3~6岁儿童超重肥胖的时空变化与关联因素分析

Spatiotemporal trends and associated factors of overweight and obesity among Chinese children aged 3 to 6 years

摘要

目的 描述2000—2020年我国3~6岁儿童超重肥胖在时间维度及城乡、不同流行区域空间维度上的变化特征,并基于2020年横断面数据分析其相关因素及交互作用,为制定儿童肥胖防控策略提供科学依据。方法 基于2000、2005、2010、2014和2020年全国国民体质监测中3~6岁儿童数据,分析超重肥胖的时空变化趋势。采用多层logistic回归模型,探讨城镇化水平、家庭环境和个体行为因素与儿童超重/肥胖的关联,并检验交互作用。结果 2000—2020年,中国3~6岁儿童超重肥胖率由15.8%升至23.8%,肥胖率由3.9%升至7.2%。农村地区增幅高于城市,城乡差距逐渐缩小。不同流行区域变化存在异质性:高流行区域始终维持较高水平并平稳上升,中流行区域增速最快,低流行区域增幅相对较缓。城镇化率与儿童超重/肥胖风险呈正相关(OR=1.008, P＜0.05)。年龄增长(OR=1.233)、男性(OR=1.232)及较长屏幕时间均与超重/肥胖风险增加相关(P＜0.05)。与<20 min/d相比,屏幕时间为20~40 min/d(OR=1.128)及>40 min/d(OR=1.276)的儿童超重/肥胖风险均显著升高(P<0.05)。交互分析显示,在城镇化率≥70%的地区,屏幕时间与超重/肥胖的关联更为显著(P <0.05)。结论 中国3~6岁儿童超重肥胖率持续上升,且城乡及不同流行区域增速存在差异。儿童肥胖的发生是城镇化环境因素与个体行为因素共同作用的结果。未来防控策略应在关注家庭和个体行为干预的同时,强化结构性环境改善,推动“环境-行为”协同促进的综合干预路径。

Abstract

Objective To describe the temporal trends and spatial patterns of overweight and obesity among Chinese children aged 3 - 6 years from 2000 to 2020 across urban-rural settings and regions with different epidemic levels, and to examine associated factors and their interaction effects using cross-sectional data from 2020, so as to provide scientific reference for making strategies for the prevention and control of childhood obesity. Methods Data on children aged 3 - 6 years were obtained from five rounds of the National Physical Fitness Surveillance conducted in 2000, 2005, 2010, 2014, and 2020. Spatiotemporal trends in overweight and obesity were described. Multilevel logistic regression models were used to examine the associations of urbanization level, family environment, and individual behavioral factors with overweight/obesity, and to test interaction effects. Results From 2000 to 2020, the prevalence of overweight and obesity among Chinese children aged 3 - 6 years increased from 15.8% to 23.8%, while the prevalence of obesity alone rose from 3.9% to 7.2%. The increase was greater in rural than in urban areas, resulting in a gradual narrowing of the urban-rural gap. Substantial regional difference was observed: prevalence remained consistently high and increased steadily in high-prevalence regions, increased most rapidly in medium-prevalence regions, and rose more slowly in low-prevalence regions. Urbanization level was positively associated with the risk of overweight/obesity (OR=1.008, P＜0.05). Older age (OR=1.233), boys (OR=1.232), and longer screen time were all associated with a higher risk of overweight/obesity (P < 0.05). Compared with screen time of <20 min/d, screen time of 20 - 40 min/d(OR=1.128) and >40 min/d(OR=1.276) was significantly associated with an increased risk of overweight/obesity (P < 0.05). Interaction analysis further showed that the association between screen time and overweight/obesity was stronger in regions with an urbanization rate of ≥70%(P<0.05). Conclusions The prevalence of overweight and obesity among Chinese children aged 3 - 6 continues to rise, with significant disparities in growth rates observed across urban-rural areas and different geographic regions. Childhood obesity is driven by the interplay between urbanization-related environmental factors and individual behaviors. Future prevention and control strategies should prioritize household and individual interventions while strengthening structural environmental improvements, thereby promoting a comprehensive intervention pathway characterized by environment-behavior synergy.

关键词

超重 / 肥胖 / 城镇化 / 交互效应 / 屏幕时间 / 儿童

Key words

overweight / obesity / urbanization / interaction effect / screen time / children

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基金资助

国家体育总局体育科学研究所基本业务费项目(24-58)