilevel logistic regression to evaluate the significance of these risk factors for overweight and obesity.
On the basis of measurements taken of 4298 grade 5 students, we estimated the provincial prevalence of overweight to be 32.9% and of obesity to be 9.9%. Children who bought lunch at school were at increased risk of overweight (fully adjusted odds ratio [OR] 1.39, 95% confidence interval [CI] 1.16-1.67), whereas those who ate supper together with their family 3 or more times a week were at decreased risk (OR 0.68, 95% CI 0.52-0.88). Physical education classes 2 or more times a week at school were associated with a decreased risk of overweight (OR 0.61, 95% CI 0.43-0.87) and obesity (OR 0.54, 95% CI 0.33-0.88). Children in high-income neighbourhoods were half as likely to be obese as their peers living in low-income neighbourhoods (OR 0.50, 95% CI 0.36-0.70).
Parents and schools provide important opportunities for public health initiatives for reducing childhood overweight and obesity. Children and schools in low-income neighbourhoods should receive priority in public health initiatives to reduce future socioeconomic inequalities in health.
儿童超重和肥胖现象的增加已成为工业化国家一个重要的公共卫生问题。需要采取预防性公共卫生行动，但在制定循证举措并有效针对这些举措之前，还需要对风险因素进行更多研究。我们调查了儿童超重和肥胖与饮食习惯、活动、父母及学校相关风险因素之间的关联。
2003年，我们对新斯科舍省五年级学生及其父母和学校校长进行了调查。我们测量了身高和体重，并评估了饮食习惯（使用哈佛青少年食物频率问卷）、体育活动和久坐活动，以及父母和学校层面的风险因素。我们通过对每所学校中该校就读儿童居住地址的邮政编码级别家庭收入均值进行平均，来估算社区收入。我们使用多水平逻辑回归来评估这些风险因素对超重和肥胖的显著性。
根据对4298名五年级学生的测量，我们估计该省超重患病率为32.9%，肥胖患病率为9.9%。在学校购买午餐的儿童超重风险增加（完全调整优势比[OR]为1.39，95%置信区间[CI]为1.16 - 1.67），而每周与家人一起吃晚餐3次或更多次的儿童风险降低（OR为0.68，95% CI为0.52 - 0.88）。每周在学校上体育课2次或更多次与超重风险降低（OR为0.61，95% CI为0.43 - 0.87）和肥胖风险降低（OR为0.54，95% CI为0.33 - 0.88）相关。高收入社区的儿童肥胖的可能性是低收入社区同龄人的一半（OR为0.50，95% CI为0.36 - 0.70）。
父母和学校为减少儿童超重和肥胖的公共卫生举措提供了重要机会。低收入社区的儿童和学校应在公共卫生举措中获得优先考虑，以减少未来健康方面的社会经济不平等。
