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Article(id=1311349889083212641, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311349802038821144, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202601470, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1769443200000, receivedDateStr=2026-01-27, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1790579777260, onlineDateStr=2026-09-28, pubDate=1783612800000, pubDateStr=2026-07-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1790579777260, onlineIssueDateStr=2026-09-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1790579777260, creator=13701087609, updateTime=1790579777260, updator=13701087609, issue=Issue{id=1311349802038821144, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='13', pageStart='2305', pageEnd='2496', issueExtLink='null', onlineDate='null', pubDate='1783612800000', pubDateStr='2026-07-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1790579756507, creator='13701087609', updateTime=1790588376143, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1311385955492258162, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311349802038821144, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1311385955496452467, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311349802038821144, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=2403, endPage=2408, ext={EN=ArticleExt(id=1311349889389396834, articleId=1311349889083212641, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Relationship between sleep duration and overweight/obesity among primary and secondary school students, columnId=1228016568949474136, journalTitle=Modern Preventive Medicine, columnName=Child and Adolescent Health, Maternal and Child Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the current situation of sleep duration among primary and secondary school students and its relationship with overweight and obesity, providing a theoretical basis for the prevention and control of overweight and obesity among primary and secondary school students.

Methods

A stratified cluster sampling method was adopted to conduct a questionnaire survey and physical examination among 10 120 primary and secondary school students in Xuchang City, Henan Province from September to December 2024. Analysis of variance, χ2 test, logistic regression analysis, restricted cubic spline(RCS) model and other statistical methods were applied to explore the association between sleep duration and overweight/obesity in primary and secondary school students.

Results

There were 1 625 people who were overweight (accounting for 16.06%)and 1 580 people who were obese (accounting for 15.61%). The rates of overweight and obesity among males were higher than those among females (χ2=191.19, P<0.001). The obesity rate among primary school students was higher than that among junior high school and senior high school students (P<0.0167). The obesity rate of primary and secondary school students who consumed sugar-sweetened beverages at least once a day on average in the past 7 days was higher than that of those who never consumed them (P<0.0167). The rates of overweight and obesity among primary school students with severely insufficient sleep were higher than those among students with sufficient sleep (χ2=13.060, P=0.011). The results of logistic regression analysis showed that compared with students with sufficient sleep, severely insufficient sleep during the primary school stage was a high-risk factor for obesity (OR=1.40, 95% CI: 1.03-1.92). The results of RCS analysis indicated that there was a nonlinear dose-response relationship between sleep duration and obesity rate among primary school students (Ptotal trend<0.001, Pnon-linear=0.039),and the optimal sleep duration was 9.50 hours.

Conclusion

The influence of sleep duration on overweight and obesity varies by educational stage. Controlling sleep time to 9.5 hours during the primary school stage is a key window for preventing overweight and obesity. During the secondary school stage, a comprehensive intervention strategy that emphasizes both academic pressure management and a healthy lifestyle should be adopted to reduce the occurrence of overweight and obesity.

, authors=Jin-cheng CAO1, 2, Xiao-can JIA1, Yan-li YU2, Deng FENG2, Bin LIU2, authorsList=Jin-cheng CAO, Xiao-can JIA, Yan-li YU, Deng FENG, Bin LIU, authorCompany=null, correspAuthors=Xiao-can JIA, 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=1311349892124083051, articleId=1311349889083212641, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=中小学生睡眠时间与超重肥胖关系的研究, columnId=1228016570031604578, journalTitle=现代预防医学, columnName=儿少卫生与妇幼保健, runingTitle=null, highlight=null, articleAbstract=
目的

探讨中小学生睡眠时间现状及其与超重肥胖的关系，为中小学生超重肥胖的防控提供理论依据。

方法

采用分层整群抽样的方法，于2024年9—12月对河南省许昌市10 120名中小学生进行问卷调查和体检，采用方差分析、χ2检验、logistic回归分析、限制性立方样条（restricted cubic splines，RCS）模型等方法分析中小学生睡眠时间与超重和肥胖的关系。

结果

超重1 625人（占比16.06%），肥胖1 580人（占比15.61%）。男性超重率和肥胖率均高于女性（χ2=191.19，P<0.001），小学生肥胖率高于初中生和高中生（P<0.0167），近7天平均每日饮用含糖饮料≥1次的中小学生肥胖率高于从不饮用者（P<0.0167）；睡眠时间严重不足的小学生超重率和肥胖率高于睡眠时间充足的小学生（χ2=13.060，P<0.05）；logistic回归分析结果显示，与睡眠时间充足学生相比，小学生阶段睡眠时间严重不足是肥胖的高危因素（OR=1.40，95%CI：1.03～1.92）；RCS分析结果显示，小学生睡眠时间和肥胖率存在非线性剂量反应关系（P总趋势<0.001，P非线性=0.039），最佳睡眠时间为9.50h。

结论

睡眠时间对超重肥胖的影响存在学段差异，小学阶段将睡眠时间控制到9.5h是防控超重肥胖的关键窗口，中学阶段应通过学业压力管理与健康生活方式并重的综合干预策略，减少超重肥胖的发生。

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曹锦程（1993—），男，硕士，主管医师，研究方向：主要从事学校卫生工作

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贾晓灿，E-mail：
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(In Chinese), articleTitle=null, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1311349892384129900, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349889083212641, xref=1., ext=[AuthorCompanyExt(id=1311349892392518509, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349889083212641, companyId=1311349892384129900, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, China), AuthorCompanyExt(id=1311349892405101422, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349889083212641, companyId=1311349892384129900, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.郑州大学公共卫生学院，河南 郑州 450001)]), AuthorCompany(id=1311349892488987503, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349889083212641, xref=2., ext=[AuthorCompanyExt(id=1311349892497376112, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349889083212641, companyId=1311349892488987503, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.许昌市疾病预防控制中心，河南 许昌 461000)])], figs=[ArticleFig(id=1311349894363841427, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349889083212641, language=EN, label=Figure 1, caption=Dose-response relationship between sleep duration and obesity among primary and secondary school students, figureFileSmall=qyB/AVW5CXIRIyp7VmfRbw==, figureFileBig=t8a3fG+Z1+x8w4si1T7j+g==, tableContent=null), ArticleFig(id=1311349894443533204, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349889083212641, language=CN, label=图1, caption=中小学睡眠时间与肥胖的剂量反应关系的剂量反应关系, figureFileSmall=qyB/AVW5CXIRIyp7VmfRbw==, figureFileBig=t8a3fG+Z1+x8w4si1T7j+g==, tableContent=null), ArticleFig(id=1311349894636471189, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349889083212641, language=EN, label=Table 1, caption=

Description of the general situation of the study subjects ［n=10 120, （）, n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
类别调查对象非超重肥胖超重肥胖F/χ2值P值
年龄（岁）13.33±2.4613.42±2.4713.42±2.4412.64±2.3268.55<0.001
性别191.19<0.001
男5 2143 243(62.20)970(18.60)1 001(19.20)
女4 9063 672(74.85)655(13.35)579(11.80)
城乡0.0150.993
城区3 6302 479(68.29)585(16.12)566(15.59)
郊县6 4904 436(68.35)1 040(16.02)1 014(15.62)
学段139.720<0.001
小学3 6482 329(63.84)555(15.21)764(20.94)
初中3 8602 687(69.61)a628(16.27)545(14.12)a
高中2 6121 899(72.70)a442(16.92)271(10.38)a
运动强度（近7 d内）7.8930.096
<1 d2 1491 494(69.52)337(15.68)318(14.80)
1～2 d3 9292 695(68.59)596(15.17)638(16.24)
≥3 d4 0422 726(67.44)692(17.12)624(15.44)
早餐习惯（近7 d内）0.7240.948
天天吃7 7135 282(68.48)1 231(15.96)1 200(15.56)
有时吃2 2581 534(67.94)367(16.25)357(15.81)
从来不吃14999(66.44)27(18.12)23(15.44)
含糖饮料（近7 d内）10.8020.029
从来不喝1 7991 271(70.65)272(15.12)256(14.23)
<1次/ d7 3144 992(68.25)1 177(16.09)1 145(15.65)
≥1次/ d1 007652(64.75)b176(17.48)179(17.78)b
油炸食品（近7 d内）2.7460.601
从来不喝1 8571 269(68.34)285(15.35)303(16.32)
<1次/ d7 4535 089(68.28)1 202(16.13)1 162(15.59)
≥1次/ d810557(68.77)138(17.04)115(14.2)
), ArticleFig(id=1311349894720357270, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349889083212641, language=CN, label=表1, caption=

研究对象一般情况描述［n=10 120,（）,n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
类别调查对象非超重肥胖超重肥胖F/χ2值P值
年龄（岁）13.33±2.4613.42±2.4713.42±2.4412.64±2.3268.55<0.001
性别191.19<0.001
男5 2143 243(62.20)970(18.60)1 001(19.20)
女4 9063 672(74.85)655(13.35)579(11.80)
城乡0.0150.993
城区3 6302 479(68.29)585(16.12)566(15.59)
郊县6 4904 436(68.35)1 040(16.02)1 014(15.62)
学段139.720<0.001
小学3 6482 329(63.84)555(15.21)764(20.94)
初中3 8602 687(69.61)a628(16.27)545(14.12)a
高中2 6121 899(72.70)a442(16.92)271(10.38)a
运动强度（近7 d内）7.8930.096
<1 d2 1491 494(69.52)337(15.68)318(14.80)
1～2 d3 9292 695(68.59)596(15.17)638(16.24)
≥3 d4 0422 726(67.44)692(17.12)624(15.44)
早餐习惯（近7 d内）0.7240.948
天天吃7 7135 282(68.48)1 231(15.96)1 200(15.56)
有时吃2 2581 534(67.94)367(16.25)357(15.81)
从来不吃14999(66.44)27(18.12)23(15.44)
含糖饮料（近7 d内）10.8020.029
从来不喝1 7991 271(70.65)272(15.12)256(14.23)
<1次/ d7 3144 992(68.25)1 177(16.09)1 145(15.65)
≥1次/ d1 007652(64.75)b176(17.48)179(17.78)b
油炸食品（近7 d内）2.7460.601
从来不喝1 8571 269(68.34)285(15.35)303(16.32)
<1次/ d7 4535 089(68.28)1 202(16.13)1 162(15.59)
≥1次/ d810557(68.77)138(17.04)115(14.2)
), ArticleFig(id=1311349894800049047, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349889083212641, language=EN, label=Table 2, caption=

Prevalence of overweight and obesity among primary and secondary school students with different sleep duration status at different educational stages ［n（%）］

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组别睡眠状况χ2值P值
严重不足不足充足
小学13.0600.011
非超重肥胖192(56.47)*1 731(63.95)406(67.55)
超重58(17.06)*420(15.52)77(12.81)
肥胖90(26.47)*556(20.54)118(19.63)
初中4.7950.309
非超重肥胖360(69.77)1 866(70.44)461(66.33)
超重80(15.50)421(15.89)127(18.27)
肥胖76(14.73)362(13.67)107(15.40)
高中5.4000.249
非超重肥胖226(67.66)1 352(73.72)321(72.30)
超重66(19.76)301(16.41)75(16.89)
肥胖42(12.57)181(9.87)48(10.81)
), ArticleFig(id=1311349896427439000, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349889083212641, language=CN, label=表2, caption=

各学段中小学生不同睡眠时间状况的超重肥胖情况［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
组别睡眠状况χ2值P值
严重不足不足充足
小学13.0600.011
非超重肥胖192(56.47)*1 731(63.95)406(67.55)
超重58(17.06)*420(15.52)77(12.81)
肥胖90(26.47)*556(20.54)118(19.63)
初中4.7950.309
非超重肥胖360(69.77)1 866(70.44)461(66.33)
超重80(15.50)421(15.89)127(18.27)
肥胖76(14.73)362(13.67)107(15.40)
高中5.4000.249
非超重肥胖226(67.66)1 352(73.72)321(72.30)
超重66(19.76)301(16.41)75(16.89)
肥胖42(12.57)181(9.87)48(10.81)
), ArticleFig(id=1311349896511325081, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349889083212641, language=EN, label=Table 3, caption=

Logistic regression analysis of the association between sleep status and the risk of obesity among primary and secondary school students at different educational stages

, figureFileSmall=null, figureFileBig=null, tableContent=
学段睡眠状况模型1模型2模型3
OR值（95%CI）P值OR值（95%CI）P值OR值（95%CI）P值
总体充足111
不足1.08(0.89～1.30)0.4431.07(0.93～1.24)0.3551.07(0.92～1.24)0.360
严重不足1.25(1.08～1.44)0.0031.48(1.22～1.81)<0.0011.47(1.21～1.79)<0.001
小学充足111
不足1.63(0.33～8.19)0.5501.07(0.86～1.34)0.5201.08(0.86～1.34)0.506
严重不足1.39(1.13～1.70)<0.0011.42(1.04～1.94)0.0291.40(1.03～1.92)0.033
初中充足111
不足0.98(0.65～1.49)0.9270.98(0.77～1.26)0.9030.98(0.77～1.26)0.898
严重不足1.15(0.91～1.46)0.1351.48(0.94～2.35)0.0911.37(0.96～1.95)0.061
高中充足111
不足1.08(0.76～1.53)0.6551.22(0.86～1.74)0.2671.24(0.87～1.77)0.239
严重不足1.79(0.64～5.01)0.2681.45(0.91～2.29)0.1161.38(0.88～2.17)0.165
), ArticleFig(id=1311349896591016858, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349889083212641, language=CN, label=表3, caption=

不同学段中小学睡眠状况与肥胖发生风险的的logistc回归模型分析

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学段睡眠状况模型1模型2模型3
OR值（95%CI）P值OR值（95%CI）P值OR值（95%CI）P值
总体充足111
不足1.08(0.89～1.30)0.4431.07(0.93～1.24)0.3551.07(0.92～1.24)0.360
严重不足1.25(1.08～1.44)0.0031.48(1.22～1.81)<0.0011.47(1.21～1.79)<0.001
小学充足111
不足1.63(0.33～8.19)0.5501.07(0.86～1.34)0.5201.08(0.86～1.34)0.506
严重不足1.39(1.13～1.70)<0.0011.42(1.04～1.94)0.0291.40(1.03～1.92)0.033
初中充足111
不足0.98(0.65～1.49)0.9270.98(0.77～1.26)0.9030.98(0.77～1.26)0.898
严重不足1.15(0.91～1.46)0.1351.48(0.94～2.35)0.0911.37(0.96～1.95)0.061
高中充足111
不足1.08(0.76～1.53)0.6551.22(0.86～1.74)0.2671.24(0.87～1.77)0.239
严重不足1.79(0.64～5.01)0.2681.45(0.91～2.29)0.1161.38(0.88～2.17)0.165
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中小学生睡眠时间与超重肥胖关系的研究
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曹锦程 1, 2 , 贾晓灿 1 , 余艳丽 2 , 冯登 2 , 刘斌 2
现代预防医学 | 儿少卫生与妇幼保健 2026,53(13): 2403-2408
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现代预防医学 |儿少卫生与妇幼保健 2026 , 53 (13) : 2403 -2408
中小学生睡眠时间与超重肥胖关系的研究
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曹锦程（1993—），男，硕士，主管医师，研究方向：主要从事学校卫生工作

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曹锦程1, 2, 贾晓灿1 , 余艳丽2, 冯登2, 刘斌2
作者信息
  • 1.郑州大学公共卫生学院，河南 郑州 450001
  • 2.许昌市疾病预防控制中心，河南 许昌 461000
通讯作者:
贾晓灿，E-mail：
作者简介:

曹锦程（1993—），男，硕士，主管医师，研究方向：主要从事学校卫生工作

Relationship between sleep duration and overweight/obesity among primary and secondary school students
Jin-cheng CAO1, 2, Xiao-can JIA1 , Yan-li YU2, Deng FENG2, Bin LIU2
Affiliations
  • School of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, China
出版时间: 2026-07-10 doi: 10.20043/j.cnki.MPM.202601470
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摘要
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目的

探讨中小学生睡眠时间现状及其与超重肥胖的关系，为中小学生超重肥胖的防控提供理论依据。

方法

采用分层整群抽样的方法，于2024年9—12月对河南省许昌市10 120名中小学生进行问卷调查和体检，采用方差分析、χ2检验、logistic回归分析、限制性立方样条（restricted cubic splines，RCS）模型等方法分析中小学生睡眠时间与超重和肥胖的关系。

结果

超重1 625人（占比16.06%），肥胖1 580人（占比15.61%）。男性超重率和肥胖率均高于女性（χ2=191.19，P<0.001），小学生肥胖率高于初中生和高中生（P<0.0167），近7天平均每日饮用含糖饮料≥1次的中小学生肥胖率高于从不饮用者（P<0.0167）；睡眠时间严重不足的小学生超重率和肥胖率高于睡眠时间充足的小学生（χ2=13.060，P<0.05）；logistic回归分析结果显示，与睡眠时间充足学生相比，小学生阶段睡眠时间严重不足是肥胖的高危因素（OR=1.40，95%CI：1.03～1.92）；RCS分析结果显示，小学生睡眠时间和肥胖率存在非线性剂量反应关系（P总趋势<0.001，P非线性=0.039），最佳睡眠时间为9.50h。

结论

睡眠时间对超重肥胖的影响存在学段差异，小学阶段将睡眠时间控制到9.5h是防控超重肥胖的关键窗口，中学阶段应通过学业压力管理与健康生活方式并重的综合干预策略，减少超重肥胖的发生。

中小学生  /  睡眠时间  /  超重肥胖  /  限制性立方样条
Objective

To explore the current situation of sleep duration among primary and secondary school students and its relationship with overweight and obesity, providing a theoretical basis for the prevention and control of overweight and obesity among primary and secondary school students.

Methods

A stratified cluster sampling method was adopted to conduct a questionnaire survey and physical examination among 10 120 primary and secondary school students in Xuchang City, Henan Province from September to December 2024. Analysis of variance, χ2 test, logistic regression analysis, restricted cubic spline(RCS) model and other statistical methods were applied to explore the association between sleep duration and overweight/obesity in primary and secondary school students.

Results

There were 1 625 people who were overweight (accounting for 16.06%)and 1 580 people who were obese (accounting for 15.61%). The rates of overweight and obesity among males were higher than those among females (χ2=191.19, P<0.001). The obesity rate among primary school students was higher than that among junior high school and senior high school students (P<0.0167). The obesity rate of primary and secondary school students who consumed sugar-sweetened beverages at least once a day on average in the past 7 days was higher than that of those who never consumed them (P<0.0167). The rates of overweight and obesity among primary school students with severely insufficient sleep were higher than those among students with sufficient sleep (χ2=13.060, P=0.011). The results of logistic regression analysis showed that compared with students with sufficient sleep, severely insufficient sleep during the primary school stage was a high-risk factor for obesity (OR=1.40, 95% CI: 1.03-1.92). The results of RCS analysis indicated that there was a nonlinear dose-response relationship between sleep duration and obesity rate among primary school students (Ptotal trend<0.001, Pnon-linear=0.039),and the optimal sleep duration was 9.50 hours.

Conclusion

The influence of sleep duration on overweight and obesity varies by educational stage. Controlling sleep time to 9.5 hours during the primary school stage is a key window for preventing overweight and obesity. During the secondary school stage, a comprehensive intervention strategy that emphasizes both academic pressure management and a healthy lifestyle should be adopted to reduce the occurrence of overweight and obesity.

Primary and secondary school students  /  Sleep duration  /  Overweight and obesity  /  Restricted cubic spline
曹锦程, 贾晓灿, 余艳丽, 冯登, 刘斌. 中小学生睡眠时间与超重肥胖关系的研究. 现代预防医学, 2026 , 53 (13) : 2403 -2408 . DOI: 10.20043/j.cnki.MPM.202601470
Jin-cheng CAO, Xiao-can JIA, Yan-li YU, Deng FENG, Bin LIU. Relationship between sleep duration and overweight/obesity among primary and secondary school students[J]. Modern Preventive Medicine, 2026 , 53 (13) : 2403 -2408 . DOI: 10.20043/j.cnki.MPM.202601470
正文
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全球儿童青少年超重肥胖检出率正快速增长，部分国家已经出现流行趋势，构成突出的公共卫生问题[1]。中国是该问题发展速度较快的国家之一[2]。数据显示，我国6～17岁儿童青少年超重肥胖率已由2015年的16%[3]增长到2020年的19%[4]。如果不采取措施，我国儿童青少年肥胖率将在2030年达到32%[5]。超重肥胖不仅会影响中小学生的身体形态和运动能力，还会增加患多种慢性疾病的风险，如心血管疾病、糖尿病等[6-7]，并对儿童心理健康产生负面影响[8]。国内外关于中小学生的超重肥胖问题常聚焦于身体活动、饮食习惯和环境因素[9-10]，但身体活动仅占每天的总能量消耗约30%[11]。因此，除了身体活动，还应当考虑从其他方面解决儿童青少年超重肥胖问题。有研究发现，睡眠可能在肥胖的发展中起着重要作用[12-13]。Tanveer等人[14]对巴基斯坦儿童青少年肥胖的因素研究发现，短时间睡眠的儿童青少年肥胖的发生风险是睡眠时间正常的儿童的5.65倍。有学者认为睡眠是儿童青少年超重肥胖的独立危险因素[15]。目前国内对儿童青少年睡眠时间与超重肥胖关系的相关研究不足，因此，本研究旨在探讨不同学段学生睡眠时间与超重肥胖的联系及剂量反应关系，科学指导儿童青少年的睡眠习惯，预防儿童青少年超重肥胖的发生。
1　资料与方法
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1.1　 研究对象
本研究基于全国学生常见病和健康影响因素监测项目，选择许昌市中小学生作为研究对象，采用多阶段分层整群抽样方法，以小学、初中、普通高中分层，使用随机数字表法，在河南省许昌市每个县随机抽取2所小学、2所初中和1所高中，每个区随机抽取2所小学、2所初中和2所高中，共抽取32所学校；抽中学校的每个年级以班级为单位，通过整群抽样的方法至少抽取80名学生。根据许昌市中小学生上课时间安排及本研究睡眠时间分布特点，将睡眠时间大于12.5 h或小于4 h的学生作为异常值剔除，同时剔除年龄大于18岁及相关资料缺失者，最终共纳入10 120名中小学生。该数据调查已获得河南省疾病预防控制中心伦理委员会批准（批件号：2024-KY-013-02），调查前研究对象及其监护人签署知情同意书。
1.2　研究方法
选择问卷调查和现场体检结合的研究方法。问卷调查收集信息包括性别、年龄、运动强度和睡眠时间等；现场体检指标包括身高、体重。由疾病预防控制中心专业人员使用身高体重测量仪对学生进行检测记录。检测时受检者赤足，立正姿势站在仪器的底板上。身高测量时检测人员站在受检者右侧，缓慢下滑水平压板，轻压于被测对象头顶。读数时，工作人员双眼与压板平面等高。记录以厘米（cm）为单位，保留小数点后一位，测试误差0.5 cm以内。测量体重时，读数以千克（kg）为单位，记录员复诵后填写读数精确小数点后一位。
1.3　判定标准
1.3.1　睡眠时间
采用问卷调查自报的方式了解学生睡眠时间信息，问卷问题为“你平均每天的睡眠时间为几小时几分钟？”受访对象根据自身情况自行作答，本研究睡眠时间的分类依据卫生部和国家标准化管理委员会编制的中小学生1日学习时间卫生要求判定，即每日小学生睡眠时间<10 h、初中生<9 h、高中生<8 h定为睡眠不足，进一步将小学生睡眠时间<8 h、初中生<7 h、高中生<6 h判定为睡眠严重不足。
1.3.2　超重肥胖
依据《学龄儿童青少年超重与肥胖筛查标准（WS/T586—2018）》将中小学生判定为消瘦、正常、超重、肥胖，本研究将正常与消瘦中小学生归为非超重肥胖。
1.4　协变量
人口学统计变量包括年龄、性别、城乡（城区、郊县），其他协变量包括运动情况（近7 d内做到中高强度运动≥60 min的天数）、早餐习惯（近7 d内天天吃、有时吃、从来不吃）、含糖饮料（近7 d内从来不喝、少于每天1次、每天1次及以上）、油炸食品（近7 d内从来不吃、少于每天1次、每天1次及以上）。
1.5　统计学分析
通过学生常见病和健康影响因素监测系统录入数据库，采用R 4.4.3软件统计分析，描述性分析中计数资料采用频数（n）和百分比（%）进行描述，计量资料采用 Kolmogorov-Smirnov 检验进行正态性检验，年龄符合正态分布用（）描述。各组年龄比较采用多因素方差分析检验，组间超重率和肥胖率采用χ2检验，三组间两两比较采用Bonferrioni校正（α'=0.05/3≈0.016 7）。以是否超重肥胖作为因变量（否=0，是=1），睡眠时间是否充足作为自变量，年龄、性别、城乡、运动情况、含糖饮料、油炸食品作为协变量，使用logistic回归模型分析睡眠状况与超重肥胖的关系。采用限制性立方样条（restricted cubic splines,RCS）评估学生在不同学段上睡眠时间与肥胖的非线性剂量反应关系，按学段分层后，每层中根据赤池信息准则（Akaiket information criterion，AIC）和贝叶斯信息准则（Bayesian information criterion，BIC）选取最优节点。检验水准α=0.05。
2　结果
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2.1　基本情况
本研究共纳入8～18岁中小学生10 120名，超重1 625人，占比16.06%，肥胖1 580人，占比15.61%。男生5 214名，占比51.52%，男生超重率和肥胖率均高于女生（P<0.05)；城区中小学生3 630名，占比35.86%，城区和郊县中小学生超重率和肥胖率差异无统计学意义（P>0.05)；小学生肥胖率高于初中生和高中生（P<0.016 7）；近7 d平均每日饮用含糖饮料≥1次的中小学生，其肥胖率显著高于从不饮用者（P<0.016 7）；不同运动强度、早餐习惯、油炸食品食用量的中小学生超重率和肥胖率均无统计学意义（P>0.05)。见表1。
2.2　各学段中小学生不同睡眠状况的超重肥胖情况
探究小学、初中和高中生睡眠状况和超重肥胖的关联，结果显示，睡眠时间严重不足的小学生超重率和肥胖率高于睡眠时间充足的小学生（P<0.016 7)；在初中和高中阶段，不同睡眠时间状况的超重率和肥胖率差异均无统计学意义（P>0.05)。见表2。
2.3　不同学段中小学睡眠状况与肥胖的关联
以是否肥胖为因变量，以睡眠状况为自变量，进行logistic回归分析。结果表明，校正了年龄、性别、城乡、运动情况、早餐习惯、含糖饮料、油炸食品后，相对于睡眠充足学生，睡眠严重不足是肥胖高危因素，其OR(95%CI)为1.47(1.21～1.79)；按照不同学段分层，小学阶段学生的睡眠严重不足是肥胖的高危因素，其OR(95%CI)为1.40(1.03～1.92)；未发现初中高中阶段学生的睡眠状况与肥胖存在统计学关联（P>0.05）。见表3。
2.4　中小学生睡眠时间与肥胖的的RCS分析
利用RCS模型，结果显示，校正了年龄、性别、城乡、运动情况、早餐习惯、含糖饮料、油炸食品后，总体上，中小学睡眠时间和肥胖存在非线性剂量反应关系（P总趋势<0.001，P非线性=0.006）；在小学生阶段，睡眠时间和肥胖存在非线性剂量反应关系（P总趋势<0.01，P非线性=0.039），小学生睡眠时间在8～11.46h/d区间内，OR<1，拐点分析结果显示，小学生睡眠时间在9.5h处存在拐点，低于该拐点睡眠时间增加与肥胖发生风险呈显著负相关，高于此拐点睡眠时间增加与肥胖发生风险呈显著正相关，最佳睡眠时间为9.50h；随睡眠时间的增加，初中生和高中生阶段肥胖率呈现先下降后上升趋势，但是两者均不存在非线性剂量反应关系（P总趋势>0.05，P非线性>0.05）。见图1。
3　讨论
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本研究聚焦8～18岁中小学生，探究其超重肥胖现状及相关影响因素，为后续睡眠时间与超重肥胖关系研究奠定基础。结果显示，男生超重和肥胖率高于女生，这与既往关于青少年超重肥胖流行病学研究一致[16]，可能与不同性别的儿童青少年类固醇差异有关[17]，也可能是文化及其对心理行为的影响[18]。小学生超重和肥胖率高于初中生、高中生，可能原因是小学生自我管理能力弱，饮食控制、运动习惯养成不足，且生长发育阶段脂肪细胞易积累，随着年龄增长，青少年健康意识提升、身体代谢模式变化，使初高中生超重肥胖率相对降低。城区与郊县学生超重肥胖率无差异，或因当下城乡经济融合显著，消除了城乡中小学生超重肥胖的差距[19]。
本研究探究不同学段中小学生睡眠时间与超重肥胖的关联，结果呈现明显学段差异。Logistic回归结果显示，在总体上，睡眠状况与学生超重肥胖率相关；在小学阶段，睡眠时间严重不足的学生超重肥胖率较高，与相关研究结论一致[20-21]。然而，并非所有研究都发现睡眠不足情况与超重或肥胖有关，本研究结果显示，在初中和高中阶段，不同睡眠时间状况的超重率和肥胖率差异无统计学意义，与小学阶段形成鲜明对比。小学阶段学生神经系统、内分泌系统发育尚未成熟，充足睡眠可调节瘦素、胃饥饿素等激素分泌，维持瘦素和胃饥饿素的平衡，瘦素能抑制食欲、增加能量消耗[22]，睡眠对代谢调节的影响更显著，充足睡眠为身体代谢提供稳定内环境，助力维持健康体重[23]，从生物学基本原理的角度出发，为本次研究结果提供了有力的印证。然而因中学阶段学业压力剧增，学生睡眠普遍受限，且伴随青春期发育，激素水平波动、自主意识增强，饮食选择、运动习惯等成为影响超重肥胖的主导因素，这些因素与睡眠不足共同导致皮质醇水平升高，从而掩盖了睡眠时间独立作用产生的影响。
本研究通过RCS分析，分析不同学段中小学生睡眠时间和睡眠状况与肥胖的关联，结果呈现显著学段特异性。总体水平上，中小学生与肥胖存在“U”字形剂量反应关系，在小学阶段，睡眠时间与肥胖率呈现中间低两边高的非线性关系，最佳睡眠时间为9.50h，但是在初中和高中阶段，睡眠时间与肥胖无关联。小学阶段的最佳睡眠时间契合小学阶段生长发育对睡眠的高需求，小学生下丘脑-垂体-靶腺轴发育尚不完善，睡眠不足易干扰瘦素-胃饥饿素调节轴，使能量摄入-消耗失衡充足睡眠可通过促进生长激素分泌、优化能量代谢，降低超重肥胖风险，但是睡眠时间过长会导致身体活动时间降低，机体代谢水平下降，反而有助于肥胖的发生[24]。本研究提示中小学生肥胖防控需采取分学段、精准化干预策略。小学阶段，应将规律且适宜的睡眠时长作为核心干预靶点，通过学校健康教育、家庭作息管理、睡眠科普宣传等方式，引导小学生维持9.5 h左右的适宜睡眠，避免熬夜与赖床。针对中学生，我们不能仅关注睡眠时间，要关注综合干预策略的重要性，通过学业压力管理与建立健康生活方式并重，强化体育锻炼时长与强度，控制含糖饮料与零食摄入，减少电子产品使用与久坐，建立健康饮食与运动习惯，全方位促进中学生身心健康，降低肥胖的发生风险。
本研究存在一定局限，一方面，睡眠时间仅为回顾性调查，可能因主观回忆产生偏差，缺乏客观睡眠监测数据；另一方面，未深入探究睡眠质量，如睡眠碎片化，对超重肥胖的影响，仅关注睡眠时间时有一定片面性。另外本研究为横断面研究，无法做因果关系推断，在未来研究中，可通过设计前瞻性研究，纳入作息时间作为潜在混杂因素，进一步探究中小学生睡眠时间与超重肥胖的关系。
综上，本研究表明，中小学生睡眠不足会增加超重肥胖的发生风险。应保证中小学生充足的睡眠，以预防超重肥胖。针对不同学段学生的身心发展特点制定精准策略，小学阶段是干预睡眠时间以防控超重肥胖的关键窗口期，该阶段学生最佳睡眠时间为9.5 h；中学阶段要通过学业压力管理与健康生活方式并重的综合干预策略，如合理规划学习时间、开展心理疏导以管理学业压力，同时保证充足睡眠、坚持规律运动、均衡饮食来践行健康生活方式，二者并重，减少中小学超重肥胖，共同促进儿童青少年健康成长。

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2026年第53卷第13期
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doi: 10.20043/j.cnki.MPM.202601470
  • 接收时间：2026-01-27
  • 首发时间：2026-09-28
  • 出版时间：2026-07-10
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  • 收稿日期：2026-01-27
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    1.郑州大学公共卫生学院，河南 郑州 450001
    2.许昌市疾病预防控制中心，河南 许昌 461000

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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