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Article(id=1325521299392574157, tenantId=1146029695717560320, journalId=1256213402557890569, issueId=1325521023759691810, articleNumber=null, orderNo=null, doi=10.16835/j.cnki.1000-9817.2025221, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1742745600000, receivedDateStr=2025-03-24, revisedDate=1748534400000, revisedDateStr=2025-05-30, acceptedDate=null, acceptedDateStr=null, onlineDate=1793958504770, onlineDateStr=2026-11-06, pubDate=1753372800000, pubDateStr=2025-07-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793958504770, onlineIssueDateStr=2026-11-06, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793958504770, creator=13701087609, updateTime=1793958504770, updator=13701087609, issue=Issue{id=1325521023759691810, tenantId=1146029695717560320, journalId=1256213402557890569, year='2025', volume='46', issue='7', pageStart='913', pageEnd='1064', issueExtLink='null', onlineDate='null', pubDate='1753372800000', pubDateStr='2025-07-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793958439054, creator='13701087609', updateTime=1793958439054, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=1037, endPage=1041, ext={EN=ArticleExt(id=1325521300202074830, articleId=1325521299392574157, tenantId=1146029695717560320, journalId=1256213402557890569, language=EN, title=Association of sleep and eating behavior on the comorbidity of overweight/obesity and elevated blood pressure among primary and secondary school students, columnId=1325500884406379444, journalTitle=Chinese Journal of School Health, columnName=Disease Control, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the prevalence and determinants of comorbid overweight/obesity and elevated blood pressure among primary and secondary school students in Yangzhou City, and to explore the association between sleep patterns, eating behavior and the comorbidity of overweight/obesity and elevated blood pressure, so as to provide reference for developing prevention strategies targeting common comorbidities in students.

Methods

By using stratified cluster random sampling, a total of 8 735 primary and secondary school students were selected from 36 schools in six counties of Yangzhou from October to November 2023. Students underwent physical examinations and a questionnaire survey was conducted using the questionnaire on students' health status and influencing factors. The Chi-square test was used to compare the detection rate of comorbid overweight/obesity and elevated blood pressure in different groups of primary and secondary school students. The Logistic regression model was used to explore the association between sleep and dietary behaviors and their combined effects and coexistence.

Results

The detection rate of comorbid overweight/obesity and elevated blood pressure among primary and secondary school students in Yangzhou was 9.85%, which was higher among boys (12.14%) than girls (7.59%)(χ2=50.86, P < 0.01). After controlling for gender, residence, educational stage, parental education, smoking, drinking, and moderate to vigorous exercise, multivariate Logistic regression analysis showed that irregular breakfast consumption and inadequate daily sleep were associated with a higher risk of comorbidities compared with regular breakfast consumption and adequate daily sleep among overall and primary school students (overall: OR=1.52, 95%CI=1.18-1.96, primary school students: OR=2.79, 95%CI=1.61-4.82)(both P < 0.05). From the perspective of primary school students of different genders, the risk of comorbidities in girls who consumed breakfast irregularly and had inadequate daily sleep was 3.59 times higher than that in girls who consumed breakfast irregularly and had inadequate daily sleep (95%CI=1.65-7.82, P < 0.01).

Conclusion

The sleep patterns and breakfast behaviors of primary and secondary school students are found to be associated with comorbid overweight/obesity and elevated blood pressure, especially in primary school girls.

, authors=Fan YANG, Qingbing YAO, Weiwei ZHU, Mingliang HU, Shasha LI, Shenghua LU*, authorsList=Fan YANG, Qingbing YAO, Weiwei ZHU, Mingliang HU, Shasha LI, Shenghua LU, authorCompany=null, correspAuthors=Shenghua LU, authorNote=null, correspAuthorsNote=null, copyrightStatement=Copyright ©2025 Chinese Journal of School Health. All rights reserved., copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1325521302324392655, articleId=1325521299392574157, tenantId=1146029695717560320, journalId=1256213402557890569, language=CN, title=睡眠饮食行为和中小学生超重肥胖与血压偏高共存的关联, columnId=1325500884628677558, journalTitle=中国学校卫生, columnName=疾病控制, runingTitle=null, highlight=null, articleAbstract=
目的

分析扬州市中小学生超重肥胖与血压偏高共存状况及其影响因素，探究睡眠、饮食行为和超重肥胖与血压偏高共存的关联，为制定学生常见病共存共防策略提供参考依据。

方法

采用分层整群随机抽样方法，于2023年10—11月在扬州市6个县(市、区)36所学校抽取8 735名中小学生为调查对象，对其进行体格检查，并采用学生健康状况及影响因素调查表进行问卷调查。采用χ2检验比较不同组别中小学生超重肥胖与血压偏高共存检出率的差异，运用Logistic回归模型探讨睡眠和饮食行为及其联合作用和超重肥胖与血压偏高共存的关联。

结果

扬州市中小学生超重肥胖与血压偏高共存检出率为9.85%，男生(12.14%)高于女生(7.59%)，差异有统计学意义(χ2=50.86，P < 0.01)。调整性别、地区、学段、父母文化程度、吸烟、饮酒、中高强度运动频率后，多因素Logistic回归分析结果显示，总体及小学生非每天吃早餐+睡眠不足组发生超重肥胖与血压偏高共存的风险高于每天吃早餐+睡眠充足组(总体：OR=1.52，95%CI=1.18~1.96；小学生：OR=2.79，95%CI=1.61~4.82)(P值均 < 0.01)。从不同性别小学生来看，非每天吃早餐+睡眠不足的女生发生超重肥胖与血压偏高共存的风险是每天吃早餐+睡眠充足组的3.59倍(95%CI=1.65~7.82，P＜0.01)。

结论

中小学生睡眠、早餐行为和超重肥胖与血压偏高共存有关，尤其是在小学女生中。

, authors=杨帆, 姚庆兵, 朱维维, 胡明亮, 李莎莎, 陆盛华*, authorsList=杨帆, 姚庆兵, 朱维维, 胡明亮, 李莎莎, 陆盛华, authorCompany=null, correspAuthors=陆盛华, authorNote=

杨帆(1994-)，女，安徽安庆人，硕士，主管医师，主要研究方向为儿童青少年健康

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陆盛华，E-mail:
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A Meta-analysis of the relationship between breakfast frequency and obesity in children and adolescents[J]. J Gannan Med Univ, 2024, 44(9): 928-932, 972. 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Nutrients, 2019, 11(2): 387., articleTitle=null, refAbstract=null)], funds=[Fund(id=1325521312805958409, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521299392574157, awardId=null, language=CN, fundingSource=扬州市基础研究计划(联合专项)卫生健康类项目(2024-4-26), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1325521302789960400, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521299392574157, xref=null, ext=[AuthorCompanyExt(id=1325521302794154705, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521299392574157, companyId=1325521302789960400, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Child and Adolescent Health Promotion Section, Yangzhou Center for Disease Control and Prevention, Yangzhou 225000, Jiangsu Province, China), AuthorCompanyExt(id=1325521302802543314, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521299392574157, companyId=1325521302789960400, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=江苏省扬州市疾病预防控制中心儿童青少年健康促进科，225000)])], figs=[ArticleFig(id=1325521312067760899, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521299392574157, language=EN, label=Tab.1, caption=

Comparison of the detection rates of comorbidity for overweight/obesity and elevated blood pressue among primary and secondary school students in different groups

, figureFileSmall=null, figureFileBig=null, tableContent=
组别选项人数共存人数χ2值P值组别选项人数共存人数χ2值P值
性别男4 324525(12.14)50.86< 0.01喝过酒是1 619186(11.49)6.050.01
女4 411335(7.59)否7 116674(9.47)
地区城区5 120472(9.22)5.470.02中高强度低频率2 593261(10.07)12.29< 0.01
郊县3 615388(10.73)运动中频率4 013430(10.72)
学段小学2 887148(5.13)110.32< 0.01高频率2 129169(7.94)
初中2 927373(12.74)每天喝含糖饮料/次＜17 929768(9.69)2.460.12
高中2 921339(11.61)≥180692(11.41)
父亲文化程度*小学及以下48740(8.21)25.73< 0.01每天吃油炸食物/次＜18 237812(9.86)0.030.87
初中/中专/高中6 052659(10.89)≥149848(9.64)
大学1 935147(7.80)每天吃新鲜水果/次*＜12 365248(10.49)1.490.22
硕士及以上26014(5.38)≥16 368612(9.61)
母亲文化程度*小学及以下849102(12.01)34.27< 0.01每天喝奶制品/次＜13 313343(10.35)1.550.21
初中/中专/高中5 898629(10.66)≥15 422517(9.54)
大学1 740115(6.61)每天吃蔬菜/次＜11 08890(8.27)3.470.06
硕士及以上24614(5.69)≥17 647770(10.07)
住校情况是97188(9.06)0.750.39每天吃早餐是7 014649(9.25)14.08< 0.01
否7 764772(9.94)否1 721211(12.26)
睡眠充足是1 921147(7.65)13.35< 0.01早餐、睡眠联合作用每天吃早餐+睡眠充足1 615119(7.37)26.53< 0.01
否6 814713(10.46)每天吃早餐+睡眠不足5 399530(9.93)
吸过烟是44159(13.38)6.530.01非每天吃早餐+睡眠充足30628(9.15)
否8 294801(9.66)非每天吃早餐+睡眠不足1 415183(12.93)
), ArticleFig(id=1325521312143258372, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521299392574157, language=CN, label=表1, caption=

不同组别中小学生超重肥胖与血压偏高共存检出率比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别选项人数共存人数χ2值P值组别选项人数共存人数χ2值P值
性别男4 324525(12.14)50.86< 0.01喝过酒是1 619186(11.49)6.050.01
女4 411335(7.59)否7 116674(9.47)
地区城区5 120472(9.22)5.470.02中高强度低频率2 593261(10.07)12.29< 0.01
郊县3 615388(10.73)运动中频率4 013430(10.72)
学段小学2 887148(5.13)110.32< 0.01高频率2 129169(7.94)
初中2 927373(12.74)每天喝含糖饮料/次＜17 929768(9.69)2.460.12
高中2 921339(11.61)≥180692(11.41)
父亲文化程度*小学及以下48740(8.21)25.73< 0.01每天吃油炸食物/次＜18 237812(9.86)0.030.87
初中/中专/高中6 052659(10.89)≥149848(9.64)
大学1 935147(7.80)每天吃新鲜水果/次*＜12 365248(10.49)1.490.22
硕士及以上26014(5.38)≥16 368612(9.61)
母亲文化程度*小学及以下849102(12.01)34.27< 0.01每天喝奶制品/次＜13 313343(10.35)1.550.21
初中/中专/高中5 898629(10.66)≥15 422517(9.54)
大学1 740115(6.61)每天吃蔬菜/次＜11 08890(8.27)3.470.06
硕士及以上24614(5.69)≥17 647770(10.07)
住校情况是97188(9.06)0.750.39每天吃早餐是7 014649(9.25)14.08< 0.01
否7 764772(9.94)否1 721211(12.26)
睡眠充足是1 921147(7.65)13.35< 0.01早餐、睡眠联合作用每天吃早餐+睡眠充足1 615119(7.37)26.53< 0.01
否6 814713(10.46)每天吃早餐+睡眠不足5 399530(9.93)
吸过烟是44159(13.38)6.530.01非每天吃早餐+睡眠充足30628(9.15)
否8 294801(9.66)非每天吃早餐+睡眠不足1 415183(12.93)
), ArticleFig(id=1325521312311030533, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521299392574157, language=EN, label=Tab.2, caption=

Univariate Logstic regression analysis of the combined effect of sleep and breakfast behavior and the coexistence of overweight, obesity, and elevated blood pressure in primary and secondary school students of different genders and academic stages[OR(95%CI), n=8 735]

, figureFileSmall=null, figureFileBig=null, tableContent=
自变量性别学段总体
男生女生小学初中高中
每天吃早餐+睡眠不足组1.40(1.08~1.81)*1.44(1.01~2.05)*1.03(0.70~1.52)1.11(0.81~1.54)1.17(0.76~1.78)1.37(1.11~0.68)**
非每天吃早餐+睡眠充足组1.19(0.68~2.10)1.49(0.76~2.91)1.90(0.72~4.99)0.48(0.17~1.37)1.09(0.59~2.02)1.27(0.82~1.95)
非每天吃早餐+睡眠不足组1.98(1.45~2.70)**1.97(1.32~2.94)**2.73(1.60~4.67)**1.10(0.75~1.62)1.41(0.90~2.22)1.87(1.47~2.38)**
), ArticleFig(id=1325521312394916614, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521299392574157, language=CN, label=表2, caption=

睡眠与早餐行为联合作用和不同性别学段中小学生超重肥胖与血压偏高共存单因素Logistic回归分析[OR值(95%CI), n=8 735]

, figureFileSmall=null, figureFileBig=null, tableContent=
自变量性别学段总体
男生女生小学初中高中
每天吃早餐+睡眠不足组1.40(1.08~1.81)*1.44(1.01~2.05)*1.03(0.70~1.52)1.11(0.81~1.54)1.17(0.76~1.78)1.37(1.11~0.68)**
非每天吃早餐+睡眠充足组1.19(0.68~2.10)1.49(0.76~2.91)1.90(0.72~4.99)0.48(0.17~1.37)1.09(0.59~2.02)1.27(0.82~1.95)
非每天吃早餐+睡眠不足组1.98(1.45~2.70)**1.97(1.32~2.94)**2.73(1.60~4.67)**1.10(0.75~1.62)1.41(0.90~2.22)1.87(1.47~2.38)**
), ArticleFig(id=1325521312470414087, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521299392574157, language=EN, label=Tab.3, caption=

Multivariate Logistic regression analysis of the combined effect of sleep and breakfast behavior and the coexistence of overweight, obesity, and elevated blood pressure in primary and secondary school students of different genders and academic stages[OR(95%CI), n=8 735]

, figureFileSmall=null, figureFileBig=null, tableContent=
自变量性别学段总体
男生女生小学初中高中
每天吃早餐+睡眠不足组1.17(0.90~1.52)1.25(0.87~1.79)1.04(0.70~1.53)1.22(0.88~1.69)1.10(0.72~1.70)1.20(0.97~1.48)
非每天吃早餐+睡眠充足组0.92(0.51~1.63)1.19(0.60~2.36)1.95(0.73~5.18)0.50(0.17~1.43)1.10(0.59~2.06)1.03(0.66~1.60)
非每天吃早餐+睡眠不足组1.50(1.09~2.07)*1.57(1.04~2.39)*2.79(1.61~4.82)**1.25(0.84~1.86)1.38(0.87~2.19)1.52(1.18~1.96)**
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睡眠与早餐行为联合作用和不同性别学段中小学生超重肥胖与血压偏高共存多因素Logistic回归分析[OR值(95%CI), n=8 735]

, figureFileSmall=null, figureFileBig=null, tableContent=
自变量性别学段总体
男生女生小学初中高中
每天吃早餐+睡眠不足组1.17(0.90~1.52)1.25(0.87~1.79)1.04(0.70~1.53)1.22(0.88~1.69)1.10(0.72~1.70)1.20(0.97~1.48)
非每天吃早餐+睡眠充足组0.92(0.51~1.63)1.19(0.60~2.36)1.95(0.73~5.18)0.50(0.17~1.43)1.10(0.59~2.06)1.03(0.66~1.60)
非每天吃早餐+睡眠不足组1.50(1.09~2.07)*1.57(1.04~2.39)*2.79(1.61~4.82)**1.25(0.84~1.86)1.38(0.87~2.19)1.52(1.18~1.96)**
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睡眠饮食行为和中小学生超重肥胖与血压偏高共存的关联
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杨帆 , 姚庆兵 , 朱维维 , 胡明亮 , 李莎莎 , 陆盛华 *
中国学校卫生 | 疾病控制 2025,46(7): 1037-1041
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中国学校卫生 |疾病控制 2025 , 46 (7) : 1037 -1041
睡眠饮食行为和中小学生超重肥胖与血压偏高共存的关联
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杨帆, 姚庆兵, 朱维维, 胡明亮, 李莎莎, 陆盛华*
作者信息
  • 江苏省扬州市疾病预防控制中心儿童青少年健康促进科，225000
通讯作者:
陆盛华，E-mail:
作者简介:

杨帆(1994-)，女，安徽安庆人，硕士，主管医师，主要研究方向为儿童青少年健康

Association of sleep and eating behavior on the comorbidity of overweight/obesity and elevated blood pressure among primary and secondary school students
Fan YANG, Qingbing YAO, Weiwei ZHU, Mingliang HU, Shasha LI, Shenghua LU*
Affiliations
  • Child and Adolescent Health Promotion Section, Yangzhou Center for Disease Control and Prevention, Yangzhou 225000, Jiangsu Province, China
出版时间: 2025-07-25 doi: 10.16835/j.cnki.1000-9817.2025221
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摘要
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目的

分析扬州市中小学生超重肥胖与血压偏高共存状况及其影响因素，探究睡眠、饮食行为和超重肥胖与血压偏高共存的关联，为制定学生常见病共存共防策略提供参考依据。

方法

采用分层整群随机抽样方法，于2023年10—11月在扬州市6个县(市、区)36所学校抽取8 735名中小学生为调查对象，对其进行体格检查，并采用学生健康状况及影响因素调查表进行问卷调查。采用χ2检验比较不同组别中小学生超重肥胖与血压偏高共存检出率的差异，运用Logistic回归模型探讨睡眠和饮食行为及其联合作用和超重肥胖与血压偏高共存的关联。

结果

扬州市中小学生超重肥胖与血压偏高共存检出率为9.85%，男生(12.14%)高于女生(7.59%)，差异有统计学意义(χ2=50.86，P < 0.01)。调整性别、地区、学段、父母文化程度、吸烟、饮酒、中高强度运动频率后，多因素Logistic回归分析结果显示，总体及小学生非每天吃早餐+睡眠不足组发生超重肥胖与血压偏高共存的风险高于每天吃早餐+睡眠充足组(总体：OR=1.52，95%CI=1.18~1.96；小学生：OR=2.79，95%CI=1.61~4.82)(P值均 < 0.01)。从不同性别小学生来看，非每天吃早餐+睡眠不足的女生发生超重肥胖与血压偏高共存的风险是每天吃早餐+睡眠充足组的3.59倍(95%CI=1.65~7.82，P＜0.01)。

结论

中小学生睡眠、早餐行为和超重肥胖与血压偏高共存有关，尤其是在小学女生中。

睡眠  /  饮食习惯  /  超重  /  肥胖症  /  血压  /  回归分析  /  学生
Objective

To analyze the prevalence and determinants of comorbid overweight/obesity and elevated blood pressure among primary and secondary school students in Yangzhou City, and to explore the association between sleep patterns, eating behavior and the comorbidity of overweight/obesity and elevated blood pressure, so as to provide reference for developing prevention strategies targeting common comorbidities in students.

Methods

By using stratified cluster random sampling, a total of 8 735 primary and secondary school students were selected from 36 schools in six counties of Yangzhou from October to November 2023. Students underwent physical examinations and a questionnaire survey was conducted using the questionnaire on students' health status and influencing factors. The Chi-square test was used to compare the detection rate of comorbid overweight/obesity and elevated blood pressure in different groups of primary and secondary school students. The Logistic regression model was used to explore the association between sleep and dietary behaviors and their combined effects and coexistence.

Results

The detection rate of comorbid overweight/obesity and elevated blood pressure among primary and secondary school students in Yangzhou was 9.85%, which was higher among boys (12.14%) than girls (7.59%)(χ2=50.86, P < 0.01). After controlling for gender, residence, educational stage, parental education, smoking, drinking, and moderate to vigorous exercise, multivariate Logistic regression analysis showed that irregular breakfast consumption and inadequate daily sleep were associated with a higher risk of comorbidities compared with regular breakfast consumption and adequate daily sleep among overall and primary school students (overall: OR=1.52, 95%CI=1.18-1.96, primary school students: OR=2.79, 95%CI=1.61-4.82)(both P < 0.05). From the perspective of primary school students of different genders, the risk of comorbidities in girls who consumed breakfast irregularly and had inadequate daily sleep was 3.59 times higher than that in girls who consumed breakfast irregularly and had inadequate daily sleep (95%CI=1.65-7.82, P < 0.01).

Conclusion

The sleep patterns and breakfast behaviors of primary and secondary school students are found to be associated with comorbid overweight/obesity and elevated blood pressure, especially in primary school girls.

Sleep  /  Food habits  /  Overweight  /  Obesity  /  Blood pressure  /  Regression analysis  /  Students
杨帆, 姚庆兵, 朱维维, 胡明亮, 李莎莎, 陆盛华. 睡眠饮食行为和中小学生超重肥胖与血压偏高共存的关联. 中国学校卫生, 2025 , 46 (7) : 1037 -1041 . DOI: 10.16835/j.cnki.1000-9817.2025221
Fan YANG, Qingbing YAO, Weiwei ZHU, Mingliang HU, Shasha LI, Shenghua LU. Association of sleep and eating behavior on the comorbidity of overweight/obesity and elevated blood pressure among primary and secondary school students[J]. Chinese Journal of School Health, 2025 , 46 (7) : 1037 -1041 . DOI: 10.16835/j.cnki.1000-9817.2025221
正文
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目前，学生常见病呈现多病共存的趋势，已严重危害儿童青少年健康[1]。2019年数据显示，22.9%的儿童青少年患有2种及以上常见病，同时患有2种常见病的比例达20.1%[2]。儿童青少年血压偏高和肥胖是我国公共卫生领域亟待解决的关键问题[3]，且流行呈上升趋势[4-5]，在2016—2018年内蒙古地区学生血压偏高和肥胖共存的检出率约为5%，2021年上升至9.45%[6]。儿童青少年肥胖与高血压关联密切，高血压是肥胖常见的共患病[7]，其出现均受饮食行为、生活习惯、学习负担等因素的共同作用[8]，肥胖合并高血压比单独肥胖或单独高血压可能导致更严重的远期靶器官损伤，增加心脑血管疾病风险[9-10]。本研究基于横断面研究，了解扬州市中小学生超重肥胖与血压偏高的共存现状及其与睡眠、饮食行为的关联，为控制其发生发展制定科学有效的干预措施提供参考。
1　对象与方法
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1.1　对象
研究依托国家学生常见病和健康影响因素监测与干预项目，采用分层整群随机抽样方法，于2023年10—11月，在扬州市3个城区和3个县(市、涉农区)中，每个区县抽取有代表性的小学2所、初中2所和高中1所，城区额外抽取普通高中、职业高中各1所；通过随机抽样，在各学校各年级抽取若干班级，以班级为单位整群抽取每年级至少80名学生，小学仅抽取四至六年级。根据体检和问卷数据最终纳入8 735名中小学生，其中男生4 324名，女生4 411名；小学生2 887名，初中生2 927名，高中生2 921名。年龄8~18岁，平均(13.42±2.61)岁。本研究已通过扬州市疾病预防控制中心伦理委员会批准(批号：KY2025001)，调查对象均知情同意。
1.2　方法
1.2.1　问卷调查
研究对象基本信息和健康影响因素采用学生健康状况及影响因素调查表[11]进行收集，该问卷的Cronbach α系数为0.83。根据《中小学生一日学习时间卫生要求》(GB/T 17223—2012)[12]，将小学生睡眠时间＜10 h/d、初中生＜9 h/d、高中生＜8 h/d定义为睡眠不足。中高强度运动使用条目“过去7 d里，你有几天能做到每天至少60 min及以上中高强度运动(可累计)”评估，分为低频率(0~1 d)、中频率(2~4 d)、高频率(5~7 d)三类。
1.2.2　体格检查
身高、体重测量：统一使用自动上传式身高体重测量仪，由专业人员进行测量，身高精确到0.1 cm，误差≤0.5 cm；体重精确到0.1 kg，误差≤0.1 kg。血压测量：统一采用电子血压计，由专业人员进行测量。每人测量2次，每次间隔1~2 min，记录2次的平均值。若2次测量数值相差超过5 mmHg(1 mmHg=0.133 kPa)，需再次测量，记录3次的平均值。
1.2.3　判定方法
超重肥胖：利用身高、体重数据计算体质量指数(body mass index，BMI)=体重(kg)/[身高(m)]2。依据《学龄儿童青少年超重与肥胖筛查》(WS/T 586—2018)[13]划分超重和肥胖，排除超重、肥胖的儿童青少年判定为非超重肥胖。血压偏高：根据《7岁~18岁儿童青少年血压偏高筛查界值》(WS/T 610—2018)[14]，收缩压和(或)舒张压≥同性别、同年龄、同身高百分位血压P95者为血压偏高。
1.3　质量控制
按照统一规程且使用合格仪器和设备测量各指标。所有参加本研究的工作人员均经过专业培训且考核合格。每天检测过程中，按照5%进行随机抽样复测，若错误率＞10%，则当天所有数据作废，进行重新测量。数据实行双录入，并对录入数据进行逻辑纠错，保证数据质量。
1.4　统计学分析
使用SPSS 26.0软件进行数据分析，计量资料采用(x±s)表示，计数资料采用频数和率描述，不同组间中小学生超重肥胖与血压偏高共存检出率比较采用χ2检验；运用多因素Logistic回归模型探讨超重肥胖与血压偏高共存相关因素及其与睡眠、饮食行为的关联。检验水准α=0.05。
2　结果
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2.1　不同组别中小学生超重肥胖与血压偏高共存率比较
中小学生超重肥胖与血压偏高共存检出率为9.85%(860名)，其中男生检出率高于女生，城区低于郊县，睡眠充足的中小学生低于睡眠不足的，每天吃早餐低于非每天吃早餐的中小学生；不同学段、父母文化程度、是否吸过烟、是否饮过酒、中高强度运动频率中小学生的共存检出率差异均有统计学意义(P值均＜0.05)。见表1。
2.2　睡眠、早餐行为和中小学生超重肥胖与血压偏高共存的关联
以是否超重肥胖与血压偏高共存为因变量(1=否，2=是)，睡眠、早餐行为为自变量(分别以睡眠充足、每天吃早餐为参照组)进行多因素Logistic回归分析。调整性别、地区、学段、父母文化程度、吸烟、饮酒、中高强度运动频率，结果显示，睡眠不足和非每天吃早餐中小学生超重肥胖与血压偏高检出率相对较高[OR值(95%CI)分别为1.25(1.04，1.52)，1.23(1.04，1.46)，P值均＜0.05]。
2.3　睡眠、早餐行为联合作用和中小学生超重肥胖与血压偏高共存的关联
以是否超重肥胖与血压偏高共存为因变量(1=否，2=是)，睡眠与早餐联合行为为自变量(以每天吃早餐+睡眠充足组为参照组)进行单因素和多因素Logistic回归分析。单因素Logistic回归分析结果显示，与每天吃早餐+睡眠充足组相比，每天吃早餐+睡眠不足组和非每天吃早餐+睡眠不足组发生超重肥胖与血压偏高共存的风险均增加，且非每天吃早餐+睡眠不足组风险更高(OR值分别为1.37，1.87，P值均＜0.01)。见表2。多因素分析显示，从不同性别来看，男生和女生中非每天吃早餐+睡眠不足组出现超重肥胖与血压偏高共存的风险均增加(P值均 < 0.05)；从不同学段来看，小学生非每天吃早餐+睡眠不足组出现共存的风险增加(P < 0.01)；而在初中、高中生中关联无统计学意义(P值均>0.05)。见表3。
2.4　睡眠与早餐行为联合作用和不同性别、学段中小学生超重肥胖与血压偏高共存的关联
以是否超重肥胖与血压偏高共存为因变量(1=否，2=是)，睡眠与早餐联合行为为自变量，调整地区、性别、学段、父母文化程度、吸烟、饮酒、中高强度运动频率后，进行多因素Logistic回归分析结果显示，与每天吃早餐+睡眠充足组相比，非每天吃早餐+睡眠不足组发生超重肥胖与血压偏高共存的风险更高(OR=1.52，95%CI=1.18~1.96，P＜0.01)。从不同性别小学生来看，非每天吃早餐+睡眠不足的女生发生共存的风险是每天吃早餐+睡眠充足组的3.59倍(95%CI=1.65~7.82)(P < 0.01)，在男生中差异无统计学意义(P>0.05)。
3　讨论
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本研究结果显示，扬州市中小学生超重肥胖与血压偏高共存检出率为9.85%，高于贵州(4.4%)[15]、宁夏(1.07%)[16]的检出率，接近内蒙古(9.45%)[6]的检出率。检出率的不同可能与不同地区营养水平、生活行为差异以及测量方法、环境不同有关[17]。可见，扬州市中小学生超重肥胖与血压偏高共存检出率处于较高水平，需采取有效措施控制其发生发展。本研究中男生超重肥胖与血压偏高共存的检出率高于女生，与蒋家诺等[6, 15, 18]研究结果一致，可能与食物摄入量的需求差异、进食速度不同以及性别差异化的食物偏好有关。郊县学生超重肥胖与血压偏高共存检出率高于城区，与内蒙古地区[6]研究结论相反，提示应加强对扬州市郊县学生的有效干预。从不同学段来看，初中生超重肥胖与血压偏高共存检出率最高，可能与初中阶段逐步进入青春期，内分泌系统活性增强有关[19]。
生活方式是超重肥胖和血压偏高共同的影响因素[20-21]，吸烟和饮酒是超重肥胖与血压偏高共存的危险因素，与蔡炳耀等[22]在大学生中开展的研究结果一致，再次证实吸烟会对血压产生不良影响。有研究表明，饮酒与超重肥胖、高血压之间具有交互作用，致使二者共存发生概率增大[23]。中高强度运动可降低超重肥胖与血压偏高共存的发生风险，与其他研究结果相同[6, 24-25]。流行病学研究表明，身体活动在肥胖的发生、血压调节和高血压的发展中起着重要作用[21, 26]，且对改善中小学生的代谢状况有积极作用[27]，可作为有效的干预手段。
本研究显示，睡眠充足的中小学生发生超重肥胖与血压偏高共存的风险较低，与其他研究结果一致[15]。Meta分析发现，睡眠时间偏短的儿童青少年发生肥胖的风险是睡眠时间正常者的1.26倍[28]。另有研究表明，睡眠不足使交感神经兴奋，通过引起体内炎症因子等释放，对血压产生影响[29]。吃早餐是影响中小学生超重肥胖与血压偏高共存的积极因素，与既往调查结果一致[22, 30]。一项Meta分析结果显示，儿童青少年早餐频次越高，发生肥胖的风险越低[31]。刘冰等[32]发现从不吃早餐中小学生血压偏高风险为每天吃早餐者的1.24倍。儿童青少年若有不吃早餐的习惯，其饮食和生活习惯更偏向于不健康，影响心血管代谢 [33]。本研究中睡眠不足和不坚持吃早餐联合作用对中小学生发生超重肥胖与血压偏高共存的风险更大，且女生高于男生，对小学生影响更大，提示睡眠不足与不良早餐习惯是导致中小学生超重肥胖与血压偏高共存的重要因素，学校和家庭应着重引导学生，从作息和饮食方面入手，培养良好的睡眠和早餐习惯，促进儿童青少年健康成长。
基金
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  • 扬州市基础研究计划(联合专项)卫生健康类项目(2024-4-26)
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2025年第46卷第7期
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doi: 10.16835/j.cnki.1000-9817.2025221
  • 接收时间：2025-03-24
  • 首发时间：2026-11-06
  • 出版时间：2025-07-25
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  • 收稿日期：2025-03-24
  • 修回日期：2025-05-30
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扬州市基础研究计划(联合专项)卫生健康类项目(2024-4-26)
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    江苏省扬州市疾病预防控制中心儿童青少年健康促进科，225000

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