Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.
Universitat Autònoma de Barcelona, Bellaterra, Spain.
JAMA Netw Open. 2020 Mar 2;3(3):e201171. doi: 10.1001/jamanetworkopen.2020.1171.
Time-trend studies of overweight and obesity in childhood by sociodemographic factors are important for prioritizing public health initiatives. However, little is known about these trends in Spain, where high levels of obesity are found and where important demographic changes have occurred during the last 2 decades.
To examine how time trends in the prevalence and incidence of overweight and obesity among children and adolescents differ by age, sex, socioeconomic status, urban/rural residence, and nationality.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included 1.1 million children and adolescents (aged 2-17 years) with at least 1 measure of height and weight in Catalonia, Spain, from 2006 to 2016. Electronic health records were accessed from the Information System for Research in Primary Care. Data analysis was conducted from January to December 2018.
Prevalence and incidence rates and trends of overweight/obesity and obesity (overweight/obesity defined as having of BMI z score greater than 2.0 among children aged <5 years and greater than 1.0 among children aged ≥5 years; obesity defined as having of BMI z score greater than 3.0 among children aged <5 years and greater than 2.0 among children aged ≥5 years) between 2006 and 2016 were calculated and stratified by sociodemographic characteristics (ie, age, sex, deprivation index, urban/rural residence, and nationality).
The study population included 1 166 609 children and adolescents (570 982 [48.9%] girls; median [interquartile range] age at entry to electronic health record system, 2.4 [0-7.7] years; 1 006 892 [86.3%] with Spanish nationality). Of 941 041 children (80.7%) who lived in urban areas, 197 427 (20.7%) lived in the most deprived areas. Overall, the prevalence of overweight/obesity and obesity decreased between 2006 and 2016 in all sex and age groups; for example, among boys and girls aged 6 to 11 years, overweight/obesity prevalence decreased from 41.9% (95% CI, 41.5%-42.2%) to 39.9% (95% CI, 39.6%-40.3%) and from 39.7% (95% CI, 39.3%-40.2%) to 37.6% (95% CI, 37.3%-38.0%), respectively. Incidence rates of overweight/obesity and obesity were highest among children aged 6 to 7 years (overweight/obesity among boys: 11.9 [95% CI, 11.8-12.0] new cases per 100 person-years; obesity among boys: 4.9 [95% CI, 4.8-4.9] new cases per 100 person-years). Prevalence and incidence rates were highest in the most deprived areas, in urban areas, and among children with North, Central, or South American nationalities. Between 2006 and 2016, prevalence increased in the most deprived areas in almost all sex and age groups. Among girls aged 6 to 11 years living in the most deprived areas, the obesity prevalence ratio increased from 1.59 (95% CI, 1.46-1.74) to 2.03 (95% CI, 1.88-2.19) compared with those living in the least deprived areas. Furthermore, during this period, prevalence increased among children with non-Spanish nationalities, especially in the African and Asian nationality groups (eg, boys aged 6-11 years with Asian nationality compared with Spanish nationality, 2006: prevalence rate, 0.78 [95% CI, 0.60-1.01]; 2016: prevalence rate, 1.27 [95% CI, 1.15-1.39]). Incidence rates decreased among younger groups (eg, ≤7 years: incidence rate ratio for January 1, 2006, to June 30, 2011, vs July 1, 2011, to December 31, 2016: 0.94; 95% CI, 0.91-0.98) but remained stable in older groups.
In this study, the overall prevalence and incidence rates of childhood overweight/obesity and obesity slightly decreased during the last decade. However, increased deprivation disparities in childhood obesity were found, given that the prevalence increased among children living in deprived areas and with non-Spanish nationalities.
重要性：了解儿童超重和肥胖在社会人口统计学因素方面的时间趋势对于确定公共卫生计划的优先次序非常重要。然而，西班牙的这些趋势尚不清楚，因为西班牙的肥胖水平较高，在过去 20 年期间发生了重要的人口统计学变化。
目的：研究儿童和青少年超重和肥胖的患病率和发病率随年龄、性别、社会经济地位、城乡居住和国籍的变化趋势。
设计、地点和参与者：本队列研究纳入了西班牙加泰罗尼亚地区的 110 万名至少有 1 次身高和体重测量值的儿童和青少年（年龄 2-17 岁），数据来自初级保健研究信息系统。分析于 2018 年 1 月至 12 月进行。
主要结局和测量指标：计算 2006 年至 2016 年期间超重/肥胖和肥胖（超重/肥胖定义为 5 岁以下儿童 BMI 得分大于 2.0，5 岁以上儿童 BMI 得分大于 1.0；肥胖定义为 5 岁以下儿童 BMI 得分大于 3.0，5 岁以上儿童 BMI 得分大于 2.0）的患病率和发病率，并按社会人口统计学特征（即年龄、性别、剥夺指数、城乡居住和国籍）进行分层。
结果：研究人群包括 1166609 名儿童和青少年（570982 名女孩；进入电子健康记录系统的中位[四分位间距]年龄为 2.4[0-7.7]岁；86.3%的儿童具有西班牙国籍）。941041 名居住在城市地区的儿童中，有 197427 名（20.7%）居住在最贫困地区。总体而言，2006 年至 2016 年间，所有性别和年龄组的超重/肥胖和肥胖患病率均有所下降；例如，6 至 11 岁的男孩和女孩中，超重/肥胖的患病率从 41.9%（95%CI，41.5%-42.2%）降至 39.9%（95%CI，39.6%-40.3%），从 39.7%（95%CI，39.3%-40.2%）降至 37.6%（95%CI，37.3%-38.0%）。超重/肥胖和肥胖的发病率在 6 至 7 岁的儿童中最高（男孩：超重/肥胖为 11.9[95%CI，11.8-12.0]每 100 人年新发病例；男孩：肥胖为 4.9[95%CI，4.8-4.9]每 100 人年新发病例）。在最贫困地区、城市地区和具有北美、中美或南美国籍的儿童中，患病率和发病率最高。2006 年至 2016 年间，几乎所有性别和年龄组在最贫困地区的患病率都有所增加。在最贫困地区居住的 6 至 11 岁女孩中，肥胖的患病率比指数从 1.59（95%CI，1.46-1.74）增加到 2.03（95%CI，1.88-2.19），与生活在最贫困地区的女孩相比。此外，在此期间，非西班牙国籍儿童的患病率增加，尤其是非洲和亚洲国籍群体（例如，6-11 岁的男孩与西班牙国籍相比，亚洲国籍的肥胖患病率，2006 年：患病率，0.78[95%CI，0.60-1.01]；2016 年：患病率，1.27[95%CI，1.15-1.39]）。发病率在年龄较小的群体中下降（例如，≤7 岁：2006 年 1 月 1 日至 2011 年 6 月 30 日与 2011 年 7 月 1 日至 2016 年 12 月 31 日相比，发病率比为 0.94；95%CI，0.91-0.98），但在年龄较大的群体中保持稳定。
结论和相关性：在这项研究中，过去十年中儿童超重/肥胖和肥胖的总体患病率和发病率略有下降。然而，发现儿童肥胖的剥夺差异增加，因为生活在贫困地区和具有非西班牙国籍的儿童的肥胖患病率增加。
