Objective: To investigate the prevalence and risk factors of overweight and obesity among Chinese children aged 3-18 years from 11 provinces, antonomous regions, or municipalities. Methods: This national cross-sectional community health survey utilized a multistage stratified cluster-random sampling method to recruit 193 997 nationally representative participants from 11 provinces, autonomous regions, or municipalities between January 2017 and December 2019. All participants underwent physical examinations, and their caregivers completed questionnaires assessing participants' dietary, lifestyle, familial, and perinatal information. Multilevel multinomial logistic regression models were employed to identify the potential risk factors. Results: The cohort comprised 193 997 children (102 178 boys, 91 819 girls),aged (10±4) years. Overall prevalence rates were 30 574(15.8%)overweight children and 17 217(8.9%) obesity children. Boys exhibited higher overweight and obesity rates than girls (17.0% (17 368/102 178) vs. 14.4% (13 206/102 178), 11.3% (11 553/91 819) vs. 6.2% (5 664/91 819), χ2=249.12,1 578.69,both P<0.001). The detection rates of obesity in Tanner stage 2 and 3 were the highest in boys and girls, with 13.4%(2 231/16 665) and 8.6%(880/10 221) respectively. Risk factors for obesity included parental overweight (paternal OR=2.34 and maternal OR=2.29), annual household income of 100 000-200 000 yuan (compared with<100 000 yuan, OR=1.04), higher paternal education (compared with below high school,high school and a college education OR=1.09,1.14), birth weight >4.0 kg (≤5 and>5 years old OR=1.74, 1.44,respectively), and western food consumption≥1 time/month (compared with<1, 1-2, 3-4,>4 times/month OR=1.36, 1.30, 1.67(≤5 years), 1.19, 1.16, 1.15 (>5 years), respectively) (all P<0.05). Conversely, coarse grain intake≥1 times/week (compared with<1 times/week, every day, 3-4, 1-2 times/week OR=0.74, 0.80, 0.71 (≤5 years), 0.75, 0.87, 0.90(>5 years), respectively, all P<0.05) was associated with reduced obesity risk. Conclusions: Obesity epidemiology in children demonstrates significant heterogeneity across age, gender, geographic regions, and pubertal stages. It is necessary to establish a personalized prevention and control strategy.
目的： 调查中国11个省、自治区、直辖市3~18岁儿童的超重和肥胖现况及影响因素。 方法： 横断面研究，2017年1月至2019年12月，采用多阶段、分层、整群抽样的方法选取来自11个省、自治区、直辖市的3~18岁儿童193 997名，测量其身高、体重，并采用问卷调查的形式了解其饮食、生活方式、家庭和围生期信息等，采用多水平多项Logistic回归模型评估超重和肥胖潜在的影响因素。 结果： 193 997名儿童中男102 178名，女91 819名，年龄（10±4）岁，超重儿童30 574名（15.8%），肥胖儿童17 217名（8.9%），其中男性超重和肥胖均高于女性［17.0%（17 368/102 178）比14.4%（13 206/102 178）、11.3%（11 553/91 819）比6.2%（5 664/91 819），χ2=249.12、1 578.69，均P<0.001］。男童和女童分别在Tanner 2和3期肥胖检出率最高，分别为13.4%（2 231/16 665）和8.6%（880/10 221）。父母超重和肥胖（OR=2.34、2.29）、家庭年收入10万~20万元（与<10万元相比，OR=1.04）、父亲学历高（与高中以下学历相比，父亲高中学历、大学及以上学历OR=1.09、1.14）、出生体重>4.0 kg（≤5岁和>5岁的OR=1.74、1.44）、食用西式快餐≥1次/月（与<1次/月相比，≤5岁和>5岁1~2、3~4、>4次/月的OR=1.36、1.30、1.67和1.19、1.16、1.15）均是儿童肥胖的危险因素（均P<0.05），食用粗粮≥1次/周（与<1次/周相比，≤5岁和>5岁每天进食、3~4、1~2次/周的OR=0.74、0.80、0.71和0.75、0.87、0.90，均P<0.05）是肥胖的保护因素。 结论： 不同发育阶段、不同性别、不同地区的儿童肥胖流行现状差异显著且存在各自特点，需重点关注围生期、小学阶段尤其围青春期儿童，有针对性地制订个性化防控措施。.