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Article(id=1241102817318981861, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241102813938380911, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202404271, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1713196800000, receivedDateStr=2024-04-16, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773831570224, onlineDateStr=2026-03-18, pubDate=1724515200000, pubDateStr=2024-08-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773831570224, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773831570224, creator=13701087609, updateTime=1773831570224, updator=13701087609, issue=Issue{id=1241102813938380911, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='16', pageStart='2881', pageEnd='3072', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773831569418, creator=13701087609, updateTime=1773831807198, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241103811318706322, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241102813938380911, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241103811318706323, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241102813938380911, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=3004, endPage=3009, ext={EN=ArticleExt(id=1241102819516797218, articleId=1241102817318981861, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Mediating effect of depressive symptoms in the association between unhealthy lifestyle and body mass index in adolescents, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the mediating effect of depressive symptoms between unhealthy lifestyle and body mass index (BMI), and to provide a reference basis for the prevention of common diseases among adolescents.

Methods

In 2023, 88, 594 students were selected by random stratified, class-based cluster sampling method from 12 municipalities in Inner Mongolia (103 counties) for questionnaire survey, to describe the basic demographic characteristics of the students, to explore the correlation between unhealthy lifestyle, depressive symptoms and BMI, and to establish the mediation effect model by using the PROCESS macro program in SPSS 26.0.

Results

The number of detections of unhealthy lifestyle was 85 866, with a detection rate of 96.92 percent; the number of detections of abnormal BMI was 32 078, with a detection rate of 36.21 per cent; and the number of detections of depressive symptoms was 19, 356, with a detection rate of 21.85 per cent. The results showed that the mediating effect value of depressive symptoms on unhealthy lifestyle and body mass index was 0.0770, 95%CI: 0.0513-0.1027, and the mediating effect accounted for 11.35% of the total effect, which indicated that unhealthy lifestyle could mediate the increase of BMI through depressive symptoms.

Conclusion

Adolescents can prevent abnormal body mass index by improving unhealthy lifestyles, and they can also improve the occurrence of depressive symptoms and thus maintain a normal body mass index.

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目的

分析抑郁症状在不健康生活方式与体质量指数(BMI)之间的中介效应，为预防青少年的常见病提供参考依据。

方法

于2023年在内蒙古地区12个盟市(103个旗县)范围内通过随机分层、以班为单位整群抽样法抽取88 594名学生进行问卷调查，描述学生基本人口学特征，探究不健康生活方式、抑郁症状与BMI之间的相关关系，采用SPSS 26.0中的PROCESS宏程序建立中介效应模型。

结果

不健康生活方式的检出人数为85 866，检出率为96.92%；BMI异常的检出人数为32 078，检出率为36.21%；抑郁症状检出人数为19 356，检出率为21.85%。结果显示抑郁症状在不健康生活方式与体质量指数之间的中介效应值为0.077 0，95%CI：0.051 3~0.102 7，中介效应占总效应的11.35%，说明不健康生活方式可以通过抑郁症状介导BMI的增加。

结论

青少年可以通过改善不健康的生活方式预防体质量指数的异常，也可以通过改善抑郁症状的发生从而保持正常的体质指数。

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杨田，E-mail： ；
张秀红，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=vwfhPq55IDVG/KhfJWIAmg==, magXml=g8akD77oLcGR/tDwJM/m6g==, pdfUrl=null, pdf=44RkX4lMa5So+/x70nGxmQ==, pdfFileSize=665342, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=7IZal5hDYECKb5jj8BnVkA==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=l0VrJjIF+jmep/8bzDUFBQ==, mapNumber=null, authorCompany=null, fund=null, authors=

马彩霞（1996—），女，硕士在读，研究方向：学校卫生方向

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Current Obesity Reports, 2018, 7(2): 193-203., articleTitle=Stress and obesity: Are there more susceptible individuals?, refAbstract=null)], funds=[Fund(id=1241102825892139712, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102817318981861, awardId=2024QN08077, language=CN, fundingSource=内蒙古自治区自然科学基金(2024QN08077), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241102820846391681, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102817318981861, xref=1., ext=[AuthorCompanyExt(id=1241102820850585986, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102817318981861, companyId=1241102820846391681, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Public Health, Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region 010059, China), AuthorCompanyExt(id=1241102820858974595, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102817318981861, companyId=1241102820846391681, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.内蒙古医科大学公共卫生学院，内蒙古自治区，呼和浩特市 010059)]), AuthorCompany(id=1241102820926083469, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102817318981861, xref=2., ext=[AuthorCompanyExt(id=1241102820934472078, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102817318981861, companyId=1241102820926083469, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.内蒙古自治区疾病预防控制中心学校卫生所)])], figs=[ArticleFig(id=1241102824742900340, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102817318981861, language=EN, label=Fig.1, caption=Modelling the mediating effect of depressive symptoms between unhealthy lifestyle and body mass index, figureFileSmall=+s+2Wpu3ZbSODi+8YvoSlQ==, figureFileBig=7IZal5hDYECKb5jj8BnVkA==, tableContent=null), ArticleFig(id=1241102824856146557, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102817318981861, language=CN, label=图1, caption=抑郁症状在不健康生活方式与体质量指数之间的中介效应模型

注：a表示P<0.001。

, figureFileSmall=+s+2Wpu3ZbSODi+8YvoSlQ==, figureFileBig=7IZal5hDYECKb5jj8BnVkA==, tableContent=null), ArticleFig(id=1241102825216856714, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102817318981861, language=EN, label=Table 1, caption=

Results of analysing the basic characteristics and body mass index (BMI) influencing factors of secondary school students

, figureFileSmall=null, figureFileBig=null, tableContent=
变量人数[n(%)]BMI(kg/m2,)t/F值P值
性别18.948<0.001
男43 616(49.23)22.51±5.13
女44 978(50.77)21.90±4.40
居住地13.951<0.001
城区27 824(31.41)22.54±4.88
郊县60 770(68.59)22.05±4.73
学段647.924<0.001
初中53 431(60.31)21.74±4.72
高中30 505(34.43)22.89±4.73
职高4 658(5.26)23.02±4.78
年级221.943<0.001
初一17 882(20.18)21.20±4.63
初二17 823(20.12)21.77±4.62
初三17 726(20.01)22.25±4.86
高一10 378(11.7122.78±4.83
高二10 189(11.50)22.84±4.68
高三9 938(11.22)23.07±4.68
职高一1 541(1.74)22.94±5.18
职高二1 619(1.83)23.23±5.26
职高三1 498(1.69)22.88±4.80
家庭结构5.570<0.001
稳定65 878(74.36)22.26±4.77
不稳定22 716(25.64)22.05±4.80
是否独生子16.907<0.001
是35 885(40.51)22.54±4.96
否52 709(59.49)21.98±4.64
是否住校8.537<0.001
否55 620(62.78)22.31±4.90
是32 974(37.22)22.03±4.58
父亲学历37.536<0.001
初中及以下54 462(61.47)22.10±4.74
高中或中专26 764(30.21)22.34±4.83
大专或以上7 368(8.32)22.43±4.87
母亲学历40.081<0.001
初中及以下56 054(63.27)22.10±4.73
高中或中专24 919(28.13)22.35±4.83
大专或以上7 621(8.60)22.44±4.90
), ArticleFig(id=1241102825330102933, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102817318981861, language=CN, label=表1, caption=

中学生基本特征及体质量指数(BMI)影响因素分析结果

, figureFileSmall=null, figureFileBig=null, tableContent=
变量人数[n(%)]BMI(kg/m2,)t/F值P值
性别18.948<0.001
男43 616(49.23)22.51±5.13
女44 978(50.77)21.90±4.40
居住地13.951<0.001
城区27 824(31.41)22.54±4.88
郊县60 770(68.59)22.05±4.73
学段647.924<0.001
初中53 431(60.31)21.74±4.72
高中30 505(34.43)22.89±4.73
职高4 658(5.26)23.02±4.78
年级221.943<0.001
初一17 882(20.18)21.20±4.63
初二17 823(20.12)21.77±4.62
初三17 726(20.01)22.25±4.86
高一10 378(11.7122.78±4.83
高二10 189(11.50)22.84±4.68
高三9 938(11.22)23.07±4.68
职高一1 541(1.74)22.94±5.18
职高二1 619(1.83)23.23±5.26
职高三1 498(1.69)22.88±4.80
家庭结构5.570<0.001
稳定65 878(74.36)22.26±4.77
不稳定22 716(25.64)22.05±4.80
是否独生子16.907<0.001
是35 885(40.51)22.54±4.96
否52 709(59.49)21.98±4.64
是否住校8.537<0.001
否55 620(62.78)22.31±4.90
是32 974(37.22)22.03±4.58
父亲学历37.536<0.001
初中及以下54 462(61.47)22.10±4.74
高中或中专26 764(30.21)22.34±4.83
大专或以上7 368(8.32)22.43±4.87
母亲学历40.081<0.001
初中及以下56 054(63.27)22.10±4.73
高中或中专24 919(28.13)22.35±4.83
大专或以上7 621(8.60)22.44±4.90
), ArticleFig(id=1241102825413989018, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102817318981861, language=EN, label=Table 2, caption=

Correlation coefficients of unhealthy lifestyle, depressive symptoms and body mass index

, figureFileSmall=null, figureFileBig=null, tableContent=
变量BMI不健康生活方式抑郁状况
BMI1.00
不健康生活方式0.12a1.00
抑郁症状0.09a0.21a1.00
), ArticleFig(id=1241102825539818146, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102817318981861, language=CN, label=表2, caption=

不健康生活方式、抑郁症状与体质量指数的相关系数

, figureFileSmall=null, figureFileBig=null, tableContent=
变量BMI不健康生活方式抑郁状况
BMI1.00
不健康生活方式0.12a1.00
抑郁症状0.09a0.21a1.00
), ArticleFig(id=1241102825661452970, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102817318981861, language=EN, label=Table 3, caption=

Analysis of the mediating effect of depressive symptoms between unhealthy lifestyle and body mass index

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效应类型路径效应值(95%CI)标准误P值
总效应c0.086 8(0.061 6~0.002 1)0.012 9<0.001
直接效应c’0.077 0(0.051 3~0.102 7)0.013 1<0.001
a1.448 2(1.554 5~2.631 2)0.024 6<0.001
b0.006 8(0.003 4~0.010 3)0.001 8<0.001
间接效应不健康生活方式-抑郁症状-BMI0.009 9(0.004 9~0.014 9)0.002 6<0.001
), ArticleFig(id=1241102825741144751, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102817318981861, language=CN, label=表3, caption=

抑郁症状在不健康生活方式与体质量指数之间的中介效应分析

, figureFileSmall=null, figureFileBig=null, tableContent=
效应类型路径效应值(95%CI)标准误P值
总效应c0.086 8(0.061 6~0.002 1)0.012 9<0.001
直接效应c’0.077 0(0.051 3~0.102 7)0.013 1<0.001
a1.448 2(1.554 5~2.631 2)0.024 6<0.001
b0.006 8(0.003 4~0.010 3)0.001 8<0.001
间接效应不健康生活方式-抑郁症状-BMI0.009 9(0.004 9~0.014 9)0.002 6<0.001
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抑郁症状在青少年不健康生活方式与体质量指数关联中的中介效应
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马彩霞 1, 2 , 杨田 2 , 张秀红 2 , 高昇 2 , 马鑫悦 2
现代预防医学 | 健康与社会行为 2024,51(16): 3004-3009
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现代预防医学 | 健康与社会行为 2024, 51(16): 3004-3009
抑郁症状在青少年不健康生活方式与体质量指数关联中的中介效应
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马彩霞1, 2, 杨田2 , 张秀红2 , 高昇2, 马鑫悦2
作者信息
  • 1.内蒙古医科大学公共卫生学院，内蒙古自治区，呼和浩特市 010059
  • 2.内蒙古自治区疾病预防控制中心学校卫生所

    • 马彩霞（1996—），女，硕士在读，研究方向：学校卫生方向

通讯作者:

杨田，E-mail： ；
张秀红，E-mail：
Mediating effect of depressive symptoms in the association between unhealthy lifestyle and body mass index in adolescents
Cai-xia MA1, 2, Tian YANG2 , Xiu-hong ZHANG2 , Sheng GAO2, Xin-yue MA2
Affiliations
  • School of Public Health, Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region 010059, China
出版时间: 2024-08-25 doi: 10.20043/j.cnki.MPM.202404271
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摘要
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目的

分析抑郁症状在不健康生活方式与体质量指数(BMI)之间的中介效应，为预防青少年的常见病提供参考依据。

方法

于2023年在内蒙古地区12个盟市(103个旗县)范围内通过随机分层、以班为单位整群抽样法抽取88 594名学生进行问卷调查，描述学生基本人口学特征，探究不健康生活方式、抑郁症状与BMI之间的相关关系，采用SPSS 26.0中的PROCESS宏程序建立中介效应模型。

结果

不健康生活方式的检出人数为85 866，检出率为96.92%；BMI异常的检出人数为32 078，检出率为36.21%；抑郁症状检出人数为19 356，检出率为21.85%。结果显示抑郁症状在不健康生活方式与体质量指数之间的中介效应值为0.077 0，95%CI：0.051 3~0.102 7，中介效应占总效应的11.35%，说明不健康生活方式可以通过抑郁症状介导BMI的增加。

结论

青少年可以通过改善不健康的生活方式预防体质量指数的异常，也可以通过改善抑郁症状的发生从而保持正常的体质指数。

不健康生活方式  /  抑郁症状  /  青少年  /  中介效应
Objective

To analyze the mediating effect of depressive symptoms between unhealthy lifestyle and body mass index (BMI), and to provide a reference basis for the prevention of common diseases among adolescents.

Methods

In 2023, 88, 594 students were selected by random stratified, class-based cluster sampling method from 12 municipalities in Inner Mongolia (103 counties) for questionnaire survey, to describe the basic demographic characteristics of the students, to explore the correlation between unhealthy lifestyle, depressive symptoms and BMI, and to establish the mediation effect model by using the PROCESS macro program in SPSS 26.0.

Results

The number of detections of unhealthy lifestyle was 85 866, with a detection rate of 96.92 percent; the number of detections of abnormal BMI was 32 078, with a detection rate of 36.21 per cent; and the number of detections of depressive symptoms was 19, 356, with a detection rate of 21.85 per cent. The results showed that the mediating effect value of depressive symptoms on unhealthy lifestyle and body mass index was 0.0770, 95%CI: 0.0513-0.1027, and the mediating effect accounted for 11.35% of the total effect, which indicated that unhealthy lifestyle could mediate the increase of BMI through depressive symptoms.

Conclusion

Adolescents can prevent abnormal body mass index by improving unhealthy lifestyles, and they can also improve the occurrence of depressive symptoms and thus maintain a normal body mass index.

Unhealthy lifestyle  /  Depressive symptoms  /  Adolescents  /  Mediating effect
马彩霞, 杨田, 张秀红, 高昇, 马鑫悦. 抑郁症状在青少年不健康生活方式与体质量指数关联中的中介效应. 现代预防医学, 2024 , 51 (16) : 3004 -3009 . DOI: 10.20043/j.cnki.MPM.202404271
Cai-xia MA, Tian YANG, Xiu-hong ZHANG, Sheng GAO, Xin-yue MA. Mediating effect of depressive symptoms in the association between unhealthy lifestyle and body mass index in adolescents[J]. Modern Preventive Medicine, 2024 , 51 (16) : 3004 -3009 . DOI: 10.20043/j.cnki.MPM.202404271
正文
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随着经济水平的不断提高，人们的生活方式也发生了巨大的变化，不健康的生活方式也越来越严重[1-2]。体质量指数(body mass index ，BMI)作为身高、体重的综合指标，它主要反应身体的营养状况，从而判断身体的健康水平[3]。已有研究表明不良生活方式会对营养状况产生负面影响，主要表现为BMI会偏离正常范围[4]。BMI异常会影响青少年的身心健康，会导致青少年的代谢紊乱、降低心肺耐力，甚至引起一系列的代谢疾病，并且这些疾病的风险因素会延续到成年期，增加成年期患心血管疾病的风险[5-6]。相关研究证实了单一饮食、久坐等与BMI存在关联[7-8]。因此，探讨不健康生活方式对BMI的影响及其作用机制，对预防青少年BMI异常具有重要意义。
抑郁症状是影响青少年身心健康常见的公共卫生问题之一[9]。既往研究表明不健康饮食模式与抑郁存在显著相关[10]，既往研究表明[11-12]，儿童青少年抑郁障碍患者肥胖患病率显著高于健康群体。基于以往研究成果，本研究主要探讨不健康生活方式与BMI之间的直接关联以及抑郁症状在不健康生活方式与BMI之间的中介效应，为预防青少年BMI异常提供科学依据。
1　对象与方法
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1.1　对象
数据的收集在2023年9—11月进行，覆盖内蒙古地区12个盟市(103个旗县)，为保证数据的真实、有效性，采用随机、整群抽样法并按照年级分层，整班纳入研究对象，每个城区直接抽取2所初中、2所普通高中及1所职业高中；每个旗县直接抽取2所初中、1所高中。每个年级抽选2~3个班级，目的是保证每个年级至少抽取80名学生，研究对象不足时可由附近同等类型学校作为补充。本研究共纳入88 594名学生。并按照伦理学要求所有参与对象签署知情同意书，研究通过内蒙古自治区疾病控制中心伦理委员会审批(202309271)。
1.2　方法
1.2.1　一般情况调查
问卷内容根据《全国学生常见病和健康影响因素监测与干预工作方案》[13],内容包含学生的年龄、性别、居住地、年级、家庭类型、是否独生子女、父母学历、住校情况等基本情况，日常饮食情况，户外活动情况，睡眠情况及吸烟饮酒等不良行为等。
1.2.2　相关指标定义
(1)不健康生活方式：参考既往研究[14]，并根据全国学生常见病和健康影响因素监测与干预工作方案[13],本研究纳入的生活方式包括一周内是否喝含糖饮料、一周内是否吃油炸食品、是否吸烟、是否饮酒、户外活动时间和睡眠时间六个条目。每种生活方式未达标定义为1分，达标定义为0分。生活方式条目得分累计即为不健康生活方式的总分，分值范围为0(无不健康生活方式)~6分(具有6种不健康生活方式)。睡眠时间<8 h为青少年不健康睡眠时间[15]，户外活动时间<2 h为不达标的户外活动时间[16],曾经吸过烟，即使只吸过一两口定义为不健康吸烟[13],曾经喝过一整杯酒定义为不健康喝酒[13]。(2)抑郁症状：根据流调中心抑郁量表(Center for Epidemiologic Studies Depression Scale，CES-D)进行评估[16]，量表共包含4项正向情感和16项负向情感，正向情感分别为4，8，12，16。填表时要求受试者说明最近一周内症状出现的频度,回答时采用4级分制,正向计分为“没有或偶尔=0分,有时=1分,时常或一半时间=2分,多数时间或持续=3分”,其中正向情感采用反向计分,量表总得分为0~60分,分数越高表明抑郁程度越高。CES-D被广泛用于人群抑郁症状的筛查，适用于青少年，具有较好的信度、效度[17]。本研究中Cronbach α系数为0.87。(3)体质量指标：根据全国学生常见病和健康影响因素监测与干预工作方案，身高测量使用机械式身高计，测量时受检者赤足，躯干自然挺直头部正直，两眼平视前方，成“三点一线”站立姿势，测量误差不得超过0.5 cm；体重测量使用电子体重计，受检者赤足，自然站立在体重计量盘中央并保持身体平稳，测量误差不得超过0.1 kg，计算BMI=体重(kg)/[身高(m)]2[18]。
1.3　质量控制
为保证问卷的有效性，在开展调查前应对相关人员进行培训，学生填写问卷前，监察人员进行相关讲解，调查进行中保证学生不受其他人员干扰，问卷收集后要及时剔除有明显错误的问卷并选取5%的学生进行现场复核。
1.4　统计学方法
连续性变量采用进行描述，分类变量使用频数和百分数进行描述。两组间的比较采用两独立样本t检验，多组间的比较采用方差分析，变量之间的相关性采用Pearson相关分析。应用SPSS 26.0中的PROCESS宏程序建立中介效应模型，分析抑郁症状在不健康生活方式与BMI之间的中介效应，检验水准α=0.05。
2　结果
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2.1　研究对象的基本特征
本研究共纳入88 594名学生，平均年龄为(15.00±1.73)岁，男性43 616人，占49.23%，女性44 978人，占50.77%；不健康生活方式平均值为(3.00±1.29)分；BMI的平均值为(22.20±4.78) kg/m2；抑郁症状评分平均值为(12.33±9.31)分，BMI异常的检出率为36.21%，抑郁症状的检出率为21.85%。研究对象体质量指数的影响因素分析中性别、居住地、学段、年级、家庭结构、是否独生子、是否住校、父母学历高的青少年BMI评分差异均有统计学意义(P<0.001)。结果显示男性、居住在城区、稳定家庭、独生子女、住校的青少年BMI评分高，初中、高中、职高学生的BMI是逐渐增高的，职高二的学生BMI值是最高，随着父母学历的提升，学生的BMI值是呈上升的。见表1。
2.2　青少年不健康生活方式、抑郁症状与BMI的关联性分析
控制性别、居住地、学段、年级、家庭结构、是否独生子、是否住校、父母学历等协变量之后，青少年不健康生活方式、抑郁症状与BMI的相关性如表2。研究结果表明不健康生活方式与BMI呈正相关，相关系数r=0.12(P<0.01)，不健康生活方式与抑郁症状呈正相关r=0.21(P<0.01)，抑郁症状与BMI呈正相关r=0.09(P<0.01)。
2.3　抑郁症状在不健康生活方式与BMI之间的中介效应分析
在控制性别、居住地、学段、年级、家庭结构、父母学历、是否独生子、是否住校等相关协变量的情况下，对抑郁症状进行中介效应检验，见表3。不健康生活方式对于BMI的总效应为0.086 8，在控制了抑郁症状这个中介效应后，不健康生活方式对BMI的直接效应为0.077 0，抑郁症状在不健康生活方式与BMI之间起部分中介作用。抑郁症状的中介效应为0.009 9(P均<0.001)，中介效应的占比为11.35%。路径的效应值见图1。
3　讨论
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研究中88 594名青少年中BMI的平均值是22.20 kg/m2。城区学生超重肥胖率为38.17%，旗县学生的超重肥胖率为35.31%。城区学生的超重肥胖率高于旗县，可能是因为城区家庭的经济水平比农村高，使城区学生比旗县学生更容易摄入高能量的饮食[19]。不住校学生的BMI高于住校学生，与李国星等[20]的研究结果一致。可能是学校餐厅的食物营养搭配更加合理，菜品更加丰富有关。家庭因素方面，稳定型家庭学生的BMI高于不稳定型家庭，独生子女BMI高于非独生子女，可能与独生子女更容易受到父母的溺爱，父母更加纵容孩子不良饮食习惯、不良生活习惯有关；父母学历高的学生BMI高于父母学历低的学生，冉飞等[21]的研究表明父母学历越高的儿童青少年膳食质量越好，与本研究的结果相反，可能是因为调查方法的不同，造成结果的不一致。关于父母学历对儿童体质量指数的影响，还有待于进一步的深入研究。
本研究表明，对协变量进行控制后，不健康生活方式得分越高，体质量指数越高，本次不健康生活方式包括睡眠时间、吸烟、饮酒、户外活动、是否喝含糖饮料和是否吃油炸食品。既往研究表明夜间睡眠时间不足与超重肥胖高风险相关[22],可能与代谢和内分泌相关，睡眠时间不足导致肾上腺分泌的皮质醇增加，生长素释放肽水平增加、使瘦素水平降低[23]，增加饥饿感、食欲，促进食物摄入。此外，夜间睡眠不足会增加暴饮暴食发生概率[24]，且睡眠时长不足会产生疲劳，从而减少体力活动，降低能量消耗，导致体质量指数升高[25]。关于吸烟对BMI的影响，现在还存在一定的争议，有研究表明吸烟会使BMI增加[26]，也有研究认为吸烟会使BMI降低，可能与烟草中的尼古丁会降低食欲，使代谢加快有关[27]。但范莉莉等[28]的研究表明二手烟是BMI增加的独立危险因素。研究中饮酒会使体质量指数升高，既往报道乙醇进入人体内会刺激下丘脑，从而使内分泌代谢紊乱，摄入热量过剩，同时乙醇在体内优于代谢，导致脂肪代谢减少在体内堆积增加，使BMI升高[29]。研究表明户外活动可以有效降低体质量指数[30]，户外活动与运动可以动员身体肌肉组织，使血液中游离脂肪酸、葡萄糖利用率大大增加，促进β氧化途径，抑制体内脂肪累积[31]。既往研究表明高糖高脂饮食会引起下丘脑-垂体-肾上腺(HPA)轴功能紊乱,导致体质量指数的升高[32]。
研究发现,不健康生活方式与抑郁症状呈正相关关系。叶盛[33]关于中学生视屏和睡眠时间与抑郁症状的相关性研究表明睡眠时间不足、吸烟、饮酒与抑郁症状呈正相关。张秀红等[34]的研究表明喝含糖饮料与吃油炸食品与抑郁症状呈正相关。因此，青少年可以通过改善不健康的生活方式，减少抑郁症状的发生。此外，抑郁症状与体质量指数呈正相关。相关研究表明青少年抑郁障碍与肥胖之间的关系是双向的，抑郁障碍青少年肥胖风险增加70%;同时，肥胖青少年抑郁风险增加40%[12]。
中介模型显示不健康生活方式可以通过抑郁症状影响青少年的体质量指数,一项大样本研究表明抑郁症状与BMI具有很强的遗传相关性[35]，说明二者可能存在共同的遗传基础。Mulugeta等[36]的研究也发现抑郁症患者具有更高BMI的遗传易感性。抑郁症状会导致下丘脑-垂体-肾上腺轴(hypothalamic pituitary adrenal axis，HPA)过度激活，过量皮质醇释放，会导致体质量指数的升高[37]。
本研究的优势在于研究数据来源于全国学生常见病和健康影响因素监测与干预工作方案，调查了88 594名学生，为一项大样本研究其结果具有一定的代表性；探讨了抑郁症状在不健康生活方式与体质量指数中的中介效应，以往研究多局限与两者关系之间的研究。研究的局限性在于本次研究采用问卷调查，可能存在一定的信息偏倚；研究属于横断面研究，无法进行因果关系的推断，可进行纵向队列研究，对体质量指数异常的相关因素及发生机制做出具体的解释。
本次通过对中介效应的研究，为预防青少年体质量指数的异常提供理论依据。通过改善不健康生活方式来降低体质量指数的异常，也可以通过改善抑郁症状从而降低青少年的体质量指数，为青少年的健康成长保驾护航。
基金
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  • 内蒙古自治区自然科学基金(2024QN08077)
文献
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参考文献 引证文献
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2024年第51卷第16期
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doi: 10.20043/j.cnki.MPM.202404271
  • 接收时间：2024-04-16
  • 首发时间：2026-03-18
  • 出版时间：2024-08-25
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  • 收稿日期：2024-04-16
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内蒙古自治区自然科学基金(2024QN08077)
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    1.内蒙古医科大学公共卫生学院，内蒙古自治区，呼和浩特市 010059
    2.内蒙古自治区疾病预防控制中心学校卫生所

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杨田，E-mail： ；
张秀红，E-mail：
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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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