Cardiovascular Risk and Nutrition Research Group (CARIN), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
Obes Facts. 2017;10(6):584-596. doi: 10.1159/000480403. Epub 2017 Dec 6.
Little is known about the cumulative effect of obesogenic behaviours on childhood obesity risk. We determined the cumulative effect on BMI z-score, waist-to-height ratio (WHtR), overweight and abdominal obesity of four lifestyle behaviours that have been linked to obesity.
In this cross-sectional analysis, data were obtained from the EnKid sudy, a representative sample of Spanish youth. The study included 1,614 boys and girls aged 5-18 years. Weight, height and waist circumference were measured. Physical activity (PA), screen time, breakfast consumption and meal frequency were self-reported on structured questionnaires. Obesogenic behaviours were defined as <1 h PA/day, ≥2 h/day screen time, skipping breakfast and <3 meals/day. BMI z-score was computed using age- and sex-specific reference values from the World Health Organization (WHO). Overweight including obesity was defined as a BMI > 1 SD from the mean of the WHO reference population. Abdominal obesity was defined as a WHtR ≥ 0.5.
High screen time was the most prominent obesogenic behaviour (49.7%), followed by low physical activity (22.4%), low meal frequency (14.4%), and skipping breakfast (12.5%). Although 33% of participants were free of all 4 obesogenic behaviours, 1, 2, and 3 or 4 behaviours were reported by 44.5%, 19.3%, and 5.0%, respectively. BMI z-score and WHtR were positively associated (p < 0.001) with increasing numbers of concurrent obesogenic behaviours. The odds of presenting with obesogenic behaviours were significantly higher in children who were overweight (OR 2.68; 95% CI 1.50; 4.80) or had abdominal obesity (OR 2.12; 95% CI 1.28; 3.52); they reported more than 2 obesogenic behaviours. High maternal and parental education was inversely associated (p = 0.004 and p < 0.001, respectively) with increasing presence of obesogenic behaviours. Surrogate markers of adiposity increased with numbers of concurrent presence of obesogenic behaviours. The opposite was true for high maternal and paternal education.
关于致肥胖行为对儿童肥胖风险的累积影响知之甚少。我们确定了与肥胖相关的四种生活方式行为对 BMI z 评分、腰高比（WHtR）、超重和腹部肥胖的累积影响。
在这项横断面分析中，数据来自西班牙青少年代表性样本的 EnKid 研究。该研究包括 1614 名年龄在 5-18 岁的男孩和女孩。测量体重、身高和腰围。通过结构化问卷自我报告身体活动（PA）、屏幕时间、早餐摄入和用餐频率。致肥胖行为定义为每天<1 小时 PA、≥2 小时屏幕时间、不吃早餐和每天<3 餐。使用世界卫生组织（WHO）的年龄和性别特异性参考值计算 BMI z 评分。超重包括肥胖定义为 BMI 高于 WHO 参考人群平均值的 1 个标准差。腹部肥胖定义为 WHtR≥0.5。
高屏幕时间是最突出的致肥胖行为（49.7%），其次是低体力活动（22.4%）、低用餐频率（14.4%）和不吃早餐（12.5%）。尽管 33%的参与者没有 4 种致肥胖行为，但分别有 44.5%、19.3%和 5.0%的参与者报告了 1 种、2 种和 3 种或 4 种行为。BMI z 评分和 WHtR 与同时存在的致肥胖行为数量呈正相关（p<0.001）。超重（OR 2.68；95%CI 1.50；4.80）或腹部肥胖（OR 2.12；95%CI 1.28；3.52）的儿童出现致肥胖行为的可能性显著更高；他们报告了超过 2 种致肥胖行为。母亲和父亲的高教育程度与致肥胖行为的发生呈负相关（p=0.004 和 p<0.001）。肥胖行为的数量增加，肥胖的替代标志物也随之增加。而母亲和父亲的高教育程度则相反。
