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Waist Circumference Distribution of Chinese School-age Children and Adolescents

Biomedical and Environmental Sciences 2010年第1期23卷 12-20页

作者： CHENG-YE JI RITA YT SUNG guan-sheng ma JUN ma ZHONG-HU HE TIAN-JIAO CHEN Institute of ChiM and Adolescent Health Peking University Health Science Center Beijing 100191 China Department of Paediatrics The Chinese University of Hong Kong Hong Kong Special Administrative Region China National Institute for Nutrition and Food Safety Chinese Center for Disease Control and Prevention Beijing 100021 China

Background Waist circumference （WC）, a proxy measure of central body fat, is a better predictor than overall body fat for cardiovascular risk factors in both adults and children. WC cutoffs have been established in many countries, but the national WC reference has not been developed in China. Objective To study the distribution of WC in a representative group of Chinese children for establishing Chinese WC cutoff points. Methods Cross-sectional data obtained from 15 mainland provinces and Hong Kong were collected. There were 160 225 children and adolescents aged 7-18 years old in total. The subjects were divided into five regional groups namely costal city, other city, noah rural, south rural, and Hong Kong, for analyzing the distribution of WC. Results A large variation in WC distribution was found among the five groups for both sexes. Coastal city group had the highest P85 WC values consistently from the early school ages to 18-year-old compared with other groups. In contrast, south rural group had P85 values consistently lagged behind not only the city groups but also the north rural group. Hong Kong group had a high P85 WC at early ages, but because of the smaller increments of WC during adolescence, the P85 curve was gradually exceeded by the north rural groups. Catch-up trend was found in the two rural groups since the peak of puberty. These disparities were caused by not only socioeconomic and urban-rural factors but also north-south differences. Because of the regional variation of WC, a ＂gradient＂ prevalence of central obesity was prospected among these groups. Comparisons of WC distributions between the Chinese and the U.S.A or Netherlands demonstrated the necessary of setting up China＇s own WC cutoffs. Sex and age-specific percentiles were obtained and smoothed by using LMS method. Conclusion The data obtained from this study could be used to develop national WC cutoff points for Chinese children and adolescents.

关键词： Overweight and obesity Central obesity Waist circumference Chinese youth School-age children and adolescents

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Application of the WHO Growth Reference (2007) to Assess the Nutritional Status of Children in China

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Biomedical and Environmental Sciences 2009年第2期22卷 130-135页

作者： YAN-PING LI XIAO-QI HU JING-ZHAO XIAO-guanG YANG AND guan-sheng ma National Institute for Nutrition and Food Safety Chinese Center for Disease Control and Prevention Beijing 100050 China

Objective To assess the nutrition status of children and adolescents in China using the WHO growth reference （2007） in comparison with that defined by the International Obesity Task Force （IOTF） and the Working Group on Obesity in China （WGOC）. Methods Overweight and obesity were defined by age-, sex-, specific BMI reference developed by WHO （2007）, IOTF （2000）, and WGOC （2004）, respectively. Stunting and thinness were defined as height and BMI less than two standard deviations （SD） of the WHO growth reference （2007）, respectively. Data of children and adolescents aged 5 to 19 years （n=54 857, 28 273 boys, 26 584 girls） from the 2002 China National Nutrition and Health Survey （CNNHS） were used in the study. Results The prevalence of overweight, obesity, stunting and thinness among Chinese children and adolescents aged 5-19 years was 5.0%, 1.2%, 13.8%, and 7.4%, respectively when the WHO growth reference （2007） was used, whereas the estimated absolute total number affected by these 4 conditions were 14.6, 3.7, 40.6, and 21.8 million, respectively. The prevalence of overweight and obesity was 18.1% in large cities, while the stunting prevalence was 25.1% in rural 4. Obesity prevalence assessed by the WHO growth reference was higher than that as assessed by the IOTF reference, and obesity prevalence assessed by the WGOC reference was lower than that as assessed by the IOTF reference. Conclusion The nutritional status of children and adolescents is not equal in different areas of China. Stunting is still the main health problem of the poor, while overweight and obesity are the main health problems in large cities.

关键词： WHO Obesity Stunting Children Adolescents China

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Association of Estrogen Receptor-α Gene PvuII Polymorphisms with the Effect of Calcium Supplementation on Skeletal Development in Chinese Pubertal Girls

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Biomedical and Environmental Sciences 2009年第6期22卷 480-487页

作者： LI-CHEN YANG QIAN ZHANG JIAN-HUA PIAO ZHENG-WU HUANG XIAO-QI HU guan-sheng ma Institute for Nutrition and Food Safety Chinese Center for Disease Control and Prevention Beijing 100021 China

Objective To investigate the association of estrogen receptor alpha （ER-c0 PvulI polymorphisms with the effect of calcium supplementation on bone development in Chinese pubertal girls, and to study the importance of calcium supplementation by maximizing the peak bone mass at their pubertal stage for bone development and osteoporosis prevention and the role of estrogen in regulating bone mass. Methods Ninety-four pubertal girls were recruited in the study and divided into two groups and three sub-groups according to the ER-α PvulI polymorphisms. One year before and after calcium supplementation, bone mineral density （BMD） was measured by DEXA, while BGP, BAP, TRACP5b, and 25-OH-VitD3, as well as estrogen were detected by ELISA. Analysis of covariance was used to examine the effect of ER-ct polymorphisms on bone development. Results The absolute increase and percentage change of BGP were significantly higher in the supplemented group than in the control group （P〈0.05）. In the intervened group, The increase and percentage change of the total body and radio distal 1/3 BMD were higher in PP than in PP genotype （P〈0.05）, and the increase of BAP in Pp was also higher than PP in the same group （P〈0.05）. Conclusion PP genotype shows a better response to calcium supplementation than the other Pvull polymorphisms.

关键词： Pubertal girls PvulI polymorphisms Calcium supplementation Skeletal development

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Report on Childhood Obesity in China (2) Verification of BMI Classification Reference for Overweight and Obesity in Chinese Children and Adolescents

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Biomedical and Environmental Sciences 2006年第1期19卷 1-7页

作者： guan-sheng ma YAN-PING LI XIAO-QI HU ZHAO-HUI CUI XIAO-guanG YANG AND CHUN-MING CHEN National Institute for Nutrition and Food Safety Chinese Center for Disease Control and Prevention 29 Nan wei Road Beijing 100050 China Chinese Center for Disease Control and Prevention 27 Nan wei Road Beijing 100050 China

Objective To verify Working Group for Obesity in China （WGOC） recommended body mass index （BMI） classification reference for overweight and obesity in Chinese children and adolescents using the data of 2002 China Nationwide Nutrition and Health Survey. Methods PediaWic metabolic syndrome （MetS） and abnormality of each risk factor for MetS were defined using the criteria for US adolescents. Definition of hyper-TC, LDL, and dyslipidemia in adults was applied as well. The average level and abnormality rate of the metabolic indicators were described by BMI percentiles and compared with general linear model analysis. Receiver operating characteristic analysis was used to summarize the potential of BMI to discriminate between the presence and absence of the abnormality of these indicators. Results There was neither significantly increasing nor significantly decreasing trend of biochemical parameter levels in low BMI percentile range （〈65th）. Slight increasing trend from the 75th and a significant increase were found when BMI≥85th percentile. In general, the prevalence of the examined risk factors varied slightly when BMI percentile〈75th, and substantial increases were consistently seen when BMI percentile≥75th. As an indicator of hyper-TG, hypertension and MetS, the sensitivity and specificity were equal at the point of BMI〈75th percentile, and the Youden＇s index of risk factors also reached peak point before 75th percentile except for MetS. When the BMI percentile was used as the screening indicator of MetS, Youden＇s index reached peak point at 85th percentile, just the point in the ROC graph that was nearest to the upper left comer. Conclusion The BMI classification reference for overweight and obesity recommended by WGOC is rational to predict and prevent health risks in Chinese children and adolescents. Lower screening cut-off points, such as 83th percentile or 80th percentile, should not be excluded when they are considered as overweight criteria in future interventi

关键词： BMI classification Verification Child China Obese

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Disease Risks of Childhood Obesity in China

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Biomedical and Environmental Sciences 2005年第6期18卷 401-410页

作者： YAN-PING LI XIAO-guanG YANG FENG-YING ZHAI JIAN-HUA PIAO WEN-HUA ZHAO JIAN ZHANG guan-sheng ma National Institute for Nutrition and Food Safety Chinese Center for Disease Control and Prevention 29 Nanwei Road Beijing 100050 China

Objective To estimate the relative risks of dyslipidemia, hypertension, diabetes mellitus, and metabolic syndromes among overweight and obese Chinese children compared with their normal weight counterparts. Methods Overweight and obesity were defined by age- and sex-specific BMI classification reference for Chinese children and adolescents. Pediatric metabolic syndrome （MetS） and each risk factor for MetS were defined using the criteria for US adolescents. Definition of hyper-TC, LDL, and dyslipidemia for adults was applied as well. General linear model factor analysis and chi-square test were used to compare the difference in metabolic indicators among normal weight, overweight, and obese groups. Multiple logistic regression analysis was performed to estimate the odds ratio of metabolic abnormalities between obesity, overweight, and normal weight children, after adjustment for living area, family economic level, age, sex, and daily exercise time and TV watching time, as well as different dietary indices in the model. Results Significant increases in blood lipids, glucose, and blood pressure were found among overweight and obese children as compared with their counterparts with normal weight. By applying WGOC-recommended BMI classification, the risks for hypertriglyceridemia, low HDL and dyslipidemia among overweight children were 1.9, 1.4, and 1.5 times, and was 3.3, 1.5, and 1.8 times among obese groups compared to their counterparts with normal weight after adjustment for age, sex, region, socioeconomic status, physical activity, and dietary intakes. The overweight and obese children （15-17.9 years） had a high-risk of developing hypertension, which was 2.3 and 2.9 times higher than their counterparts with normal weight. Above 90% obese adolescents had abdominal obesity, while less than 1% normal weight ones had abdominal obesity. No obese adolescents were free from any risk factors for MetS, while 36.9% of normal weight adolescents were from the risk factors. 83.

关键词： Chinese obese children Metabolic syndrome (MetS) Hypertension Lipids Relative risk

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Relationship of Body mass Index, Waist Circumference and Cardiovascular Risk Factors in Chinese Adult

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Biomedical and Environmental Sciences 2010年第2期23卷 92-101页

作者： SONG-MING DU guan-sheng ma YAN-PING LI HONG-YUN FANG XIAO-QI HU XIAO-guanG YANG YONG-HUA HU School of Public Health Peking University Health Science Center Beijing 100083 China National Institute for Nutrition and Food Safety Chinese Center for Disease Control and Prevention Beijing 100021 China

Objective To compare the relative risk of waist circumference （WC） and/or BMI on cardiovascular risk factors. Methods A cross-sectional data of 41 087 adults （19 567 male and 21 520 female） from the 2002 China National Nutrition and Health Survey were examined. According to the obesity definition of WGOC （BMI, 24 kg/m^2 and 28 kg/m^2; WC, male 85 cm and 95 cm for male, 80 cm and 90 cm for female）, the study population were divided into 9 groups. The prevalence and odds ratio （ORs） of cardiovascular disease （CVD） risk factors （hypertension, high fasting plasma glucose and dyslipidemia） were compared among these 9 groups. Stepwise linear regression analyses were used to compare the likelihood of BMI and/or WC on CVD risk factors. Results Both the indexes levels and the odds ratios of CVD risk factors were significantly increased （decreased for HDL-C levels） along with the increase of WC and/or BMI, even when the effect of age, sex, income, education, sedentary activity and dietary factors were adjusted. The variances （R2） in CVD risk factors explained by WC only and BMI only were quite similar, but a little bit larger when WC and BMI were combined. The standard fl was higher of BMI when predicting systolic BP and was higher of WC when predicting TG, TC and HDL. Conclusions BMI and WC had independent effects on CVD risk factors and combination of BMI and WC would be more predictive. Findings from the present study provided substantive evidence for the WGOC recommendation of a combined use of BMI and WC classifications.

关键词： obesity central obesity cardiovascular disease risk factors multivariate regression

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Interactions Between Effects of Estrogen Receptor Gene Polymorphisms on BMD and Experiences of the First Spermorrhea in Chinese Han Boys

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Biomedical and Environmental Sciences 2008年第2期21卷 129-136页

作者： JING YIN QIAN ZHANG XIAO-QI HU WEI-JING DU AI-LING LIU XIAO-YAN WANG ZHI-QIN TONG guan-sheng ma National Institute for Nutrition and Food Safety Chinese Center for Disease Control and Prevention 29 Nanwei Road Beijing 100050 China

Objective To study the interaction between polymorphisms of estrogen receptor （ER） gene and puberty on bone mineral density （BMD）. Methods One hundred and forty-six boys aged 13-17 years were divided into two groups according to their first sperrnorrhea. DNA was analyzed for Xba I and Pvu 1/genotypes by PCR-RFLP. BMD of the total body, forearm and lumbar spine was measured by dual-energy X-ray absorptiometry （DXA）. The relationship between polymorphisms of ER gene and BMD in these two groups was analyzed. Results The BMD at all sites in the sperrnorrhea group was significantly higher than that in the un-sperrnorrhea group. The independent contribution of ER genotypes to BMD at two pubertal stages was analyzed after adjusting co-variables. In the un-sperrnorrhea group, the BMD at distal 1/10 and 1/3 forearm of those carrying pp genotype was significantly higher than that of the non-carries, whereas in the sperrnorrhea group BMD in those carrying the same genotype was significantly lower than that in the non-carriers. Similar results were obtained by haplotype analysis. Multiple stepwise regression analysis showed that body weight, age and the first sperrnorrehea were the dominant determinants for BMD. BMD at forearm might be influenced by interaction between ER genotype and the first spermorrehea. Conclusion The polymorphisms of ER gene play a different role in BMD influenced by the first spermorrhea. Chinese boys carrying p or x allele should pay more attention to their bone mass.

关键词： BMD Puberty Hormones and receptors Polymorphism Boys

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Report on Childhood Obesity in China (5) Body Weight, Body Dissatisfaction, and Depression Symptoms of Chinese Children Aged 9-10 Years

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Biomedical and Environmental Sciences 2007年第1期20卷 11-18页

作者： YAN-PING LI guan-sheng ma EVERT G. SCHOUTEN XIAO-QI HU ZHAO-HUI CUI DONG WANG FRANS J. KOK National Institute for Nutrition and Food Safety Chinese Center for Disease Control and Prevention 29 Nanwei Road Beijing 100050 China Division of Human Nutrition Wageningen University The Netherlands

Objective To investigate the relationship between body weight, body dissatisfaction and depression symptoms among Chinese children. Methods The fasting body weight and height of the third and fourth grade students （n=3886, aged 9 or 10 years） from 20 schools in Beijing, China, were measured, and the students were asked to choose the figures of body image and to complete the self-reported children＇s depression inventory （CDI） questionnaire. Results The CDI Cronbach＇s alpha was 0.81. The total CDI score was 9.60±7.50, 13.2% of children （boys 16.7% vs girls 9.5%） were at risk of developing depression symptoms. Overweight girls, but not boys, had significantly higher total CDI score than their normal weight counteparts. Both obese girls and boys showed a higher negative self-esteem score. More than one fifth underweight girls still wanted to be thinner while more than one third obese boys still wanted to be heavier. Children who wanted to be thinner showed slightly higher scores of ineffectiveness and negative self-esteem. After introducing the body dissatisfaction into the model, overweight was still associated with total CDI score among girls and obesity was still associated with negative self-esteem among both boys and girls. Conclusion Overweight girls show a significantly higher depression symptom score than their normal weight counterparts, which maybe partially explained by body dissatisfaction. Obese boys and girls are both more likely to suffer from low self-esteem, which is partially explained by body dissatisfaction.

关键词： Depression symptoms Body dissatisfaction Overweight Children

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Report on Childhood Obesity in China (6) Evaluation of a Classroom-based Physical Activity Promotion Program

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Biomedical and Environmental Sciences 2007年第1期20卷 19-23页

作者： AI-LING LIU XIAO-QI HU guan-sheng ma ZHAO-HUI CUI YONG-PING PAN Su-YING CHANG WEN-HUA ZHAO HUN-MING CHEN National Institute for Nutrition and Food Safety Chinese Center for Disease Control and Prevention 29 Nanwei Road Beijing 100050 China Dongcheng School Healthcare Institute Beijing 100007 China International Life Science Institute Focal Point-China Beijing 100050 China

Objectives To evaluate the effect of Happy 10 program on the promotion of physical activity, physical growth and development of primary-school students, and on obesity control and prevention. Methods Two similar primary schools from one district of Beijing, China were selected, one as an intervention school and the other as a control school. Happy 10 program was implemented at least once every school day in the intervention school for two semesters, whereas no intervention was adopted in the control school. The information on energy expenditure and duration of physical activity was collected by a validated 7-day physical activity questionnaire. Height and weight were measured by trained investigators following the standardized procedure. Energy expenditure and intensity of each Happy 10 session was measured by a physical activity monitor. Results The average energy expenditure and duration of total physical activity per day among students in the intervention school increased significantly from 15.0 to 18.2 kcal/kg, and 2.8 to 3.3 h respectively, whereas the figures significantly decreased in the control school. There was a significant difference in change of weight and BMI between girls in the intervention and control school （2.4 kg vs 4.6 kg, -0.47 kg/m^2 vs 0.66 kg/m^2）. The prevalence of overweight and obesity in the intervention school decreased by 0.4%-5.6%, as compared to the increase by 0.6%-4.5% in the control school. The average energy expenditure and intensity per 10-minute session ranged from 25.0-35.1 kcal, 4.8-6.2 kcal/kg/h respectively in grades 1-5. Conclusion Happy 10 program provides a useful strategy to promote physical activity among school children and also plays a positive role in building up physical growth and development of girls.

关键词： Happy 10 Physical activity Obesity Intervention

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Report on Childhood Obesity in China(8):Effects and Sustainability of Physical Activity Intervention on Body Composition of Chinese Youth

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Biomedical and Environmental Sciences 2010年第3期23卷 180-187页

作者： YAN-PING LI XIAO=QI HU EVERT G. SCHOUTEN AI-LING LIU SONG-MING DU LIN-ZHONG LI ZHAO-HuI CUI DONG WANG FRANS J KOK FRANK B HU guan-sheng ma National Institute for Nutrition and Food Safety Chinese Center for Disease Control and Prevention Beijing 100050 China Division of Human Nutrition Wageningen University The Netherlands Departments of Nutrition and Epidemiology Harvard School of Public Health USA Department of Global Health and Population Harvard School of Public Health USA

Objectives To determine whether a large-scale physical activity intervention could affect body composition in primary school students in Beijing, China. Methods The study design was one-year cluster randomized controlled trial of physical activity intervention （20 rain of daily exercise in the classroom） with an additional year of follow-up among 4 700 students aged 8-11 years at baseline. Results After the one-year intervention, BMI increased by 0.56 kg/m2 （SD 1.15） in the intervention group and by 0.72 kg/m^2 （SD 1.20） in the control group, with a mean difference of-0.15 kg/m^2 （95% CI： -0.28 to -0.02）. BMI z score decreased by -0.05 （SD 0.44） in the intervention group, but increased by 0.01 （SD 0.46） in the control group, with a mean difference of-0.07 （-0.13 to -0.01）. After another year of follow up, compared to the control group, children in the intervention group had significantly lower BMI （-0.13, -0.25 to -0.01 ）, BMI z score （-0.05, -0.10 to -0.01）, fat mass （-0.27 kg, -0.53 to -0.02） and percent body fat （-0.53, -1.00 to -0.05）. The intervention had a more pronounced effect on weight, height, BMI, BMI z score, and body composition among obese children than among normal weight or overweight children. Compared to the control group, the intervention group had a significantly higher percentage of children who maintained or reduced their BMI z score at year 1 （P-0.008） and year 2 （P=-0.04）. Conclusions These findings suggest that 20 min of daily moderate to vigorous physical activity during the school year is a feasible and effective way to prevent excessive gain of body weight, BMI, and body fatness in primary school students.

关键词： Intervention BMI School China

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