發(fā)布時間：2018-04-30 14:38

  本文選題：膳食 + 體力活動�。� 參考：《復旦大學》2012年博士論文

【摘要】：學齡兒童超重和肥胖在全世界范圍內(nèi)呈現(xiàn)上升趨勢,而在我國,學齡兒童超重肥胖的發(fā)展同樣呈現(xiàn)全面流行趨勢。學齡兒童超重肥胖會給兒童帶來代謝性紊亂、心肺功能紊亂、發(fā)育障礙等生理方面的損害,也會帶來社會接受性低、自我意識受損等心理方面的影響,并且更可增加成年期肥胖的風險,從而增加心血管疾病、糖尿病等一系列慢性病的發(fā)病風險。目前普遍認為肥胖是由基因、膳食、運動等遺傳和環(huán)境因素相互作用引起的。 研究目的 了解學齡兒童超重肥胖的流行病學特點,探討膳食因素(特別是膳食模式)、體力活動(包括靜態(tài)運動情況)、PPARγC161→T基因多態(tài)對兒童超重肥胖的易感性和血脂血糖的影響,并初步研究PPARγC161→T基因多態(tài)與膳食、體力活動交互作用對兒童超重肥胖易感性和血脂血糖的影響,為今后確定學齡兒童超重肥胖重點監(jiān)測人群和個性化防制措施提供合理的理論依據(jù)。 方法 采用整群隨機抽樣法,從上海市某區(qū)整群分層隨機抽取的6所學校抽取三、四、五年級的學齡兒童,每所學校每個年級隨機抽取2個班作為研究對象。采用3d24h小時膳食記錄法進行膳食調(diào)查,通過發(fā)放自制的《7天回顧性身體活動調(diào)查問卷》,回顧過去7天包括各項運動、出行方式和時間、各項靜態(tài)運動時間等身體活動情況,由經(jīng)過培訓的工作人員進行身高、體重、腰圍體格檢查。抽取調(diào)查對象清晨空腹靜脈血5m1,檢測血清中血脂(包括總膽固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白)、血糖、胰島素的含量。采用酚-氯仿的方法提取血凝塊中的基因組DNA,然后通過PCR-RFLP方法進行PPARγC161→T基因型分析。 結(jié)果 1、上海某區(qū)兒童超重肥胖流行現(xiàn)狀 上海某區(qū)學齡兒童超重率為10.4%,肥胖率為8.9%,超重肥胖率為19.3%,其中男性學齡兒童超重肥胖率為24.9%,女性為13.5%,男性高于女性(X2=25.506,P=-0.000)。 2、學齡兒童超重肥胖情況及影響因素分析 (1)膳食因素與學齡兒童超重肥胖 超重肥胖者大豆類和奶類的攝入低于正常組,糧谷類300g/d攝入者比≤300g/d者超重肥胖患病風險降低；膳食總抗氧化能力正常組7.92±3.36mmol,超重肥胖組7.38±3.18mmol,正常組高于超重肥胖組(P0.05),第1四分位數(shù)(Q1)的兒童超重肥胖風險最高,并且膳食總抗氧化能力與學齡兒童體重和腰圍成負相關(guān)；因子分析后富含優(yōu)質(zhì)蛋白和蔬菜水果的膳食模式因素1代表的健康飲食模式,是超重肥胖的保護性因素,其第4四分位數(shù)(Q4)超重肥胖風險低于第1四分位數(shù)(Q1),OR(95%CI)為0.615(0.387～0.978)。 (2)體力活動與學齡兒童超重肥胖 總靜態(tài)活動時間≥28h/w者超重肥胖風險高于28h/w者,OR(95%CI)為1.425(1.020～1.991),睡眠時間每天≥9h者超重肥胖風險低于9h兒童,其OR(95%CI)為0.516(0.337～0.790),靜態(tài)運動時間和腰圍、BMI和體重呈正相關(guān),睡眠時間和這些體檢指標負相關(guān)。 (3)綜合生活模式與學齡兒童超重肥胖 靜態(tài)運動時間長、西方膳食模式為主、睡眠時間短的西方生活模式Q4組超重肥胖風險高于Q1組,OR(95%CI)為1.834(1.172～2.871),體力活動時間長、健康膳食模式為主、靜態(tài)運動時間較少的健康生活模式的Q2組超重肥胖風險低于于Q1組,OR(95%CI)為0.560(0.351～0.894)。 (4) PPAR γC161→T基因多態(tài)性與學齡兒童超重肥胖 PPAR γC161→T基因多態(tài)性與性別、糧谷類的攝入、生活模式對學齡兒童超重肥胖存在交互作用；T突變基因是女性學齡兒童超重肥胖的危險因素,OR(95%CI)為1.833(1.041-3.277),對男性兒童的影響沒有統(tǒng)計學意義；在糧谷類攝入300g/d水平的兒童中,T突變基因攜帶者超重肥胖風險降低,OR(95%CI)為0.275(0.083-0.914)；在西方生活模式因子得分的Q1組,T突變基因攜帶者超重肥胖風險增加,OR (95%CI)為2.248(1.022-4.948)。 (5)學齡兒童超重肥胖多影響因素分析 Logistic多因素回歸模型顯示,兒童超重肥胖的危險因素有年齡的增加、男性、膳食總抗氧化能力低、靜態(tài)運動時間長等,保護性因素有膳食模式1(健康飲食模式)、睡眠時間大于9h/d、糧谷類攝入300g/d；各體檢指標影響因素采用多元線性回歸顯示,BMI的主要影響因素有年齡、性別、步行時間、睡眠時間,主要影響體重和腰圍的變量有年齡、性別、步行時間、靜態(tài)運動時間和睡眠時間。 3、學齡兒童血糖血脂影響因素 (1)一般情況與學齡兒童血脂血糖 血脂血糖基本隨著年齡的增加而增加；超重肥胖者TG、LDL、LDL/HDL、 TCH/HDL、胰島素、HOMA指數(shù)都高于體重正常者,而HDL低于正常者。 (2)膳食營養(yǎng)素攝入與學齡兒童血脂血糖 碳水化合物、膳食纖維、植物蛋白、糧谷類、水果類、蛋類的攝入、碳水化合物供能比與學齡兒童血糖血脂呈負相關(guān),飽和脂肪酸、單不飽和脂肪酸、晚餐供能比、魚肉類攝入與血脂血糖呈正相關(guān)：總學齡兒童中,膳食模式1(健康飲食模式)與葡萄糖呈現(xiàn)負相關(guān),在超重肥胖學齡兒童中,膳食模式2(西方飲食模式)與葡萄糖成正相關(guān)。 (3)體力活動情況與學齡兒童血脂血糖 TG和血糖與步行時間負相關(guān),步行次數(shù)與血糖負相關(guān)；寫作業(yè)時間和靜態(tài)運動總時間與血糖正相關(guān)；運動時間與血糖負相關(guān)。 (4)綜合生活模式與學齡兒童血脂血糖 西方生活模式因子得分與胰島素、HOMA指數(shù)呈現(xiàn)正相關(guān),健康生活模式與血糖負相關(guān)。 (5) PPAR γC161→T基因多態(tài)與學齡兒童血脂血糖 總學齡兒童和體重正常兒童中,T突變基因攜帶兒童TCH高于野生基因型兒童,但在超重肥胖兒童中,T等位基因攜帶者TG高于野生基因型；基因型和性別之間對TG存在交互作用,女性學齡兒童中,T突變基因攜帶者TCH和TG濃度高于野生基因型；西方生活模式和健康生活模式Q1組中,T突變基因攜帶者TCH濃度高于野生型。 (6)學齡兒童血脂血糖影響因素多元線性回歸 TCH, TG,血糖,HDL, TCH/HDL,胰島素的影響變量分別為基因攜帶者,寫作業(yè)時間,年齡、性別和膳食模式1健康飲食模式,年齡,做作業(yè)時間,年齡。 結(jié)論 1、上海某區(qū)兒童超重肥胖率的流行現(xiàn)狀嚴峻,且男生的超重和肥胖率均大于女生。 2、男性、膳食糧谷類攝入少、膳食總抗氧化能力低、健康飲食模式評分低、靜態(tài)活動時間長、睡眠時間短、PPAR γC161→T基因突變是學齡兒童超重肥胖風險因素。 3、不同性別、膳食、運動等生活方式的學齡兒童,PPAR γC161→T基因多態(tài)性對超重肥胖所起的作用不同。T突變基因是女性學齡兒童、西方生活模式者超重肥胖的危險因素,是糧谷類攝入300g/d兒童的保護性因素,可以為肥胖超重監(jiān)控的重點人群和個性化預防措施提供初步線索。 4、健康飲食模式評分低、靜態(tài)運動時間長、運動時間短、PPAR γC161→T基因突變與高血脂高血糖相關(guān)。 5、PPAR γC161→T基因多態(tài)性對學齡兒童血脂的影響受到性別和膳食、運動生活方式等環(huán)境的影響。女性學齡兒童中、西方生活模式和健康生活模式因子Q1組中,T等位基因攜帶者TCH和(或)TG濃度高于野生型,可為學齡兒童血脂血糖監(jiān)測重點人群提供理論依據(jù)。
[Abstract]:Overweight and obesity in school-age children are on the rise in the world, but in China, the development of overweight and obesity in school age children also presents a comprehensive trend. Overweight and obesity in school-age children will bring about metabolic disorders, cardiopulmonary dysfunction, developmental disorders and other physiological aspects, and also bring low social acceptability and self meaning. It can increase the risk of obesity and increase the risk of obesity in adulthood, which increases the risk of a series of chronic diseases such as cardiovascular disease and diabetes. It is generally believed that obesity is caused by genetic and environmental factors such as gene, diet, exercise and so on.
research objective
To understand the epidemiological characteristics of overweight and obesity in school-age children, to explore the dietary factors (especially dietary patterns), physical activity (including static exercise), the effect of PPAR gamma C161 to T gene polymorphism on the susceptibility to overweight and obesity in children and the effect of blood lipid and blood glucose, and to study the interaction of PPAR gamma C161 to T gene polymorphism with dietary and physical activity. The susceptibility of overweight and obesity and the influence of blood lipid and blood sugar in children provide a reasonable theoretical basis for determining the key monitoring population and individual prevention measures for overweight and obesity in school-age children.
Method
A cluster random sampling method was used to extract three, four and five grade school aged children from 6 schools with stratified and random sampling in a district of Shanghai. 2 classes were randomly selected from each grade of each school. The dietary survey was carried out by the 3d24h hour diet recording method, and the self-made questionnaire on the retrospective physical activity of <7 days was carried out. In the past 7 days, the past 7 days include physical activity, travel mode and time, and static exercise time, and the body height, weight, and waist circumference of the trained staff were examined. The early morning venous blood was extracted from the subjects. The serum lipids (including total cholesterol, triglycerides, LDL, HDL, HDL) were detected. Protein), blood sugar, insulin content. Genomic DNA in blood clot was extracted by phenol chloroform method, and then PPAR gamma C161 to T genotypes were analyzed by PCR-RFLP method.
Result
1, the prevalence of overweight and obesity in children in a district of Shanghai
The overweight rate of school-age children in Shanghai was 10.4%, the obesity rate was 8.9%, the overweight and obesity rate was 19.3%, of which the rate of overweight and obesity in male school-age children was 24.9%, the female was 13.5%, and the male was higher than that of the female (X2=25.506, P=-0.000).
2, overweight and obesity in school age children and its influencing factors
(1) dietary factors and overweight and obesity in school-age children
The intake of soybean and milk in overweight and obese people was lower than that of the normal group, and the 300g/d intake of cereals was lower than that of those with less than 300g/d; the total dietary antioxidant capacity was 7.92 + 3.36mmol, the overweight and obesity group was 7.38 + 3.18mmol, the normal group was higher than the overweight group (P0.05), and the children with first four quantiles (Q1) were at the highest risk of overweight and obesity. The total antioxidant capacity of the diet was negatively correlated with the weight and waist circumference of school-age children; the healthy diet model, which was rich in quality protein and vegetables and fruits 1, was a protective factor for overweight and obesity, the fourth four quantile (Q4) was lower than first and four quantiles (Q1), and OR (95%CI) was 0.615 (0.387). To 0.978).
(2) physical activity and overweight and obesity in school-age children
The risk of overweight and obesity with total static time > 28h/w was higher than that of 28h/w, OR (95%CI) was 1.425 (1.020 ~ 1.991), the risk of overweight and obesity was lower than 9h children, and OR (95%CI) was 0.516 (0.337 ~ 0.790). The static exercise time and waist circumference were positively correlated with the weight of BMI and weight, and the sleep time was negatively correlated with these physical indexes.
(3) comprehensive life model and overweight and obesity of school-age children
The risk of overweight and obesity in the western life model Q4 group with long static exercise time, Western diet mode and short sleep time was higher than that of Q1 group, OR (95%CI) was 1.834 (1.172 ~ 2.871), physical activity time was long, the healthy diet mode was mainly, the Q2 group with less static exercise time was lower than the Q1 group, and OR (95%CI) was 0.5. 60 (0.351 to 0.894).
(4) PPAR gamma C161 to T polymorphism and overweight and obesity in school-age children.
PPAR gamma C161 / T gene polymorphism and sex, grain intake and life pattern have interaction effect on overweight and obesity in school-age children; T mutation gene is a risk factor for overweight and obesity in female school-age children, OR (95%CI) is 1.833 (1.041-3.277), and the effect on male children is not statistically significant; children in grain cereals intake 300g/d level are not statistically significant. In the T mutation carrier, the risk of overweight and obesity was reduced, and OR (95%CI) was 0.275 (0.083-0.914); the risk of overweight and obesity in the T mutant gene carriers was increased in the Q1 group with the Western lifestyle factor, and the OR (95%CI) was 2.248 (1.022-4.948).
(5) analysis of the factors affecting overweight and obesity in school-age children
Logistic multi factor regression model showed that the risk factors of overweight and obesity in children were increasing age, male, low dietary total antioxidant capacity, long static time, dietary pattern 1 (healthy diet mode), sleep time greater than 9h/d, cereals were taken into 300g/d, and the factors affecting the physical examination indexes were linear regression. The main influencing factors of BMI were age, sex, walking time, sleep time, and age, sex, walking time, statically exercise time and sleep time, which mainly influenced the weight and waist circumference.
3, the influencing factors of blood glucose and blood lipid in school-age children
(1) general situation and blood lipid and blood sugar of school-age children
Blood lipid and blood glucose increased with age; the TG, LDL, LDL/HDL, TCH/HDL, insulin, and HOMA index of overweight and obese people were higher than those of normal weight, and HDL was lower than those of normal ones.
(2) dietary intake of nutrients and blood lipids in school-age children
Carbohydrates, dietary fiber, plant protein, Cereals, fruits, eggs, and carbohydrates are negatively correlated with blood glucose and blood lipids in school-age children, saturated fatty acids, monounsaturated fatty acids, dinner energy ratios, fish intake and blood lipid and blood glucose Cheng Zhengxiang: total school age children, diet model 1 (healthy eating mode) and Portuguese. There was a negative correlation between sugar and glucose. In overweight and obese school-age children, dietary pattern 2 (Western diet pattern) was positively correlated with glucose.
(3) physical activity and blood lipid and blood sugar in school-age children
TG and blood glucose were negatively correlated with walking time, and the number of walking times was negatively correlated with blood sugar, and the writing time and the total static exercise time were positively related to blood glucose, and the exercise time was negatively correlated with blood glucose.
(4) comprehensive life pattern and blood lipid and blood sugar in school-age children
Western lifestyle factor score was positively correlated with insulin and HOMA index, and healthy lifestyle was negatively correlated with blood glucose.
(5) polymorphism of PPAR gamma C161 to T gene and blood glucose and blood glucose in school-age children.
Among school-age children and normal weight children, the T mutant gene carried children TCH higher than the wild genotypic children, but in overweight and obese children, the T allele carrier TG was higher than the wild genotype, and the genotype and sex had interaction with TG, and the TCH and TG concentration of T mutant gene carriers was higher than that of the wild genotypes in female school-age children. In the Western lifestyle and healthy lifestyle group Q1, the T mutation gene carrier TCH concentration was higher than that of the wild type.
(6) multiple linear regression of factors affecting blood glucose and blood glucose in school-age children
TCH, TG, blood sugar, HDL, TCH/HDL, and insulin were the gene carriers, respectively, to write job time, age, sex and dietary pattern 1 healthy eating patterns, age, work time, age.
conclusion
1, the prevalence of overweight and obesity among children in a certain district of Shanghai is serious, and the overweight and obesity rates of boys are greater than that of girls.
2, male, dietary grain intake is less, dietary total antioxidant capacity is low, healthy diet model score is low, static activity time is long, sleep time is short, PPAR gamma C161 T gene mutation is the risk factor of overweight and obesity in school-age children.
3, school-age children with different sex, diet, sports and other lifestyle, PPAR gamma C161 T gene polymorphism plays the role of overweight and obesity, different.T mutation genes are female school age children, the risk factors of overweight and obesity in Western life models are the protective factors for grain cereals intake of 300g/d children, which can be the key people for overweight and overweight monitoring. Group and individualized precautions provide preliminary clues.
4, low score of healthy diet pattern, long static exercise time, short exercise time, and PPAR gamma C161 to T gene mutation were associated with hyperlipidemia and hyperglycemia.
5, the influence of PPAR gamma C161 to T gene polymorphism on the blood lipid of school-age children is influenced by sex and diet, sports life style and other environment. In the female school age children, the TCH and (or) TG concentration of T allele carriers in the western life model and healthy lifestyle factor Q1 group are higher than those of the wild type, which can be used to monitor the blood lipid and blood glucose in school children. The group provides a theoretical basis.

【學位授予單位】：復旦大學
【學位級別】：博士
【學位授予年份】：2012
【分類號】：R725.8

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