Wang Z H, Xu R B, Dong Y H, Yang Y D, Wang S, Wang X J, Yang Z G, Zou Z Y, Ma J
Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, Beijing 100191, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2017 Dec 10;38(12):1598-1602. doi: 10.3760/cma.j.issn.0254-6450.2017.12.002.
To explore the association between cesarean section and obesity in child and adolescent. In this study, a total number of 42 758 primary and middle school students aged between 6 and 17 were selected, using the stratified cluster sampling method in 93 primary and middle schools in Hunan, Ningxia, Tianjin, Chongqing, Liaoning, Shanghai and Guangdong provinces and autonomous regions. Log-Binomial regression model was used to analyze the association between cesarean section and obesity in childhood or adolescent. Mean age of the subjects was (10.5±3.2) years. The overall rate of cesarean section among subjects attending primary or secondary schools was 42.3%, with 55.9% in boys and, 40.6% in girls respectively and with difference statistically significant (<0.001). The rate on obesity among those that received cesarean section (17.6%) was significantly higher than those who experienced vaginal delivery (10.2%) (<0.001). Results from the log-binomial regression model showed that cesarean section significantly increased the risk of obesity in child and adolescent (=1.72, 95%: 1.63-1.82; <0.001). After adjusting for factors as sex, residential areas (urban or rural), feeding patterns, frequencies of milk-feeding, eating high-energy foods, eating fried foods and the levels of parental education, family income, parental obesity, physical activity levels, gestational age and birth weight ., the differences were still statistically significant (=1.48, 95%: 1.39-1.57; <0.001). The rate of cesarean section among pregnant women in China appeared high which may significantly increase the risk of obesity in child or adolescent.
探讨剖宫产与儿童及青少年肥胖之间的关联。在本研究中，采用分层整群抽样方法，选取了湖南、宁夏、天津、重庆、辽宁、上海和广东等省、自治区93所中小学中年龄在6至17岁的42758名中小学生。采用对数二项回归模型分析剖宫产与儿童期或青少年期肥胖之间的关联。研究对象的平均年龄为（10.5±3.2）岁。中小学在校学生的剖宫产总体发生率为42.3%，其中男生为55.9%，女生为40.6%，差异有统计学意义（<0.001）。剖宫产组的肥胖发生率（17.6%）显著高于顺产组（10.2%）（<0.001）。对数二项回归模型结果显示，剖宫产显著增加了儿童及青少年肥胖的风险（比值比=1.72，95%置信区间：1.63 - 1.82；<0.001）。在调整了性别、居住地区（城市或农村）、喂养方式、母乳喂养频率、食用高能量食物、食用油炸食品以及父母教育水平、家庭收入、父母肥胖、身体活动水平、孕周和出生体重等因素后，差异仍有统计学意义（比值比=1.48，95%置信区间：1.39 - 1.57；<0.001）。我国孕妇剖宫产率较高，这可能会显著增加儿童或青少年肥胖的风险。
