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Article(id=1241771808278515856, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241771801366299468, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202404316, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1713369600000, receivedDateStr=2024-04-18, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773991070098, onlineDateStr=2026-03-20, pubDate=1729785600000, pubDateStr=2024-10-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773991070098, onlineIssueDateStr=2026-03-20, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773991070098, creator=13701087609, updateTime=1773991070098, updator=13701087609, issue=Issue{id=1241771801366299468, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='20', pageStart='3649', pageEnd='3840', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773991068450, creator=13701087609, updateTime=1773991676896, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241774353457681403, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241771801366299468, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241774353457681404, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241771801366299468, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=3725, endPage=3729, ext={EN=ArticleExt(id=1241771808693751973, articleId=1241771808278515856, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Association between body mass index, body fat and bone age development of 8-year-old children, Xuzhou, columnId=null, journalTitle=Modern Preventive Medicine, columnName=null, runingTitle=null, highlight=null, articleAbstract=
Objective

To assess the body mass index (BMI), percentage of body fat (PBF), and bone age of school-age children in Xuzhou city, and to explore the relationship between BMI, PBF, and bone age, so as to provide reference for promoting the health of children.

Methods

A cluster sampling method was used to select 601 students of grade three from three schools in Xuzhou from July to August 2023, questionnaire surveys and physical examinations were used to collect children’s data, and disordered multi-classification logistic regression analysis was used to explore the association between different types of BMI or PBF and bone age development.

Results

The rates for thinness, overweight, and obesity in boys were 14.2%, 11.1%, and 19.2% respectively, in girls were 17.6%, 9.3%, and 14.0%, respectively; Multivariate logistic regression showed that after adjusting for covariates such as gender, development of secondary sexual characteristics, average monthly household income, birth weight, father’s height, and mother’s height, the risk of early bone age development was significantly increased in both the BMI obese and overweight groups compared to the BMI normal group (OR=10.10, 95%CI:4.83-21.12; OR=3.78, 95%CI:1.53-9.33); The PBF high body fat group had a significantly increased risk of early bone age development compared to the PBF normal group (OR=3.79, 95%CI:2.01-7.13); BMI obese and PBF high body fat groups are protective factors for delayed bone age development (OR=0.40, 95%CI: 0.20-0.78; OR=0.52, 95%CI:0.31-0.87).

Conclusion

Overweight and obese children are prone to premature bone age. It is recommended to regularly monitor weight, bone age and body composition while preventing and controlling overweight and obesity in children.

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目的

了解徐州市学龄期儿童体质指数（body mass index, BMI）、体脂百分比（percentage of body fat，PBF）和骨龄发育情况，探讨BMI、PBF与骨龄发育的关联，为促进儿童健康提供参考依据。

方法

采用整群抽样方法，于2023年7~8月抽取徐州3所学校3年级601名学龄期学生，进行问卷调查和体格检查，运用无序多分类logistic回归分析不同BMI和PBF对儿童骨龄发育的影响。

结果

本次研究中，男童消瘦、超重和肥胖率分别为14.2%、11.1%、19.2%，女童消瘦、超重和肥胖率分别为17.6%、9.3%、14.0%；无序多分类logistic回归分析显示，调整协变量性别、第二性征发育、人均月收入、出生体重、父亲身高、母亲身高后，BMI肥胖组和超重组较BMI正常组，骨龄发育提前风险均明显增加 (OR=10.10, 95%CI: 4.83~21.12; OR=3.78, 95%CI:1.53~9.33)；PBF高体脂组较PBF正常组，骨龄发育提前风险亦明显增加(OR=3.79，95%CI: 2.01~7.13)。BMI肥胖、PBF高体脂是骨龄发育落后的保护因素(OR=0.40, 95%CI:0.20~0.78; OR=0.52,95%CI:0.31~0.87)。

结论

超重、肥胖儿童会增加骨龄发育提前的风险。建议预防控制儿童超重、肥胖的同时，定期监测体重、骨龄及体成分情况。

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彭磊，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=2ZuCNmjfDp7qqxA0fIXE6A==, magXml=xh9c53j+cX9KDEah0xdvNQ==, pdfUrl=null, pdf=eJEcufOJcnlpyyXIIkeqBA==, pdfFileSize=512367, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=vqVh2rExrZKVk4+qxvp44Q==, mapNumber=null, authorCompany=null, fund=null, authors=

刘阳（1990—）,女, 硕士，主治医师，研究方向：儿童保健

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刘阳（1990—）,女, 硕士，主治医师，研究方向：儿童保健

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Association between body fat rate and early pubertal development in girls aged 6-9 years in Zhongshan, Guangdong[D]. Guangzhou: Southern Medical University, 2022. （In Chinese), articleTitle=Association between body fat rate and early pubertal development in girls aged 6-9 years in Zhongshan, Guangdong, refAbstract=null), Reference(id=1241771826070754197, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771808278515856, doi=null, pmid=null, pmcid=null, year=2009, volume=33, issue=1, pageStart=14, pageEnd=20, url=null, language=null, rfNumber=[18], rfOrder=31, authorNames=Mamun AA, Hayatbakhsh MR, O’Callaghan M, journalName=International Journal of Obesity, refType=null, unstructuredReference=Mamun AA, Hayatbakhsh MR, O’Callaghan M, et al. Early overweight and pubertal maturation-pathways of association with young adults’ overweight: a longitudinal study[J]. 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Journal of Hygiene Research, 2016, 45(4): 568-573.（In Chinese), articleTitle=Correlation of pubertal timing, obesity, and body composition of children and adolescents in Chongqing City, refAbstract=null), Reference(id=1241771826406298529, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771808278515856, doi=null, pmid=null, pmcid=null, year=2022, volume=13, issue=5, pageStart=30, pageEnd=33, url=null, language=null, rfNumber=[20], rfOrder=34, authorNames=谢秋梅, 陈艳琳, 余婉燕, journalName=中国妇幼卫生杂志, refType=null, unstructuredReference=谢秋梅，陈艳琳，余婉燕，等．某院儿童保健门诊肥胖儿童骨龄发育状况分析[J]．中国妇幼卫生杂志，2022，13（5）：30-33．, articleTitle=某院儿童保健门诊肥胖儿童骨龄发育状况分析, refAbstract=null), Reference(id=1241771826494378917, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771808278515856, doi=null, pmid=null, pmcid=null, year=2022, volume=13, issue=5, pageStart=30, pageEnd=33, url=null, language=null, rfNumber=[20], rfOrder=35, authorNames=Xie QM, Chen YL, Yu WY, journalName=Chinese Journal of Women and Children Health, refType=null, unstructuredReference=Xie QM, Chen YL, Yu WY, et al. Bone age development among obese children from a child health care clinic[J]. Chinese Journal of Women and Children Health, 2022, 13(5): 30-33.（In Chinese), articleTitle=Bone age development among obese children from a child health care clinic, refAbstract=null), Reference(id=1241771828008522665, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771808278515856, doi=null, pmid=null, pmcid=null, year=2021, volume=36, issue=10, pageStart=1302, pageEnd=1304, 1318, url=null, language=null, rfNumber=[21], rfOrder=36, authorNames=王婷, 潘嘉严, 夏维, journalName=川北医学院学报, refType=null, unstructuredReference=王婷，潘嘉严，夏维．青春期前单纯性肥胖儿童骨龄、血清胰岛素生长因子-1水平与BMI的关系[J]．川北医学院学报，2021，36（10）：1302-1304, 1318．, articleTitle=青春期前单纯性肥胖儿童骨龄、血清胰岛素生长因子-1水平与BMI的关系, refAbstract=null), Reference(id=1241771828113380270, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771808278515856, doi=null, pmid=null, pmcid=null, year=2021, volume=36, issue=10, pageStart=1302, pageEnd=1304, 1318, url=null, language=null, rfNumber=[21], rfOrder=37, authorNames=Wang T, Pan JY, Xia W, journalName=Journal of North Sichuan Medical College, refType=null, unstructuredReference=Wang T, Pan JY, Xia W. Relationship between bone age, serum insulin growth factor-1 level and BMI in simple obese children before puberty[J]. Journal of North Sichuan Medical College, 2021, 36(10): 1302-1304, 1318. （In Chinese), articleTitle=Relationship between bone age, serum insulin growth factor-1 level and BMI in simple obese children before puberty, refAbstract=null), Reference(id=1241771828247598002, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771808278515856, doi=null, pmid=null, pmcid=null, year=2021, volume=29, issue=7, pageStart=767, pageEnd=771, url=null, language=null, rfNumber=[22], rfOrder=38, authorNames=高海涛, 王曦, 许琪, journalName=中国儿童保健杂志, refType=null, unstructuredReference=高海涛，王曦，许琪，等．儿童超重和肥胖与骨龄发育的相关性研究[J]．中国儿童保健杂志，2021，29（7）：767-771．, articleTitle=儿童超重和肥胖与骨龄发育的相关性研究, refAbstract=null), Reference(id=1241771828356649911, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771808278515856, doi=null, pmid=null, pmcid=null, year=2021, volume=29, issue=7, pageStart=767, pageEnd=771, url=null, language=null, rfNumber=[22], rfOrder=39, authorNames=Gao HT, Wang X, Xu Q, journalName=Chinese Journal of Child Health Care, refType=null, unstructuredReference=Gao HT, Wang X, Xu Q, et al. Correlation of bone age with overweight and obesity in children[J]. Chinese Journal of Child Health Care, 2021, 29(7): 767-771. （In Chinese), articleTitle=Correlation of bone age with overweight and obesity in children, refAbstract=null), Reference(id=1241771828469896123, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771808278515856, doi=null, pmid=null, pmcid=null, year=2018, volume=39, issue=9, pageStart=1354, pageEnd=1356, url=null, language=null, rfNumber=[23], rfOrder=40, authorNames=刘慧然, 陆大江, journalName=中国学校卫生, refType=null, unstructuredReference=刘慧然，陆大江．3～6岁肥胖儿童身体素质体成分与骨龄发育的关系[J]．中国学校卫生，2018，39（9）：1354-1356．, articleTitle=3～6岁肥胖儿童身体素质体成分与骨龄发育的关系, refAbstract=null), Reference(id=1241771828604113852, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771808278515856, doi=null, pmid=null, pmcid=null, year=2018, volume=39, issue=9, pageStart=1354, pageEnd=1356, url=null, language=null, rfNumber=[23], rfOrder=41, authorNames=Liu HR, Lu DJ, journalName=Chinese Journal of School Health, refType=null, unstructuredReference=Liu HR, Lu DJ. Physical fitness, body composition and bone age among 3-6 years old obese children[J]. Chinese Journal of School Health, 2018, 39(9): 1354-1356.（In Chinese), articleTitle=Physical fitness, body composition and bone age among 3-6 years old obese children, refAbstract=null)], funds=[Fund(id=1241771820840456920, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771808278515856, awardId=KC21272, language=CN, fundingSource=徐州市科技创新项目重点研发计划（社会发展）(KC21272), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241771811818508557, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771808278515856, xref=1., ext=[AuthorCompanyExt(id=1241771811831091470, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771808278515856, companyId=1241771811818508557, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Xuzhou Maternal and Child Health Family Planning Service Center, Xuzhou, Jiangsu 221009, China), AuthorCompanyExt(id=1241771811839480079, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771808278515856, companyId=1241771811818508557, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.徐州市妇幼保健计划生育服务中心，江苏 徐州 221009)]), AuthorCompany(id=1241771811940143383, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771808278515856, xref=2., ext=[AuthorCompanyExt(id=1241771811944337688, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771808278515856, companyId=1241771811940143383, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.铜山妇幼保健计划生育服务中心)]), AuthorCompany(id=1241771812216967458, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771808278515856, xref=3., ext=[AuthorCompanyExt(id=1241771812225356068, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771808278515856, companyId=1241771812216967458, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.徐州市妇幼保健院)])], figs=[ArticleFig(id=1241771820047733403, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771808278515856, language=EN, label=Table 1, caption=

Analysis of the general situation of the research object

, figureFileSmall=null, figureFileBig=null, tableContent=
测量指标BMI分组χ2/tP值
消瘦正常超重肥胖
性别[n(%)]4.060.255
男46（14.2）179（55.5）36（11.1）62（19.2）
女49（17.6）165（59.1）26（9.3）39（14.0）
第二性征发育[n(%)]55.39<0.001
无91（17.2）321（60.8）45（8.5）71（13.5）
有4（5.5）23（31.5）17（23.3）29（39.7）
人均月收入（元）[n(%)]4.800.852
<4 00018（17.0）63（59.4）12（11.3）13（12.3）
4 000~6 00026（18.6）77（55.0）15（10.7）22（15.7）
6 001~8 00026（15.9）96（58.5）15（9.1）27(16.5)
>8 00025(13.1)108(56.5)20(10.5)38(19.9)
出生体重(g)[n(%)]17.000.009
<2 5001(11.2)4(44.4)04(44.4)
2 500~399985(16.7)302(59.2)49(9.6)74(14.5)
≥4 0009(11.0)38(46.3)13(15.9)22(26.8)
父亲身高（cm）175.1±4.5174.9±4.4174.9±5.1175.6±4.30.760.519
母亲身高（cm）162.8±4.4162.7±4.7162.7±4.6162.4±4.90.170.919
测量指标PBF分组χ2/tP值
低体脂正常高体脂
性别[n(%)]2.490.287
男87（27.0）150（46.6）85（26.4）
女66（23.7）148（53.0）65（23.3）
第二性征发育[n(%)]47.11<0.001
无143（27.1）277（52.5）108（20.4）
有10（13.7）21（28.8）42（57.5）
人均月收入（元）[n(%)]5.770.449
<4 00032(30.2)51(48.1)23(21.7)
4 000~6 00042(30.0)64(45.7)34(24.3)
6 001~8 00040(24.4)81(49.4)43(26.2)
>8 00039(20.4)102(53.4)50(26.2)
出生体重(g)[n(%)]12.690.013
<2 5001(11.2)4(44.4)4(44.4)
2 500~3 999132(25.9)264(51.8)114(22.3)
≥4 00020(24.4)30(36.6)32(39.0)
父亲身高（cm）175.0±4.6175.1±4.3175.0±4.70.030.973
母亲身高（cm）162.9±4.7162.7±4.6162.4±4.70.570.567
), ArticleFig(id=1241771820156785317, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771808278515856, language=CN, label=表1, caption=

研究对象一般情况分析

, figureFileSmall=null, figureFileBig=null, tableContent=
测量指标BMI分组χ2/tP值
消瘦正常超重肥胖
性别[n(%)]4.060.255
男46（14.2）179（55.5）36（11.1）62（19.2）
女49（17.6）165（59.1）26（9.3）39（14.0）
第二性征发育[n(%)]55.39<0.001
无91（17.2）321（60.8）45（8.5）71（13.5）
有4（5.5）23（31.5）17（23.3）29（39.7）
人均月收入（元）[n(%)]4.800.852
<4 00018（17.0）63（59.4）12（11.3）13（12.3）
4 000~6 00026（18.6）77（55.0）15（10.7）22（15.7）
6 001~8 00026（15.9）96（58.5）15（9.1）27(16.5)
>8 00025(13.1)108(56.5)20(10.5)38(19.9)
出生体重(g)[n(%)]17.000.009
<2 5001(11.2)4(44.4)04(44.4)
2 500~399985(16.7)302(59.2)49(9.6)74(14.5)
≥4 0009(11.0)38(46.3)13(15.9)22(26.8)
父亲身高（cm）175.1±4.5174.9±4.4174.9±5.1175.6±4.30.760.519
母亲身高（cm）162.8±4.4162.7±4.7162.7±4.6162.4±4.90.170.919
测量指标PBF分组χ2/tP值
低体脂正常高体脂
性别[n(%)]2.490.287
男87（27.0）150（46.6）85（26.4）
女66（23.7）148（53.0）65（23.3）
第二性征发育[n(%)]47.11<0.001
无143（27.1）277（52.5）108（20.4）
有10（13.7）21（28.8）42（57.5）
人均月收入（元）[n(%)]5.770.449
<4 00032(30.2)51(48.1)23(21.7)
4 000~6 00042(30.0)64(45.7)34(24.3)
6 001~8 00040(24.4)81(49.4)43(26.2)
>8 00039(20.4)102(53.4)50(26.2)
出生体重(g)[n(%)]12.690.013
<2 5001(11.2)4(44.4)4(44.4)
2 500~3 999132(25.9)264(51.8)114(22.3)
≥4 00020(24.4)30(36.6)32(39.0)
父亲身高（cm）175.0±4.6175.1±4.3175.0±4.70.030.973
母亲身高（cm）162.9±4.7162.7±4.6162.4±4.70.570.567
), ArticleFig(id=1241771820274225837, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771808278515856, language=EN, label=Table 2, caption=

The Spearman correlation analysis between BMI, PBF and BAD

, figureFileSmall=null, figureFileBig=null, tableContent=
变量BMIPBFBAD
MI1.000.88a0.40a
PBF0.88a1.000.36a
BAD0.40a0.36a1.00
), ArticleFig(id=1241771820404249272, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771808278515856, language=CN, label=表2, caption=

BMI、PBF与BAD的Spearman相关分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量BMIPBFBAD
MI1.000.88a0.40a
PBF0.88a1.000.36a
BAD0.40a0.36a1.00
), ArticleFig(id=1241771820525884098, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771808278515856, language=EN, label=Table 3, caption=

Multinomial logistic regression analysis of association between BMI, PBF and bone age[OR(95%CI)]

, figureFileSmall=null, figureFileBig=null, tableContent=
测量指标骨龄发育提前骨龄发育落后
调整前调整后a调整前调整后a
BMI分组
正常1.001.001.001.00
消瘦--1.33（0.84~2.11）1.37（0.85~2.19）
超重8.34（4.29~16.22）c3.78（1.53~9.33）c0.60（0.32~1.13）0.66（0.34~1.27）
肥胖3.28（1.38~7.81）c10.10（4.83~21.12）c0.35（0.18~0.66）c0.40（0.20~0.78）c
PBF分组
正常1.001.001.001.00
低体脂0.10（0.01~0.72）b0.10（0.01~0.71）b1.19（0.79~1.78）1.16(0.77~1.75)
高体脂3.65（2.02~6.62）c3.79（2.01~7.13）c0.45（0.27~0.74）c0.52(0.31~0.87)c
), ArticleFig(id=1241771820668490442, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771808278515856, language=CN, label=表3, caption=

儿童BMI、PBF与骨龄发育的多分类logistic回归分析[OR值（95%CI）]

, figureFileSmall=null, figureFileBig=null, tableContent=
测量指标骨龄发育提前骨龄发育落后
调整前调整后a调整前调整后a
BMI分组
正常1.001.001.001.00
消瘦--1.33（0.84~2.11）1.37（0.85~2.19）
超重8.34（4.29~16.22）c3.78（1.53~9.33）c0.60（0.32~1.13）0.66（0.34~1.27）
肥胖3.28（1.38~7.81）c10.10（4.83~21.12）c0.35（0.18~0.66）c0.40（0.20~0.78）c
PBF分组
正常1.001.001.001.00
低体脂0.10（0.01~0.72）b0.10（0.01~0.71）b1.19（0.79~1.78）1.16(0.77~1.75)
高体脂3.65（2.02~6.62）c3.79（2.01~7.13）c0.45（0.27~0.74）c0.52(0.31~0.87)c
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徐州市8岁儿童体质指数、体脂与骨龄发育的关联分析
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刘阳 1 , 王波 2 , 戚娟 1 , 姜懿轩 2 , 刘继杰 1 , 杨丽 3 , 宫相君 1 , 彭磊 1
现代预防医学 | 儿少卫生与妇幼保健 2024,51(20): 3725-3729
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现代预防医学 | 儿少卫生与妇幼保健 2024, 51(20): 3725-3729
徐州市8岁儿童体质指数、体脂与骨龄发育的关联分析
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刘阳1, 王波2, 戚娟1, 姜懿轩2, 刘继杰1, 杨丽3, 宫相君1, 彭磊1
作者信息
  • 1.徐州市妇幼保健计划生育服务中心，江苏 徐州 221009
  • 2.铜山妇幼保健计划生育服务中心
  • 3.徐州市妇幼保健院

    • 刘阳（1990—）,女, 硕士，主治医师，研究方向：儿童保健

通讯作者:

彭磊，E-mail:
Association between body mass index, body fat and bone age development of 8-year-old children, Xuzhou
Yang LIU1, Bo WANG2, Juan QI1, Yi-xuan JIANG2, Ji-jie LIU1, Li YANG3, Xiang-jun GONG1, Lei PENG1
Affiliations
  • Xuzhou Maternal and Child Health Family Planning Service Center, Xuzhou, Jiangsu 221009, China
出版时间: 2024-10-25 doi: 10.20043/j.cnki.MPM.202404316
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摘要
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目的

了解徐州市学龄期儿童体质指数（body mass index, BMI）、体脂百分比（percentage of body fat，PBF）和骨龄发育情况，探讨BMI、PBF与骨龄发育的关联，为促进儿童健康提供参考依据。

方法

采用整群抽样方法，于2023年7~8月抽取徐州3所学校3年级601名学龄期学生，进行问卷调查和体格检查，运用无序多分类logistic回归分析不同BMI和PBF对儿童骨龄发育的影响。

结果

本次研究中，男童消瘦、超重和肥胖率分别为14.2%、11.1%、19.2%，女童消瘦、超重和肥胖率分别为17.6%、9.3%、14.0%；无序多分类logistic回归分析显示，调整协变量性别、第二性征发育、人均月收入、出生体重、父亲身高、母亲身高后，BMI肥胖组和超重组较BMI正常组，骨龄发育提前风险均明显增加 (OR=10.10, 95%CI: 4.83~21.12; OR=3.78, 95%CI:1.53~9.33)；PBF高体脂组较PBF正常组，骨龄发育提前风险亦明显增加(OR=3.79，95%CI: 2.01~7.13)。BMI肥胖、PBF高体脂是骨龄发育落后的保护因素(OR=0.40, 95%CI:0.20~0.78; OR=0.52,95%CI:0.31~0.87)。

结论

超重、肥胖儿童会增加骨龄发育提前的风险。建议预防控制儿童超重、肥胖的同时，定期监测体重、骨龄及体成分情况。

体质指数  /  体质百分比  /  骨龄  /  超重  /  肥胖
Objective

To assess the body mass index (BMI), percentage of body fat (PBF), and bone age of school-age children in Xuzhou city, and to explore the relationship between BMI, PBF, and bone age, so as to provide reference for promoting the health of children.

Methods

A cluster sampling method was used to select 601 students of grade three from three schools in Xuzhou from July to August 2023, questionnaire surveys and physical examinations were used to collect children’s data, and disordered multi-classification logistic regression analysis was used to explore the association between different types of BMI or PBF and bone age development.

Results

The rates for thinness, overweight, and obesity in boys were 14.2%, 11.1%, and 19.2% respectively, in girls were 17.6%, 9.3%, and 14.0%, respectively; Multivariate logistic regression showed that after adjusting for covariates such as gender, development of secondary sexual characteristics, average monthly household income, birth weight, father’s height, and mother’s height, the risk of early bone age development was significantly increased in both the BMI obese and overweight groups compared to the BMI normal group (OR=10.10, 95%CI:4.83-21.12; OR=3.78, 95%CI:1.53-9.33); The PBF high body fat group had a significantly increased risk of early bone age development compared to the PBF normal group (OR=3.79, 95%CI:2.01-7.13); BMI obese and PBF high body fat groups are protective factors for delayed bone age development (OR=0.40, 95%CI: 0.20-0.78; OR=0.52, 95%CI:0.31-0.87).

Conclusion

Overweight and obese children are prone to premature bone age. It is recommended to regularly monitor weight, bone age and body composition while preventing and controlling overweight and obesity in children.

Body mass index  /  Body fat percentage  /  Bone age  /  Overweight  /  Obesity
刘阳, 王波, 戚娟, 姜懿轩, 刘继杰, 杨丽, 宫相君, 彭磊. 徐州市8岁儿童体质指数、体脂与骨龄发育的关联分析. 现代预防医学, 2024 , 51 (20) : 3725 -3729 . DOI: 10.20043/j.cnki.MPM.202404316
Yang LIU, Bo WANG, Juan QI, Yi-xuan JIANG, Ji-jie LIU, Li YANG, Xiang-jun GONG, Lei PENG. Association between body mass index, body fat and bone age development of 8-year-old children, Xuzhou[J]. Modern Preventive Medicine, 2024 , 51 (20) : 3725 -3729 . DOI: 10.20043/j.cnki.MPM.202404316
正文
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随着人类生活方式的改变和生活水平的不断提高，超重及肥胖快速增长，已成为影响我国儿童身心健康的重要问题[1-2]。近年来超重肥胖与骨龄发育的关联日益受到关注，有研究表明儿童超重肥胖将导致骨龄发育提前，影响成年身高[3-5]。体质量指数（body mass index，BMI）是当前较为常见用于评价儿童超重肥胖的指标，但有研究显示BMI无法区分多余脂肪组织和肌肉增加所造成的儿童超重肥胖[6]。体脂百分比（percentage of body fat，PBF）是指人体脂肪含量占全身质量的比重，可以更好地反映脂肪对人体的影响，因此有学者认为用PBF衡量肥胖更为科学[7]。国内虽有部分文献报道儿童BMI、体成分对骨龄发育的影响，但鲜有研究分析PBF对骨龄发育的影响，本研究同时探讨BMI和PBF对儿童骨龄发育的影响。
1　对象与方法
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1.1　对象
2023年7~8月采用整群抽样方法抽取徐州3所小学3年级621名儿童作为调查对象。剔除当前接受生长激素或促性腺激素释放激素治疗2人；患有甲状腺功能减退、先天性心脏病3人；未检测体成分或骨龄15人。共纳入601名研究对象，其中男生男生322名，女生279名。本研究经伦理委员会批准，所有研究对象均签署知情同意书。
1.2　方法
1.2.1　体格检查
身高、体重测量参照《学生健康检查技术规范》[8]，身高精确到0.1 cm，体重精确到0.1 kg，所有测量工具在调查前均经过统一校正，并由经过培训的医护人员操作。使用身高、体重数据计算BMI＝体重（kg）/[身高（m）]2。
1.2.2　体成分
采用Biospace公司InBody230人体体成分分析仪（生物电阻抗法，BIA法）测定体重、体脂含量，体重精确到0.1 kg。PBF＝体脂（kg）/体重（kg）*100%。
1.2.3　体格评价
根据《学龄儿童青少年超重与肥胖筛查》（WS/T 586-2018）[9]和《学龄儿童青少年营养不良筛查》（WS/T 458-2014）[10]标准，将BMI分为消瘦、正常、超重、肥胖4组。PBF为非正态分布数据，M（P25～P75）为17.9（13.6～26.0），利用四分位法分为低体脂、正常、高体脂3组。
1.2.4　骨龄评价
受试者全部利用直接数字化X射线摄影系统（DR）拍摄左手腕部后前位X光片。利用《中国青少年儿童手腕骨成熟度及评价方法》判定骨龄。骨龄发育情况，以骨龄年龄差（bone age difference，BAD）进行分组，BAD（岁）＝骨龄（bone age，BA）－年龄（chronological age，CA）。－1岁≤BAD≤1岁为骨龄发育正常，BAD>1岁为骨龄发育提前，BAD<-1岁为骨龄发育落后[11]。
1.2.5　第二性征发育评估
由经过专业培训的医生，通过视诊和触诊相结合的方式评估女童乳房发育Tanner分期，利用睾丸测量仪比对测量男童睾丸容积大小。女性乳房B1期和男性睾丸体积<4 ml为无第二性征发育[12]。
1.2.6　问卷调查
本研究采用自制调查表，由调查对象监护人线上完成问卷，调查内容包括儿童基本情况（出生日期、性别、家庭人均收入）、出生信息（出生孕周、体重、身长）、父母信息（双方目前身高、体重、学历）等。
1.3　统计学处理
采用EpiData 3.1录入数据，使用SPSS 23.0进行数据处理和统计分析。定量资料统计描述采用，定性资料采用频数和构成比/率。组间率的比较采用χ2检验，均值比较采用单因素方差分析。使用Spearman相关分析BMI、PBF和骨龄年龄差的相关性。利用无序多分类logistic回归模型分析儿童BMI和PBF对骨龄发育的影响。检验水准α＝0.05。
2　结果
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2.1　研究对象一般特征
调查的601名儿童中，男童消瘦、超重和肥胖检出率分别为14.2%、11.1%、19.2%，女童消瘦、超重和肥胖检出率分别为17.6%、9.3%、14.0%；第二性征发育儿童的超重、肥胖或高体脂检出率明显高于无第二性征发育儿童，组间差异有统计学意义（χ2分别为55.39、47.11，P值均<0.01）；出生体重≥4 000 g组儿童肥胖和高体脂率明显高于出生体重2 500~3 999 g组，各组间差异有统计学意义（χ2分别为17.00、12.69，P值均≤0.01）。人均月收入、父亲身高、母亲身高在不同BMI和PBF组间无显著差异（P值均>0.05）。见表1。
2.2　儿童BMI、PBF与BAD相关关系
Spearman相关分析结果显示，BMI与PBF（r＝0.88，P<0.01）、BMI与BAD（r＝0.40，P<0.01）、PBF与BAD（r＝0.36，P<0.01）均成正相关。见表2。
2.3　儿童BMI、PBF与骨龄发育的无序多分类logistic回归分析
以骨龄发育（骨龄发育正常=0，骨龄发育提前=1，骨龄发育落后=2）为因变量进行无序多分类logistic回归分析，结果显示，调整协变量前，BMI超重、肥胖，PBF高体脂是骨龄发育提前的危险因素（OR=8.34，95% CI：4.29~16.22；OR=3.28，95% CI：1.38~7.81；OR=3.65, 95% CI：2.02~6.62），BMI肥胖、PBF低体脂是骨龄发育落后的保护因素（OR=0.35，95% CI：0.18~0.66；OR=0.45，95% CI：0.27~0.74）。调整协变量性别、第二性征发育、人均月收入、出生体重、父亲身高、母亲身高后，BMI肥胖、超重，PBF高体脂增加了骨龄发育提前的发生风险（OR=10.10，95% CI：4.83~21.12；OR=3.78，95% CI：1.53~9.33；OR=3.79，95% CI：2.01~7.13），BMI肥胖、PBF高体脂是骨龄发育落后的保护因素（OR=0.40，95% CI：0.20~0.78；OR=0.52，95% CI：0.31~0.87）。见表3。
3　讨论
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本研究中男童超重率11.1%、女童超重率9.3%，男童肥胖19.2%、女童肥胖率14.0%，男、女童超重率均低于2019年全国学生体质健康调研结果，肥胖率均高于2019年全国学生体质健康调研结果[13]，男童肥胖和超重率高于女童，与国内其他研究一致[14-16] ，造成肥胖偏高检出率的原因可能是生活方式的改变，运动减少以及抽样的不同等，也说明我们在儿童肥胖方面的防控面临着巨大的挑战。本研究结果显示儿童PBF M（P25，P75）为17.9（13.6，26.0），低于广东6~9岁女童PBF中位数18.4%[17]，高于深圳6~8岁儿童PBF水平（男童PBF均值15.89±7.48，女童PBF均值为16.75±6.91）[16]。既往研究发现儿童超重肥胖与青春期发育提前明显相关[18-19]，本研究中亦发现第二性征发育儿童超重、肥胖和高体脂率明显高于无第二性征发育儿童，同时本研究发现出生体重>4 000 g组儿童超重、肥胖和高体脂发生率明显高于正常出生体重组儿童，提示应尽早进行营养干预。
BMI和PBF是评价儿童超重肥胖的重要指标。本研究结果显示BMI、PBF均与BAD呈正相关；BMI超重或肥胖骨龄发育提前风险显著高于BMI正常组。谢秋梅等[20]采用病例对照研究发现肥胖组儿童骨龄发育提前的比例明显高于正常组儿童。王婷等[21]研究发现，青春期前单纯性肥胖儿童骨龄较实际年龄明显提前，肥胖儿童骨龄年龄差与BMI呈正相关。高海涛等[22]研究发现6~12岁儿童骨龄年龄差大于13~15岁儿童，超重或肥胖儿童儿童骨龄年龄差明显大于正常儿童，与本研究结果基本一致。目前有关PBF对骨龄发育影响的研究较少，刘慧然等[23]研究发现3~6岁肥胖儿童体脂肪含量与骨龄发育显著相关，骨龄越大，脂肪量越高。程双喜等[12]研究发现7~8岁青春期前儿童PBF与骨龄呈正相关，肥胖组儿童骨龄和PBF均明显高于正常组儿童。本研究利用无序多分类logistic回归分析发现高体脂组儿童骨龄发育提前风险是正常体脂组儿童的3.79倍，与上述研究结果相符。超重、肥胖和高PBF对骨龄发育提前的影响不容忽视，临床需结合相关评估指标，提前对儿童给予干预。
综上所述，BMI、PBF与骨龄发育密切相关，BMI越大，PBF越高，骨龄发育提前风险就越大。针对超重肥胖或高PBF儿童，应及早进行营养干预，同时密切监测体重、体成分变化和骨龄发育情况。同时，本研究存在一定局限性，纳入研究对象仅选择城区3所学校的3年级儿童，样本代表性受限；其次，本次研究为横断面研究，无法判断各因素与骨龄发育的因果关联；有关儿童BMI和PBF对骨龄发育的影响，有待进一步纵向观察研究。
基金
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  • 徐州市科技创新项目重点研发计划（社会发展）(KC21272)
文献
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2024年第51卷第20期
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doi: 10.20043/j.cnki.MPM.202404316
  • 接收时间：2024-04-18
  • 首发时间：2026-03-20
  • 出版时间：2024-10-25
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  • 收稿日期：2024-04-18
基金
徐州市科技创新项目重点研发计划（社会发展）(KC21272)
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    1.徐州市妇幼保健计划生育服务中心，江苏 徐州 221009
    2.铜山妇幼保健计划生育服务中心
    3.徐州市妇幼保健院

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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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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
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