能量平衡相关行为在中小学生睡眠和肥胖之间的中介效应分析

doi:10.3969/j.issn.1674-8115.2021.04.017

摘要/Abstract

摘要：

目的·探讨能量平衡相关行为对中小学生睡眠与肥胖关联的中介效应。方法·2016年9月—11月以5 179名广东省茂名市中小学生为研究对象，根据我国《学龄儿童青少年超重与肥胖筛查》体质量指数临界值分为肥胖组与非肥胖组。运用自填式问卷和标准人体测量方法，收集中小学生身高、体质量、睡眠时间参数、体育活动、视屏行为和饮食模式等信息。采用线性回归和Logistic回归分析分别评估睡眠及能量平衡相关行为（即饮食模式、体育活动、视屏行为）与肥胖之间的关联，并使用MacKinnon乘积分布法评估能量平衡相关行为在睡眠与肥胖之间中介效应的显著性。结果·与非肥胖组比较，肥胖组的特征为男性、年幼、父母肥胖、家庭月收入高、视屏时间长、高能量类饮食和水果-奶类饮食频率偏高。中小学生睡眠时间、就寝时间、起床时间均与肥胖风险存在显著关联（均P=0.000）。观察到“睡眠→视屏行为→肥胖”“睡眠→体育活动→肥胖”中介途径在睡眠与肥胖的关联中有统计学意义（P<0.05），未发现高能量类饮食及水果-奶类饮食的中介效应证据。结论·体育活动、视屏行为可能部分介导睡眠与肥胖之间关联的总效应。

关键词: 肥胖, 睡眠, 能量平衡相关行为, 中介效应

Abstract:

Objective· To investigate the possible mediation effects of energy balance-related behaviors on the association of sleep with obesity among elementary and junior high school students.

Methods· Data of 5 179 primary and middle school students were assessed via a self-reported questionnaire and anthropometric measurement, including sleep variables, physical activities, screen behaviors, dietary patterns, height and weight status in Maoming City, Guangdong Province from September to November 2016. The enrolled students were divided into obese group and non-obese group according to body mass index threshold of Screening of Overweight and Obesity in School-age Children and Adolescents in China. Linear regression and Logistic regression analyses were used to estimate the associations between sleep, the aforementioned energy balance-related behaviors and obesity. The MacKinnon's product-of-coefficients method was used to assess the mediation effects of energy balance-related behaviors.

Results· Compared with the non-obese group, most obese students were characterized by being male, young, parental obesity, high monthly house income, long screen time, high frequency of high calorie food and fruit-milk diet. Significant associations were observed between sleep duration, bedtime and wake-up time of elementary and junior high school students with the risk of obesity (all P=0.000). The intermediary pathways of obesity (sleep→screen behavior→obesity, and sleep→physical activity→obesity) were statistically significant (P<0.05). No evidence for the mediating role of high calorie or fruit-milk dietary habits was found in this study.

Conclusion· Physical activity and screen behavior were identified as possible mediators of the association between sleep and obesity.

Key words: obesity, sleep, energy balance-related behavior, mediation effect

中图分类号:

R723.14

楼淑萍, 黄彦, 刘攀越, 陈辉. 能量平衡相关行为在中小学生睡眠和肥胖之间的中介效应分析[J]. 上海交通大学学报(医学版), 2021, 41(4): 519-524.

Shu-ping LOU, Yan HUANG, Pan-yue LIU, Hui CHEN. Mediation effects of energy balance-related behaviors on associations between sleep and the risk of obesity among elementary and junior high school students[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(4): 519-524.

图/表 6

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Variable	Total (n=5 179)	Obese group (n=725)	Non-obese group (n=4 454)	P value
Age/year	10.66 (8.78, 12.32)	8.95 (7.81, 10.64)	10.92 (9.09, 12.60)	0.000
Physical activity/h	1.00 (0.50, 1.20)	1.00 (0.50, 1.24)	1.00 (0.50, 1.20)	0.349
Screen behavior/h	1.50 (0.50, 2.50)	2.00 (1.50, 2.67)	1.50 (0.50, 2.50)	0.000
Monthly fruit and milk/time	4.00 (3.00, 10.50)	5.00 (3.00, 14.00)	4.00 (3.00, 10.50)	0.038
Monthly high calorie diet/time	18.00 (6.50, 30.50)	20.00 (6.25, 30.50)	18.00 (6.50, 30.50)	0.963
Sleep duration/h	9.00 (8.50, 10.00)	8.67 (7.85, 9.50)	9.50 (8.50, 10.00)	0.000
Wake-up time	6∶40 (6∶00, 7∶00)	6∶30 (6∶00, 6∶57)	6∶50 (6∶10, 7∶00)	0.000
Bedtime	22∶00 (22∶00, 23∶00)	23∶00 (22∶00, 23∶15)	22∶00 (22∶00, 23∶00)	0.000
Gender (male)/n (%)	2 899 (56.0)	478 (65.9)	2 421 (54.4)	0.000
Breastfeeding for 6 months/n (%)	2 293 (44.3)	336 (46.9)	1 957 (43.8)	0.051
Parental obesity/n (%)				0.000
None	4 776 (92.2)	617 (85.1)	4 159 (93.4)
Either	372 (7.2)	97 (13.4)	275 (6.2)
Both	31 (0.6)	11 (1.5)	20 (0.4)
Monthly house income/n (%)				0.006
<1 000 yuan	459 (8.9)	49 (6.8)	410 (9.2)
1 000?4 999 yuan	3 203 (61.8)	440 (60.8)	2 763 (62.0)
5 000?10 000 yuan	1 138 (22.0)	164 (22.5)	974 (21.9)
>10 000 yuan	379 (7.3)	72 (9.9)	307 (6.9)

Variable	Total (n=5 179)	Obese group (n=725)	Non-obese group (n=4 454)	P value
Age/year	10.66 (8.78, 12.32)	8.95 (7.81, 10.64)	10.92 (9.09, 12.60)	0.000
Physical activity/h	1.00 (0.50, 1.20)	1.00 (0.50, 1.24)	1.00 (0.50, 1.20)	0.349
Screen behavior/h	1.50 (0.50, 2.50)	2.00 (1.50, 2.67)	1.50 (0.50, 2.50)	0.000
Monthly fruit and milk/time	4.00 (3.00, 10.50)	5.00 (3.00, 14.00)	4.00 (3.00, 10.50)	0.038
Monthly high calorie diet/time	18.00 (6.50, 30.50)	20.00 (6.25, 30.50)	18.00 (6.50, 30.50)	0.963
Sleep duration/h	9.00 (8.50, 10.00)	8.67 (7.85, 9.50)	9.50 (8.50, 10.00)	0.000
Wake-up time	6∶40 (6∶00, 7∶00)	6∶30 (6∶00, 6∶57)	6∶50 (6∶10, 7∶00)	0.000
Bedtime	22∶00 (22∶00, 23∶00)	23∶00 (22∶00, 23∶15)	22∶00 (22∶00, 23∶00)	0.000
Gender (male)/n (%)	2 899 (56.0)	478 (65.9)	2 421 (54.4)	0.000
Breastfeeding for 6 months/n (%)	2 293 (44.3)	336 (46.9)	1 957 (43.8)	0.051
Parental obesity/n (%)				0.000
None	4 776 (92.2)	617 (85.1)	4 159 (93.4)
Either	372 (7.2)	97 (13.4)	275 (6.2)
Both	31 (0.6)	11 (1.5)	20 (0.4)
Monthly house income/n (%)				0.006
<1 000 yuan	459 (8.9)	49 (6.8)	410 (9.2)
1 000?4 999 yuan	3 203 (61.8)	440 (60.8)	2 763 (62.0)
5 000?10 000 yuan	1 138 (22.0)	164 (22.5)	974 (21.9)
>10 000 yuan	379 (7.3)	72 (9.9)	307 (6.9)

Sleep variable	β value	SE	OR (95%CI)
Sleep duration	-0.559	0.037	0.572 (0.532?0.614)
Bedtime	0.741	0.053	2.097 (1.890?2.327)
Wake-up time	-1.064	0.087	0.345 (0.291?0.409)

Sleep variable	β value	SE	OR (95%CI)
Sleep duration	-0.559	0.037	0.572 (0.532?0.614)
Bedtime	0.741	0.053	2.097 (1.890?2.327)
Wake-up time	-1.064	0.087	0.345 (0.291?0.409)

Sleep variable	Fruit and milk		High calorie diet		Physical activity		Screen behavior
Sleep variable	β (95%CI)	P value	β (95%CI)	P value	β (95%CI)	P value	β (95%CI)	P value
Sleep duration	0.049 (-0.310?0.408)	0.790	-0.936 (-1.366?-0.505)	0.000	0.081 (0.059?0.103)	0.000	0.051 (0.015?0.088)	0.005
Bedtime	1.769 (1.139?2.398)	0.000	0.531 (0.005?1.057)	0.048	-0.100 (-0.132?-0.068)	0.000	-0.040 (-0.093?0.013)	0.136
Wake-up time	-0.277 (-1.248?0.693)	0.576	0.960 (0.153?1.767)	0.020	0.068 (0.019?0.117)	0.007	0.190 (0.109?0.272)	0.000