Guo Chunlei, Wang Liusen, Wang Zhihong, Ouyang Yifei, Wang Huijun, Su Chang, Zhang Jiguo, Zhang Bing
National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China.
Wei Sheng Yan Jiu. 2019 Mar;48(2):249-258.
To analyze the influence of dietary environmental factors in 12 provinces of China on obesity among children and adolescents aged 7-17 in 2011.
Based on the dietary environmental and physical examination data of China Health and Nutrition Survey 2011(Multi-stage stratified cluster random sampling method, 3 day 24 hour retrospective method, individual-household-community questionnaire survey and physical examination method such as height and weight measurement were used), 1416 children and adolescents aged 7-17(male 50. 71%; the age group of 7-10 years old accounted for 43. 50%, that of 11-14 years old 37. 43%, and that of 15-17 years old 19. 07%) with complete data were selected as the research subjects, and combined with the dietary environmental data of the corresponding provinces from National Statistical Yearbook 2011, a three-level(province-community-individual) logistic mixed effect(random intercept) model was constructed to binary outcome variables of obesity or not, the effect of dietary environments on obesity in children and adolescents was analyzed, and the characteristics of risk factors were determined.
Considering that the P values of the two-level empty model of "province-individual"and"community-individual" constructed separately were P<0. 005 and 0. 050<P<0. 100 respectively when the random effects of layering being tested, this study fitted the three-level(province-community-individual) logistic random intercept mixed effect model. The model analysis showed that after adjusting the impact of other indicators at various levels, the provincial GDP(OR=1. 00006, P=0. 001, 95% CI1. 00003-1. 00010) and the provincial per capita daily consumption of edible oil(OR=1. 18317, P<0. 001, 95% CI 1. 10054-1. 27200) were positively correlated with obesity aged 7-17. Taking the age group of 7-10 years old as the reference group, the two groups of 11-14 years old and 15-17 years old were negatively correlated with obesity, with parameter estimates of(OR=0. 59518, P=0. 049, 95% CI(0. 35465-0. 99885) and(OR=0. 13225, P<0. 001, 95% CI0. 04716-0. 37084) respectively. In addition, the estimated parameters of the logistic three-level random intercept prediction model for obesity in children and adolescents aged 7-17 years were obtained: intercept(-2. 23457, P<0. 001, 95% CI-2. 59581--1. 87334]); provincial GDP(0. 00003, P=0. 007, 95% CI 0. 00001-0. 00005); per capita edible oil intake in province(0. 10642, P<0. 001, 95% CI 0. 06365-0. 14919); taking age group 7-10 years old as a reference, the group of 11-14 years old(-0. 56777, P=0. 007, 95% CI-0. 97837--0. 15717), the group of 15-17 years old(-1. 36679, P<0. 001, 95% CI-2. 02890--0. 70469).
This study suggests that in addition to individual factors, obesity of children and adolescents aged 7-17 years is also affected by the dietary environmental factors at provincial level, among which provincial GDP and per capita daily edible oil consumption have significant positive impacts. In terms of individuals, the age between 7 and 10 years before puberty is a highly risky period for childhood and adolescent obesity.
分析2011年中国12个省份的饮食环境因素对7-17岁儿童青少年肥胖的影响。
基于2011年中国健康与营养调查的饮食环境和体格检查数据（采用多阶段分层整群随机抽样方法、3天24小时回顾法、个体-家庭-社区问卷调查以及身高体重测量等体格检查方法），选取1416名7-17岁数据完整的儿童青少年（男性占50.71%；7-10岁年龄组占43.50%，11-14岁年龄组占37.43%，15-17岁年龄组占19.07%）作为研究对象，并结合《2011年国家统计年鉴》中相应省份的饮食环境数据，构建三级（省份-社区-个体）逻辑混合效应（随机截距）模型，以肥胖与否作为二元结局变量，分析饮食环境对儿童青少年肥胖的影响，并确定危险因素特征。
单独构建的“省份-个体”和“社区-个体”二级空模型在检验分层随机效应时，P值分别为P<0.005和0.050<P<0.100，故本研究拟合了三级（省份-社区-个体）逻辑随机截距混合效应模型。模型分析表明，在调整各水平其他指标的影响后，省级GDP（OR=1.00006，P=0.001，95%CI 1.00003-1.00010）和省级人均每日食用油消费量（OR=1.（此处原文有误，应为1.18317），P<(此处原文有误，应为<0.001)，95%CI 1.10054-1.27200）与7-17岁肥胖呈正相关。以7-10岁年龄组作为参照组，11-14岁和15-17岁两组与肥胖呈负相关，参数估计分别为（OR=0.59518，P=0.049，95%CI(0.35465-0.99885)）和（OR=0.13225，P<(此处原文有误，应为<0.001)），95%CI 0.04716-0.37084）。此外，得到了7-17岁儿童青少年肥胖的逻辑三级随机截距预测模型的估计参数：截距（-2.234(此处原文有误，应为57)，P<(此处原文有误，应为<0.001)，95%CI -2.59581--1.873(此处原文有误，应为34)）；省级GDP（0.00003，P=0.007，95%CI 0.00001-0.00005）；省份人均食用油摄入量（0.1064(此处原文有误，应为2)，P<(此处原文有误，应为<(此处原文有误，应为0.001)），95%CI 0.06365-0.14919）；以7-10岁年龄组作为参照，11-14岁组（-0.5677(此处原文有误，应为7)，P=0.007，95%CI -0.97837--0.1571(此处原文有误，应为7)），15-17岁组（-1.3667(此处原文有误，应为9)，P<(此处原文有误应为<0.001)，95%CI -2.02890--0.7046(此处原文有误，应为9)）。
本研究表明，7-17岁儿童青少年肥胖除受个体因素影响外，还受省级饮食环境因素影响，其中省级GDP和人均每日食用油消费量有显著正向影响。就个体而言，青春期前7至10岁是儿童青少年肥胖的高风险期。
