| ?Objective?(1) To analyze gender differences in risk factors of simple obesity in children.(2) To analyze awareness of childhood obesity and its associated chronic diseases in parents of the participants in order to provide basis for subsequent education work in intervention.(3) To assess the effect of family-school-community-based intervention on childhood obesity and analyze the influencing factors of early life factors and family on the outcomes.?Methods?The cross-sectional survey included 2852 participants from five schools aged between 6 and 16 years old. We not only measured the participants' height and weight but also released the self-administered questionnaire including age, gender, birth weight, education degree of the guardians, feeding way in 6 months after birth, history of parent's obesity and chronic disease(including DM, hypertension, dyslipidemia, NAFLD), diet and physical activity, and the complications and prevention of childhood obesity among the guardians. According to BMI,they were divided into normal weight group and overweight /obesity group. For both boys and girls, firstly we carried out single factor statistical analysis and then multi-factor logistic regression analysis for those statistically significant risk factors. c 2 tests were adopted to compare the awareness between two groups. Binary logistic regression models were used for analysis of influencing factors of the awareness of childhood obesity and its associated chronic disease in parents. A 1-year intervention program involving the family, school and community was implemented on the overweight and obese children(n= 775). The severity of obesity(BMI z-score) and body fat percentage z-score were evaluated at baseline and 1 year after intervention. The self-administered questionnaires filled by the parents were used to assess the influencing factors on the outcomes using t tests or wilcoxon tests according to the distribution of the data.?Results?1. Premature birth was only girls' risk factor and the risks of obesity was 2.3 times of the full term birth group's(P=0.016). High birth weight was only boys' risk factor and the risks of obesity was 1.78 times of the normal birth weight group's(c2=7.69, P=0.006), the risks of obesity for the boys and girls whose fathers were obese or overweight are 1.70 times and 1.91 times of the normal-weight fathers respectively(P<0.001). Accordingly, the risks of obesity for the boys and girls whose mothers are obese or overweight were 1.86 times and 2.32 times respectively(P<0.001).The fathers had at least one kind of chronic disease only affected boys(OR=1.45, P=0.024). In terms of diet, the girls who like to eat meat but not vegetables proned to be obese(OR=1.85, P=0.03). At the same time, the risks of obesity for the boys and girls whose eating rate being 10 minutes were 3.93 times and 2.92 times of the 25 minutes respectively(P< 0.05). In terms of exercise, the result shows that winter and summer vacation outdoor sports condition had statistically differences between overweight /obese girls and normal girls(OR=2.32, P=0.018);the result also shows that weekdays outdoor sports situation had been statistically different between overweight and obese boys and normal boys(OR=2.56, P<0.001).2. The rank of well known diseases related with childhood obesity was NAFLD, high blood pressure, precocious puberty, abnormal blood glucose, OSAHS, joint pain respectively in the views of parents. And the reasons for childhood obesity was unreasonable diet, less exercise, genetic factors, other disease, psychological factors respectively in the view of parents.According to the survey, more than half of 595 overweight children's parents underestimated the children's weight status. Binary Logistic regression analysis showed that parents of overweight children were more prone to underestimate the weight compared with the obese children's parents(OR=5.44; 95%CI 3.75-7.90, P<0.001). Likewise, its similar when compared parents whose children without obesity related diseases with parents whose children with obesity related diseases(OR=2.03; 95%CI 1.40-2.97, P<0.001). Interestingly, parents without chronic diseases were easier to wrongly estimate their children's weight status compared to parents with chronic diseases(95%CI 1.20-7.90, P=0.004).3. 640 children completed the one-year intervention and the data showed a mild significant decrease in BMI Z-score of 0.03(P <0.05) and a mild decrease in body fat percentage Z-score of 0.03 with no statistical significance(P >0.05). The ordinal regression indicated that the possibility of improving one weight-loss level increased linearly with age(OR=1.09[1.03-1.15]for 1-year increment) and also with initial BMI Z-score(OR=1.25[1.07-1.47] for 1-unit increment). Likewise, the children having mother suffering from chronic diseasewere 1.79 times the children having healthy mothers(P=0.01).The children having father suffering from chronic disease did not show better change in BMI Z-score(OR= 0.78, 95%CI 0.62-0.99, P=0.04).?Conclusion?1. The common risk factors of simple obesity in both girls and boys are history of parents' obesity and eating speed and mothers' genetic effect are more obvious. Risk factors only for boys include high birth weight, history of fathers chronic disease(have at least one kind among hypertension, diabetes, fatty liver,metabolic disorder of serum lipids, almost have no sports from Monday to Friday after school; Otherwise, risk factors only for girls include premature birth, lower consumption of vegetables than meat, and outdoor sports that more than half an hour less than 5 times weekly in winter and summer vacation.2.The parents are lack of the knowledge related with childhood obesity. They are prone to underestimate the weight status of the overweight or obese children.3.The intervention was effective in managing children's obesity. We found a positive correlation of age, initial BMI z-score and mothers suffering from chronic disease with children's weight-loss and a negative correlation of fathers suffering from chronic disease with children's weight-loss. |
PDF Full Text Request