【作者】 薛琨；

【导师】 郭红卫；

【作者基本信息】 复旦大学 ， 营养与食品卫生学， 2012， 博士

【摘要】 [目的]探讨儿童肥胖与食欲的关系及环境因素、遗传因素对两者的影响。[方法]通过文献评阅收集筛选食欲测量的工具,制订中文版《儿童饮食行为问卷》,并进行了信度检验。以上海市某区1500余名1-4年级小学生为研究对象,开展体格检查和问卷调查,并采血进行生化指标检测及肥胖易感基因分型,按照BMI值分为正常体重和超重肥胖组,比较两组儿童食欲特征的差异。用非条件logistic回归方程综合分析环境因素、遗传因素对儿童食欲特征及超重肥胖的影响作用。[结果]本地化的中文版《儿童饮食行为问卷》内在一致性检验克朗巴哈系数在0.571-0.822之间,重测评分显著相关,pearson系数均接近或大于0.5。我国7-10岁儿童的CEBQ评分一年前后两次测量结果相关系数在0.163和0.649之间,配对t检验无显著差异。研究对象中总体超重肥胖率18.6%(95%CI：16.7%-20.5%)。男生高于女生,城区学校高于郊区学校。与对照组儿童相比,超重肥胖儿童腰围、腰高比、血压、血糖、血甘油三酯、胰岛素、胰岛素抵抗系数IR明显较高,高密度脂蛋白胆固醇、胰岛素敏感系数ISI及QUICKI系数明显较低。血清中总胆固醇、瘦素、瘦素受体水平无明显差别。与对照组儿童相比,超重肥胖儿童“慢食表现”和“饱食反应”评分明显偏低,“食物反应”和“食物享受”评分明显偏高。单因素方差分析和多因素logistic回归分析结果表明,儿童超重肥胖危险因素包括：男生、学校位于城区、父亲超重、母亲超重,睡眠时间过短或过长,西式快餐偏好,食欲特征中EF(食物享受)高分,SR(饱食效应)低分；保护因素包括：多吃蔬菜水果、增加运动,睡眠时间适宜,食欲特征EF低分和SR高分。与儿童食欲特征可能有关的因素有：父母BMI,父母文化水平,睡眠时间,多吃蔬果,营养肥胖知识,体形自我评价。LEPR SNP rs113710多态性与儿童的超重肥胖率和食欲评分的高低没有显著关联,A等位基因携带者在WHtR较高的儿童中比例较高。[结论]中文版《儿童饮食行为问卷》用于食欲测量可靠性良好,我国小学儿童食欲特征较稳定连续,一年时间内无显著变化。超重肥胖儿童已经开始积累代谢综合征风险,表现出胰岛素抵抗的倾向,同时超重肥胖儿童有明显的食欲特征,表现为较高的食物趋向和较低的食物回避倾向。父母超重,睡眠时间过长或过短,常吃快餐,都是儿童超重肥胖的危险因素,增加运动,多吃蔬菜水果,提高营养肥胖相关知识,父母文化水平高,适宜的睡眠时间及食欲特征则是保护因素。食欲特征与父母BMI,父母文化水平,睡眠时间,多吃蔬果,营养肥胖知识等有较弱的关联,与体形自我评价相关性最大,提示食欲受心理因素影响较大。单个基因位点多态性对肥胖和食欲的影响很小。更多还原

【Abstract】 [Objective]The aim of the study is to investigate the relationship and risk factors of childhood obesity and appetite.[Methods]Chinese CEBQ (Children Eating Behavior Questionnaire) was worked out and validated after reviewing, collecting and screening literatures and tools related to measurement of appetite.About1500elementary school children in Shanghai elementary school were involved in the study and had their heights, weights and waist circumferences measured and blood test for metabolic profile examination and DNA extracting.The children were divided into overweight/obesity group or normal weight group to compare the physical or biochemical parameters mentioned above, appetite traits as well. Non-conditional Logistic regression model was applied for comprehensive analysis of the effects of environmental and genetic factors on obesity development and appetite traits.[Results]The Cronbach’s aof the Localized Chinese CEBQ fell in the rang of0.571to0.822and the retest scores were correlated significantly with the Pearson correlative coefficients mostly near or more than0.5. The correlative coefficients of CEBQ scores before or after a year were ranged from0.163to0.649in7to10years old Chinese children and there was no significant difference found with paired T test.For the whole study population the overweight and obesity prevalence is 18.6%(95%CI:16.7%to20.5%), and there was a higher ratio in boys than in girls, in urban than in suburban. Compared with children of normal weight, the overweight or obesity children have elevated levels of waist circumference, waist to height ratio (WHtR), blood pressure, blood sugar, triglycerides, insulin, IR, but lower Hdl-C, ISI and QUICKI significantly. There is no statistically significant difference in serum total cholesterol, leptin or soluble Lp-R. Overweight or obesity children have lower scores in SE(slowness in eating) and SR(satiety responsiveness) but higher scores in FR(food responsiveness) and EF(enjoyment of food).One way ANOVA and Multi-factors Logistic regression analysis showed that the risk factors of childhood obesity are male, school located in urban areas, parental overweight or obesity, sleeping too long or too short, preferring to fast food, high EF score, low SR score, while the protective factors are having more vegetables and fruits, increasing physical activities, adaptive sleep time, low EF score and high SR score. Factors those related to children’s appetite traits are including parental BMI, parental educational level, sleeping time, eating more vegetable and fruits, nutrition and obesity related knowledge, self-body assessment.No significant associations between LEPR SNP rs1137101and BMI, WHtR, obesity prevalence or appetite traits (CEBQ scores) was found by general linear model, non-conditional logistic regression or Chi-square test. The odds ratio of high WHtR(more than the median) was1.31(95%CI:1.02-1.69) in children with AA/AG alleles (OR=1in children with GG alleles).[Conclusions]The Chinese CEBQ can be applied in the study for appetite measurement with acceptable inner consistency and retest reliability. Chinese elementary school children’s appetite traits are stable and continuous, without significant variation in a year.Overweight or obesity children had already begun to subject the potential risks of metabolic syndrome and show somewhat insulin resistant. They also represented typical appetite traits, including higher food tendency and lower food-avoidness.Parental overweight or obesity, sleeping too long or too short, often eating fast food are all among the risk factors to develop obesity, while the protective factors are increasing physical activities, eating more vegetable and fruits, more nutrition and obesity related knowledge, higher parental educational levels, adaptive sleeping time and appetite traits and so on.Appetite traits showed weak correlations to parental BMI, parental educational levels, sleeping time, eating more vegetable and fruits, more nutrition and obesity related knowledge, but strong correlation to self-body assessment, which suggested that appetite traits were influenced by psychology factors to a large extent.The associations between Obesity, appetite and Polymorphism in a single gene or a single locus are always too weak to observe.更多还原