中国儿童体质指数与性发育水平的关系  

Relationship between body mass index and sexual development in Chinese children

作　　者：许晓琴[1] 章建伟[2] 陈瑞敏 罗静思[4] 陈少科[4] 郑荣秀[5] 吴迪[6] 朱岷[7] 王春林[8] 梁雁 姚辉[10] 卫海燕[11] 苏喆[12] 米热古丽·买买提[13] 杜红伟[14] 罗飞宏 李嫔[16] 斯淑婷 吴蔚[1] 黄轲[1] 董关萍[1] 余运贤[17] 傅君芬[1] Xu Xiaoqin;Zhang Jianwei;Chen Ruimin;Luo Jingsi;Chen Shaoke;Zheng Rongxiu;Wu Di;Zhu Min;Wang Chunlin;Liang Yan;Yao Hui;Wei Haiyan;Su Zhe;Maimaiti Mireguli;Du Hongwei;Luo Feihong;Li Pin;Si Shuting;Wu Wei;Huang Ke;Dong Guanping;Yu Yunxian;Fu Junfen(Department of Endocrinology,the Children′s Hospital,Zhejiang University School of Medicine,National Clinical Research Center for Child Health,Hangzhou 310052,China;Department of Pediatrics,Shaoxing Maternity and Child Health Care Hospital,Shaoxing 312000,China;Department of Endocrinology,Fuzhou Children′s Hospital of Fujian Province,Fuzhou 350000,China;Department of Endocrinology and Genetic Diseases,Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region,Nanning 530003,China;Department of Pediatrics,Tianjin Medical University General Hospital,Tianjin 350002,China;Department of Endocrinology Genetics and Metabolism,Beijing Children′s Hospital,Capital Medical University,Beijing 100045,China;Department of Endocrinology,Children′s Hospital of Chongqing Medical University,Chongqing 400014,China;Department of Pediatrics,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310053,China;Department of Pediatrics,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Department of Genetic Metabolism and Endocrinology,Wuhan Children′s Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430016,China;Department of Endocrinology and Metabolism,Genetics,Children′s Hospital Affiliated to Zhengzhou University,Zhengzhou 450000,China;Department of Endocrinology,Shenzhen Children′s Hospital,Shenzhen 518028,China;Department of Pediatrics,the First Affiliated Hospital of Xinjiang Medical University,Urumchi 830054,China;Department of Pediatrics,the First Bethune Hospital of Jilin University,Changchun 130021,China;Department of Endocrinology,Children′s Hospital of Fudan University,Shanghai 201102,China;Department of Endocrinology,Children′s Hospital of Shan

机构地区：[1]浙江大学医学院附属儿童医院内分泌科国家儿童健康与疾病临床医学研究中心,杭州310052 [2]绍兴市妇幼保健院儿内科,绍兴312000 [3]福建省福州儿童医院内分泌科,福州350000 [4]广西壮族自治区妇幼保健院遗传代谢中心实验室,南宁530003 [5]天津医科大学总医院儿科,天津350002 [6]首都医科大学附属北京儿童医院内分泌遗传代谢科,北京100045 [7]重庆医科大学附属儿童医院内分泌科,重庆400014 [8]浙江大学医学院附属第一医院儿科,杭州310053 [9]华中科技大学同济医学院附属同济医院儿科,武汉430030 [10]华中科技大学同济医学院附属武汉儿童医院遗传代谢内分泌科,武汉430016 [11]郑州大学附属儿童医院内分泌遗传代谢科,郑州450000 [12]深圳市儿童医院内分泌科,深圳518028 [13]新疆医科大学第一附属医院儿科,乌鲁木齐830054 [14]吉林大学白求恩第一医院儿科,长春130021 [15]复旦大学附属儿科医院内分泌科,上海201102 [16]上海市儿童医院内分泌科,上海200062 [17]浙江大学公共卫生学院,杭州310014

出　　处：《中华儿科杂志》2022年第4期311-316,共6页Chinese Journal of Pediatrics

基　　金：国家重点研发计划重大慢性非传染性疾病防控研究(2016YFC1305301);国家自然科学基金(81570759);中央高校基本科研业务费专项(2017xzzx001-01);浙江省医学重点学科(创新学科)(11-CX24)。

摘　　要：目的评估中国儿童体质指数(BMI)与性发育水平之间的关系。方法2017年1月至2018年12月在中国13个省、自治区、直辖市对3~<18岁的208179名健康儿童进行横断面调查。调查指标包括性别、年龄、身高、体重,计算BMI值,并评估第二性征发育情况。根据年龄将3~18岁儿童分为3~<6岁、6~<10岁、10~<15岁、15~<18岁4组,采用多因素Logistic回归分析,分析每组BMI与性发育水平的相关性。根据BMI标准分为正常体重、超重、肥胖组,采用二分类Logistic回归分析组间早发育与非早发育分布差异。绘制曲线图分析青春期不同发育分期女童和男童的早发育百分比与BMI分布之间的关系。结果208179名健康儿童中女96471名、男111708名。多因素Logistic回归分析(以正常体重Tanner 1期为对照)发现超重及肥胖女童B2、B3、B4+期OR值分别为1.72(95%CI:1.56~1.89)、3.19(95%CI:2.86~3.57)、7.14(95%CI:6.33~8.05)及2.05(95%CI:1.88~2.24)、4.98(95%CI:4.49~5.53)、11.21(95%CI:9.98~12.59);超重及肥胖男童G2、G3、G4+期OR值分别为1.27(95%CI:1.17~1.38)、1.52(95%CI:1.36~1.70)、1.88(95%CI:1.66~2.14)及1.27(95%CI:1.17~1.37)、1.59(95%CI:1.43~1.78)、1.93(95%CI:1.70~2.18),均P<0.01。3~<6岁肥胖女童B2期、男童G2期的OR值分别为2.02(95%CI:1.06~3.86)和2.32(95%CI:1.05-5.12),均P<0.05。6~<10岁超重女童性发育水平B3期的风险高达5.45倍,肥胖则高达12.54倍。超重女童发生早发育的风险是正常体重女童的2.67倍,肥胖女童则高达3.63倍,在男童分别为1.22和1.35倍(均P<0.01)。青春期不同发育阶段儿童早发育百分比随着BMI增加而增加,其中8~<9、10~<11、11~<12岁女童各BMI水平的早发育百分比分别从5.7%(80/1397)、16.1%(48/299)、13.8%(27/195)至25.7%(198/769)、65.1%(209/321)、65.4%(157/240),9~<10、12~<13、13~<14岁男童分别从6.6%(34/513)、18.7%(51/273)、21.6%(57/264)至13.3%(96/722)、46.4%(140/302)、47.5%(105/221)。结论中国儿童BMI与性发育水平呈正相关,女童Objective To investigate the relationship between body mass index(BMI)and sexual development in Chinese children.Methods A nationwide multicenter and population-based large cross-sectional study was conducted in 13 provinces,autonomous regions and municipalities of China from January 2017 to December 2018.Data on sex,age,height,weight were collected,BMI was calculated and sexual characteristics were analyzed.The subjects were divided into four groups based on age,including ages 3-<6 years,6-<10 years,10-<15 years and 15-<18 years.Multiple Logistic regression models were used for evaluating the associations of BMI with sexual development in children.Dichotomous Logistic regression was used to compare the differences in the distribution of early and non-early puberty among normal weight,overweight and obese groups.Curves were drawn to analyze the relationship between the percentage of early puberty and BMI distribution in girls and boys at different Tanner stages.Results A total of 208179 healthy children(96471 girls and 111708 boys)were enrolled in this study.The OR values of B2,B3 and B4+in overweight girls were 1.72(95%CI:1.56-1.89),3.19(95%CI:2.86-3.57),7.14(95%CI:6.33-8.05)and in obese girls were 2.05(95%CI:1.88-2.24),4.98(95%CI:4.49-5.53),11.21(95%CI:9.98-12.59),respectively;while the OR values of G2,G3,G4+in overweight boys were 1.27(95%CI:1.17-1.38),1.52(95%CI:1.36-1.70),1.88(95%CI:1.66-2.14)and in obese boys were 1.27(95%CI:1.17-1.37),1.59(95%CI:1.43-1.78),and 1.93(95%CI:1.70-2.18)(compared with normal weight Tanner 1 group,all P<0.01).Analysis in different age groups found that OR values of obese girls at B2 stage and boys at G2 stage were 2.02(95%CI:1.06-3.86)and 2.32(95%CI:1.05-5.12)in preschool children aged 3-<6 years,respectively(both P<0.05).And in the age group of 6-10 years,overweight girls had a 5.45-fold risk and obese girls had a 12.54-fold risk of B3 stage compared to girls with normal BMI.Compared with normal weight children,the risk of early puberty was 2.67 times higher in overweight girls,

关 键 词：人体质量指数 性发育 儿童 

分 类 号：R179[医药卫生—妇幼卫生保健]