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加强儿童营养与健康研究推动儿童期肥胖防控

更新时间:2021-05-31 09:39点击:

  摘    要:在过去的40年中,全球儿童青少年肥胖症患病率大大增加,无论在发达国家还是发展中国家中均呈蔓延趋势,而我国儿童青少年肥胖数量在全世界排首位。儿童期超重肥胖会增加成年期心脑血管疾病、胰岛素抵抗、肌肉骨骼疾患和过早死亡等风险,同时还会带来一系列心理问题。儿童肥胖影响因素众多,而三大宏量营养素供能比不合理、含糖饮料摄入过量等不良膳食结构导致的营养不平衡是其中的关键因素。控制我国儿童青少年的超重肥胖率,进一步加强儿童营养与健康研究刻不容缓。
  
  关键词:儿童青少年; 宏量营养素; 含糖饮料; 全身性肥胖; 中心性肥胖;
  
  Strengthen the research on children’s health and nutrition and promote the prevention and control of childhood obesity
  
  ZHANG Wen-ting LIU Dan MAO Chen YANG Xing-fen
  
  Department of Epidemiology,School of Public Health,Southern Medical University Food Safety and Health Research Center,School of Public Health,Southern Medical University
  
  Abstract:The global prevalence of childhood and adolescent obesity has greatly increased in past four decades, and it has spread in both developed and developing countries. Overweight or obesity in childhood may increase the risk of cardiovascular disease, insulin resistance, musculoskeletal diseases and premature death; secondly, overweight and obesity may also lead to a series of mental, psychological and psychosocial disorders in children, including depression, anxiety, inferiority, a range of emotional and behavioral disorders. The number of obese children and adolescents in China ranks first in the world, which is related to excessive intake of sugary drinks, unreasonable dietary structure and reduced amount of exercise.
  
  Keyword:Children and adolescents; Macronutrients; Sugar-sweetened beverages; Systemic obesity; Central obesity ;
  
  在过去的40年中,全球儿童青少年肥胖症患病率大大增加,无论在发达国家还是发展中国家中均呈蔓延趋势[1],成为全球性“流行病”。据WHO估计,到2025年,全球超重或肥胖儿童将超过7 000万。因此,WHO在《2013―2020年预防和控制非传染性疾病全球战略行动计划》中提出了争取在2025年全球儿童青少年肥胖率停止增长的目标。据报道[2],在评估195个不同经济发展状况的国家和地区在36年间儿童青少年超重肥胖患病率的趋势中,中国成为肥胖儿童人数最多的两个国家之一;同时,健康指标和评估研究所(the Institute for Health Metrics and Evaluation, IHME)调查[3]表明,2015年中国5~19岁儿童青少年肥胖数量在全世界排首位;再者,根据《中国居民营养与健康状况监测报告(2010―2013)》[4]显示,我国6~17岁儿童青少年超重率为9.6%,肥胖率为6.4%,儿童青少年肥胖超重问题形势严峻。儿童青少年肥胖症与含糖饮料的过度摄入[5]、不合理的膳食结构以及身体活动减少有关,且约75.0%的超重肥胖儿童成年后也会持续肥胖[6],发展成各种慢性非传染性疾病的风险也会大大增加[7]。
  
  近几十年来,我国儿童营养素摄入及供能比发生了巨大变化,导致儿童青少年出现营养不良双重负担[8,9]。由于我国营养普及教育尚不够完善,造成了许多营养认识上的混乱和误区。据《中国居民膳食指南(2016)》[10]可知,近几十年来,虽然我国儿童青少年总能量摄入呈现缓慢下降趋势,但是含糖饮料摄入量、脂肪供能比等呈现较大幅度上升趋势,全谷物、深色蔬菜、水果、奶类、鱼虾类和大豆类摄入普遍不足。而由此导致的能量代谢不平衡是肥胖、高血压、糖尿病等慢性非传染性疾病发生率大幅上升的主要因素之一[11]。肥胖症的流行会带来许多严重的后果,许多研究表明在儿童时期超重肥胖增加患心脑血管疾病[12,13]、胰岛素抵抗[14]、骨关节炎[15]和过早死亡[16]等发生风险。同时,超重肥胖也可能会带来一系列的儿童的精神[17]、心理和社会心理障碍[18]问题,包括抑郁、焦虑、自卑等一系列情绪和行为障碍,这使我国儿童公共卫生事业面临巨大挑战。儿童青少年肥胖流行及肥胖本身所带来的一系列问题引起了全球各界的普遍关注,因此,防治儿童青少年超重肥胖刻不容缓。
  
  本期“营养与健康监测”栏目的论文,是利用中国健康与营养调查(China Health and Nutrition Survey, CHNS)数据围绕三大宏量营养素及含糖饮料摄入与儿童青少年全身性肥胖及中心性肥胖关联性等内容展开的研究结果。CHNS是由美国北卡罗来纳大学和中国CDC营养与健康所合作进行。该调查始于1989年,由1989、1991、1993、1997、2000、2004、2006、2009、2011和2015年的10轮调查组成。1989、1991、1993年的3轮调查在中国辽宁、山东、江苏、河南、湖南、湖北、广西和贵州8个省(区)开展;1997年在黑龙江、山东、江苏、河南、湖南、湖北、广西和贵州8个省(区)进行。2000、2004、2006、2009年的4轮调查在黑龙江、辽宁、山东、江苏、河南、湖南、湖北、广西和贵州9个省(区)进行。CHNS采用多阶段、随机聚类方法来抽取研究对象。调查方法包括问卷调查、体格检查和实验室检测等,问卷通过面对面访谈的方式进行数据收集,并由有资质且经过统一培训的人员进行相关体格检查。
  
  利用CHNS项目1997―2011年6轮调查数据,对7~17岁儿童青少年三大宏量营养素供能比及含糖饮料摄入与儿童肥胖的关联性进行分析,宋玮琦等[19]发现过量的脂肪和蛋白质摄入可能导致儿童青少年肥胖发生,提示应当通过加强健康教育改善不良的膳食结构,从而预防超重肥胖的发生。梁芬等[20]发现儿童青少年脂肪和蛋白质供能比较高、碳水化合物供能比低等不良的膳食结构会增加中心性肥胖发生风险,这提示要适当调整儿童青少年膳食结构,合理分配宏量营养素摄入的比例,以控制儿童青少年超重肥胖率增长。王劲东等[21]发现我国儿童青少年含糖饮料摄入呈上升趋势,含糖饮料摄入是我国儿童青少年肥胖的危险因素,提示国家及相关机构应引导儿童青少年及其家长有意识控制含糖饮料的摄入量及摄入频率,同时采取相应的措施改善群众对超重肥胖的认识和生活习惯,以达到促进儿童青少年健康的目的。
  
  展望未来,仍需进一步加强儿童青少年健康与营养相关研究,推动对儿童青少年肥胖的防控。造成儿童肥胖的因素很复杂,主要与遗传因素以及环境因素相关,包括父母肥胖、孕期状况、睡眠因素、运动因素、饮食因素等[22,23,24,25,26]。关于儿童肥胖干预研究主要有饮食干预、运动干预、心理行为干预等[27,28,29],我国的公共卫生大部分主要集中于身体活动干预[30]、饮食干预[31]对儿童肥胖的影响。总体来说,能量摄入和身体活动之间的不平衡是导致青少年肥胖的主要原因,然而目前预防肥胖的干预措施研究主要是集中于单一因素,相对于单一干预措施,多因素、多层次联合干预措施对儿童肥胖的效果有待更多研究验证。因此未来研究还需要针对多因素联动干预儿童青少年肥胖的发生发展,而基于社会环境联合干预对儿童青少年肥胖的研究,是目前我国儿童肥胖干预研究的空缺,也是未来儿童肥胖干预研究的方向。
  
  家庭、学校、社区和国家政策在内的社会环境因素联动可以对儿童青少年肥胖发挥关键作用[32,33,34]。迫切需要基于社会环境的改善措施,搭建包含家庭、学校、社区和国家政策在内的适合不同阶段的儿童青少年肥胖控制的连续性的健康体系,形成基于学校和社区的多元干预措施,针对早期学龄儿童,需要家长和教师进行针对性干预,包括保证优质蛋白质,充足的膳食纤维及适量的碳水化合物摄入,控制含糖饮料及脂肪的过量摄入;在青春期,进行以学校为基础的干预,学校需要给予支持与协助,如强制性的膳食标准[35]改善中小学的课间餐及营养午餐,保证饮食的多样性和营养均衡[36];据《2018美国身体活动指南科学证据报告》[37],定期的体力活动可以为儿童青少年提供健康益处,降低超重和肥胖的风险,因此建议增加学校的日常体育活动[38,39],每天应进行60 min或更长时间的中度或强度运动;国家相关机构需要就儿童肥胖个体和群体进行筛查[40]、监测、预防、治疗和管理[41],出台专门的干预和治疗指南,用于遏制超重肥胖给儿童带来的健康危害和减轻公共卫生负担。此外,通过健康传播加大对肥胖的干预力度,加强儿童青少年及其家长的营养健康教育知识,树立健康饮食的习惯和理念。有效的干预措施可以增加肥胖儿童青少年健康实践的知识和提高自我认知,从而有可能发展为持续的行为改变。超重和肥胖在很大程度上是可预防的,支持性的政策、学校和社区是决定父母和儿童做出选择的关键所在[31,32,33,34,35,36,37,38,39,40,41,42,43],从有利健康角度选择适宜的食品和定期进行身体活动,在短期规划中减少儿童青少年肥胖数量,在长期中达成降低我国儿童青少年肥胖率的目的。
  
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