Trends in physical fitness, growth, and nutritional status of Chinese children and adolescents: a retrospective analysis of 1.5 million students from six successive national surveys between 1985 and 2014
Trends in physical fitness, growth, and nutritional status of Chinese children and adolescents: a retrospective analysis of 1.5 million students from six successive national surveys between 1985 and 2014
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中国儿童青少年体质、生长发育和营养状况的变化趋势——1985年至2014年连续六次全国调查1·500万学生的回顾性分析
DOI：
10.1016/s2352-4642(19)30302-5
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发表时间：
2019-12-01
影响因子：
36.4
通讯作者：
Patton, George C.
中科院分区：
文献类型：
--
作者：
Dong, Yanhui;Lau, Patrick W. C.;Patton, George C.
背景体能与健康密切相关。尽管在中国发生了从食物短缺到高脂肪和精制碳水化合物饮食的营养转变，但据我们所知，尚未描述身体健康的趋势。我们的目的是评估中国儿童和青少年的身体健康趋势及其与营养转型的关系。方法在这项回顾性分析中，从1985年至2014年连续进行的六次全国调查中提取了7 - 18岁中国在校学生的数据。在每次调查中重复测量身体素质的六个组成部分（用力肺活量，立定跳远，坐位体前伸，身体肌肉力量，50米短跑和耐力跑），并汇总为一个概括的身体素质指标（PFI）。生长和营养状况（发育迟缓、消瘦、正常体重、超重和肥胖）的定义采用WHO定义，我们将发育迟缓和消瘦合并为未发育，将超重和肥胖合并为过度发育。城市化水平来自中国国家统计局和省统计局的统计年鉴。我们使用分数多项式回归和广义加法模型来评估PFI和营养结果之间的关联和PFI和城市化水平之间的关联。结果在1985年至2014年期间，1513435名学生参加了中国全国学生体质与健康调查，1494485名学生被纳入我们的研究。我们观察到1985 - 2014年期间PFI下降（总体PFI变化-0.8），尽管从1985年到1995年有所增加（PFI变化1.2），与主要营养问题从发育迟缓和消瘦到超重和肥胖的转变相吻合。2014年，营养不良（瘦的PFI为-2.44，发育迟缓的PFI为-3.42）和营养过剩（超重的PFI为-1.49，肥胖的PFI为-3.63）的学生的PFI都低于体重正常的学生（-0.41）。1985 - 2014年，男孩的PFI下降幅度大于女孩，尤其是肥胖男孩（PFI变化-2.7）。我们观察到1995年的PFI最高（1.17），当时体重正常的学生比例最高。随着城市化的推进，这些地区的农村学生和城市学生的身体健康水平都出现了下降。解释我们的研究支持在贫困的农村地区继续实施以经济补贴等为重点的改善身体健康的政策。然而，对中国大部分地区来说，对不健康食品征税、促进体育活动、减少学业压力、促进饮食多样性、减少久坐时间和参加正式体育活动应成为促进健康体重状况和预防学生肥胖的政策要素，这也将支持身体健康。版权所有（C）2019 Elsevier Ltd.保留所有权利。
Background Physical fitness is strongly associated with health. Despite the extent of the nutritional transition from food scarcity to diets high in fats and refined carbohydrates that has occurred in China, to our knowledge, trends in physical fitness have not been described. We aimed to assess trends in physical fitness and its association with the nutritional transition among Chinese children and adolescents.Methods In this retrospective analysis, data from Chinese school students aged 7-18 years were extracted from six successive national surveys undertaken between 1985 and 2014. Six components of physical fitness (forced vital capacity, standing long jump, sit-and-reach, body muscle strength, 50 m dash, and endurance running) were measured repeatedly in each survey and aggregated as a summary physical fitness indicator (PFI). Growth and nutritional status (stunting, thinness, normal weight, overweight, and obesity) were defined by use of WHO definitions, and we combined stunting and thinness as undemutrition and overweight and obesity as ovemutrition. Urbanisation levels were obtained from the statistical yearbook of the National and Provincial Bureau of Statistics of China. We used fractional polynomial regression and generalised additive models to assess associations between PFI and nutritional outcomes and between PFI and levels of urbanisation.Findings Between 1985 and 2014, 1513435 students participated in the Chinese National Survey on Students' Constitution and Health, and 1494485 were included in our study. We observed a decline of the PFI during 1985-2014 (overall PFI change -0.8), albeit with an increase from 1985 to 1995 (PFI change 1.2), coinciding with a shift in the major nutritional problems from stunting and thinness to overweight and obesity. Both undernourished (PFI -2.44 for thin and -3.42 for stunting) and ovemourished (-1.49 for overweight and -3.63 for obese) students had a lower PFI than that of those with normal weight (-0.41) in 2014. Boys had a larger decline in PFI than girls in 1985-2014, especially boys with obesity (PFI change -2.7). We observed the highest PFI in 1995 (1.17), when the proportion of students with normal weight was highest. Advancing urbanisation was accompanied by dedines in physical fitness, which occurred in both students in rural settings and those in urban settings in these regions.Interpretation Our study supports the continuation of policies to improve physical fitness that focus on undemutrition, including economic subsidies, in poorer rural regions. However, for most of China, taxation of unhealthy foods, promotion of physical activity, reduction in academic pressures, promotion of dietary diversity, reduction of sedentary time, and engagement in formal sporting activities should be elements of policies to promote healthy weight status and prevent obesity in school students, which will also support physical fitness. Copyright (C) 2019 Elsevier Ltd. All rights reserved.