| Objective:This study aims to understand the trends of underweight,overweight and obesity among children and adolescents in the urban and ruaral,to explore the relationship between blood pressure,lipids and nutritional status in children and adolescents,and to find out the influencing factors of overweight,obesity,high blood pressure,and blood lipid disorders in children and adolescents,and to provide a scientific basis for formulating targeted group intervention strategies and promoting the healthy growth of children and adolescents in Yanbian by examining the nutrition and health status and related living habits in Yanji during 2010 to 2016.Methods:A total of 47 373 students from 49 primary and middle schools in urban and rural areas of Yanji conducted physical examinations,and the test indicators included the height,weight,and blood pressure.The percentile values of gender-age were calculated by uisng the lambda(skowness,L),median(M),and coefficient of variation(S)methods,and the LMS curve was drawn and the height reference value for children and adolescents in Yanji was eastablished.Using the criteria established by the Chinese Obesity Working Group to screen for overweight and obesity,the "Health Industry Standard of the People’s Republic of China" was used to screen for malnutrition among children and adolescents.Using systematic cluster analysis to divide the growth period of children and adolescents in Yanji,using a stratified cluster sampling method,1 920 students aged 9 to 14 years were selected to conduct a questionnaire survey on dietary behavior and lifestyle,and the plasma levels of vitamin A,vitamin E,and 25(OH)D3 were measured by high performance liquid chromatography.A total of 531 people was randomly selected and their plasma total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL)and high-density lipoprotein cholesterol(HDL)levels were measured using an automatic biochemical analyzer.Logistic regression analysis,mediation analysis,multiple linear regression analysis,and optimal-scale regression analysis were used to analyze the relationship between lifestyle and height growth,overweight,and blood pressure.Using the receiver operating characteristic curve(ROC)to determine the blood pressure height ratio is better than predicting the optimal threshold of hypertension in Yanji.Results:1.Based on height growth,the growth period of school-age children in Yanji will be divided into four periods:boys are in the early period of sudden increase(6 to 10 years old),sudden increase period(11 to 13 years old),late increase period(14 to 18 years old);girls are in the early period of rapid growth(6 to 9 years old),rapid growth period(10 to 11 years old),late growth period(12 to 14 years old)and stable period(15 to 18 years old).The growth trend of the height of boys and girls in Yanji is obvious.Boys begin to enter the peak of height development at the age of 12 and the height curve tends to be stable after 15 years of age.Girls have entered the peak of height development since the age of 11 and after 13 years of age,the curve has stabilized.2.Between the ages of 6 and 15 years,urban males were significantly taller than boys in towns and towns(P<0.01).After 11 years of age,urban females were significantly taller than girls in towns and towns.Between the ages of 12 and 18,the height of Han boys and girls in all age groups was significantly higher than that of Korean boys and girls respectively(P<0.01).Between the ages of 6 and 14 years,the normal height of boys was significantly higher than that of weight-reducing boys,and the height of overweight or obese men was significantly higher than that of normal boys(P<0.01),but the heights of boys of various sizes between 15 and 18 years old were not significant difference.3.In 2016,the height of urban boys after entering the peak of growth was significantly higher than that of 2010,but the growth of boys in towns and towns did not change significantly.In 2016,the heights of urban and rural girls entering the period of rapid growth and stabilization were significantly higher than those of 2010.4.The dietary behaviors that affected the height growth of children and adolescents were:weekly frequency of eating meat,the frequency of eating dairy products,and the frequency of drinking sweet drinks were all positively correlated with height growth;the frequency of eating expanded foods per week was negatively correlated with the height of boys;and Parents living together and eating vegetables for breakfast are conducive to height growth;the high frequency of partial eclipses and sweet desserts per week is not conducive to height growth.The ratio of Han boys eating vegetables for breakfast,the ratio of drinking milk per day,and the ratio of living with their parents were higher than Koreans.The ratio of partial Han food and more than 3 times of sweet desserts per week were lower than those of Koreans.5.Overweight and obesity status:In 2016,the underweight prevalence rate of male students in Yanji was 5.7%,the overweight prevalence rate was 18.2%,the obesity prevalence rate was 21.5%,the overweight plus obesity prevalence rate was 39.7%.Underweight prevalence rate of female students was 5.1%,the overweight prevalence rate was 14.5%,the obesity prevalence rate was 14.2%,the overweight plus obesity prevalence rate was 28.7%;the Han boys’ obesity prevalence rate(22.3%)was higher than the Korean boys(19.9%).The prevalence rate of overweight(14.1%)for Han girls was lower than that of Korean girls(15.3%),but the prevalence rate of obesity for Han girls(14.6%)was higher than that of Korean girls(13.5%).The prevalence rate of underweight in ruaral boys was higher(8.4%)than that of urban boys(4.9%).The prevalence rate of overweight and obesity in urban boys(18.6%,22.8%)was higher than that of boys in ruaral(14.4%,16.7%).The prevalence rate of underweight girls in ruaral(4.6%)was higher than that of urban girls(8.0%),while the prevalence rate of overweight and obesity girls in ruaral(11.3%,12.8%)was lower than that of urban girls(14.6%,14.9%).6.Overweight and obesity trends:the overall student’s prevalence rate of underweight in 2016 was lower than in 2010,and the prevalence rate of overweight and obesity was higher than that in 2010.There was no significant change in the prevalence rate of overweight and obesity between rural and urban students in 2016 and 2010,but in 2016,the prevalence rate of ruaral male students was 8.6%,which was lower than that in 2010(13.5%).7.Relationships between dietary behaviors and overweight/obesity:Eating barbecued food ≥ 3 times per week(boys’ OR=1.767,girls’ OR=2.205),dieting for weight loss(boys’ OR=2.113,girls’ OR=2.128)increased the risk of overweight/obesity in children and adolescents.Eating dessert≥ 3 times a week(OR=0.359 for boys and OR=0.324 for girls)reduced the risk of overweight/obesity.Eating three meals on time(OR=0.683 for boys and OR=0.624 for girls)reduced the risk of overweight/obesity.The mediating effect of self-evaluation on body size between overweight,obesity and dieting and weight loss was not significant among boys,but was statistically significant among girls(z=2.692,P<0.01),accounting for 15.8%of the total effect.Self-evaluation of body type had a complete mediating effect between overweight,obesity,and eating three meals on time.Among boys,37.0%of the total effects and 25.8%of girls.8.Plasma fat-soluble vitamin levels:(1)Vitamin E levels:Girls(7.385 μg/mL)were higher than boys(6.778 μg/mL)(adjusted age),and town boys(8.030 μg/mL)were higher than urban boys(6.501 μg/mL).(Adjusted for age).Boys aged 9 to 11(7.181 μg/mL)were higher than boys aged 12 to 14 years(6.428 μg/mL)(adjusted for urban and rural areas).Korean women(7.628 μg/mL)were higher than Han girls(7.033).Mg/mL).(2)Vitamin A levels:Plasma vitamin A levels(1.113 μg/mL)were significantly higher in girls aged 9 to 11 years than boys 12 to 14 years old(1.050μg/mL)(adjusted for urban and rural areas).(3)25(OH)D3 levels:Girls in townships(0.304 ng/mL)were higher than urban girls(0.288 ng/mL)(adjusted for age);girls 9 to 11 years old(0.326 ng/mL)were higher than girls 12 to 14 years old(0.254 ng/mL).9.In 2016,hypertension prevalence in Korean and Han boys aged 12 to 17 were 12.8%and 13.0%,and 5.9%and 6.2%of girls.There was no significant difference between the two ethnic groups.The prevalence rate of hypertension in boys was higher(12.9%)than that of girls(6.1%).The prevalence rate of hypertension in ruaral girls(9.28%)was higher than that of urban girls(6.31%).The prevalence of hypertension among obese boys and girls(28.79%,18.31%)was higher than that of other boys and girls.The prevalence of hypertension in adolescents in Yanji was significantly higher than that in Changchun.10.The threshold for systolic hypertension using systolic height-to-height ratio(SBPHR)within the age range of 12 to 17 years was 0.73 mmHg/cm for boys(sensitivity:92.2%,specificity:88.9%,PPV:52.6%,NPV:98.8%),girls 0.75 mmHg/cm(sensitivity:95.6%,specificity:89.5%,PPV:33.6%,NPV=99.6%);The diastolic pressure height ratio(DBPHR)was used to screen for diastolic hypertension threshold of 0.49 mmHg/cm for boys(sensitivity:91.6%,specificity:93.9%,PPV:35.3%,NPV=99.6%),female 0.51 mmHg/cm(sensitivity:89.8%,specificity:94.3%,PPV:26.7%,NPV=99.8%).11.Relationship between plasma fat-soluble vitamin levels and height and weight:There was a positive correlation between plasma vitamin A levels and height,weight,and BMI(P<0.01).12.The relationship between plasma fat-soluble vitamin levels and lipids:The prevalence rate of dyslipidemia in overweight and obese students(22.4%)was higher than that of wasting and normal weight students(10.01%)(P<0.001).After adjusting for age and gender,the levels of 25(OH)D3 and Vit E in the dyslipidemia group were significantly higher than those in the normal lipid group(P<0.001).Plasma vitamin E and 25(OH)D3 levels were positively correlated with TG levels in children and adolescents,while vitamin E was negatively correlated with plasma HDL levels.Plasma vitamin E and 25(OH)D3 levels in the abnormal blood pressure group were significantly higher than those in the normal lipid group.Conclusions:1.The reference value of children’s height between 6 and 18 years old in Yanji city established by the LMS method is different from the national standard.The national uniform height standard is not suitable for evaluating the difference in height with special living habits,genetic factors and geographic location.2.In 2016,the height of urban and rural children and adolescents in Yanji increased significantly compared with five years ago.Appropriately increasing the frequency of eating meat every week,eating dairy products every day,eating vegetables for breakfast,and living with parents are all conducive to promoting the growth of children and adolescents.Eating habits such as puffed foods,desserts,and partial eclipses are not conducive to height growth.The low ratio of Han Chinese breakfast to Korean food for breakfast,the ratio of drinking milk every day,and the low rate of living with parents may be a negative factor affecting their height growth.3.The prevalence of overweight and obesity among children and adolescents aged 6 to 18 years in Yanji is at a relatively high level.Dietary habits and dieting are the major factors affecting overweight and obesity.4.The prevalence rate of hypertension among young people in Yanji is lower than the national average,but higher than other areas in the Jilin province.Obese adolescents have a high risk of hypertension.Blood Pressure Height Ratio(BPHR)is a simple and accurate indicator of screening for adolescent hypertension.It can prevent the missed diagnosis of hypertension in children and adolescents.5.The prevalence of dyslipidemia among children and adolescents in Yanji is severe.We must pay close attention and take active prevention and control measures.6.Plasma vitamin E and 25(OH)D3 levels are associated with dyslipidemia and hypertension in children and adolescents,and vitamin A levels are associated with height growth. |
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