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Article(id=1324050983151599798, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324050669933572771, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202509486, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1758988800000, receivedDateStr=2025-09-28, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793607954060, onlineDateStr=2026-11-02, pubDate=1778342400000, pubDateStr=2026-05-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793607954060, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793607954060, creator=13701087609, updateTime=1793607954060, updator=13701087609, issue=Issue{id=1324050669933572771, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='9', pageStart='1537', pageEnd='1728', issueExtLink='null', onlineDate='null', pubDate='1778342400000', pubDateStr='2026-05-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793607879384, creator='13701087609', updateTime=1793670100562, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324311644528050975, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324050669933572771, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324311644528050976, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324050669933572771, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=1579, endPage=1584, ext={EN=ArticleExt(id=1324050983378092215, articleId=1324050983151599798, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Effects of three-dimensional built environment and multi-source environmental factors on obesity among community-dwelling adults in Wuhan, columnId=1228016570660745413, journalTitle=Modern Preventive Medicine, columnName=Environmental and Occupational Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To examine the effects of the residential built environment on obesity among adults, and to provide evidence to inform built environment optimization for the prevention and control of overweight and obesity.

Methods

This cross-sectional study included individuals who underwent health examinations at the Health Management Center of Renmin Hospital of Wuhan University between May and August 2023. Of 1 672 examinees, 1 349 participants who met the inclusion criteria and had complete data were included in the analysis. Information on long-term residential address, residential floor, sex, age, and body mass index (BMI) was collected, and spatial analysis methods were applied to quantify environmental characteristics surrounding participants’ residential locations. Least Trimmed Squares (LTS) regression and logistic regression models were used to assess the associations between environmental factors and BMI, as well as overweight/obesity status. Generalized linear mixed models (GLMMs) were employed to examine the relationship between residential floor level and the likelihood of overweight/obesity.

Results

Among the 1 349 participants, the prevalence of overweight and obesity was 36.4% and 11.0%, respectively. Higher accessibility to transportation facilities (coef=0.324, P<0.001) and dining facilities (coef=0.233, P=0.006) were associated with increased BMI. Greater accessibility to transportation facilities (OR=1.141, 95% CI:1.000-1.302) and exercise facilities (OR=1.177, 95% CI: 1.017-1.362) were associated with a higher risk of overweight/obesity. As residential floor level increased, the probability of overweight/obesity first increased and then decreased, reaching a peak at around the 14th floor.

Conclusion

BMI and the likelihood of overweight/obesity were associated with multiple environmental factors. Residential floor level affected the probability of overweight/obesity, which may be related to stair-related physical activity and the indirect influence of individual characteristics across different floor levels.

, authors=Yan-qing XU1, Mo-jie SONG1, Ren LIN2, Yan LIU1, Su-jin ZHANG1, Wei XU2, authorsList=Yan-qing XU, Mo-jie SONG, Ren LIN, Yan LIU, Su-jin ZHANG, Wei XU, authorCompany=null, correspAuthors=Wei XU, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1324050983998849210, articleId=1324050983151599798, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=三维建成环境与多源环境因子对武汉市社区成人肥胖的影响分析, columnId=1228016571273113811, journalTitle=现代预防医学, columnName=环境与职业卫生, runingTitle=null, highlight=null, articleAbstract=
目的

调查与分析居住环境对成年人肥胖的影响，为优化建成环境以防治超重肥胖提供参考依据。

方法

本研究为横断面研究，于2023年5—8月选取在武汉大学人民医院健康体检中心进行体检的1 672名体检人群，最终纳入符合标准且无数据缺失的1 349名体检人员作为研究对象并进行分析。通过调查问卷收集研究对象的长期住址、居住楼层、性别、年龄、身体质量指数（body mass index，BMI）等一般资料，使用空间分析方法计算研究对象常住地址的环境因素。研究分别采用最小截平方和模型和logistic回归模型分析环境因素对研究对象BMI和是否超重/肥胖的影响，使用广义线性混合效应模型分析研究对象常住楼层与研究对象是否超重/肥胖的相关性。

结果

1 349位研究对象的超重率为36.4%，肥胖率为11.0%。更高的交通设施可接近性（coef.=0.324，P<0.001）和餐饮设施可接近性（coef.=0.233，P=0.006）是BMI升高的促进因素；更高的交通设施可接近性（OR=1.141，95%CI：1.000～1.302）和更高的运动设施可接近性（OR=1.177，95%CI：1.017～1.362）是超重/肥胖的风险因素。随着居住楼层的升高，楼层对研究对象超重、肥胖概率呈现出先促进后抑制的趋势，于14层左右达到峰值。

结论

研究对象的BMI与超重/肥胖的发生概率与环境因素存在相关关系。常住楼层对研究对象的超重/肥胖概率存在影响，其原因可能与楼梯体力活动水平、不同楼层个人特征的间接影响有关。

, authors=许艳青1, 宋墨杰1, 林任2, 刘岩1, 张素金1, 徐威2, authorsList=许艳青, 宋墨杰, 林任, 刘岩, 张素金, 徐威, authorCompany=null, correspAuthors=徐威, authorNote=

许艳青（1985—），女，博士，教授，研究方向：环境与健康

, correspAuthorsNote=
徐威，E-mail：
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=IO2pDVNHjQaP9oC8Sd+qPA==, magXml=ReV8TknY4qX5NawWtl9EUQ==, pdfUrl=null, pdf=jQs+xTb+XHuQcL/sWBlYVA==, pdfFileSize=900989, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=zcnTwU7fjz2uPZpKkiGNGw==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=WUUcyB/vXWIpMIU+jtNpMw==, mapNumber=null, fund=null)}, authors=[Author(id=1324050984376336577, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050983151599798, orderNo=0, firstName=null, middleName=null, lastName=null, nameCn=null, orcid=null, stid=null, country=null, authorPic=null, dead=0, email=null, emailSecond=null, emailThird=null, correspondingAuthor=0, authorType=1, ext={EN=AuthorExt(id=1324050984460222659, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050983151599798, authorId=1324050984376336577, language=EN, stringName=Yan-qing XU, firstName=Yan-qing, middleName=null, lastName=XU, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=1, address=School of Remote Sensing and Information Engineering, Wuhan University, Wuhan, Hubei 430079, China, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null), CN=AuthorExt(id=1324050984531525828, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050983151599798, authorId=1324050984376336577, language=CN, stringName=许艳青, firstName=null, middleName=null, lastName=null, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=1, address=1.武汉大学遥感信息工程学院，湖北 武汉 430079, bio={"content":"

许艳青（1985—），女，博士，教授，研究方向：环境与健康

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Cities, 2023, 137: 104311., articleTitle=Pathways from the campus-based built environment to obesity：Evidence from undergraduates in China, refAbstract=null), Reference(id=1324051000843174157, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050983151599798, doi=null, pmid=null, pmcid=null, year=2023, volume=11, issue=Suppl 1, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[22], rfOrder=26, authorNames=Jia P, Shi YY, Jiang Q, journalName=Lancet Global Health, refType=null, unstructuredReference=Jia P, Shi YY, Jiang Q, et al. Environmental determinants of childhood obesity：a meta-analysis [J]. 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注：单个点对应各组平均楼层的随机效应，折线为使用LOESS拟合得到的拟合曲线，灰色部分为置信区间

, figureFileSmall=/6oBD/8SDazgyzFUmouZnw==, figureFileBig=zcnTwU7fjz2uPZpKkiGNGw==, tableContent=null), ArticleFig(id=1324050992387457259, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050983151599798, language=EN, label=Table 1, caption=

Baseline characteristics of the 1 349 participants［M（P25，P75），n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
项目结果
BMI (kg/m2)23.8(21.5,26.2)
年龄38(33,48)
性别
男805(59.7)
女544(40.3)
锻炼频率（次/周）
<1442(32.8)
1～2520(38.6)
3～5226(16.8)
>5161(11.9)
锻炼强度
低强度（不出汗或微微出汗，舒适）652(48.3)
中等强度（少许出汗，气喘）556(41.2)
高强度（大汗淋漓或非常疲倦）141(10.5)
吸烟
从不吸烟985(73.0)
吸烟241(17.9)
曾经吸烟，现已戒烟80(5.9)
长期二手烟43(3.2)
工作性质
静坐为主（连续数小时静坐办公）975（72.3）
轻度运动306（22.7）
体力劳动68（5.0）
平均睡眠时长（h/d）
<7299（22.2）
7～<8938（69.5）
8～<9104（10.5）
9～<105（0.4）
≥103（0.2）
精神压力
很小73（5.4）
较小118（8.8）
适中740（54.8）
较大356（26.4）
很大62（4.6）
), ArticleFig(id=1324050992479731948, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050983151599798, language=CN, label=表1, caption=

1 349个研究对象的基线资料［M（P25，P75），n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
项目结果
BMI (kg/m2)23.8(21.5,26.2)
年龄38(33,48)
性别
男805(59.7)
女544(40.3)
锻炼频率（次/周）
<1442(32.8)
1～2520(38.6)
3～5226(16.8)
>5161(11.9)
锻炼强度
低强度（不出汗或微微出汗，舒适）652(48.3)
中等强度（少许出汗，气喘）556(41.2)
高强度（大汗淋漓或非常疲倦）141(10.5)
吸烟
从不吸烟985(73.0)
吸烟241(17.9)
曾经吸烟，现已戒烟80(5.9)
长期二手烟43(3.2)
工作性质
静坐为主（连续数小时静坐办公）975（72.3）
轻度运动306（22.7）
体力劳动68（5.0）
平均睡眠时长（h/d）
<7299（22.2）
7～<8938（69.5）
8～<9104（10.5）
9～<105（0.4）
≥103（0.2）
精神压力
很小73（5.4）
较小118（8.8）
适中740（54.8）
较大356（26.4）
很大62（4.6）
), ArticleFig(id=1324050992559423725, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050983151599798, language=EN, label=Table 2, caption=

Environmental exposure and built environment characteristics of participants’ residential addresses

, figureFileSmall=null, figureFileBig=null, tableContent=
项目P25P50P75
绿地暴露0.1230.1850.254
蓝地暴露0.0000.0000.000
交通0.4030.5850.851
运动0.4580.7181.233
餐饮0.9851.7734.157
休闲0.1600.2290.372
), ArticleFig(id=1324050992668475630, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050983151599798, language=CN, label=表2, caption=

研究对象的常住地址环境暴露与建成环境指标特征

, figureFileSmall=null, figureFileBig=null, tableContent=
项目P25P50P75
绿地暴露0.1230.1850.254
蓝地暴露0.0000.0000.000
交通0.4030.5850.851
运动0.4580.7181.233
餐饮0.9851.7734.157
休闲0.1600.2290.372
), ArticleFig(id=1324050992739778799, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050983151599798, language=EN, label=Table 3, caption=

Results of LTS and logistic regression analyses of built environment and environmental exposure on BMI and overweight/obesity among 1 349 participants

, figureFileSmall=null, figureFileBig=null, tableContent=
预测变量BMI超重/肥胖
回归系数P值OR值(95%CI)P值
截距21.827<0.0010.284(0.225～0.359)<0.001
年龄0.3030.0001.143(0.993～1.315)0.063
性别
女01
男2.899<0.0015.777(4.305～7.752)<0.001
吸烟
从不吸烟01
吸烟0.7120.0011.399(0.987～1.982)0.059
长期二手烟0.1990.6490.928(0.429～2.010)0.850
曾经吸烟，现已戒烟0.2180.5071.440(0.836～2.482)0.189
工作性质
静坐为主（连续数小时静坐办公）01
轻度运动-0.1270.4780.844(0.623～1.143)0.274
体力劳动-0.0020.9930.784(0.437～1.409)0.416
锻炼频率-0.0780.3360.908(0.791～1.042)0.169
锻炼强度-0.0360.6401.005(0.883～1.144)0.943
睡眠时长-0.1490.0520.900(0.790～1.026)0.116
精神压力0.0170.8251.058(0.927～1.208)0.403
绿地暴露0.0580.4080.951(0.838～1.079)0.436
蓝地暴露-0.0610.4181.023(0.897～1.166)0.738
交通0.324<0.0011.141(1.000～1.302)0.049
运动0.1360.0691.177(1.017～1.362)0.029
餐饮0.2330.0061.088(0.966～1.225)0.166
休闲0.1290.0791.083(0.915～1.282)0.355
), ArticleFig(id=1324050992819470576, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050983151599798, language=CN, label=表3, caption=

建成环境和环境暴露对1 349名研究对象BMI与是否超重/肥胖的LTS和logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
预测变量BMI超重/肥胖
回归系数P值OR值(95%CI)P值
截距21.827<0.0010.284(0.225～0.359)<0.001
年龄0.3030.0001.143(0.993～1.315)0.063
性别
女01
男2.899<0.0015.777(4.305～7.752)<0.001
吸烟
从不吸烟01
吸烟0.7120.0011.399(0.987～1.982)0.059
长期二手烟0.1990.6490.928(0.429～2.010)0.850
曾经吸烟，现已戒烟0.2180.5071.440(0.836～2.482)0.189
工作性质
静坐为主（连续数小时静坐办公）01
轻度运动-0.1270.4780.844(0.623～1.143)0.274
体力劳动-0.0020.9930.784(0.437～1.409)0.416
锻炼频率-0.0780.3360.908(0.791～1.042)0.169
锻炼强度-0.0360.6401.005(0.883～1.144)0.943
睡眠时长-0.1490.0520.900(0.790～1.026)0.116
精神压力0.0170.8251.058(0.927～1.208)0.403
绿地暴露0.0580.4080.951(0.838～1.079)0.436
蓝地暴露-0.0610.4181.023(0.897～1.166)0.738
交通0.324<0.0011.141(1.000～1.302)0.049
运动0.1360.0691.177(1.017～1.362)0.029
餐饮0.2330.0061.088(0.966～1.225)0.166
休闲0.1290.0791.083(0.915～1.282)0.355
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三维建成环境与多源环境因子对武汉市社区成人肥胖的影响分析
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许艳青 1 , 宋墨杰 1 , 林任 2 , 刘岩 1 , 张素金 1 , 徐威 2
现代预防医学 | 环境与职业卫生 2026,53(9): 1579-1584
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现代预防医学 |环境与职业卫生 2026 , 53 (9) : 1579 -1584
三维建成环境与多源环境因子对武汉市社区成人肥胖的影响分析
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许艳青1, 宋墨杰1, 林任2, 刘岩1, 张素金1, 徐威2
作者信息
  • 1.武汉大学遥感信息工程学院，湖北 武汉 430079
  • 2.武汉大学人民医院健康管理中心，湖北 武汉 430060
通讯作者:
徐威，E-mail：
作者简介:

许艳青（1985—），女，博士，教授，研究方向：环境与健康

Effects of three-dimensional built environment and multi-source environmental factors on obesity among community-dwelling adults in Wuhan
Yan-qing XU1, Mo-jie SONG1, Ren LIN2, Yan LIU1, Su-jin ZHANG1, Wei XU2
Affiliations
  • School of Remote Sensing and Information Engineering, Wuhan University, Wuhan, Hubei 430079, China
出版时间: 2026-05-10 doi: 10.20043/j.cnki.MPM.202509486
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摘要
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目的

调查与分析居住环境对成年人肥胖的影响，为优化建成环境以防治超重肥胖提供参考依据。

方法

本研究为横断面研究，于2023年5—8月选取在武汉大学人民医院健康体检中心进行体检的1 672名体检人群，最终纳入符合标准且无数据缺失的1 349名体检人员作为研究对象并进行分析。通过调查问卷收集研究对象的长期住址、居住楼层、性别、年龄、身体质量指数（body mass index，BMI）等一般资料，使用空间分析方法计算研究对象常住地址的环境因素。研究分别采用最小截平方和模型和logistic回归模型分析环境因素对研究对象BMI和是否超重/肥胖的影响，使用广义线性混合效应模型分析研究对象常住楼层与研究对象是否超重/肥胖的相关性。

结果

1 349位研究对象的超重率为36.4%，肥胖率为11.0%。更高的交通设施可接近性（coef.=0.324，P<0.001）和餐饮设施可接近性（coef.=0.233，P=0.006）是BMI升高的促进因素；更高的交通设施可接近性（OR=1.141，95%CI：1.000～1.302）和更高的运动设施可接近性（OR=1.177，95%CI：1.017～1.362）是超重/肥胖的风险因素。随着居住楼层的升高，楼层对研究对象超重、肥胖概率呈现出先促进后抑制的趋势，于14层左右达到峰值。

结论

研究对象的BMI与超重/肥胖的发生概率与环境因素存在相关关系。常住楼层对研究对象的超重/肥胖概率存在影响，其原因可能与楼梯体力活动水平、不同楼层个人特征的间接影响有关。

建成环境  /  多元环境因子  /  成人肥胖  /  楼层  /  回归分析
Objective

To examine the effects of the residential built environment on obesity among adults, and to provide evidence to inform built environment optimization for the prevention and control of overweight and obesity.

Methods

This cross-sectional study included individuals who underwent health examinations at the Health Management Center of Renmin Hospital of Wuhan University between May and August 2023. Of 1 672 examinees, 1 349 participants who met the inclusion criteria and had complete data were included in the analysis. Information on long-term residential address, residential floor, sex, age, and body mass index (BMI) was collected, and spatial analysis methods were applied to quantify environmental characteristics surrounding participants’ residential locations. Least Trimmed Squares (LTS) regression and logistic regression models were used to assess the associations between environmental factors and BMI, as well as overweight/obesity status. Generalized linear mixed models (GLMMs) were employed to examine the relationship between residential floor level and the likelihood of overweight/obesity.

Results

Among the 1 349 participants, the prevalence of overweight and obesity was 36.4% and 11.0%, respectively. Higher accessibility to transportation facilities (coef=0.324, P<0.001) and dining facilities (coef=0.233, P=0.006) were associated with increased BMI. Greater accessibility to transportation facilities (OR=1.141, 95% CI:1.000-1.302) and exercise facilities (OR=1.177, 95% CI: 1.017-1.362) were associated with a higher risk of overweight/obesity. As residential floor level increased, the probability of overweight/obesity first increased and then decreased, reaching a peak at around the 14th floor.

Conclusion

BMI and the likelihood of overweight/obesity were associated with multiple environmental factors. Residential floor level affected the probability of overweight/obesity, which may be related to stair-related physical activity and the indirect influence of individual characteristics across different floor levels.

Built environment  /  Multi-source environmental factors  /  Adult obesity  /  Residential floor  /  Regression analysis
许艳青, 宋墨杰, 林任, 刘岩, 张素金, 徐威. 三维建成环境与多源环境因子对武汉市社区成人肥胖的影响分析. 现代预防医学, 2026 , 53 (9) : 1579 -1584 . DOI: 10.20043/j.cnki.MPM.202509486
Yan-qing XU, Mo-jie SONG, Ren LIN, Yan LIU, Su-jin ZHANG, Wei XU. Effects of three-dimensional built environment and multi-source environmental factors on obesity among community-dwelling adults in Wuhan[J]. Modern Preventive Medicine, 2026 , 53 (9) : 1579 -1584 . DOI: 10.20043/j.cnki.MPM.202509486
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肥胖是一种慢性、复发性和进行性疾病，是一项全球性的公共卫生挑战。多年以来，肥胖症在全球范围持续存在[1]。截至2023年，中国共有38.4% 的人超重，14.1%的人肥胖[2]。肥胖是多种并发症的公认危险因素，有必要采取保健干预措施，以预防和管理超重和肥胖及其相关并发症的发展。超重与肥胖因能量摄入和能量消耗失衡所致[3]，其病因与致胖环境相关。已有研究表明，接触绿色空间与健康状况的改善有关，可以降低2型糖尿病和肥胖症的风险[4]。接触户外蓝色空间则与心理健康和幸福感以及更多体育活动存在正相关[5-6]。建成环境是肥胖的上游决定因素[7]，紧凑的建成环境可以通过缩短与目的地之间的旅行距离而促进更多的积极出行[8]，亦可提供更多的体育设施和更高质量的公共空间，提升休闲活动水平，从而降低肥胖风险。但景观的拥挤属性也可能增加久坐或亚健康决策的倾向[9]，过度密集的建成环境也可能会减少人均体育设施和公共空间，从而导致缺乏运动和肥胖[10]。当下国内外已有大量关于建成环境与肥胖关系的研究，但鲜有结合三维环境与环境因子的综合性研究[11]。随着当今城市化的发展，居住在多层建筑和高楼层的情况越来越普遍，有理由警惕居住楼层对健康的潜在影响。居住楼层与健康存在关联[12-13]。高层住宅可能会影响居民的社会关系，导致社会隔离和孤独感，进而削弱人们的心理健康[14]。Panczak等[15]在一项瑞士研究中发现，随着居住楼层的增加，中风和一般心血管疾病的死亡率也随之降低。Wolinsky等[16]的一项研究发现，居住在多层建筑中与老年人群的中风发病率之间存在显著关联。不同楼层造成的环境噪声[17]等物理因素的垂直分布差异、使用楼梯的体力活动水平差异和个人特征造成的间接影响差异等均可能对肥胖的发病产生影响。因此，本研究通过探讨多源环境因子对研究对象BMI与是否超重/肥胖之间的影响和居住楼层对研究对象超重/肥胖概率的影响，旨在揭示成年人肥胖的潜在环境诱因，为制定更加合理化、个性化的干预措施提供理论参考依据。
1　对象与方法
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1.1　研究对象
本研究为横断面研究，选取2023年5—8月在武汉大学人民医院健康管理中心进行健康体检的1 672名体检人员为研究对象，最终1 349名人员符合标准且无数据缺失纳入分析。本研究已通过武汉大学人民医院临床研究伦理委员会审查，属于多中心研究的分中心项目，伦理审查批准号为WDRY2025-K171。研究过程严格遵循《赫尔辛基宣言》和中国 GCP 相关伦理规范。
纳入标准：（1）年龄≥18岁，性别不限；（2）自愿参加本研究，并填写调查问卷。
排除标准：（1）居住地址不在武汉市的研究对象；（2）居住地址地理编码地址理解程度不佳（返回字段参数comprehension<100）的研究对象。
1.2　方法
1.2.1　资料收集
（1）一般资料收集：通过体检报告及调查问卷收集研究对象的性别、年龄（岁）、身高（m）、体重（kg）、常住地址与居住楼层等，并计算身体质量指数（body mass index，BMI），统计是否超重、肥胖。（2）空间信息收集：根据调查问卷收集研究对象的常住地址，使用百度地图API提供的地理编码服务得到研究对象常住地址的地理坐标。（3）建成环境与多源环境因子资料：包括武汉市区蓝地、绿地和兴趣点数据。城市蓝地指城市生态系统中大部分由水体，水道构成的区域，研究使用OSM（open street map）的水系数据；城市绿地包括城市地区的植被实体，如公园和绿色缓冲区等，研究使用UGS-1m模型提取的武汉市细粒度城市绿色空间地图数据[18]；使用高德地图API爬取武汉市行政范围内兴趣点数据，兴趣点数据包括名称、经度、纬度、类别等基本信息，基于高德地图对兴趣点的类别（包括大类、中类、小类）进行定义，对兴趣点进行筛选与重分类，最终使用的兴趣点包括餐饮（大类为餐饮服务）、交通（大类为交通设施服务、中类为公交车站或地铁站）、运动（大类为运动休闲服务、中类为运动场馆）、休闲（大类为风景名胜、中类为公园广场）四类。（3）三维环境数据，包括研究对象的常住楼层，由调查问卷收集。
1.2.2　指标定义
（1）BMI（kg/m2）：BMI是评估全身性肥胖的通用标准，该指数应用身高对体重进行校正，以减少身高因素对肥胖症评估的影响，其计算方式为：体重（kg）除以身高的二次方（m2），BMI可反映肥胖症相关疾病的患病风险。（2）是否超重/肥胖：表征研究对象是否已超重或肥胖的二元逻辑变量（若已超重或肥胖则变量赋为1，反之为0），根据《肥胖症诊疗指南（2024年版）》，在我国成年人群中，BMI≥24kg/m2且<28kg/m2为超重、BMI≥28kg/m2为肥胖，将BMI≥24kg/m2的研究对象记作已超重/肥胖。（3）环境暴露：包括绿地暴露与蓝地暴露，环境暴露通常用于描述个人或群体收到的外部环境因素的影响或接触。本研究中的环境暴露特指计算每个研究对象常住地址所在空间位置的环境暴露。使用常住地址空间位置的300 m缓冲区内的绿地与蓝地面积占比作为研究对象的绿地暴露与蓝地暴露[19]。（3）建成环境指标：建成环境通常指包括大型城市环境在内的人类活动而提供的人造环境。本研究分别计算各研究对象居住地至四类兴趣点中最近兴趣点的地理距离（km），并以距离倒数作为建成环境因素指标，用以反映研究对象居住地到达最近交通、运动、餐饮和休闲四类设施的便利程度，即四类设施的可接近性（可达性）。（4）三维建成环境指标：包括研究对象的居住楼层，研究样本常住楼层大多分布于1～7层，各层数量占总数的5% 左右。7层以上的研究对象数量随楼层的上升递减。男性与女性样本常住楼层的分布与分布趋势大致相同。鉴于单个楼层的样本数量较少，将楼层按由低到高每累积130个研究对象记为一组，确保每个楼层组别中样本的数量。（5）控制变量：包括一般人口学特征（性别、年龄、工作性质）、行为与生活方式（吸烟、饮酒、平均睡眠时长、锻炼频率、锻炼强度）、社会心理因素（精神压力）。其中，精神压力、锻炼频率与锻炼强度为有序分类变量，采用等距线性赋值法将其转换为连续型评分变量。
1.2.3　统计学方法
采用R 4.3.3和Python 3.12.1对数据进行清洗和统计学分析。基线数据的描述性分析中，正态分布连续变量采用（均值±标准差）表示，非正态分布连续变量采用中位数和上下四分位数，即 M（Q1,Q3）表示，分类变量采用频数和百分比，即例（%）描述。使用OLS（ordinary least square）和LTS（least trimmed squares）回归模型评估环境暴露与建成环境对研究对象BMI的影响（LTS模型在多极端值的情况下可以得到更稳健的回归结果，故最终选用LTS模型），使用logistic回归模型评估变量对是否超重/肥胖的影响。在原有解释变量不变，是否超重/肥胖为结果变量的基础上，以楼层分组为分层数据，构建广义线性混合效应模型（generalized linear mixed model，GLMM）分析研究对象居住楼层对研究对象是否超重/肥胖的影响。检验水准α=0.05。
2　结果
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2.1　研究对象基本情况
共纳入研究对象1 672名，有效研究对象1 349名，有效率为80.68%。其中男性805人(59.7%)，女性544人(40.3%)，男女比例为1.5∶1；年龄［M（P25，P75）］为38(33，48)岁；BMI［M（P25，P75）］为23.8(21.5，26.2) kg/m2，491例(36.4%)超重，149例(11.0%)肥胖；研究对象的一般情况见表1。
2.2　研究对象常住地址环境暴露与建成环境指标基本情况
1 349个研究对象中，绿地暴露［M（P25，P75）］为0.185(0.123，0.254)，大多数研究对象居住地附近无蓝地。研究对象的常住地址环境暴露与建成环境指标统计见表2。
2.3　环境因素对研究对象BMI和是否超重/肥胖的影响分析
LTS回归模型表明交通设施可接近性（coef.=0.324, P<0.001）与餐饮设施可接近性（coef.=0.233, P=0.006）是BMI升高的促进因素；logistic回归模型表明交通设施可接近性（OR=1.141, 95%CI:1.000～1.302）与运动设施可接近性（OR=1.177, 95%CI:1.017～1.362）是超重/肥胖的促进因素。见表3。
2.4　常住楼层对研究对象是否超重/肥胖的影响
在logistic模型的变量基础上以常住楼层为分组变量构建GLMM模型。以每个分组的平均楼层为X轴，每组混合效应模型的随机效应为Y轴，结果见图1。使用局部加权回归(locally weighted scatterplot smoothing，LOESS)对随机效应进行局部拟合，得到的拟合曲线见图1。随机效应随研究对象居住楼层的升高呈现出“先升高，后下降”的趋势，于14层左右达到峰值。
3　讨论
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截至2023年，中国共有38.4%的人超重，14.1%的人肥胖[2]。本研究中研究对象的超重与肥胖比例分别为36.4%和11.0%。考虑可能本研究对象为省级三甲医院的健康体检人群，健康素养普遍较高，因此超重率和肥胖率低于一般人群，但考虑到国内超重与肥胖患病的上升趋势，对肥胖的管理与防控刻不容缓。
3.1　建成环境与环境暴露对社区对成人肥胖的影响
研究结果显示，在调整混杂因素后，研究对象的BMI、是否超重/肥胖与常住地址的建成环境存在一定的相关关系，其中BMI与交通设施可接近性（coef.=0.324, P<0.001）和餐饮设施可接近性（coef.=0.233, P=0.006）关系显著；超重/肥胖发生则与交通设施可接近性（OR=1.141, 95%CI:1.000～1.302）和运动设施可接近性（OR=1.177, 95%CI:1.017～1.362）显著相关，与过往研究结果一致[20]。高密度的交通设施可达性导致居民非刚性出行距离减少，在既定的出行方式下，体力消耗降低，导致BMI升高的可能性增加。更高的餐饮设施可接近性意味着更容易获得食物，这可能会导致不健康的食物摄入[21]，具有较多饭店、快餐店的食品环境也会提高食品或者高热量食品的可接近性，增加肥胖风险[22]。对于运动设施的可接近性与超重/肥胖概率的正相关关系，紧凑的建成环境提供了更多的体育设施，却可能会减少人均体育设施与公共空间，从而导致缺乏运动和肥胖[10]。
3.2　三维环境对社区成人肥胖的影响
混合效应模型分析得到的随机效应结果表明，居住楼层与研究对象的超重/肥胖存在一定关联。居住楼层对是否超重/肥胖的随机效应随楼层升高呈现出“先上升，后下降”的趋势。1～13层，研究对象常住楼层与是否超重/肥胖呈现出正相关关系，14～15层随机效应迎来峰值，16层及以上呈负相关。Panczak等[15]提出了三种居住楼层影响健康的潜在机制：环境噪声[17]和空气污染等物理因素的垂直分布，使用楼梯的体力活动水平差异，以及与不同楼层的个人特征（例如社会经济地位）有关的间接影响。居住楼层对肥胖的影响是三维环境、建成环境、自然环境、心理因素等多方面影响因子混合导致的结果。低楼层（楼层≤5）的随机效应为负，这说明在高层住宅（楼层数大于7层）必须加装电梯的前提下，居住在低楼层的研究对象可能受到使用楼梯带来的更高的体力活动水平这一潜在机制影响，因此有更小的超重/肥胖概率。对于中低楼层（5～13层）居民，居住楼层的升高可能意味着更多的电梯使用和相对较少的外出活动，从而导致较低的楼梯体力活动水平，因此有更高的超重/肥胖概率。对于高层住宅的负相关关系，则可能与其他潜在机制的影响相关，例如物理因素的垂直分布或与不同楼层的个人特征（例如社会经济地位）有关的间接影响。
本研究具有局限性：（1）研究对象数量有限，每个楼层的研究对象数量不多，未来需进一步扩大研究对象数量以确定常驻楼层与研究对象BMI和超重/肥胖发生的关系。（2）本研究为横断面研究，只能进行相关性判断，无法确定因果关系。（3）对于三维环境的探讨较为简单，本研究仅以居住楼层分组的随机效应探讨了居住地点的三维环境与肥胖的关联，并未通过量化并控制其相关的混杂因素衡量背后的潜在影响机制。未来的研究可以通过增加相关变量，如楼梯的使用频率与强度、研究对象的社会经济地位、环境噪声情况等，进一步探讨三维环境对肥胖影响的潜在机制，以及三维环境与建成环境的联合效应。
综上所述，本研究首先基于环境暴露与建成环境两个方面，通过量化蓝绿地暴露和交通、运动、餐饮和休闲四类设施的可接近性建成环境指标，分别构建LTS回归模型和logistic回归模型，分析了建成环境与环境暴露对研究对象BMI与超重/肥胖的影响，并进一步以研究对象居住的楼层分组为分层数据构建GLMM回归模型，评估了居住楼层与居民超重/肥胖的关联。肥胖与研究对象的居住环境、居住楼层密切相关。这表明在当前城市扩展引发健康问题的情况下，优化城市建成环境可以改善城市居民的健康状况。此外，对于中居住楼层成年人群体，倡导开展针对性的社区健康干预，鼓励其主动利用社区设施和增加室内运动以应对肥胖风险。
基金
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  • 国家自然科学基金(42471444)
  • 武汉大学人民医院交叉创新人才项目(JCRCYG-2022-013)
文献
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参考文献 引证文献
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2026年第53卷第9期
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doi: 10.20043/j.cnki.MPM.202509486
  • 接收时间：2025-09-28
  • 首发时间：2026-11-02
  • 出版时间：2026-05-10
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  • 收稿日期：2025-09-28
基金
国家自然科学基金(42471444)
武汉大学人民医院交叉创新人才项目(JCRCYG-2022-013)
作者信息
    1.武汉大学遥感信息工程学院，湖北 武汉 430079
    2.武汉大学人民医院健康管理中心，湖北 武汉 430060

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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