Article(id=1241034445101256838, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241034441380917539, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202501148, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1736438400000, receivedDateStr=2025-01-10, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773815269017, onlineDateStr=2026-03-18, pubDate=1749484800000, pubDateStr=2025-06-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773815269017, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773815269017, creator=13701087609, updateTime=1773815269017, updator=13701087609, issue=Issue{id=1241034441380917539, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='11', pageStart='1921', pageEnd='2112', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773815268130, creator=13701087609, updateTime=1773815340947, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241034746873049765, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241034441380917539, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241034746873049766, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241034441380917539, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2003, endPage=2008, ext={EN=ArticleExt(id=1241034445411635344, articleId=1241034445101256838, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Establishment of a nomogram prediction model for overweight and obesity in middle school students based on Lasso regression, columnId=1228016568949474136, journalTitle=Modern Preventive Medicine, columnName=Child and Adolescent Health, Maternal and Child Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the factors influencing overweight and obesity among middle school students and to establish a nomogram for predicting the risk of overweight and obesity in this population.

Methods

From September to November 2024, a random cluster sampling method was used to select 5 135 middle school students from 20 schools in Tongren city for physical examinations and questionnaire surveys. Lasso regression was employed to identify factors affecting overweight and obesity, and a nomogram prediction model was established and validated.

Results

The prevalence of overweight and obesity among middle school students was 25.02%. Multivariate logistic regression analysis revealed that being female (OR=0.430, 95%CI: 0.371-0.499),boarding at school (OR=0.582, 95%CI: 0.500-0.678), engaging in moderate to high-intensity physical activity for one hour daily (OR=0.730, 95%CI: 0.630-0.847), having non-obese parents (OR=0.466, 95%CI: 0.404-0.538), and external eating triggers (OR=0.945, 95%CI: 0.935-0.956) were protective factors against overweight and obesity. Conversely, consuming fresh fruits and vegetables at every meal (OR=1.308, 95%CI: 1.103-1.549), restrictive eating (OR=1.100, 95%CI: 1.089-1.111), and emotional eating (OR=1.091, 95%CI: 1.079-1.103) were identified as risk factors. The areas under the curve (AUC) for the training and validation sets were 0.790 (95%CI: 0.775-0.806) and 0.765 (95%CI: 0.731-0.799), respectively, indicating good discrimination of the nomogram prediction model. The Brier score was 0.15, and the Hosmer-Leeshawn test suggested good model fit (χ2=10.984, P=0.203).

Conclusion

The nomogram model established in this study effectively predicts the risk of overweight and obesity, providing a reference for screening high-risk students and implementing personalized prevention strategies.

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目的

分析影响初中生超重肥胖的因素,建立列线图预测初中生超重肥胖的风险。

方法

于2024年9 —11月在贵州省铜仁市采用随机整群抽样方法选取20所初中的5 135名初中生进行体格检查和问卷调查,利用lasso回归筛选影响超重肥胖的因素,建立并验证列线图预测模型。

结果

初中生超重肥胖的检出率为25.02%。多因素logistic回归分析显示,女生(OR=0.430,95%CI:0.371~0.499)、住校(OR=0.582,95%CI:0.500~0.678)、每天中高等强度活动1 h(OR=0.730,95%CI:0.630~0.847)、父母都不胖(OR=0.466,95%CI:0.404~0.538)、外因性进食(OR=0.945,95%CI:0.935~0.956)是预防超重肥胖的保护因素。每顿饭都吃新鲜蔬果(OR=1.308,95%CI:1.103~1.549)、限制性进食(OR=1.100,95%CI:1.089~1.111)、情绪性进食(OR=1.091,95%CI:1.079~1.103)是超重肥胖的危险因素。训练集和验证集的受试者曲线下面积(AUC)分别为0.790(95%CI:0.775~0.806)、0.765(95%CI:0.731~0.799),表明该列线图预测模型区分度良好。Brier得分为0.15,Hosmer-Lemeshow检验结果提示模型拟合良好(χ2=10.984,P=0.203)。

结论

本研究建立的列线图模型可以有效预测超重肥胖发生风险,为筛查高危学生和个体化防控提供参考依据。

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任达飞,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=HF8RZE7NVbzEdWgPwXFftg==, magXml=D25LFPkhbHzg5YMwhRbg1Q==, pdfUrl=null, pdf=Tyv9zzDDzEa75Sq4CTMzBQ==, pdfFileSize=877808, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=on/Y8oss8LPqfYUrS5LR4w==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=FuSQD3YosDMSTqIQOYYOPA==, mapNumber=null, authorCompany=null, fund=null, authors=

胡君(1999—),女,硕士在读,研究方向:疾病预防与控制

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胡君(1999—),女,硕士在读,研究方向:疾病预防与控制

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Why do you lose more weight ? - Psychological mechanism and influencing factors of overeating in restrictive dieters[J].Progress in Psychological Science, 2019, 27(2): 322-328.(In Chinese), articleTitle=Why do you lose more weight ? - Psychological mechanism and influencing factors of overeating in restrictive dieters, refAbstract=null), Reference(id=1241050846155297426, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034445101256838, doi=null, pmid=null, pmcid=null, year=2018, volume=125, issue=null, pageStart=410, pageEnd=417, url=null, language=null, rfNumber=[23], rfOrder=38, authorNames=Braden A, Musher-Eizenman D, Watford T, journalName=Appetite, refType=null, unstructuredReference=Braden A, Musher-Eizenman D, Watford T, et al. Eating when depressed, anxious, bored, or happy: Are emotional eating types associated with unique psychological and physical health correlates?[J]. Appetite, 2018, 125: 410-417., articleTitle=Eating when depressed, anxious, bored, or happy: Are emotional eating types associated with unique psychological and physical health correlates?, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1241050829633933351, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034445101256838, xref=1., ext=[AuthorCompanyExt(id=1241050829659099180, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034445101256838, companyId=1241050829633933351, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Public Health and Health, Guizhou Medical University, Key Laboratory of Environmental Pollution and Disease Monitoring, Ministry of Education, Guiyang, Guizhou 561113, China), AuthorCompanyExt(id=1241050829663293486, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034445101256838, companyId=1241050829633933351, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.贵州医科大学公共卫生与健康学院,环境污染与疾病监控教育部重点实验室,贵州 贵阳 561113)]), AuthorCompany(id=1241050829793316921, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034445101256838, xref=2., ext=[AuthorCompanyExt(id=1241050829801705530, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034445101256838, companyId=1241050829793316921, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.贵州省铜仁市疾病预防控制中心,贵州 铜仁 554300)])], figs=[ArticleFig(id=1241050835422073173, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034445101256838, language=EN, label=Figure 1, caption=Lasso regression model screening variables, figureFileSmall=Ol9VDIQe2NLssIKTFbvv+w==, figureFileBig=kyDiuOP2sb6Q2DYSud2Unw==, tableContent=null), ArticleFig(id=1241050835912806748, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034445101256838, language=CN, label=图1, caption=Lasso回归模型筛选变量

注:A为回归系数路线图;B为回归交叉验证曲线。

, figureFileSmall=Ol9VDIQe2NLssIKTFbvv+w==, figureFileBig=kyDiuOP2sb6Q2DYSud2Unw==, tableContent=null), ArticleFig(id=1241050836101550440, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034445101256838, language=EN, label=Figure 2, caption=Nomogram model for predicting the risk of overweight and obesity, figureFileSmall=SCw6RLaDoFN3AE28IshWag==, figureFileBig=Bzf3Aj4cVk6mp0lV9iG7rA==, tableContent=null), ArticleFig(id=1241050836198019438, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034445101256838, language=CN, label=图2, caption=超重肥胖风险预测的列线图模型, figureFileSmall=SCw6RLaDoFN3AE28IshWag==, figureFileBig=Bzf3Aj4cVk6mp0lV9iG7rA==, tableContent=null), ArticleFig(id=1241050836357402997, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034445101256838, language=EN, label=Figure 3, caption=ROC curve of overweight and obesity prediction model, figureFileSmall=OhZb788nWShLqNcQBeEpOg==, figureFileBig=OZX0EUCPLE3vEJA0b7NVzw==, tableContent=null), ArticleFig(id=1241050836692947329, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034445101256838, language=CN, label=图3, caption=超重肥胖预测模型的ROC曲线

注:A为训练集ROC曲线;B为验证集ROC曲线。

, figureFileSmall=OhZb788nWShLqNcQBeEpOg==, figureFileBig=OZX0EUCPLE3vEJA0b7NVzw==, tableContent=null), ArticleFig(id=1241050836911051144, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034445101256838, language=EN, label=Table 1, caption=

Comparison of basic conditions between overweight and obese students and non-overweight and obese students[n(%),MP25P75),()]

, figureFileSmall=null, figureFileBig=null, tableContent=
因素选项非超重肥胖组超重肥胖组χ2/t/ZP
性别2 052(79.66)524(20.34)60.413<0.001
1 798(70.26)761(29.74)
学校所在地郊县3 125(76.41)965(23.59)21.911<0.001
城区725(69.38)320(30.62)
住校1 556(80.54)376(19.46)51.082<0.001
2 294(71.62)909(28.38)
每天吃谷物、杂粮或杂豆2 805(76.02)885(23.98)7.5680.006
1 045(72.32)400(27.68)
每顿饭都吃新鲜蔬果2 847(74.28)986(25.72)3.9440.047
1 003(77.04)299(22.96)
每天中高等强度活动1 h 1 735(77.11)515(22.89)9.7340.002
2 115(73.31)770(26.69)
定期测量体重1 447(73.04)534(26.96)6.4150.011
2 403(76.19)751(23.81)
父母都不胖2 401(81.11)559(18.89)140.383<0.001
1 449(66.62)726(33.38)
限制性进食评分18.00(15.00,23.00)25.00(19.00,30.00)-21.711<0.001
情绪性进食评分15.00(13.00,18.00)17.00(15.00,26.00)-15.724<0.001
外因性进食评分27.36±0.1226.08±0.195.470<0.001
), ArticleFig(id=1241050837229818259, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034445101256838, language=CN, label=表1, caption=

超重肥胖组与非超重肥胖组学生基本情况比较[n(%),MP25P75),()]

, figureFileSmall=null, figureFileBig=null, tableContent=
因素选项非超重肥胖组超重肥胖组χ2/t/ZP
性别2 052(79.66)524(20.34)60.413<0.001
1 798(70.26)761(29.74)
学校所在地郊县3 125(76.41)965(23.59)21.911<0.001
城区725(69.38)320(30.62)
住校1 556(80.54)376(19.46)51.082<0.001
2 294(71.62)909(28.38)
每天吃谷物、杂粮或杂豆2 805(76.02)885(23.98)7.5680.006
1 045(72.32)400(27.68)
每顿饭都吃新鲜蔬果2 847(74.28)986(25.72)3.9440.047
1 003(77.04)299(22.96)
每天中高等强度活动1 h 1 735(77.11)515(22.89)9.7340.002
2 115(73.31)770(26.69)
定期测量体重1 447(73.04)534(26.96)6.4150.011
2 403(76.19)751(23.81)
父母都不胖2 401(81.11)559(18.89)140.383<0.001
1 449(66.62)726(33.38)
限制性进食评分18.00(15.00,23.00)25.00(19.00,30.00)-21.711<0.001
情绪性进食评分15.00(13.00,18.00)17.00(15.00,26.00)-15.724<0.001
外因性进食评分27.36±0.1226.08±0.195.470<0.001
), ArticleFig(id=1241050837548585369, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034445101256838, language=EN, label=Table 2, caption=

Multivariate Logistic regression analysis results of lasso regression model screening variables

, figureFileSmall=null, figureFileBig=null, tableContent=
自变量选项β标准误Waldχ2OR值(95%CIP
性别1
-0.8430.076123.3950.430(0.371~0.499)<0.001
住校1
-0.5410.07848.5580.582(0.500~0.678)<0.001
每顿饭都吃新鲜果蔬1
0.2680.0879.5961.308(1.103~1.549)0.002
每天中高等强度活动1 h1
-0.3140.07617.2020.730(0.630~0.847)<0.001
父母都不胖1
-0.7630.073109.3740.466(0.404~0.538)<0.001
限制性进食评分0.0950.005359.6661.100(1.089~1.111)<0.001
情绪性进食评分0.0870.006249.4811.091(1.079~1.103)<0.001
外因性进食评分-0.0560.00698.8730.945(0.935~0.956)<0.001
), ArticleFig(id=1241050837716357535, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034445101256838, language=CN, label=表2, caption=

Lasso回归模型筛选变量的多因素logistic回归分析结果

, figureFileSmall=null, figureFileBig=null, tableContent=
自变量选项β标准误Waldχ2OR值(95%CIP
性别1
-0.8430.076123.3950.430(0.371~0.499)<0.001
住校1
-0.5410.07848.5580.582(0.500~0.678)<0.001
每顿饭都吃新鲜果蔬1
0.2680.0879.5961.308(1.103~1.549)0.002
每天中高等强度活动1 h1
-0.3140.07617.2020.730(0.630~0.847)<0.001
父母都不胖1
-0.7630.073109.3740.466(0.404~0.538)<0.001
限制性进食评分0.0950.005359.6661.100(1.089~1.111)<0.001
情绪性进食评分0.0870.006249.4811.091(1.079~1.103)<0.001
外因性进食评分-0.0560.00698.8730.945(0.935~0.956)<0.001
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基于lasso回归建立初中生超重肥胖的列线图预测模型
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胡君 1 , 洪峰 1 , 郭亚君 2 , 王娜 1 , 任达飞 1, 2
现代预防医学 | 儿少卫生与妇幼保健 2025,52(11): 2003-2008
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现代预防医学 | 儿少卫生与妇幼保健 2025, 52(11): 2003-2008
基于lasso回归建立初中生超重肥胖的列线图预测模型
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胡君1, 洪峰1, 郭亚君2, 王娜1, 任达飞1, 2
作者信息
  • 1.贵州医科大学公共卫生与健康学院,环境污染与疾病监控教育部重点实验室,贵州 贵阳 561113
  • 2.贵州省铜仁市疾病预防控制中心,贵州 铜仁 554300
  • 胡君(1999—),女,硕士在读,研究方向:疾病预防与控制

通讯作者:

任达飞,E-mail:
Establishment of a nomogram prediction model for overweight and obesity in middle school students based on Lasso regression
Jun HU1, Feng HONG1, Ya-jun GUO2, Na WANG1, Da-fei REN1, 2
Affiliations
  • School of Public Health and Health, Guizhou Medical University, Key Laboratory of Environmental Pollution and Disease Monitoring, Ministry of Education, Guiyang, Guizhou 561113, China
出版时间: 2025-06-10 doi: 10.20043/j.cnki.MPM.202501148
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目的

分析影响初中生超重肥胖的因素,建立列线图预测初中生超重肥胖的风险。

方法

于2024年9 —11月在贵州省铜仁市采用随机整群抽样方法选取20所初中的5 135名初中生进行体格检查和问卷调查,利用lasso回归筛选影响超重肥胖的因素,建立并验证列线图预测模型。

结果

初中生超重肥胖的检出率为25.02%。多因素logistic回归分析显示,女生(OR=0.430,95%CI:0.371~0.499)、住校(OR=0.582,95%CI:0.500~0.678)、每天中高等强度活动1 h(OR=0.730,95%CI:0.630~0.847)、父母都不胖(OR=0.466,95%CI:0.404~0.538)、外因性进食(OR=0.945,95%CI:0.935~0.956)是预防超重肥胖的保护因素。每顿饭都吃新鲜蔬果(OR=1.308,95%CI:1.103~1.549)、限制性进食(OR=1.100,95%CI:1.089~1.111)、情绪性进食(OR=1.091,95%CI:1.079~1.103)是超重肥胖的危险因素。训练集和验证集的受试者曲线下面积(AUC)分别为0.790(95%CI:0.775~0.806)、0.765(95%CI:0.731~0.799),表明该列线图预测模型区分度良好。Brier得分为0.15,Hosmer-Lemeshow检验结果提示模型拟合良好(χ2=10.984,P=0.203)。

结论

本研究建立的列线图模型可以有效预测超重肥胖发生风险,为筛查高危学生和个体化防控提供参考依据。

Lasso回归  /  超重肥胖  /  异常进食行为  /  列线图
Objective

To analyze the factors influencing overweight and obesity among middle school students and to establish a nomogram for predicting the risk of overweight and obesity in this population.

Methods

From September to November 2024, a random cluster sampling method was used to select 5 135 middle school students from 20 schools in Tongren city for physical examinations and questionnaire surveys. Lasso regression was employed to identify factors affecting overweight and obesity, and a nomogram prediction model was established and validated.

Results

The prevalence of overweight and obesity among middle school students was 25.02%. Multivariate logistic regression analysis revealed that being female (OR=0.430, 95%CI: 0.371-0.499),boarding at school (OR=0.582, 95%CI: 0.500-0.678), engaging in moderate to high-intensity physical activity for one hour daily (OR=0.730, 95%CI: 0.630-0.847), having non-obese parents (OR=0.466, 95%CI: 0.404-0.538), and external eating triggers (OR=0.945, 95%CI: 0.935-0.956) were protective factors against overweight and obesity. Conversely, consuming fresh fruits and vegetables at every meal (OR=1.308, 95%CI: 1.103-1.549), restrictive eating (OR=1.100, 95%CI: 1.089-1.111), and emotional eating (OR=1.091, 95%CI: 1.079-1.103) were identified as risk factors. The areas under the curve (AUC) for the training and validation sets were 0.790 (95%CI: 0.775-0.806) and 0.765 (95%CI: 0.731-0.799), respectively, indicating good discrimination of the nomogram prediction model. The Brier score was 0.15, and the Hosmer-Leeshawn test suggested good model fit (χ2=10.984, P=0.203).

Conclusion

The nomogram model established in this study effectively predicts the risk of overweight and obesity, providing a reference for screening high-risk students and implementing personalized prevention strategies.

Lasso regression  /  Overweight and obesity  /  Abnormal eating behaviors  /  Nomogram
胡君, 洪峰, 郭亚君, 王娜, 任达飞. 基于lasso回归建立初中生超重肥胖的列线图预测模型. 现代预防医学, 2025 , 52 (11) : 2003 -2008 . DOI: 10.20043/j.cnki.MPM.202501148
Jun HU, Feng HONG, Ya-jun GUO, Na WANG, Da-fei REN. Establishment of a nomogram prediction model for overweight and obesity in middle school students based on Lasso regression[J]. Modern Preventive Medicine, 2025 , 52 (11) : 2003 -2008 . DOI: 10.20043/j.cnki.MPM.202501148
在全球范围内,儿童青少年超重肥胖已成为日益严重的公共卫生问题。我国中小学生超重、肥胖率分别从2016年的22.3%、9.1%上升到了2020年的26.7%、11.6%[1]。根据最新版《世界肥胖地图》报告,预计2020 —2035年间我国儿童青少年肥胖率上升速度远超成年人,我国儿童青少年肥胖年增长率高达6.6%[2]。儿童青少年时期超重肥胖不仅影响生长发育,还可能持续到成年,增加患心血管疾病、糖尿病和癌症等疾病风险[3-4]。超重和肥胖对儿童的学习能力和心理健康产生负面影响,进而影响其学业成绩和社会适应能力[5]。研究表明,情绪性进食、不规律的饮食习惯等均与超重肥胖密切相关[6]。初中生正处于身心发展和自我意识形成的关键阶段,在面对自我认同、自尊和社会适应等问题时,可能容易出现异常进食行为等。列线图(nomogram)作为一种直观的预测工具,能够将多个预测变量综合为一个易于理解的风险评估系统,其预测能力优于其他预测模型,已被广泛应用于医学和公共卫生领域[7]。因此,本研究通过分析贵州省铜仁市初中生超重肥胖影响因素,以回归分析筛选出的因素建立列线图预测模型。
本研究在95%的置信度下,采用公式对抽样调查样本量进行估算,Z=1.96,以贵州省2021年12~15岁年龄组儿童青少年超重肥胖检出率21.48%[8]作为P的估计值,d=0.02(为检出率的10%左右)。计算上述样本量为1 620人,考虑无应答和无效问卷,增加10%的样本量,确定可达到统计学意义的最小调查样本量为1 782人。
本研究于2024年9 —11月在铜仁市10个区(县)范围内进行横断面调查,采用多阶段分层整群抽样的方法,在每个区(县)随机抽取2所初中学校,每所学校的七至九年级每分别抽取2个班级,所选班级所有学生全部作为调查对象。纳入标准:依从性较好;自愿参与研究项目,并签署知情同意书。排除标准:调查期间缺勤未参加监测学生;不愿意参加本研究;详细询问肥胖儿童患病史,排除继发性肥胖病。本次共选择20所初中(七至九年级)的5 989名学生进行体格检查和问卷调查。最终回收问卷5 597份(回收率93.45%),其中有效问卷5 135份(有效回收率91.75%)。预计训练集样本量至少为1 782例,根据外部验证样本量一般为建模集1/4~1/2的原则[9],将纳入对象按区(县)分为训练集3 093例及验证集1 042例。本研究经铜仁市疾病预防控制中心伦理委员会审核批准(批号:铜疾伦审(2024)2号),研究对象及其监护人均知情同意且自愿参与。
包括学生性别、年龄、年级、学校所在地、住校情况、饮食和运动行为因素以及父母体型情况等。
采用中文版荷兰饮食行为问卷(C-DEBQ)[10]调查学生的异常进食行为。该问卷共33个题目,分为限制性、情绪性和外因性进食三个维度。问卷采用李克特5级计分法,从1分(从不)到5分(总是),问卷得分越高,表示相应进食行为水平越高。在本研究中,该问卷总量表Cronbach α系数为0.860。
体检人员培训考核合格,采用已校准的仪器设备测量身高、体重,分别精确至0.1 cm、0.1 kg,并抽取5%的学生进行抽样复测。计算身体质量指数(BMI)=体重(kg)/身高的二次方(m2)。依据《学龄儿童青少年超重肥胖筛查》WS /T 586—2018[11]进行分类。
统一培训调查员,问卷由学生自行现场填写,调查员应用通俗易懂的语言向调查对象解释调查表内容,但避免使用引导性或暗示性语言影响调查对象作答,填写完成后由调查员及时核查有无问题遗漏,确认后收回。
采用软件R 4.2.3和SPSS 26.0对数据进行统计分析。计数资料用例数和百分比描述,采用χ2检验分析组间超重肥胖率的差异。正态分布的连续数据表示为(均值±标准差),并使用t检验进行分析。对于非正态分布的连续数据,报告中位数和四分位数范围,并使用Mann-Whitney U检验进行比较。使用lasso回归和logistic回归筛选影响因素以建立列线图风险预测模型。采用受试者工作特征曲线(ROC)、校准曲线图分别评估模型的区分度和校准度,Hosmer-Lemeshow检验判断模型的拟合度。检验水准α=0.05。
本研究共纳入5 135名初中生,其中检出超重肥胖学生1 285名(25.02%)。超重肥胖组和非超重肥胖组在性别、学校所在地、住校情况、每天吃谷物/杂粮或杂豆、每顿饭都吃新鲜蔬果、每天中高等强度活动1 h、定期测量体重、父母都不胖、限制性进食评分、情绪性进食评分、外因性进食评分方面存在统计学差异(P<0.05)。见表1。两组间无统计学差异的其他因素,未在表格中列出(P>0.05)。
将单因素分析中具有统计学意义的变量作为自变量,超重肥胖为因变量建立lasso回归模型,见图1。结合交叉验证图,选择lambda.min=0.000 367,此时均方差误最小,模型拟合效果最好。将筛选后的11个变量纳入多因素logistic回归分析,结果显示女生、住校、每顿饭都吃新鲜蔬果、每天中高等强度活动1 h、父母都不胖、外因性进食评分高是预防超重肥胖的保护因素,限制性进食评分高、情绪性进食评分高是超重肥胖的危险因素。见表2
根据lasso和logistic回归分析的结果,建立一个由8个预测变量(女生、住校、每顿饭都吃新鲜蔬果、每天中高等强度活动1 h、父母都不胖、限制性进食评分、情绪性进食评分、外因性进食评分)组成的列线图预测模型。根据不同的变量,在列线图的顶部画一条垂直线,得到相应的分数。将各个变量的分数相加得到总分,在列线图底部得到相应的风险总分,影响因素总分越高,超重肥胖风险越大。见图2
绘制ROC曲线以评估模型的准确性,分析结果显示训练集列线图预测学生超重肥胖的曲线下面积(area under the curve,AUC)为0.790(95%CI:0.775~0.806),灵敏度为69.7%,特异度为75.8%,验证集列线图预测模型的AUC为0.765(95%CI:0.731~0.799),灵敏度为71.6%,特异度为70.7%,表明该列线图预测模型区分度良好。模型Brier得分为0.15,表明绘制校准曲线实际值和预测值一致性良好,模型与观察数据吻合度较高。Hosmer-Lemeshow检验结果为χ2= 10.984,P=0.203,提示所建立模型拟合优度良好。见图3
近年来,我国儿童青少年的超重肥胖率呈持续上升趋势[12-13]。超重肥胖的危害不仅是对个体健康产生负面影响,还可能增加成年期慢性疾病的风险。因此,早期建立预测模型、识别高危人群是预防的关键,并采取有效干预措施降低超重肥胖的发生风险。本研究通过lasso回归和多因素logistic回归相结合的分析方法筛选出了8个超重肥胖的影响因素,并建立列线图预测模型,以预测学生超重肥胖的发生风险,为超重肥胖防控提供参考。
本研究结果显示,铜仁市初中生的超重肥胖检出率为25.02%,高于2021年贵州省12~15岁儿童青少年超重肥胖率的20.80%[8]。女生的超重肥胖风险低于男生,与既往调查结果一致[14]。走读生在外就餐可能性更大,更容易选择高热量、高脂肪的不健康食物,从而增加了超重肥胖的风险[15-16]。研究表明,遗传因素在超重肥胖的影响中起着重要作用,肥胖具有一定的遗传易感性[17],本研究也发现父母均不胖的学生超重肥胖风险更低。每天进行1 h的中高等强度身体活动可能是降低超重肥胖率的有效措施。本次研究发现每顿饭都吃新鲜蔬果会增加超重肥胖风险,与其他研究结果不一致[18]。也有研究指出水果摄入量较高或较低均可能是儿童超重肥胖的危险因素[19]。此外,新鲜蔬菜、水果中的高果糖可能促进能量储存而非利用,与肥胖发生有关[20]
在异常进食行为方面,超重肥胖组学生限制性进食和情绪性进食得分更高,而外因性进食得分更低,相关研究结论相同[21]。本研究中学生外因性进食得分普遍较高,表明学生往往会受到外部因素的影响而进食,非内在的饥饿感或饱腹感驱动。可能由于超重肥胖学生对体重的担忧或自身形象的关注,从而表现出外因性进食行为水平更低。与此同时,限制性进食也是个体为了控制体重而严格限制食物摄入,是超重肥胖的危险因素。限制性饮食者可能因为长期严格的饮食限制可能导致进食行为的去抑制效应,产生暴饮暴食的心理机制,从而导致体重反弹或增加[22]。而情绪性进食是指个体在面对负面情绪时,通过进食来寻求安慰或逃避的一种心理行为,这种行为模式往往倾向于选择高热量、高脂肪的食物,从而增加超重肥胖风险[6,23]
本研究基于横断面数据,通过lasso回归和logistic回归相结合的分析方法筛选出预测变量,降低多重共线性的可能性,使筛选变量更具有代表性从而提高了预测模型的可靠性。回归列线图将logistic回归的结果可视化,直观地预测个体发生超重肥胖的风险。为进一步验证模型的区分度与准确度,本研究中训练集和验证集ROC曲线下面积分析结果显示,AUC均大于0.7,且敏感度和特异度均较高,表明本研究建立的列线图预测模型具有较好的区分度,可识别出超重肥胖风险较高的学生。进一步采用校准曲线进行验证结果显示,训练集与验证集的预测概率与实际发生概率一致性良好,曲线拟合优度较好。
综上所述,本研究建立的超重肥胖风险列线图预测模型区分度和准确度良好,具有较好的预测效能,在常见病监测工作中有助于早期筛查出超重肥胖学生并加以干预。本研究存在一定的局限性,一方面,横断面研究限制了因果关系推断;另一方面,只分析了部分青少年超重肥胖的影响因素。未来,我们应该进一步开展多因素研究,以降低学生超重肥胖的发生风险。
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doi: 10.20043/j.cnki.MPM.202501148
  • 接收时间:2025-01-10
  • 首发时间:2026-03-18
  • 出版时间:2025-06-10
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    1.贵州医科大学公共卫生与健康学院,环境污染与疾病监控教育部重点实验室,贵州 贵阳 561113
    2.贵州省铜仁市疾病预防控制中心,贵州 铜仁 554300

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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
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红菇属 Russula 17 8.13
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