社会生态因素对城乡肥胖儿童体重轨迹的影响

Socio-Ecologic Influences on Weight Trajectories Among Children with Obesity Living in Rural and Urban Settings.

作者信息

Barbour Zoe, Mojica Cynthia, Alvarez Hector Olvera, Foster Byron Alexander

机构信息

Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA.

College of Public Health Sciences, Oregon State University, Portland, OR, USA.

出版信息

Child Obes. 2024 Dec;20(8):624-633. doi: 10.1089/chi.2023.0193. Epub 2024 Jul 8.

Abstract

Childhood obesity is a risk factor for poor cardiovascular, metabolic, and respiratory health. The studies examining influences of socio-ecologic factors on weight trajectories using longitudinal data are limited, often examine single measures (e.g., proximity to parks), and have not examined the specific trajectories of children with obesity. We examined influences on weight among 1518 children, 6-12 years of age, who had obesity using body mass index (BMI) criteria. BMI slope trajectories were categorized as decreasing, flat, or increasing, with a median of 2.1 years of follow-up. We examined socio-ecologic exposures, stratified by rural and urban settings, using census tracts to map indices, including food access, proximity to parks, normalized difference vegetation index, and area deprivation index (ADI). We used ordinal logistic regression to examine the associations between the socio-ecologic factors and BMI trajectories. Among the 1518 children, 360 (24%) had a decreasing BMI trajectory with the remainder having flat (23%) or increasing (53%) trajectories. Children in rural areas were more likely to live in high disadvantage areas, 85%, compared with urban children, 46%. In the multivariable ordinal model, living in a lower ADI census tract had a 0.78 (95% CI 0.61-0.99) lower odds of being in an increasing BMI slope group, and no other socio-ecologic factor was associated. The area deprivation index captures a range of resources and social context compared with the built environment indicators, which had no association with BMI trajectory. Further work examining how to develop effective interventions in high deprivation areas is warranted.

摘要

儿童肥胖是心血管、代谢和呼吸系统健康不佳的一个风险因素。利用纵向数据研究社会生态因素对体重轨迹影响的研究有限,通常只考察单一指标(如距离公园的远近),且未研究肥胖儿童的具体轨迹。我们对1518名6至12岁符合体重指数(BMI)标准的肥胖儿童的体重影响因素进行了研究。BMI斜率轨迹分为下降、平稳或上升三类,随访时间中位数为2.1年。我们通过普查区绘制指标,包括食物获取情况、距离公园的远近、归一化植被指数和区域贫困指数(ADI),按农村和城市环境对社会生态暴露情况进行分层研究。我们使用有序逻辑回归分析社会生态因素与BMI轨迹之间的关联。在这1518名儿童中,360名(24%)的BMI轨迹呈下降趋势,其余儿童的轨迹为平稳(23%)或上升(53%)。农村地区的儿童比城市儿童更有可能生活在高劣势地区,分别为85%和46%。在多变量有序模型中,生活在ADI较低的普查区进入BMI斜率上升组的几率降低0.78(95%CI 0.61 - 0.99),且没有其他社会生态因素与之相关。与建筑环境指标相比,区域贫困指数涵盖了一系列资源和社会背景,而建筑环境指标与BMI轨迹无关。有必要进一步研究如何在高贫困地区制定有效的干预措施。

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