Article(id=1325500680600944841, tenantId=1146029695717560320, journalId=1256213402557890569, issueId=1325500677975318675, articleNumber=null, orderNo=null, doi=10.16835/j.cnki.1000-9817.2025036, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1723046400000, receivedDateStr=2024-08-08, revisedDate=1726675200000, revisedDateStr=2024-09-19, acceptedDate=null, acceptedDateStr=null, onlineDate=1793953588866, onlineDateStr=2026-11-06, pubDate=1740412800000, pubDateStr=2025-02-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793953588866, onlineIssueDateStr=2026-11-06, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793953588866, creator=13701087609, updateTime=1793953588866, updator=13701087609, issue=Issue{id=1325500677975318675, tenantId=1146029695717560320, journalId=1256213402557890569, year='2025', volume='46', issue='2', pageStart='153', pageEnd='304', issueExtLink='null', onlineDate='null', pubDate='1740412800000', pubDateStr='2025-02-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793953588241, creator='13701087609', updateTime=1793953588241, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=162, endPage=166, ext={EN=ArticleExt(id=1325500683167858891, articleId=1325500680600944841, tenantId=1146029695717560320, journalId=1256213402557890569, language=EN, title=Relationship of physical activity and screen time with overweight and obesity among children and adolescents with special needs in Tianjin, columnId=1325500683088167114, journalTitle=Chinese Journal of School Health, columnName=Column on Physical and Mental Health of Children with Disabilities, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the association of physical activity and screen time with overweight and obesity among children and adolescents with special needs in Tianjin, so as to provide scientific evidence for childhood obesity prevention and intervention measures in the population.

Methods

From January 2022 to June 2024, 296 children and adolescents with intellectual disabilities and autism spectrum disorders aged 2-18 years were recruited from special education schools and institutions in Tianjin. Height and weight were measured, and a standardized questionnaire was used to assess physical activity and screen time. Binary Logistic regression analysis was carried out to investigate the association of physical activity and screen time with overweight and obesity.

Results

The prevalence of overweight and obesity among children and adolescents with special needs in Tianjin were 17.2% and 21.6%, respectively, and the combined prevalence of overweight and obesity was 38.9%. The median of moderate-to-vigorous physical activity (MVPA) time was 0.20 h/d, and physical activity sufficiency rate was 7.8%. The median of screen time was 1.79 h/d, and the screen time compliance rate was 68.2%. The binary Logistic regression results showed that lower levels of MVPA time and increased screen time were associated with a higher risk of overweight and obesity among children and adolescents with special needs [OR(95%CI)=1.80(1.06-3.07), 2.40(1.42-4.07), P < 0.05].

Conclusions

Insufficient physical activity and excessive screen time are associated with an increased risk of overweight and obesity among children and adolescents with special needs. Therefore, comprehensive intervention measures should be implemented as early as possible to prevent and reduce the incidence of overweight and obesity in this population.

, authors=Yu HAN, Zhi LI, Penghong LI, Tingkai CUI, Wenjuan XIONG, Zhiyi QU, Wei XI, Xin ZHANG*, authorsList=Yu HAN, Zhi LI, Penghong LI, Tingkai CUI, Wenjuan XIONG, Zhiyi QU, Wei XI, Xin ZHANG, authorCompany=null, correspAuthors=Xin ZHANG, 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=1325500684698779853, articleId=1325500680600944841, tenantId=1146029695717560320, journalId=1256213402557890569, language=CN, title=天津市特殊儿童青少年体力活动和视屏时间与超重肥胖的关联, columnId=1325500683864113356, journalTitle=中国学校卫生, columnName=残疾儿童身心健康状况专栏, runingTitle=null, highlight=null, articleAbstract=
目的

了解天津市特殊儿童青少年体力活动和视屏时间与超重肥胖的关联,为制定特殊儿童肥胖的预防和干预措施提供科学依据。

方法

2022年1月至2024年6月,在天津市多家特殊教育学校和机构招募296名2~18岁智力障碍和孤独症谱系障碍儿童青少年进行身高、体重测量,采用结构化问卷评估儿童青少年的体力活动和视屏时间,运用二元Logistic回归分析体力活动和视屏时间与超重肥胖的关联。

结果

天津市特殊儿童青少年超重率为17.2%,肥胖率为21.6%,超重肥胖合并检出率为38.9%;中高强度体力活动(MVPA)时长中位数为0.20 h/d,体力活动合格率为7.8%;视屏时长中位数为1.79 h/d,视屏时长合格率为68.2%。二元Logistic回归分析结果显示,较少的MVPA时长和较多的视屏时长会增加特殊儿童青少年超重肥胖的风险[OR值(95%CI)分别为1.80(1.06~3.07),2.40(1.42~4.07),P值均 < 0.05]。

结论

体力活动时长不足和视屏时长较多会增加特殊儿童青少年超重肥胖的风险,应尽早在特殊儿童青少年中开展综合性干预措施预防和减少超重肥胖的发生。

, authors=韩钰, 李值, 李芃宏, 崔庭凯, 熊文娟, 曲之毅, 席薇, 张欣*, authorsList=韩钰, 李值, 李芃宏, 崔庭凯, 熊文娟, 曲之毅, 席薇, 张欣, authorCompany=null, correspAuthors=张欣, authorNote=

韩钰(1988-),女,河南安阳人,博士,讲师,主要研究方向为儿童神经行为发育

, correspAuthorsNote=
张欣,E-mail:
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The physical activity patterns of children with autism[J]. BMC Res Notes, 2011(4): 422., articleTitle=null, refAbstract=null), Reference(id=1325500720362946880, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325500680600944841, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=33, rfOrder=45, authorNames=null, journalName=null, refType=null, unstructuredReference=BARLOW S E. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report[J]. 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Prev Chronic Dis, 2010, 7(4): A82., articleTitle=null, refAbstract=null)], funds=[Fund(id=1325500698686783760, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325500680600944841, awardId=null, language=CN, fundingSource=天津市教委科研计划项目(2020KJ201), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1325500685181124814, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325500680600944841, xref=null, ext=[AuthorCompanyExt(id=1325500685189513423, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325500680600944841, companyId=1325500685181124814, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Public Health, Tianjin Medical University, Tianjin (300070), China), AuthorCompanyExt(id=1325500685197902032, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325500680600944841, companyId=1325500685181124814, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=天津医科大学公共卫生学院,天津 300070)])], figs=[ArticleFig(id=1325500696056955144, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325500680600944841, language=EN, label=Tab.1, caption=

Comparison of the detection rates of overweight and obesity among children and adolescents with special needs in different groups

, figureFileSmall=null, figureFileBig=null, tableContent=
组别人数统计值超重肥胖
性别
  男22536(16.0)49(21.8)
  女7115(21.1)15(21.1)
χ2值1.000.01
P值0.320.91
年龄/岁
  2~58214(17.1)5(6.1)
  6~911813(11.0)25(21.2)
  10~134810(20.8)21(43.8)
  14~184814(29.2)13(27.1)
χ2值8.4326.39
P值0.04< 0.01
残疾类型
  智障7816(20.5)23(29.5)
  孤独症21835(16.1)41(18.8)
χ2值0.803.87
P值0.370.04
父亲文化程度
  初中及以下6113(21.3)16(26.2)
  高中/中专6714(20.9)15(22.4)
  大专及以上16824(14.3)33(19.6)
χ2值2.371.18
P值0.310.56
母亲文化程度
  初中及以下5913(22.0)17(28.8)
  高中/中专6615(22.7)8(12.1)
  大专及以上17123(13.5)39(22.8)
χ2值4.075.46
P值0.130.07
家庭月收入/元
   < 5 00011025(22.7)22(20.0)
  5 000~10 00010117(16.8)21(20.8)
   > 10 000859(10.6)21(24.7)
χ2值4.970.69
P值0.080.71
), ArticleFig(id=1325500696170201353, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325500680600944841, language=CN, label=表1, caption=

不同组别特殊儿童青少年超重肥胖检出率比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别人数统计值超重肥胖
性别
  男22536(16.0)49(21.8)
  女7115(21.1)15(21.1)
χ2值1.000.01
P值0.320.91
年龄/岁
  2~58214(17.1)5(6.1)
  6~911813(11.0)25(21.2)
  10~134810(20.8)21(43.8)
  14~184814(29.2)13(27.1)
χ2值8.4326.39
P值0.04< 0.01
残疾类型
  智障7816(20.5)23(29.5)
  孤独症21835(16.1)41(18.8)
χ2值0.803.87
P值0.370.04
父亲文化程度
  初中及以下6113(21.3)16(26.2)
  高中/中专6714(20.9)15(22.4)
  大专及以上16824(14.3)33(19.6)
χ2值2.371.18
P值0.310.56
母亲文化程度
  初中及以下5913(22.0)17(28.8)
  高中/中专6615(22.7)8(12.1)
  大专及以上17123(13.5)39(22.8)
χ2值4.075.46
P值0.130.07
家庭月收入/元
   < 5 00011025(22.7)22(20.0)
  5 000~10 00010117(16.8)21(20.8)
   > 10 000859(10.6)21(24.7)
χ2值4.970.69
P值0.080.71
), ArticleFig(id=1325500696547688714, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325500680600944841, language=EN, label=Tab.2, caption=

Comparison of the physical activity and screen time among children and adolescents with special needs in different groups[M(P25, P75), h/d]

, figureFileSmall=null, figureFileBig=null, tableContent=
组别人数统计值体力活动时长视屏时长
性别
  男2250.21(0.00, 0.60)1.57(0.86, 2.29)
  女710.14(0.04, 0.43)1.86(1.14, 3.00)
Z值-0.67-1.61
P值0.500.11
年龄/岁
  2~5820.27(0.06, 0.75)1.29(0.50, 2.29)
  6~91180.29(0.02, 0.54)1.64(0.98, 2.71)
  10~13480.14(0.00, 0.50)2.21(1.29, 2.79)
  14~18480.07(0.00, 0.20)2.18(1.29, 2.50)
H值15.3016.25
P值0.00< 0.01
残疾类型
  智障780.14(0.00, 0.38)2.00(1.70, 2.61)
  孤独症2180.21(0.04, 0.63)1.29(0.71, 2.32)
Z值-2.52-3.13
P值0.01< 0.01
父亲文化程度
  初中及以下610.14(0.00, 0.27)1.93(1.14, 2.46)
  高中/中专670.21(0.04, 0.50)1.79(0.64, 2.79)
  大专及以上1680.27(0.00, 0.66)1.43(0.93, 2.29)
H值9.153.08
P值0.010.22
母亲文化程度
  初中及以下590.14(0.00, 0.29)2.00(1.00, 2.50)
  高中/中专660.18(0.07, 0.56)1.68(0.64, 2.52)
  大专及以上1710.25(0.00, 0.58)1.57(1.00, 2.50)
H值5.841.89
P值0.050.39
家庭月收入/元
   < 5 0001100.14(0.00, 0.45)1.86(0.84, 2.95)
  5 000~10 0001010.21(0.00, 0.57)1.79(1.14, 2.64)
   > 10 000850.29(0.02, 0.69)1.50(0.79, 2.29)
H值4.182.76
P值0.120.25
BMI
  非超重肥胖1810.17(0.00, 0.55)1.29(0.71, 2.54)
  超重肥胖1150.21(0.05, 0.50)2.14(1.29, 2.50)
Z值-0.55-3.01
P值0.58< 0.01
), ArticleFig(id=1325500697281691915, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325500680600944841, language=CN, label=表2, caption=

不同组别特殊儿童青少年体力活动和视屏时长比较[M(P25,P75),h/d]

, figureFileSmall=null, figureFileBig=null, tableContent=
组别人数统计值体力活动时长视屏时长
性别
  男2250.21(0.00, 0.60)1.57(0.86, 2.29)
  女710.14(0.04, 0.43)1.86(1.14, 3.00)
Z值-0.67-1.61
P值0.500.11
年龄/岁
  2~5820.27(0.06, 0.75)1.29(0.50, 2.29)
  6~91180.29(0.02, 0.54)1.64(0.98, 2.71)
  10~13480.14(0.00, 0.50)2.21(1.29, 2.79)
  14~18480.07(0.00, 0.20)2.18(1.29, 2.50)
H值15.3016.25
P值0.00< 0.01
残疾类型
  智障780.14(0.00, 0.38)2.00(1.70, 2.61)
  孤独症2180.21(0.04, 0.63)1.29(0.71, 2.32)
Z值-2.52-3.13
P值0.01< 0.01
父亲文化程度
  初中及以下610.14(0.00, 0.27)1.93(1.14, 2.46)
  高中/中专670.21(0.04, 0.50)1.79(0.64, 2.79)
  大专及以上1680.27(0.00, 0.66)1.43(0.93, 2.29)
H值9.153.08
P值0.010.22
母亲文化程度
  初中及以下590.14(0.00, 0.29)2.00(1.00, 2.50)
  高中/中专660.18(0.07, 0.56)1.68(0.64, 2.52)
  大专及以上1710.25(0.00, 0.58)1.57(1.00, 2.50)
H值5.841.89
P值0.050.39
家庭月收入/元
   < 5 0001100.14(0.00, 0.45)1.86(0.84, 2.95)
  5 000~10 0001010.21(0.00, 0.57)1.79(1.14, 2.64)
   > 10 000850.29(0.02, 0.69)1.50(0.79, 2.29)
H值4.182.76
P值0.120.25
BMI
  非超重肥胖1810.17(0.00, 0.55)1.29(0.71, 2.54)
  超重肥胖1150.21(0.05, 0.50)2.14(1.29, 2.50)
Z值-0.55-3.01
P值0.58< 0.01
), ArticleFig(id=1325500697369772300, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325500680600944841, language=EN, label=Tab.3, caption=

Comparison of pass rates of physical activity and screen time among children and adolescents with special needs in different groups

, figureFileSmall=null, figureFileBig=null, tableContent=
组别人数统计值体力活动视屏时长
残疾类型
  智障786(7.7)49(62.8)
  孤独症21817(7.8)153(70.2)
χ2值0.001.44
P值0.980.23
父亲文化程度
  初中及以下613(4.9)40(65.6)
  高中/中专671(1.5)42(62.7)
  大专及以上16819(11.3)120(71.4)
χ2值7.311.94
P值0.030.38
母亲文化程度
  初中及以下594(6.8)39(66.1)
  高中/中专663(4.5)45(68.2)
  大专及以上17116(9.4)118(69.0)
χ2值1.640.17
P值0.440.92
家庭月收入/元
   < 5 0001105(4.5)70(63.6)
  5 000~10 00010111(10.9)67(66.3)
   > 10 000857(8.2)65(76.5)
χ2值3.003.90
P值0.220.14
BMI
  非超重肥胖18115(8.3)122(67.4)
  超重肥胖1158(7.0)80(69.6)
χ2值0.170.15
P值0.680.70
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不同组别特殊儿童青少年体力活动视屏时长合格率比较

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组别人数统计值体力活动视屏时长
残疾类型
  智障786(7.7)49(62.8)
  孤独症21817(7.8)153(70.2)
χ2值0.001.44
P值0.980.23
父亲文化程度
  初中及以下613(4.9)40(65.6)
  高中/中专671(1.5)42(62.7)
  大专及以上16819(11.3)120(71.4)
χ2值7.311.94
P值0.030.38
母亲文化程度
  初中及以下594(6.8)39(66.1)
  高中/中专663(4.5)45(68.2)
  大专及以上17116(9.4)118(69.0)
χ2值1.640.17
P值0.440.92
家庭月收入/元
   < 5 0001105(4.5)70(63.6)
  5 000~10 00010111(10.9)67(66.3)
   > 10 000857(8.2)65(76.5)
χ2值3.003.90
P值0.220.14
BMI
  非超重肥胖18115(8.3)122(67.4)
  超重肥胖1158(7.0)80(69.6)
χ2值0.170.15
P值0.680.70
), ArticleFig(id=1325500697814368526, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325500680600944841, language=EN, label=Tab.4, caption=

Logistic regression analysis of physical activity and screen time with overweight and obesity among children and adolescents with special needs(n=296)

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模型自变量β值标准误P值OR值(95%CI)
1体力活动0.140.240.551.15(0.72~1.84)
视屏时长1.060.25<0.012.88(1.77~4.69)
2体力活动0.550.270.041.74(1.03~2.93)
视屏时长0.890.26< 0.012.44(1.47~4.06)
3体力活动0.590.270.031.80(1.06~3.07)
视屏时长0.880.27< 0.012.40(1.42~4.07)
), ArticleFig(id=1325500698133135631, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325500680600944841, language=CN, label=表4, caption=

特殊儿童青少年体力活动和视屏时长与超重肥胖Logistic回归分析(n=296)

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模型自变量β值标准误P值OR值(95%CI)
1体力活动0.140.240.551.15(0.72~1.84)
视屏时长1.060.25<0.012.88(1.77~4.69)
2体力活动0.550.270.041.74(1.03~2.93)
视屏时长0.890.26< 0.012.44(1.47~4.06)
3体力活动0.590.270.031.80(1.06~3.07)
视屏时长0.880.27< 0.012.40(1.42~4.07)
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天津市特殊儿童青少年体力活动和视屏时间与超重肥胖的关联
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韩钰 , 李值 , 李芃宏 , 崔庭凯 , 熊文娟 , 曲之毅 , 席薇 , 张欣 *
中国学校卫生 | 残疾儿童身心健康状况专栏 2025,46(2): 162-166
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中国学校卫生 |残疾儿童身心健康状况专栏 2025 , 46 (2) : 162 -166
天津市特殊儿童青少年体力活动和视屏时间与超重肥胖的关联
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韩钰, 李值, 李芃宏, 崔庭凯, 熊文娟, 曲之毅, 席薇, 张欣*
作者信息
  • 天津医科大学公共卫生学院,天津 300070
通讯作者:
张欣,E-mail:
作者简介:

韩钰(1988-),女,河南安阳人,博士,讲师,主要研究方向为儿童神经行为发育

Relationship of physical activity and screen time with overweight and obesity among children and adolescents with special needs in Tianjin
Yu HAN, Zhi LI, Penghong LI, Tingkai CUI, Wenjuan XIONG, Zhiyi QU, Wei XI, Xin ZHANG*
Affiliations
  • School of Public Health, Tianjin Medical University, Tianjin (300070), China
出版时间: 2025-02-25 doi: 10.16835/j.cnki.1000-9817.2025036
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目的

了解天津市特殊儿童青少年体力活动和视屏时间与超重肥胖的关联,为制定特殊儿童肥胖的预防和干预措施提供科学依据。

方法

2022年1月至2024年6月,在天津市多家特殊教育学校和机构招募296名2~18岁智力障碍和孤独症谱系障碍儿童青少年进行身高、体重测量,采用结构化问卷评估儿童青少年的体力活动和视屏时间,运用二元Logistic回归分析体力活动和视屏时间与超重肥胖的关联。

结果

天津市特殊儿童青少年超重率为17.2%,肥胖率为21.6%,超重肥胖合并检出率为38.9%;中高强度体力活动(MVPA)时长中位数为0.20 h/d,体力活动合格率为7.8%;视屏时长中位数为1.79 h/d,视屏时长合格率为68.2%。二元Logistic回归分析结果显示,较少的MVPA时长和较多的视屏时长会增加特殊儿童青少年超重肥胖的风险[OR值(95%CI)分别为1.80(1.06~3.07),2.40(1.42~4.07),P值均 < 0.05]。

结论

体力活动时长不足和视屏时长较多会增加特殊儿童青少年超重肥胖的风险,应尽早在特殊儿童青少年中开展综合性干预措施预防和减少超重肥胖的发生。

运动活动  /  注视,眼  /  超重  /  肥胖症  /  回归分析  /  儿童  /  青少年
Objective

To investigate the association of physical activity and screen time with overweight and obesity among children and adolescents with special needs in Tianjin, so as to provide scientific evidence for childhood obesity prevention and intervention measures in the population.

Methods

From January 2022 to June 2024, 296 children and adolescents with intellectual disabilities and autism spectrum disorders aged 2-18 years were recruited from special education schools and institutions in Tianjin. Height and weight were measured, and a standardized questionnaire was used to assess physical activity and screen time. Binary Logistic regression analysis was carried out to investigate the association of physical activity and screen time with overweight and obesity.

Results

The prevalence of overweight and obesity among children and adolescents with special needs in Tianjin were 17.2% and 21.6%, respectively, and the combined prevalence of overweight and obesity was 38.9%. The median of moderate-to-vigorous physical activity (MVPA) time was 0.20 h/d, and physical activity sufficiency rate was 7.8%. The median of screen time was 1.79 h/d, and the screen time compliance rate was 68.2%. The binary Logistic regression results showed that lower levels of MVPA time and increased screen time were associated with a higher risk of overweight and obesity among children and adolescents with special needs [OR(95%CI)=1.80(1.06-3.07), 2.40(1.42-4.07), P < 0.05].

Conclusions

Insufficient physical activity and excessive screen time are associated with an increased risk of overweight and obesity among children and adolescents with special needs. Therefore, comprehensive intervention measures should be implemented as early as possible to prevent and reduce the incidence of overweight and obesity in this population.

Motor activity  /  Fixation, ocular  /  Overweight  /  Obesity  /  Regression analysis  /  Child  /  Adolescent
韩钰, 李值, 李芃宏, 崔庭凯, 熊文娟, 曲之毅, 席薇, 张欣. 天津市特殊儿童青少年体力活动和视屏时间与超重肥胖的关联. 中国学校卫生, 2025 , 46 (2) : 162 -166 . DOI: 10.16835/j.cnki.1000-9817.2025036
Yu HAN, Zhi LI, Penghong LI, Tingkai CUI, Wenjuan XIONG, Zhiyi QU, Wei XI, Xin ZHANG. Relationship of physical activity and screen time with overweight and obesity among children and adolescents with special needs in Tianjin[J]. Chinese Journal of School Health, 2025 , 46 (2) : 162 -166 . DOI: 10.16835/j.cnki.1000-9817.2025036
儿童青少年超重肥胖已成为全球重大的公共卫生问题,近30年全球儿童肥胖的人数增长了约10倍[1],我国7~18岁儿童青少年超重肥胖的检出率由1985年的1.2%增长至2019年的23.4%,增长了18.1倍[2]。已有研究证实,儿童青少年时期的超重肥胖会大幅增加成年期糖尿病、心脑血管疾病、癌症等慢性病的风险[3]。特殊儿童青少年由于认知功能障碍常伴有不良的生活习惯[4-5],超重肥胖的风险高于正常同龄人[6]。特殊儿童青少年的超重肥胖往往会持续至成年,超重肥胖产生健康危害的同时会加剧其功能障碍,进一步降低生活能力,限制其融入正常社会[7]。体力活动不足、视屏时间过长等不良生活方式是近年来儿童青少年超重肥胖率攀升的重要原因[8]。本研究调查天津市特殊教育机构儿童青少年的超重肥胖以及体力活动和视屏时间现状及其关联,为制定特殊儿童肥胖的预防和干预措施提供科学依据。
2022年1月至2024年6月,通过在天津市4所特殊教育学校和5家孤独症康复机构发放项目宣传页,共招募296名特殊儿童青少年完成体格检查和问卷填写。其中单纯智力障碍者78名,孤独症谱系障碍者218名;男生225名,女生71名。年龄2~18岁,平均年龄(8.96±4.50)岁。参与本次调查的特殊儿童均由三甲医院儿童心理科高级职称的临床医师诊断为孤独症谱系障碍或单纯智力障碍,父母或监护人均签署书面知情同意书。本研究已通过天津医科大学伦理审查委员会审查(批准号:TMUhMEC2023 0032)。
调查问卷为统一编制的结构化问卷,内容包括儿童青少年姓名、性别、出生日期、父母文化程度和家庭月收入、儿童体力活动和视屏时长。体力活动采用国际体力活动问卷中文版短卷[9]调查最近一周内中高强度体力活动(moderate to vigorous physical activity, MVPA)的天数和时间;其中高强度体力活动指提重物、挖掘、有氧运动或快速骑自行车等剧烈的体育活动,中强度体力活动指提轻的物品、以平常速度骑车或双人网球等适度的体育活动,体力活动时间指过去7 d每天高、中强度体力活动的平均时长。每天视屏时长是指过去7 d每天看电视、手机、平板和电脑等电子设备时间的平均值。问卷由统一培训并经考核合格的调查员协助家长填写。严格按照“中国学生体质与健康调研检测细则”[10]规定的方法和仪器测量身高、体重,并计算体质量指数(body mass index, BMI)=体重(kg)/[身高(m)]2。
以2010年李辉等[11]制定的中国2~18岁儿童青少年超重和肥胖筛查体重指数界值点作为评价特殊儿童超重肥胖的标准。依据《中国儿童青少年身体活动指南》[12]推荐儿童青少年每天≥60 min的MVPA为“体力活动合格”,视屏时长每天<2 h为“视屏时长合格”。
所有调查人员经过统一培训,考核合格后再进行调查测量。调查人员一对一向家长解释问卷调查的内容和注意事项,家长现场填写问卷并当场回收。问卷回收后,研究人员对填写的问卷逐一检查,确保问卷的正确性和完整性。各所学校和机构使用统一标准的仪器和方法,测量过程中由质量控制人员进行监督,抽取5%的调查对象进行复测。
采用EpiData 3.1软件建立数据库,SPSS24.0软件进行统计分析。采用中位数和四分位数[M(P25, P75)]描述体力活动时长和视屏时长,采用Mann-Whitney U或Kruskal-Wallis H检验比较不同组别间体力活动时长和视屏时长。采用χ2检验比较不同组间率(%)或构成比(%)。以中位数作为界值,将体力活动时长和视屏时长转换为二分类变量作为自变量,采用二元Logistic回归模型分析体力活动和视屏时长与超重肥胖发生风险的关联,并调整年龄、性别、父母文化程度、家庭月收入和残疾类型等混杂因素。以P<0.05为有统计学意义。
见表1。
296名特殊儿童青少年中,超重51名(17.2%),肥胖64名(21.6%),超重肥胖合并检出115名(38.9%)。不同年龄特殊儿童青少年超重、肥胖检出率差异均有统计学意义(P值均 < 0.05);10~13岁组肥胖检出率最高(43.8%),14~18岁组超重检出率最高(29.2%)。智力障碍儿童青少年肥胖检出率高于孤独症儿童青少年,差异有统计学意义(P < 0.05)。不同残疾类型儿童青少年超重检出率差异无统计学意义,不同性别、父母文化程度和家庭月收入间特殊儿童青少年超重、肥胖检出率差异均无统计学意义(P值均>0.05)。见表1。
见表2~3。
特殊儿童青少年MVPA时长的中位数为0.20(0.00,0.54)h/d,体力活动合格率为7.8%(23名),视屏时长的中位数为1.79(0.93,2.50)h/d,视屏时长合格率为68.2%(202名)。不同年龄组别体力活动时长差异有统计学意义(P < 0.01),6~9岁组时长最长,14~18岁组时长最短。孤独症儿童青少年体力活动时长多于智力障碍儿童青少年,差异有统计学意义(P=0.01)。不同父亲文化程度组别体力活动时长和体力活动合格率差异均有统计学意义(P值均 < 0.05),父亲文化程度为大专及以上的儿童体力活动时长最长,且合格率最高。不同年龄组别视屏时长差异有统计学意义(H=16.25,P < 0.01),2~5岁组最短,10~13岁组最长。孤独症儿童视屏时长低于智障儿童,超重肥胖儿童视屏时长高于非超重肥胖儿童,差异均有统计学意义(P值均<0.05)。
见表4。
以是否超重/肥胖为因变量(否=0,是=1),体力活动时长和视屏时长作为自变量(体力活动时长大于等于中位数=0,小于中位数=1;视屏时长小于等于中位数=0,大于中位数=1),在校正性别、年龄、父母文化程度、家庭月收入和残疾类型等混杂因素后,进行多因素Logistic回归分析,结果显示,较低的体力活动时长和较长的视屏时长会增加特殊儿童青少年超重肥胖的风险(P值均 < 0.05)。
本研究结果显示,天津市特殊儿童青少年的超重检出率为17.2%,肥胖检出率为21.6%,超重肥胖合并检出率为38.9%。高于Zhang等[13]2017—2019年全国11个省、自治区和直辖市3~18岁儿童青少年超重肥胖的调查结果(超重率15.8%,肥胖率8.9%),也高于2014年天津市6~18岁儿童青少年超重肥胖的检出率(超重率16.3%,肥胖率14.9%)[14],与其他研究结果一致,特殊儿童青少年的超重肥胖率高于正常同龄人[15-16],略低于北京市(44.3%)[17]和济南市(41.69%)[18]6~18岁智力障碍儿童青少年的超重肥胖率,可能是由于本研究包含了6岁以下的儿童,学龄前儿童的超重肥胖率低于学龄儿童。本研究结果发现,特殊儿童青少年的超重肥胖率有随年龄增长而上升的趋势,与相关研究结果一致[19-20],此外儿童期肥胖是成年期肥胖和慢性疾病重要的预测因子[3],因此,在儿童时期对特殊人群开展肥胖的预防和干预十分必要。
本研究结果发现,天津市特殊儿童青少年体力活动合格率为7.8%,低于京津冀地区中小学生体力活动合格率(24.85%)[21]。张曌华等[22]Meta分析结果表明,中国儿童青少年中高强度体力活动时长为36.23 min/d,而本研究中特殊儿童青少年的体力活动时长更短。Einarsson等[23]和McCoy等[24]的研究同样发现,智力障碍和孤独症儿童青少年的体力活动水平低于正常同龄人,可能与特殊儿童身体协调障碍、运动能力不足以及行为问题和社交障碍有关。本研究中,特殊儿童青少年视屏时长的合格率为68.2%,高于京津冀地区的38.69%[21],但低于吕雅杰等[25]对中国6~13岁儿童青少年视屏时长的调查结果。本研究结果发现,随着年龄的增长,特殊儿童青少年体力活动的时长逐渐减少,而视屏时长则随之增加,原雅青等[26]也发现济南市智力障碍儿童青少年的静态时间有随年龄增长而增加的趋势。已有的研究证实儿童青少年时期体力活动和久坐的行为模式会持续到成年[27],所以应该在生命早期就帮助特殊儿童建立起良好的生活习惯,促进特殊儿童的健康。
大量研究证实,体力活动不足和屏幕时间过长是儿童青少年超重肥胖的重要危险因素[28-29]。Wang等[30]在我国香港地区发现,较长的静态时间与智力障碍儿童超重肥胖相关,与本研究的结果一致。与正常儿童相比,特殊儿童由于先天性的认知、运动和社交障碍,较难进行持续和剧烈的运动,更难参与团体性体育活动,可能导致他们更喜欢从事简单和久坐不动的活动[31-32]。因此,建议针对特殊儿童社区-学校-家庭共同开展包括健康教育、教师培训、改变学校课程安排、增加体育活动、提供营养食品以及家长教育或咨询等在内的综合性肥胖预防和干预措施[33-34],提高特殊儿童的健康水平。
综上所述,天津市特殊儿童青少年超重肥胖检出率较高,体力活动不足和视屏时间较多会增加超重肥胖的风险。本研究仍存在一定的局限性:(1)调查对象中青少年和智力障碍的人数偏少,未来可扩大样本量,提高样本的代表性;(2)体力活动的评估采用父母报告的方式,可能存在回忆偏倚,未来可使用加速计等客观测量儿童体力活动的工具,提高研究的准确性;(3)研究属于横断面研究,无法进行因果推断。
  • 天津市教委科研计划项目(2020KJ201)
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doi: 10.16835/j.cnki.1000-9817.2025036
  • 接收时间:2024-08-08
  • 首发时间:2026-11-06
  • 出版时间:2025-02-25
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  • 收稿日期:2024-08-08
  • 修回日期:2024-09-19
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天津市教委科研计划项目(2020KJ201)
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    天津医科大学公共卫生学院,天津 300070

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