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Article(id=1241319152070226328, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241319148798669160, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202501102, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1736179200000, receivedDateStr=2025-01-07, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773883148447, onlineDateStr=2026-03-19, pubDate=1750780800000, pubDateStr=2025-06-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773883148447, onlineIssueDateStr=2026-03-19, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773883148447, creator=13701087609, updateTime=1773883148447, updator=13701087609, issue=Issue{id=1241319148798669160, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='12', pageStart='2113', pageEnd='2304', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773883147667, creator=13701087609, updateTime=1773885555254, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241329247004971040, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241319148798669160, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241329247004971041, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241319148798669160, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2126, endPage=2132, ext={EN=ArticleExt(id=1241319153865388469, articleId=1241319152070226328, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Association and gender differences between adverse childhood experiences and body roundness index among older people in China, columnId=1228016567443718970, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods Advances, runingTitle=null, highlight=null, articleAbstract=
Objective

Based on the life course theory, this study aims to understand the relationship between adverse childhood experiences (ACEs) and body roundness index (BRI) among Chinese older adults, as well as gender heterogeneity, in order to provide scientific evidence for the formulation of obesity prevention and control policies for older adults.

Methods

Data from 7 695 participants in the China Health and Retirement Longitudinal Study (CHARLS, 2013-2015) were analyzed. OLS regression and RCS models were used to assess the linear and dose-response relationships, respectively, and examine gender differences.

Results

Of the 7 695 older adults included in the analysis, those who had experienced ACEs exhibited higher BRI compared to those who had not (β1=0.68, P<0.01;β2=0.74, P<0.01;β3=0.78, P<0.01;β4=0.74, P<0.01). The impact of ACEs on BRI was partially explained by family environment, living conditions, and policy environment, as outlined in the theory of health ecology. The RCS results showed a significant non-linear inverted “J” shaped distribution between ACEs and BRI in the overall population. Gender heterogeneity was observed, with a significant non-linear inverted “U” shaped distribution among males and a significant non-linear relationship among females.

Conclusion

ACEs are significantly linked to BRI in Chinese seniors, with gender differences. This has key implications for policy improvement, emphasizing healthy environments, risk prevention, counseling, and early interventions to reduce future health risks.

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目的

基于生命历程理论，了解中国老年人早期逆境(ACEs)与身体圆润指数(BRI)之间的关系及性别异质性，进而为制定老年人肥胖防控政策提供科学依据。

方法

使用2013年、2014年和2015年中国健康与退休纵向研究数据库(CHARLS)中的7 695名参与者数据，首先运用最小二乘回归模型(OLS)评估ACEs与BRI之间的线性关系，后使用限制性立方样条模型(RCS)进一步探讨二者之间的剂量-反应关系，并分析性别异质性。

结果

纳入分析的7 695名中国老年人中，经历过ACEs的会表现出更高的BRI (β1=0.68, P<0.01;β2=0.74, P<0.01;β3=0.78, P<0.01;β4=0.74, P<0.01)，同时二者之间的关联能够部分被健康生态学理论中的家庭环境网络、生活条件和政策环境层所解释。RCS结果显示，全人群ACEs和BRI之间呈现显著非线性倒“J”型分布，男性呈现显著非线性倒“U”型分布，女性则为显著非线性正相关。

结论

中国老年人的ACEs与BRI显著相关，且存在性别差异。这一发现凸显了营造健康成长环境、从源头预防健康风险、加强心理疏导的重要性，以及在风险源头进行干预以降低未来健康风险的必要性，对公共政策的调整和完善具有重要启示作用。

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杨乐，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=jJWMnVJ69puObOkKeHQI4g==, magXml=Sc9uGZ7xCgBdOHM8wCRO0w==, pdfUrl=null, pdf=EMZ2mUbCT1RRKFR5fOx2oQ==, pdfFileSize=985943, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=M8niCeENgBKNcF8XhzuP3A==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=jgNaGig+qp00cuSu7Hbo1g==, mapNumber=null, authorCompany=null, fund=null, authors=

姚典瑞 (2001—)，女，硕士在读，研究方向：老年健康

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姚典瑞 (2001—)，女，硕士在读，研究方向：老年健康

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姚典瑞 (2001—)，女，硕士在读，研究方向：老年健康

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注:已控制性别、慢性病、吸烟、饮酒、锻炼时间、抑郁症状、医疗服务可及性、养老保险、医疗保险等变量。

, figureFileSmall=X8T73vFft/v8Xb+eldvDXQ==, figureFileBig=k+CBbNBMgbfDmWwSu8xlsQ==, tableContent=null), ArticleFig(id=1241319162975417214, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319152070226328, language=EN, label=Fig.3, caption=RCS curves of ACEs and BRI of older male, figureFileSmall=5Z67+7v+2IfHRGyEF2NYow==, figureFileBig=FYlaasFrpGTeLyxWU9eeXg==, tableContent=null), ArticleFig(id=1241319163155772301, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319152070226328, language=CN, label=图3, caption=ACEs与老年男性BRI的RCS曲线

注:已控制性别、慢性病、吸烟、饮酒、锻炼时间、抑郁症状、医疗服务可及性、养老保险、医疗保险等变量。

, figureFileSmall=5Z67+7v+2IfHRGyEF2NYow==, figureFileBig=FYlaasFrpGTeLyxWU9eeXg==, tableContent=null), ArticleFig(id=1241319163298378646, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319152070226328, language=EN, label=Fig.4, caption=RCS curves of ACEs and BRI of older female, figureFileSmall=F1UbPKM1Ngbx8kBZJkOFwQ==, figureFileBig=jDhB8M/pB3BTmRK8CCBEbQ==, tableContent=null), ArticleFig(id=1241319163432596382, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319152070226328, language=CN, label=图4, caption=ACEs与老年女性BRI的RCS曲线

注:已控制性别、慢性病、吸烟、饮酒、锻炼时间、抑郁症状、医疗服务可及性、养老保险、医疗保险等变量。

, figureFileSmall=F1UbPKM1Ngbx8kBZJkOFwQ==, figureFileBig=jDhB8M/pB3BTmRK8CCBEbQ==, tableContent=null), ArticleFig(id=1241319163571008426, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319152070226328, language=EN, label=Table 1, caption=

Basic characteristics of different BRI

, figureFileSmall=null, figureFileBig=null, tableContent=
变量BRI分组统计量P
1(n=1 578)2(n=1 583)3(n=1 358)4(n=1 583)5(n=1 593)
ACEs分组657.416<0.001
0525(33.27)533(33.67)363(26.73)94(5.94)90(5.65)
1132(8.37)144(9.10)123(9.06)202(12.76)176(11.05)
2160(10.14)166(10.49)172(12.67)232(14.66)235(14.75)
3311(19.71)260(16.42)278(20.47)434(27.42)457(28.69)
≥4450(28.52)480(30.32)422(31.08)621(39.23)635(39.86)
性别-2.2810.023
男性776(49.18)820(51.80)662(48.75)760(48.01)741(46.52)
女性802(50.82)763(48.20)696(51.25)823(51.99)852(53.48)
年龄(岁)72.05±6.8171.95±6.9972.04±7.0172.24±7.1472.23±7.111.0350.407
慢病情况,M(P25,P75)14(13,15)14(13,15)14(13,15)14(13,15)14(13,15)4.8910.173
自评健康2.8540.091
健康382(24.21)377(23.82)345(25.41)333(21.04)362(22.72)
不健康1 196(75.79)1 206(76.18)1013(74.59)1 250(78.96)1 231(77.28)
残疾状况3.2900.070
是527(33.40)548(34.62)468(34.46)485(30.64)509(31.95)
否1 051(66.60)1 035(65.38)890(65.54)1 098(69.36)1 084(68.05)
吸烟-5.266<0.001
是271(17.17)223(14.09)189(13.92)184(11.62)179(11.24)
否1 307(82.83)1 360(85.91)1 169(86.08)1 399(88.38)1 414(88.76)
饮酒-1.239<0.001
是525(33.27)570(36.01)501(36.89)573(36.20)566(35.53)
否1 053(66.73)1 013(63.99)857(63.11)1 010(63.80)1 027(64.47)
睡眠时间(h)6.42±1.926.28±1.846.30±1.826.32±1.836.27±1.825.9080.116
锻炼时间(h/d)-2.5020.012
<2717(45.44)721(44.55)623(45.88)748(47.25)789(49.53)
≥2861(54.56)862(54.45)735(54.12)835(52.75)804(50.47)
抑郁症状-9.296<0.001
否993(62.93)991(62.60)891(65.61)790(49.91)812(50.97)
是585(37.07)592(37.40)467(34.39)793(50.09)781(49.03)
住宅类型10.4280.236
社区居住1 549(98.16)1 561(98.61)1 341(98.75)1 549(97.85)1 562(98.05)
机构居住19(1.20)17(1.07)7(0.52)19(1.20)21(1.32)
其他10(0.63)5(0.32)10(0.74)15(0.95)10(0.63)
婚姻状况-0.8250.409
在婚状态1 360(86.19)1 362(86.04)1 186(87.33)1 358(85.79)1 357(85.19)
非在婚状态218(13.81)221(13.96)172(12.67)225(14.21)236(14.81)
学历7.9380.094
小学及以下1 428(90.49)1 470(92.86)1 245(91.68)1 435(90.65)1 466(90.65)
初中及以上150(9.51)113(7.14)113(8.32)148(9.35)148(9.35)
月收入(元)6.1760.628
≤1 0001 471(93.22)1 466(92.61)1 268(93.37)1 451(91.66)1 461(91.71)
1 000~3 00080(5.07)88(5.56)68(5.01)96(6.06)96(6.03)
≥3 00027(1.71)29(1.83)22(1.62)36(2.27)36(2.26)
医疗服务可及性948.660<0.001
综合医院1 307(82.83)1 316(83.13)1 156(85.13)875(55.27)924(58.00)
专科医院28(1.77)25(1.58)25(1.84)26(1.64)26(1.63)
社区卫生服务中心110(6.97)101(6.38)70(5.15)95(6.00)90(5.65)
卫生服务站18(1.14)17(1.07)18(1.33)475(30.01)429(26.93)
诊所115(7.29)124(7.83)89(6.55)112(7.08)124(7.78)
养老保险-2.2200.026
是1 474(93.41)1 442(91.09)1 253(92.27)1 430(90.33)1 455(91.34)
否104(6.59)141(8.91)105(7.73)153(9.67)138(8.66)
医疗保险-8.617<0.001
是1 456(92.27)1 441(91.03)1 229(90.50)1 343(84.84)1 345(84.43)
否122(7.73)142(8.97)129(9.50)240(15.16)248(15.57)
), ArticleFig(id=1241319163734586295, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319152070226328, language=CN, label=表1, caption=

不同BRI组的基线特征比较

, figureFileSmall=null, figureFileBig=null, tableContent=
变量BRI分组统计量P
1(n=1 578)2(n=1 583)3(n=1 358)4(n=1 583)5(n=1 593)
ACEs分组657.416<0.001
0525(33.27)533(33.67)363(26.73)94(5.94)90(5.65)
1132(8.37)144(9.10)123(9.06)202(12.76)176(11.05)
2160(10.14)166(10.49)172(12.67)232(14.66)235(14.75)
3311(19.71)260(16.42)278(20.47)434(27.42)457(28.69)
≥4450(28.52)480(30.32)422(31.08)621(39.23)635(39.86)
性别-2.2810.023
男性776(49.18)820(51.80)662(48.75)760(48.01)741(46.52)
女性802(50.82)763(48.20)696(51.25)823(51.99)852(53.48)
年龄(岁)72.05±6.8171.95±6.9972.04±7.0172.24±7.1472.23±7.111.0350.407
慢病情况,M(P25,P75)14(13,15)14(13,15)14(13,15)14(13,15)14(13,15)4.8910.173
自评健康2.8540.091
健康382(24.21)377(23.82)345(25.41)333(21.04)362(22.72)
不健康1 196(75.79)1 206(76.18)1013(74.59)1 250(78.96)1 231(77.28)
残疾状况3.2900.070
是527(33.40)548(34.62)468(34.46)485(30.64)509(31.95)
否1 051(66.60)1 035(65.38)890(65.54)1 098(69.36)1 084(68.05)
吸烟-5.266<0.001
是271(17.17)223(14.09)189(13.92)184(11.62)179(11.24)
否1 307(82.83)1 360(85.91)1 169(86.08)1 399(88.38)1 414(88.76)
饮酒-1.239<0.001
是525(33.27)570(36.01)501(36.89)573(36.20)566(35.53)
否1 053(66.73)1 013(63.99)857(63.11)1 010(63.80)1 027(64.47)
睡眠时间(h)6.42±1.926.28±1.846.30±1.826.32±1.836.27±1.825.9080.116
锻炼时间(h/d)-2.5020.012
<2717(45.44)721(44.55)623(45.88)748(47.25)789(49.53)
≥2861(54.56)862(54.45)735(54.12)835(52.75)804(50.47)
抑郁症状-9.296<0.001
否993(62.93)991(62.60)891(65.61)790(49.91)812(50.97)
是585(37.07)592(37.40)467(34.39)793(50.09)781(49.03)
住宅类型10.4280.236
社区居住1 549(98.16)1 561(98.61)1 341(98.75)1 549(97.85)1 562(98.05)
机构居住19(1.20)17(1.07)7(0.52)19(1.20)21(1.32)
其他10(0.63)5(0.32)10(0.74)15(0.95)10(0.63)
婚姻状况-0.8250.409
在婚状态1 360(86.19)1 362(86.04)1 186(87.33)1 358(85.79)1 357(85.19)
非在婚状态218(13.81)221(13.96)172(12.67)225(14.21)236(14.81)
学历7.9380.094
小学及以下1 428(90.49)1 470(92.86)1 245(91.68)1 435(90.65)1 466(90.65)
初中及以上150(9.51)113(7.14)113(8.32)148(9.35)148(9.35)
月收入(元)6.1760.628
≤1 0001 471(93.22)1 466(92.61)1 268(93.37)1 451(91.66)1 461(91.71)
1 000~3 00080(5.07)88(5.56)68(5.01)96(6.06)96(6.03)
≥3 00027(1.71)29(1.83)22(1.62)36(2.27)36(2.26)
医疗服务可及性948.660<0.001
综合医院1 307(82.83)1 316(83.13)1 156(85.13)875(55.27)924(58.00)
专科医院28(1.77)25(1.58)25(1.84)26(1.64)26(1.63)
社区卫生服务中心110(6.97)101(6.38)70(5.15)95(6.00)90(5.65)
卫生服务站18(1.14)17(1.07)18(1.33)475(30.01)429(26.93)
诊所115(7.29)124(7.83)89(6.55)112(7.08)124(7.78)
养老保险-2.2200.026
是1 474(93.41)1 442(91.09)1 253(92.27)1 430(90.33)1 455(91.34)
否104(6.59)141(8.91)105(7.73)153(9.67)138(8.66)
医疗保险-8.617<0.001
是1 456(92.27)1 441(91.03)1 229(90.50)1 343(84.84)1 345(84.43)
否122(7.73)142(8.97)129(9.50)240(15.16)248(15.57)
), ArticleFig(id=1241319163831055292, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319152070226328, language=EN, label=Table 2, caption=

OLS regression analysis of ACEs on BRI of older people

, figureFileSmall=null, figureFileBig=null, tableContent=
Model 1Model 2Model 3
β(95% CI)S.Eβ(95% CI)S.Eβ(95% CI)S.E
ACEs分组(ref=0)
10.88c(0.77~1.00)0.060.89c(0.77~1.00)0.060.89c(0.77~1.01)0.06
20.92c(0.81~1.03)0.060.93c(0.82~1.04)0.060.93c(0.82~1.04)0.06
30.96c(0.87~1.06)0.050.97c(0.88~1.06)0.050.99c(0.89~1.08)0.05
≥40.91c(0.82~0.99)0.040.92c(0.83~1.00)0.040.93c(0.84~1.01)0.04
性别(ref=男)0.08b(0.02~0.14)0.030.07a(0.01~0.13)0.03
吸烟(ref=是)0.29c(0.20~0.38)0.05
饮酒(ref=是)-0.12c(-0.14~-0.01)0.04
锻炼时间(ref=<2h)-0.10b(-0.16~-0.04)0.03
抑郁症状(ref=是)
医疗服务可及性(ref=综合医院)
专科医院
社区卫生服务中心
卫生服务站
诊所
养老保险(ref=是)
医疗保险(ref=是)
obs7 6957 6957 695
R20.070.070.08
P<0.01<0.01<0.01
Model 4Model 5Model 6
β(95% CI)S.Eβ(95% CI)S.Eβ(95% CI)S.E
ACEs分组(ref=0)
11.01c(0.90~1.13)0.060.73c(0.62~0.85)0.060.68c(0.57~0.80)0.06
21.04c(0.93~1.15)0.050.78c(0.69~0.90)0.050.74c(0.64~0.85)0.05
31.08c(0.99~1.17)0.050.83c(0.74~0.92)0.050.78c(0.69~0.87)0.05
≥41.01c(0.93~1.10)0.040.78c(0.70~0.86)0.040.74c(0.66~0.82)0.04
性别(ref=男)0.06(0.00~0.12)0.030.07a(0.01~0.13)0.030.07a(0.01~0.13)0.03
吸烟(ref=是)0.30c(0.21~0.39)0.050.21c(0.12~0.29)0.040.20c(0.12~0.29)0.04
饮酒(ref=是)-0.08a(-0.15~-0.02)0.03-0.09b(-0.14~-0.02)0.03-0.08b(-0.14~-0.02)0.03
锻炼时间(ref=<2h)-0.09a(-0.15~-0.03)0.03-0.08b(-0.14~-0.02)0.03-0.08b(-0.14~-0.02)0.03
抑郁症状(ref=是)0.25c(0.19~0.31)0.030.22c(0.15~0.27)0.030.20c(0.14~0.26)0.03
医疗服务可及性(ref=综合医院)
专科医院0.13(-0.10~0.35)0.120.13(-0.09~0.35)0.11
社区卫生服务中心0.07(-0.05~0.19)0.060.09(-0.03~0.21)0.06
卫生服务站1.19b(1.07~1.25)0.051.20c(1.11~1.29)0.05
诊所0.18b(0.07~0.29)0.060.20c(0.09~0.31)0.06
养老保险(ref=是)0.10(-0.01~0.21)0.05
医疗保险(ref=是)0.32c(0.23~0.41)0.05
obs7 6957 695
R20.170.21
P<0.01<0.01
), ArticleFig(id=1241319164015604682, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319152070226328, language=CN, label=表2, caption=

ACEs对老年人BRI的OLS回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
Model 1Model 2Model 3
β(95% CI)S.Eβ(95% CI)S.Eβ(95% CI)S.E
ACEs分组(ref=0)
10.88c(0.77~1.00)0.060.89c(0.77~1.00)0.060.89c(0.77~1.01)0.06
20.92c(0.81~1.03)0.060.93c(0.82~1.04)0.060.93c(0.82~1.04)0.06
30.96c(0.87~1.06)0.050.97c(0.88~1.06)0.050.99c(0.89~1.08)0.05
≥40.91c(0.82~0.99)0.040.92c(0.83~1.00)0.040.93c(0.84~1.01)0.04
性别(ref=男)0.08b(0.02~0.14)0.030.07a(0.01~0.13)0.03
吸烟(ref=是)0.29c(0.20~0.38)0.05
饮酒(ref=是)-0.12c(-0.14~-0.01)0.04
锻炼时间(ref=<2h)-0.10b(-0.16~-0.04)0.03
抑郁症状(ref=是)
医疗服务可及性(ref=综合医院)
专科医院
社区卫生服务中心
卫生服务站
诊所
养老保险(ref=是)
医疗保险(ref=是)
obs7 6957 6957 695
R20.070.070.08
P<0.01<0.01<0.01
Model 4Model 5Model 6
β(95% CI)S.Eβ(95% CI)S.Eβ(95% CI)S.E
ACEs分组(ref=0)
11.01c(0.90~1.13)0.060.73c(0.62~0.85)0.060.68c(0.57~0.80)0.06
21.04c(0.93~1.15)0.050.78c(0.69~0.90)0.050.74c(0.64~0.85)0.05
31.08c(0.99~1.17)0.050.83c(0.74~0.92)0.050.78c(0.69~0.87)0.05
≥41.01c(0.93~1.10)0.040.78c(0.70~0.86)0.040.74c(0.66~0.82)0.04
性别(ref=男)0.06(0.00~0.12)0.030.07a(0.01~0.13)0.030.07a(0.01~0.13)0.03
吸烟(ref=是)0.30c(0.21~0.39)0.050.21c(0.12~0.29)0.040.20c(0.12~0.29)0.04
饮酒(ref=是)-0.08a(-0.15~-0.02)0.03-0.09b(-0.14~-0.02)0.03-0.08b(-0.14~-0.02)0.03
锻炼时间(ref=<2h)-0.09a(-0.15~-0.03)0.03-0.08b(-0.14~-0.02)0.03-0.08b(-0.14~-0.02)0.03
抑郁症状(ref=是)0.25c(0.19~0.31)0.030.22c(0.15~0.27)0.030.20c(0.14~0.26)0.03
医疗服务可及性(ref=综合医院)
专科医院0.13(-0.10~0.35)0.120.13(-0.09~0.35)0.11
社区卫生服务中心0.07(-0.05~0.19)0.060.09(-0.03~0.21)0.06
卫生服务站1.19b(1.07~1.25)0.051.20c(1.11~1.29)0.05
诊所0.18b(0.07~0.29)0.060.20c(0.09~0.31)0.06
养老保险(ref=是)0.10(-0.01~0.21)0.05
医疗保险(ref=是)0.32c(0.23~0.41)0.05
obs7 6957 695
R20.170.21
P<0.01<0.01
), ArticleFig(id=1241319164166599635, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319152070226328, language=EN, label=Table 3, caption=

Analysis of ACEs and BRI of older people

, figureFileSmall=null, figureFileBig=null, tableContent=
因变量自变量全人群男性女性
β(95% CI)Pβ(95% CI)Pβ(95% CI)P
BRI10.57(0.50~0.65)<0.0010.56(0.46~0.66)<0.0010.63(0.53~0.73)<0.001
20.90(0.80~0.99)<0.0010.87(0.74~1.01)<0.0010.97(0.84~1.11)<0.001
30.85(0.77~0.93)<0.0010.82(0.71~0.93)<0.0010.91(0.80~1.02)<0.001
40.78(0.71~0.86)<0.0010.74(0.63~0.85)<0.0010.85(0.74~0.97)<0.001
50.78(0.69~0.86)<0.0010.70(0.59~0.81)<0.0010.88(0.76~1.00)<0.001
60.80(0.69~0.91)<0.0010.68(0.53~0.84)<0.0010.95(0.78~1.11)<0.001
70.82(0.66~0.99)<0.0010.67(0.45~0.90)<0.0011.02(0.78~1.11)<0.001
80.85(0.63~1.07)<0.0010.66(0.36~0.96)<0.0011.10(0.78~1.41)<0.001
90.87(0.60~1.15)<0.0010.65(0.27~1.03)<0.0011.17(0.76~1.58)<0.001
), ArticleFig(id=1241319164309205977, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319152070226328, language=CN, label=表3, caption=

ACEs和老年人BRI分析

, figureFileSmall=null, figureFileBig=null, tableContent=
因变量自变量全人群男性女性
β(95% CI)Pβ(95% CI)Pβ(95% CI)P
BRI10.57(0.50~0.65)<0.0010.56(0.46~0.66)<0.0010.63(0.53~0.73)<0.001
20.90(0.80~0.99)<0.0010.87(0.74~1.01)<0.0010.97(0.84~1.11)<0.001
30.85(0.77~0.93)<0.0010.82(0.71~0.93)<0.0010.91(0.80~1.02)<0.001
40.78(0.71~0.86)<0.0010.74(0.63~0.85)<0.0010.85(0.74~0.97)<0.001
50.78(0.69~0.86)<0.0010.70(0.59~0.81)<0.0010.88(0.76~1.00)<0.001
60.80(0.69~0.91)<0.0010.68(0.53~0.84)<0.0010.95(0.78~1.11)<0.001
70.82(0.66~0.99)<0.0010.67(0.45~0.90)<0.0011.02(0.78~1.11)<0.001
80.85(0.63~1.07)<0.0010.66(0.36~0.96)<0.0011.10(0.78~1.41)<0.001
90.87(0.60~1.15)<0.0010.65(0.27~1.03)<0.0011.17(0.76~1.58)<0.001
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中国老年人早期逆境与身体圆润指数的关联及性别异质性
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姚典瑞 , 杨乐 , 杨洋 , 李振浩 , 于琦
现代预防医学 | 流行病与统计方法 2025,52(12): 2126-2132
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现代预防医学 | 流行病与统计方法 2025, 52(12): 2126-2132
中国老年人早期逆境与身体圆润指数的关联及性别异质性
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姚典瑞, 杨乐 , 杨洋, 李振浩, 于琦
作者信息
  • 山西医科大学管理学院，山西 太原 030000

    • 姚典瑞 (2001—)，女，硕士在读，研究方向：老年健康

通讯作者:

杨乐，E-mail：
Association and gender differences between adverse childhood experiences and body roundness index among older people in China
Dian-rui YAO, Le YANG , Yang YANG, Zhen-hao LI, Qi YU
Affiliations
  • School of Management, Shanxi Medical University, Taiyuan, Shanxi 030000, China
出版时间: 2025-06-25 doi: 10.20043/j.cnki.MPM.202501102
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摘要
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目的

基于生命历程理论，了解中国老年人早期逆境(ACEs)与身体圆润指数(BRI)之间的关系及性别异质性，进而为制定老年人肥胖防控政策提供科学依据。

方法

使用2013年、2014年和2015年中国健康与退休纵向研究数据库(CHARLS)中的7 695名参与者数据，首先运用最小二乘回归模型(OLS)评估ACEs与BRI之间的线性关系，后使用限制性立方样条模型(RCS)进一步探讨二者之间的剂量-反应关系，并分析性别异质性。

结果

纳入分析的7 695名中国老年人中，经历过ACEs的会表现出更高的BRI (β1=0.68, P<0.01;β2=0.74, P<0.01;β3=0.78, P<0.01;β4=0.74, P<0.01)，同时二者之间的关联能够部分被健康生态学理论中的家庭环境网络、生活条件和政策环境层所解释。RCS结果显示，全人群ACEs和BRI之间呈现显著非线性倒“J”型分布，男性呈现显著非线性倒“U”型分布，女性则为显著非线性正相关。

结论

中国老年人的ACEs与BRI显著相关，且存在性别差异。这一发现凸显了营造健康成长环境、从源头预防健康风险、加强心理疏导的重要性，以及在风险源头进行干预以降低未来健康风险的必要性，对公共政策的调整和完善具有重要启示作用。

早期逆境  /  身体圆润指数  /  性别异质性  /  生命历程理论
Objective

Based on the life course theory, this study aims to understand the relationship between adverse childhood experiences (ACEs) and body roundness index (BRI) among Chinese older adults, as well as gender heterogeneity, in order to provide scientific evidence for the formulation of obesity prevention and control policies for older adults.

Methods

Data from 7 695 participants in the China Health and Retirement Longitudinal Study (CHARLS, 2013-2015) were analyzed. OLS regression and RCS models were used to assess the linear and dose-response relationships, respectively, and examine gender differences.

Results

Of the 7 695 older adults included in the analysis, those who had experienced ACEs exhibited higher BRI compared to those who had not (β1=0.68, P<0.01;β2=0.74, P<0.01;β3=0.78, P<0.01;β4=0.74, P<0.01). The impact of ACEs on BRI was partially explained by family environment, living conditions, and policy environment, as outlined in the theory of health ecology. The RCS results showed a significant non-linear inverted “J” shaped distribution between ACEs and BRI in the overall population. Gender heterogeneity was observed, with a significant non-linear inverted “U” shaped distribution among males and a significant non-linear relationship among females.

Conclusion

ACEs are significantly linked to BRI in Chinese seniors, with gender differences. This has key implications for policy improvement, emphasizing healthy environments, risk prevention, counseling, and early interventions to reduce future health risks.

Adverse childhood experiences  /  Body roundness index  /  Gender heterogeneity  /  Life course theory
姚典瑞, 杨乐, 杨洋, 李振浩, 于琦. 中国老年人早期逆境与身体圆润指数的关联及性别异质性. 现代预防医学, 2025 , 52 (12) : 2126 -2132 . DOI: 10.20043/j.cnki.MPM.202501102
Dian-rui YAO, Le YANG, Yang YANG, Zhen-hao LI, Qi YU. Association and gender differences between adverse childhood experiences and body roundness index among older people in China[J]. Modern Preventive Medicine, 2025 , 52 (12) : 2126 -2132 . DOI: 10.20043/j.cnki.MPM.202501102
正文
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中国疾病预防控制中心发布的《中国慢性病及危险因素监测报告（2018）》显示，我国60岁及以上居民超重率为36.63%，肥胖率为13.6%[1]。老年人肥胖不仅增加了慢性非传染性疾病的患病率，而且降低了老年生活质量。随着身体圆润指数(Body Roundness Index, BRI)这一概念的引入，人们对老年人肥胖问题的特殊性给予了更多关注。BRI结合腰围和身高评估体型，比传统指标更能反映脂肪与肌肉比例，更适用于老年人肥胖评估[2]。研究显示，当前降低老年人肥胖率的措施多针对已发生的肥胖问题，但个体健康状况受生命轨迹影响，由童年境况和成年后因素共同决定[3]。生命历程理论指出，早期逆境会增加个体未来暴露于健康风险的可能性[4]。累积劣势假说进一步提出，生命不同阶段的风险因素会随时间累积，导致健康资本的持续损失，且这种效应会随生命历程加剧[5]。早期逆境(Adverse Childhood Experiences, ACEs)指童年时期的身心虐待、性虐待或家庭功能障碍[6]。研究表明，ACEs是导致个体肥胖的潜在风险因素[7]。例如，Felitti发现ACEs暴露数量与成人肥胖呈“剂量-反应”关系[6]；Lynch等证实，暴露于两种及以上ACEs与超重显著相关[8]。既有文献从不同视角为ACEs与肥胖的关系提供了思路，但也存在以下局限：首先，现有研究多集中于成人群体，针对老年人的研究较为匮乏；其次，多数研究仅关注ACEs累积风险或单一事件，未能全面揭示其与BRI的多维关联；最后，受文化差异影响，研究结论的外推性受限，对我国老年人参考价值有限。因此，本研究基于生命历程理论和累积劣势假说，结合ACEs累计数和不同组别，探讨其对中国老年人BRI的影响，并分析性别异质性，进而为全生命周期人群健康促进提供理论支撑和科学依据。
1　材料与方法
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1.1　材料来源
本研究数据来源于中国健康与退休纵向研究数据库(China Health and Retirement Longitudinal Survey, CHARLS)，该数据库由北京大学国家发展研究院主持，涵盖了全国28个省。基于研究问题的需要，此次研究选用2013年和2015年的追踪调查数据及2014年的“中国中老年生命历程调查”数据库。早期逆境为自变量，数据来源于2014年专项调查，将两次追踪调查与2014年调查匹配获得样本相关信息。调查对象为60岁及以上老年人，分别对三期数据缺失值进行事后分析，发现每期数据中超过一半的条目占比超过总条目的6%，故对其进行多重插补。样本筛选过程中，因变量采用2015年数据，如若样本缺失，则用2013年数据弥补。控制变量的筛选过程与其一致。最终得到7 695个有效样本。样本筛选流程见图1。
1.2　变量选择
1.2.1　因变量
身体圆润指数：根据Thomas等人[2]开发的公式：。由于缺乏BRI分类标准，所以根据BRI的第20、40、60、80分位数将其分为5组，分别是0≤BRI<3.18，3.18≤BRI<3.91，3.91≤BRI<4.53，4.53≤BRI<5.42，BRI≥5.42 [9]。
1.2.2　自变量
ACEs指标(包括7个常规指标和5个拓展指标)，分为四类：(1)儿童虐待：身体虐待和情感忽视；(2)接触暴力：家庭暴力、同伴欺凌及社区安全；(3)亲人死亡或残疾：父母死亡、父母残疾或兄弟姐妹死亡；(4)父母适应不良：父母精神疾病、父母药物滥用、父母分居或离婚和父母被监禁。对每个项目以二进制形式评估，0=不认可，1=认可，后将12种早期逆境事件合并，构建一个0~12分的童年逆境指数。为了调查不同ACEs经历的积累与身体圆润指数之间的关系，根据ACEs指标的累计数将其分为5个组：0、1、2、3和≥4 [10]。
1.2.3　协变量
为全面分析ACEs和老年人BRI之间的关系，本研究依据健康生态学理论，将协变量分为五个维度[11]，分别为：(1)社会人口学特征：性别、年龄、慢性病、自评健康、残疾状况；(2)健康相关行为：吸烟、饮酒、睡眠时间、锻炼情况、抑郁症状；(3)家庭环境网络：住宅类型、婚姻状况、学历；(4)生活条件：收入、医疗服务可及性；(5)环境政策情况：养老保险、医疗保险。其中，(1)自评健康，以“您觉得您的健康状况如何？”来衡量，“一般”及以下回答定义为“不健康”，其他定义为“健康”；(2)残疾状况，以“您是否有躯体残疾、大脑受损/智力障碍、失明或半失明、聋或半聋、哑或严重口吃等残疾问题？”来衡量，拥有一项则被定义为“残疾”；(3)抑郁症状：以抑郁量表(CESD-10)衡量，CESD-10<10分判定为无抑郁症状，CESD-10≥10分判定为有抑郁症状[12]；(4)婚姻状况：以“您目前的婚姻状态？”来衡量，“已婚与配偶同住”、“已婚未与配偶同住”和“分居”视为“在婚状态”，其他视为“非在婚状态”；(5)医疗服务可及性：根据既往研究，选定数据库中“您若找医生看病，一般去哪儿？”来衡量[13]。
1.3　统计学方法
第一，使用SPSS 26.0对老年人BRI进行描述性统计分析。计数资料以率或构成比表示，组间比较采用卡方检验或Fisher确切概率法。计量资料先进行正态性检验，符合正态分布者以均数±标准差 ()表示，组间比较采用t检验或方差分析，不符合正态分布者以中位数和四分位数间距表示，组间比较采用秩和检验 (Mann-Whitney U检验)或Kruskal-Wallis检验。第二，应用Stata 18.0，使用最小二乘法(Ordinary Least Squares, OLS)，明晰不同ACEs组对老年人BRI的影响效应。粗模型和调整模型均被执行。第三，为研究ACEs累积数与老年人BRI之间的非线性关系，应用R 4.4.1，使用RCS分析剂量-反应关系和性别异质性，进一步探讨ACEs与BRI之间的潜在关系。最后，所有检验采取双侧检验，检验水准α=0.05。
2　结果
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2.1　描述性分析
在7 695名参与者中，男性3 759名(48.85%)，女性3 936名(51.15%)，具体情况见表1。单因素分析结果显示：不同组的ACEs、性别、吸烟、饮酒、锻炼时间、抑郁症状、医疗服务可及性、养老保险、医疗保险与老年人BRI不同组差异均具有统计学意义(P<0.05)。
2.2　ACEs对老年人BRI的影响分析
为探究ACEs与老年人BRI之间的线性关系，因变量根据BRI的20、40、60、80分位数将其分为5组，自变量根据ACEs累计数将其分为5组，分别为0、1、2、3、≥4。选取表1分析中有意义的变量作为协变量，分别为社会人口学变量：性别，将其视为模型2，进行OLS分析。模型3在模型2基础上增加吸烟、饮酒、锻炼时间等健康相关行为变量，模型4在模型3基础上继续增加抑郁症状等家庭环境网络变量，模型5在模型4基础上继续增加医疗服务可及性等生活条件变量，模型6在模型5基础上继续增加养老保险、医疗保险等环境政策变量。共线性检验结果显示，模型方差膨胀因子(VIF)为1.013~1.028，均小于10，提示各变量不存在多重共线性。
表2结果显示：当未添加控制变量时，经历过ACEs的老年人会表现出更高的BRI(β1=0.88, P<0.01;β2=0.92, P<0.01;β3=0.96, P<0.01;β4=0.91, P<0.01)，系数为标准化回归系数。加入模型2~3中的控制变量后，各类ACEs的显著性基本保持不变；加入模型4~6中的控制变量后，各类ACEs的作用系数均有不同程度的变化，表明ACEs对BRI的影响能够部分被家庭环境、生活条件和政策环境等变量所解释。
2.3　ACEs与老年人BRI的“剂量-反应”效应及性别异质性
上述分析表明ACEs与老年人BRI之间存在线性关系，应用RCS进一步研究二者间的非线性关系，自变量为ACEs累计数，因变量为BRI。研究表明，全人群的ACEs和BRI之间存在显著非线性关系(P<0.001)，呈倒“J”型分布，即当ACEs<2时，BRI逐渐增加，ACEs=2时，BRI相对较高(β=0.90, 95% CI [0.80~0.99])，后随着ACEs的增加，BRI增加减缓，在ACEs=4和5时，降到最低值(β(ACEs=4)=0.78, 95% CI [0.71~0.86];β(ACEs=5)=0.78, 95% CI [0.69~0.86])，随后趋于平缓，具体见图2和表3。男性的ACEs和BRI之间存在显著非线性关系(P<0.001)，呈倒“U”型分布，即当ACEs<2时，BRI逐渐增加，到ACEs=2时，BRI相对较高(β=0.87, 95% CI [0.74~1.01])，后随着ACEs的增加，BRI增加减缓，具体见图3和表3。女性的ACEs和BRI之间存在双拐点，称二者之间存在非线性正向相关(P<0.001)，即当ACEs<2时，BRI逐渐增加，到ACEs=2时，BRI相对较高(β=0.97, 95% CI [0.84~1.11])，随着ACEs的增加，BRI逐渐降低，当ACEs=4时，BRI降到最低(β=0.85, 95% CI[0.74~0.97])，随后逐渐升高，具体见图4和表3。
3　讨论
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3.1　ACEs与老年人BRI的线性关系
本研究显示，经历过ACEs的老年人具有更高的BRI。首先，从饮食行为角度出发，以往研究探讨了ACEs与饮食行为之间的关系，经历过ACEs的人对于自然食品摄入量低，加工食品摄入量较高，更容易摄入“致肥胖”食品[14]。其次，从生理角度出发，ACEs可能影响生理结构和功能，增加老年时期慢性病风险，而心血管疾病、关节炎等慢性病与BRI显著相关[15]。最后，ACEs可能通过影响睡眠和认知功能间接影响BRI。研究已证实ACEs与终生睡眠问题有关，而睡眠不足与肥胖相关[16]。同时，ACEs会导致大脑中的杏仁核、海马体等关键区域的体积缩小。这些脑区的损伤会在不同程度上影响认知功能的正常发展。此外，已有研究表明，认知障碍与BRI之间可能存在正向的线性关系[17]。
3.2　ACEs与老年人BRI的“剂量-反应”关系及性别异质性
本研究首次系统评估了ACEs与BRI之间的非线性关联，数据分析表明全人群ACEs和BRI之间存在倒“J”型分布。具体而言，随着ACEs数量的增加，BRI呈现先快速上升后逐渐平缓的趋势。在低ACEs暴露水平下(ACEs<2时)，BRI显著升高；然而，当ACEs数量达到一定阈值后(ACEs=2时)，BRI上升幅度趋于减缓；当ACE=4或5时，达到最低值，随后趋于平缓。针对这一现象，可以从生理机制和行为决策两方面来解释：首先，从生理机制看，ACEs会加速神经生物学压力系统的激活，进而引发一系列与肥胖相关的生理现象，特别是中心性肥胖[18]。其次，从行为选择角度看，ACEs与病态肥胖治疗方式选择显著相关。选择减肥手术的患者比非手术治疗者报告终身逆境的可能性更低[19]。但过多ACEs可能损害老年时期骨骼肌线粒体的生物能量功能，引发代谢失衡，导致能量供应不足和身体机能下降[20]。
随后讨论了性别异质性，结果显示男性中ACEs与BRI呈倒“U”型关系，女性呈非线性正向分布结果。针对这一结果，可以从生理因素、心理因素和健康行为三个方面来分析。首先，在生理因素方面，Appelmann等研究表明，ACEs能显著预测成年后不良健康状况，而下丘脑-垂体-肾上腺素(HPA)轴功能障碍可能是其中的关键机制[21]。对男性而言，ACEs可能抑制HPA轴释放糖皮质激素，引发低血糖、疲劳、食欲下降和体重减轻。而对女性来说，ACEs不会显著抑制HPA轴，而是通过慢性心理压力导致过量糖皮质激素分泌，进而促进脂肪堆积和体重增加。其次，在心理因素方面，王登峰的研究发现，中国男性一直被赋予更高的社会期望，使其心理韧性得分高于女性，更倾向于选择积极的应对机制来处理压力和逆境[22]。例如，男性可能通过更多的体育活动和社会参与来缓解压力，这有助于维持健康的体重。相比之下，女性在面对压力和逆境时，可能更倾向于内化情绪，导致情绪调节能力下降，增加肥胖风险。最后，在健康行为方面，男性在应对ACEs暴露时，更倾向于通过高强度工作或劳动来应对压力。这种行为虽然短期内有助于缓解压力，但长期可能导致能量消耗过度和体重减轻[23]。而女性在ACEs暴露后，可能更容易出现久坐不动的生活方式和饮食失调(如暴饮暴食)，这可能导致体重的增加。
3.3　研究启示
本研究证实了ACEs与老年人BRI之间存在显著因果属性和性别异质性，该结论为公共政策调整和完善提供了多方面视角, 具有重要启示作用。首先，重视成长环境的打造。本研究ACEs共纳入12个指标，其中10个与家庭环境有关。原生家庭是儿童成长的关键，早期家庭职能缺失是疾病、贫困等社会问题的根源。因此，公共政策应以家庭为单位，将增强家庭能力作为重要目标。其次，重视健康风险的源头防治。研究表明，ACEs具有“童年长臂效应”，会对老年BRI产生影响，即早期风险因素对整个生命历程至关重要。因此，公共政策应聚焦于缓解或阻断早年劣势的累积过程，从源头防治，降低未来健康风险。最后，重视老年人心理健康的疏导。ACEs对老年BRI的影响多与个体较差的心理状态相关，其心理创伤具有强伤害性和持久性，对个体能动性和心理健康造成不良影响。因此，应通过心理干预与疏导，减轻ACEs带来的心理创伤，防止劣势进一步累积。
基金
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  • 国家自然科学基金青年项目(72204152)
  • 中国科协2024年度研究生科普能力提升项目(KXYJS2024021)
  • 山西省科技创新人才团队专项资助(202304051001017)
  • 2020年度山西医科大学博士启动基金(XD2042)
  • 2020年度山西医科大学省级博士启动基金(SD2029)
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2025年第52卷第12期
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doi: 10.20043/j.cnki.MPM.202501102
  • 接收时间：2025-01-07
  • 首发时间：2026-03-19
  • 出版时间：2025-06-25
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  • 收稿日期：2025-01-07
基金
国家自然科学基金青年项目(72204152)
中国科协2024年度研究生科普能力提升项目(KXYJS2024021)
山西省科技创新人才团队专项资助(202304051001017)
2020年度山西医科大学博士启动基金(XD2042)
2020年度山西医科大学省级博士启动基金(SD2029)
作者信息
    山西医科大学管理学院，山西 太原 030000

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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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