儿童肥胖至成年期生长轨迹的模拟
Simulation of Growth Trajectories of Childhood Obesity into Adulthood.
作者信息
Ward Zachary J, Long Michael W, Resch Stephen C, Giles Catherine M, Cradock Angie L, Gortmaker Steven L
机构信息
From the Center for Health Decision Science (Z.J.W., S.C.R.) and the Department of Social and Behavioral Sciences (C.M.G., A.L.C., S.L.G.), Harvard T.H. Chan School of Public Health, Boston; and the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC (M.W.L.).
出版信息
N Engl J Med. 2017 Nov 30;377(22):2145-2153. doi: 10.1056/NEJMoa1703860.
BACKGROUND
Although the current obesity epidemic has been well documented in children and adults, less is known about long-term risks of adult obesity for a given child at his or her present age and weight. We developed a simulation model to estimate the risk of adult obesity at the age of 35 years for the current population of children in the United States.
METHODS
We pooled height and weight data from five nationally representative longitudinal studies totaling 176,720 observations from 41,567 children and adults. We simulated growth trajectories across the life course and adjusted for secular trends. We created 1000 virtual populations of 1 million children through the age of 19 years that were representative of the 2016 population of the United States and projected their trajectories in height and weight up to the age of 35 years. Severe obesity was defined as a body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) of 35 or higher in adults and 120% or more of the 95th percentile in children.
RESULTS
Given the current level of childhood obesity, the models predicted that a majority of today's children (57.3%; 95% uncertainly interval [UI], 55.2 to 60.0) will be obese at the age of 35 years, and roughly half of the projected prevalence will occur during childhood. Our simulations indicated that the relative risk of adult obesity increased with age and BMI, from 1.17 (95% UI, 1.09 to 1.29) for overweight 2-year-olds to 3.10 (95% UI, 2.43 to 3.65) for 19-year-olds with severe obesity. For children with severe obesity, the chance they will no longer be obese at the age of 35 years fell from 21.0% (95% UI, 7.3 to 47.3) at the age of 2 years to 6.1% (95% UI, 2.1 to 9.9) at the age of 19 years.
CONCLUSIONS
On the basis of our simulation models, childhood obesity and overweight will continue to be a major health problem in the United States. Early development of obesity predicted obesity in adulthood, especially for children who were severely obese. (Funded by the JPB Foundation and others.).
背景
尽管当前儿童和成人肥胖流行情况已有充分记录，但对于特定年龄和体重的儿童而言，成人肥胖的长期风险却鲜为人知。我们开发了一个模拟模型，以估计美国当前儿童群体35岁时患成人肥胖症的风险。
方法
我们汇总了五项具有全国代表性的纵向研究中的身高和体重数据，共计来自41567名儿童和成人的176720条观测数据。我们模拟了整个生命过程中的生长轨迹，并对长期趋势进行了调整。我们创建了1000个虚拟群体，每个群体包含100万名19岁以下儿童，这些群体代表了2016年美国人口，并预测了他们到35岁时的身高和体重轨迹。严重肥胖定义为成人体重指数（BMI，千克体重除以米身高的平方）达到35或更高，儿童达到第95百分位数的120%或更高。
结果
鉴于当前儿童肥胖水平，模型预测，如今的大多数儿童（57.3%；95%不确定区间[UI]，55.2至60.0）在35岁时将肥胖，且预计患病率的大约一半将发生在儿童期。我们的模拟表明，成人肥胖的相对风险随年龄和BMI增加，从超重2岁儿童的1.17（95%UI，1.09至1.29）增加到严重肥胖19岁儿童的3.10（95%UI，2.43至3.65）。对于严重肥胖的儿童，他们在35岁时不再肥胖的几率从2岁时的21.0%（95%UI，7.3至47.3）降至19岁时的6.1%（95%UI，2.1至9.9）。
结论
基于我们的模拟模型，儿童肥胖和超重在美国仍将是一个主要的健康问题。肥胖的早期发展预示着成年期肥胖，尤其是对于严重肥胖的儿童。（由JPB基金会等资助。）
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