Y HQC VigT NAM THANG 10 - S6 BAC BlgT/2013 CONG TRINH KHOA HOC VA CTNG DUNG LAM SANG
THUC TRANG THllrA CAN - BEO PHI VA M O T SO YEU TO U l N QUAN
0 TRE M A U GIAO 3-5 TUOi TAI HA m
Nguyen Phuc Humg', Hoftng Qu^* Tinh^, Nguyin Hfhi Nhan'*
TOM TAT
Nghien cuXi du'dc tien hanh tren 207 tr6 em mau giao tiif 3 - 5 tuoi d tru'dng Mam non Tu*
thuc Anh Sao, quan Ba Dinh va tru'dng Mam non TU thuc Sac Mau, qu^n Hoang Mai, thanh pho Ha Ngi. Phu'dng phap nhan trie hgc va xa hgi hgc duOc sir dung de danh gia tinh trang thii^ can - beo phi va cac yeu to lien quan cua tre em trong nghien cuU. Ket qua nghien culi cho thay: Tre 3 - 5 tuoi tai dia ban nghien ciiu co tinh trang beo phi kha cao, len tdi 13,04%. Day la mgt dieu dang bao dgng tnang van de sdtc khde va siT phat trien the chat ciia tre 3 - 5 tuoi. Cac yeu to anh hu'dng Idn den tinh trang beo phi cua tre trong dp tuoi 3 - 5 tuoi bao gom; (1) Yeu to dlnh duSng; (2) Yeu to van dgng; (3) Yeu to di truyen. Phan mem WHO Anthro 2.04 la phan mem rat hffu ich trong viec nghien ciiu danh gia SI/ phat trien cd the ciia tre d gia dinh va tru'dng mam non ma cd sd ha tang ve cdng nghe thong tin cho phep.
SUMMARY
OVERWEIGHT AND OBESITY STATUS IN 3- 5 YEAR CHILDREN IN HA NOI AND SOME
RELATED FACTORS
A study was conducted on 207 preschool children from 3 to 5 years of age studing at Anh Sao school, Ba Dinh district and at Sac Mau, Hoang Mai district, Anthrophometric and social methods were used to evaluate overweight and obesity /. Khoa Sinh hgc. Trudng Dai hgc Suphgm Hd Ngi 2. Khoa Gido dvc Mam non, Trudng Dgi hgc Sir phgm 3. Khoa Sinh hgc. Trudng Dai hgc Khoa hgc Tv nhien, Phan bi^n khoa hgc: GS.TS. Le Gia Vinh
Situations and to assess related factors. Results showed that: The rate of obesity of preschool children from 3 to 5 years of age was relatively high (13.04%). Factors related to overweight and obesity situations of preschool children were playing activities of children, economic circumstances of children families, numbers of children in a family, and education levels of parents. WHO Anthro 2.04 is a useful software to assess growth of children at schools and families.
I. DATVANOE
Trudc day ngudi ta hay ndi nhieu ve tinh trang suy dinh dirong: la tinh trang ca the khdng duac cung cap du nang lupng va cac chat dinh duang, dac biet la chat protein de dam bao cho sy phat trien binh thudng cua CO the. Gan day, ben canh tinh trang suy dinh duang cdn xudt hien tinh trang thira can, beo phi: la benh man tinh do sir du thira qua muc ciia lupng md trong co the. Trong ca the chiing ta ludn cd mdt lupng md nhat dinh va lugng md nay cJin thiet de luu trii nang lugng, giu nhiet, hap thu nhutig chan dgng va thi hien cac chuc nang khac.
Tir thap nien 90 cua the ky XX den nay, ti le tre em bi thira can, beo phi (TC - BP) tren thi gidi dang cd xu hudng gia tSng mdt each dang kl. Den nam 2010 tren the gidi cd 43 trieu tre TC - BP, trong dd 35% sd tre nay l^ d cac nudc dang phat trien. Sd tre TC - BP
Ha Ngi DHQGHN
CHUYEN oi: HJHH THAI HpC VA C 6 N G NGHg THONG TIN
da tang tCr 4,2% nam 1990 len 6,7% nam 2010. Xu the nay dugc du doan se tSng len tdi 9,1% vao nam 2020 [1]. Theo sd li?u cua Td chuc Y tl Thi gidi (WHO), hi?n nay tren the gidi cd khoang 17,6 tripu tre em dudi 5 tudi thira can va cd nguy ca bj b^o phi [2]. 0 Viet Nam, ti le tre em bi TC - BP cung dang tang !en nhanh chdng. Theo Le Danh Tuyen, Vi?n Dinh duang - Bp Y tl, ti le tr6 dudi 5 tudi bj TC - BP d nudc ta hien nay la 5,6%, cao gap hon 6 lan so vdi nam 2000 vk dang tiep tuc gia tang.
Thuc trang TC - BP da va dang trd thanh mgt van de nghiem trpng doi vdi sue khde cpng ddng [3]. Tre em bj TC - BP, ngoai nhihig he luy vl tam ly, cdn ddi mat vdi eac nguy ca ve sue khde sau nay nhu: diira ma mau, huyet ap cao, cae benh vl tim mach, dot quy, tai bien mach mau nao, tiiu dudng, sdi mat, va mpt sd ung thu tai tui mat, tuyin vu, dai trang, tiln liet tuyin va than [4, 5,6].
Cho den nhirng nam gan day, da cd kha nhieu nghien cuu vl tinh trang thira TC - BP d tre em, tir tieu hgc den trung hgc ea sd va trung hgc pho thdng, dac biet d cac thanh phd ldn nhu Ha Ndi va Thanh phd Hd Chi Minh, nai cd dieu kien kinh tl xa hdi phat triln va chat Iugng cupc sdng eao han cac vung khac.
Tuy nhien, cac edng trinh nghien cuu nhin chung chua tap trung nhilu din tinh trang TC - BP ciia tre mam non. Tre bi beo phi ngay tir lira tudi mam non se anh hudng ldn tdi sue khde, tam ly va kha nang hpc tap, vui choi.
Vi vay, viec phat hien tre mkm non bi TC - BP va tim hiiu cac nguyen nhan dl tir dd sdm cd cac bien phap ngan ngira va phdng chdng hpfp li la c^n thiit.
II. Oo't TUpNG VA PHUONG PHAP NGHIEN COU I. Doi tu-ffng nghien ciru
Ddi tugng nghien cuu la 207 tre em miu
giao tir 3 - 5 tudi d trudng Mam non Tu thue Anh Sao, quan Ba Dinh va trudng Mam non Tu thue sac Mau, quan Hoang Mai, thanh phd Ha Ngi.
2. Phuong phdp nghien cihi - Phuang phap xac dinh c6 mau: Co mau dugc tinh theo cdng thiirc dugc dan bdi Ha Huy Khdi nam 1997 [7].
- Phuang phap dieu tra xa hgi hgc: Diing c^c phieu dieu tra vdi cac npi dung can tim hieu de phdng van. Cac ndi dung bao gdm:
thdng tin chung ve ddi tugng nghien cuu, cac cau hdi dieu tra xS hgi hgc diing cho tre va bd me cac em.
- Phuang phap xac djnh eac chi s6 nhan trdc hgc:
+ Do chieu cao dung: Thudc do nhan trac cd sai sd 0.1 cm duge dat theo chilu thang diing, vudng goc vdi mSt nin nSm ngang. Tre di chan khdng, dung quay lung vao thudc do. Got chan. mdng, vai va dau theo chieu thang ap sat vao thudc, mat nhin thang ra phia trudc, hai tay bd thdng theo hai ben minh. Dung thudc vudng ap sat dinh ddu va thang gde vdi thudc do. Kit qua dugc ghi lai bang dan vi cm.
+ Do can nang: Can nang cua tre dugc xac djnh bang can dien tu cd sai sd lOg. Can dugc dat tren mat phang ngang, tre duge mac quan ao mdng, dung thang sao cho trgng tam cua CO thi rai vao diim giira can. Kit qua duge ghi Iai bang don vi.
- Phuong phap tinh tudi: Tudi cua tre dugc tinh theo phuong phap eua WHO. Tinh til' ngay, thang, nam, sinh din ngay, thang, nam tien hanh do cac ehi sd. Tre 3 tudi: 24 thang I ngay din 36 thang 0 ngay; tre 4 tudi:
36 thang 1 ngay din 48 thang 0 ngay; tre 5 tudi; 48 thang 1 ngay din 60 thang 0 ngay.
- Tieu chu4n danh gia tinh treing TC - BP: Tieu chudn danh gia tinh trang TC - BP
Y Hpc VigT NAM T H A N G 10 - SO OAC BlgT/2013
cho tr6 dugc ^p dung theo tieu chudn ciia WHO, 2006.
- Phuang phap xir li sd lieu bang phSn mIm WHO Anthro 2.04, SPSS 11.5, EPl - INFO 6.04.
III. KET QOk NGHIEN CLfU VA BAN LUAN 1. Tinh trang thura can, b^o phi cua tre trong nghien cihi
Kit qua d bang 1 vl tinh trang dinh duang ciia tre theo dg tudi cho thdy, tinh trang dinh duang ciia tre 3 - 5 tudi cd sy khac nhau d cae dg tudi. Ti le beo phi d nhdm 3 tuoi chiem 6,78%, d nhdm 4 tudi la
16,17%, va nhdm 5 tudi la 15,00%. Tinh trang thira can d nhdm 3 tudi (15,25%) thap han nhdm 4 tudi (29,41%), trong khi ti le thira can d nhdm 5 tuoi la 12,50%. Tre ed nguy ca thira can cao nhat d nhdm 3 tudi (50,84%) ban nhdm 4 tudi (32,35%) la 18,49% va cao han nhdm 5 tudi ( 16,25%) la 34,59%. Tinh trang tre cd can nang binh thudng d nhdm 3 tudi la 27,13%, d nhdm 4 tudi la 20,58%, va d nhdm 5 tudi la 56,25%.
Tinh trang tre cdm cd d nhdm 4 tudi vdi ti le la 1,49%. 0 hai nhdm 3 va 5 tudi ti le tre cdm la 0%.
Bdng I. Tinh trang dinh duong ciia tre theo do tudi
Tinh t r a n g dinh du'dng
Beo phi T i i i i ^ can Co nquv cd ttiLfa can Binh thiTdnq Com TSng
Tuoi 3 tuoi
n 4 9 30 16 0 59
%
6,78 15,25 50,84 27,13 0 100,00
4 tuoi n 11 20 22 14 1 68
»/o 16,17 29,41 32,35 20,58 1,49 100,00
5 tuoi n 12 10 13 45 0 80
»/o 15,00 12,50 16,25 56,25 0 100,00
Ket qua ve tinh trang TC - BP ciia tre trong nghien curu nay cao han so vdi nghien cuu ciia Biii Thi Thiit nam (2012) tien hanh tai tinh Nam Dinh [8]. Theo tac gia, tinh trang beo phi d nhdm 3 tudi la 3,13%, nhdm 4 tudi la 13,39%, va nhdm 5 tudi la 18,38%
[8]. Mdt trong nhiJng nguyen nhan de Ii giai sir khae nhau nay la do dia diem nghien cuu ciia Biii Thi Thiit dugc tien hanh d mdt sd viing ndng thdn thugc tinh Nam Djnh, noi cd mue sdng thdp hon Ha Ndi. Theo thdng ke ciia Vien Dinh duang - Bd Y te, ti le TC - BP tai thanh thi la 6,5%, cao han so vdi muc 4,2% d cac viing ndng thdn [9].
Ket qua d bang 2 ve tinh trang dinh dudng cua tre theo gidi tinh cho thdy, ti le tre nam beo phi chiem 14,15% trong khi dd ti le tre nu bi beo phi la 11,88%. Ti le tre nam bi thira can la 19,81%, va ti le tre nu: bi thira can la 17,82%. Ti le tre nam cd nguy co thira can (24,53%) thap hon so vdi ti le tre nii cd nguy CO bj thira cdn (38,61%). Ti le tre nam can nang binh thudng chiim 40,56%, trong khi ti Ie tre ntr cd cdn nang binh thudng la 31,68%.
Ti le tre edm chiem rat it hoac khdng cd, d nam la 0,94% cdn d nii ia 0%.
CHUVeN B 6 ; HiNH THAI HpC vA C 6 N G NOHg T H 6 N G TIN
Bang 2. Tinh trans dinh duong ciia tre theo
Tinh tr^ng dinh du'dng
Beo phi Thu^ can Co NC thifa can
Tong
gidri tinh
Gidi tinh Nam n 15 21 26 43 01 106
»/o 14,15 19,81 24,53 40,56 0,94 100,00
NO' n 12 18 39 32 0 101
%
11,88 17,82 38,61 31,68 0,00 100,00 Nhu v?y, ti 1? TC - BP o tr6 nam co xu hudng cao hctn 6 tre nil. Ket qua trong nghien cilu nay cung tuong l\f nhu lc8t luan cua Biii Thj Tliift (2012) 14 chi sd dinh duong tre nam cao hon tre ntr (tre nam beo phi chiim 15,10%, tri niS chiim 14,47%) [8).
2. M^t so yeu to lien quan den tinli trang thii-a can - beo phi ciia tre trong nghien cihi Ti suit chenh (OR) duac sii dung di xac dinh do tuong quan giOa cac yiu t6 va tinh trang TC - BP cua tre. Niu OR > 1, Icha nang mic benh cua tre cao hon kha nang ichong mjc benh;
ngugc lai, niu OR < 1, kha nang mic benh ciia tre thap hon kha nang khong mac benh.
Bdng 3. Moi lien quan giira can nang luc so sinh voi tinh trang
Can nang stf sinh cua tre (l<g)
> 2,5 kq
< 2,5 kq
Tinh trang dinh du'dng ciia tre Beo phi
20 7
Binh thu'dng 20 55
beo phi ciia tre OR 7,69 2,36 < OR < 26,17 Bang 3 eho thdy, cdn nang lue so sinh ed Hen quan den tinh trang beo phi eua tre. Sd tre cd can nang liic so sinh tren 2,5kg cd nguy ca beo phi cao gdp 7,69 Idn so vdi nhirng tre cd cdn nang liic so sinh dudi 2,5kg (OR = 7,69; 2,36< OR < 26,17).
Bang 4. Moi lien quan giOa hoat dong vui choi voi tinh tran
Chdi dien tir, xem ti vi Tham qia chdi the thao
Tinh trang dinh dudng ciia tre Beo phi
19 8
Binh thu'dng 12 63
^ beo phi ciia tre
OR 26,13 6,09 < OR < 124,65 Ket qua 6 bang 4 cho thay, khi tre choi dien tu hoac xem ti vi thi nguy ca bj beo phi cao gap 26,13 lan so voi nhQng tre tham gia vao cdc hoat dpng thi thao (OR = 26,13; 6,09
< OR < 124,65). Nghien cim gan day cua cac nha khoa hoc chi ra ring viec choi dien tu hay xem ti vi qua nhieu, khong diiu do khien cho tre khong con thoi gian di tham gia vao cac hoat dpng ngoai khoa va luyen tap the chit, la yiu t6 dan din nguy co tre bi beo phi [10].
Y HQC VigT NAM T H A N G 10 - SO OAC BlgT/2013
Bang S, Moi lien quan giiJa tinh trang kinh te gia dinh
Tinh trang kinh te Dii qia Oil an
T)nh trang dinh du'dnq cua tre Beo phi
19 8
Binh thirdng 40 35
/a tinh trang beo phi cua tre OR 1,19 0,38 < OR < 3,73 Bang 5 cho thay, ed mdi lien quan giGa tinh tr^g kinh te gia dinh va nguy eo beo phi d tre. Con cua nhflng gia dinh du gia cd nguy eo beo phi eao gdp 1,19 Idn con ciia nhung gia dinh du an (OR = 1,19; 0,38 < OR < 3,73). Theo Vu Thi Thu va cs nam 2003, tre TC-BP cao hon d cac gia dinh cd kinh te kha gia. Tre d cac gia dinh nay duge an udng day du, cd khi du thua, an nhieu thvc pham giau chat dinh duong, an nhieu biia nhung lai it boat dpng nen ed nguy ca TC - BP cap han cdc gia dinh khde [11].
Bans 6. Mdi lien quan giiTa sd eon trong gia dinh vdi tinh trang beo phi ciia tre So con tn>ng gia dinh
1
> 1
Tinh trang dinh du'dng cua tre Beo phi
15 12
Binh thu'dng 32 43
OR 1,75 0,61 < OR < 5,07 Bang 6 cho thdy cd mdi lien he giiia sd con trong gia dinh vdi nguy co beo phi cua tre.
Nhiing tre sdng trong gia dinh la eon I ed nguy ca beo phi cao gdp 1,75 lan so vdi nhiing tre la eon thijr 2 trd 18n (OR = 1,75; 0,61< OR < 5,07). Sd lieu nay cua chiing tdi cung phii hpp vdi kit ludn eiia Biii Thi Thiit nam 2012 [8]. Nhiing tre sdng trong gia dinh it eon sg n h ^ dugc sir quan tam eiia gia dinh nhilu hon, eham sdc ve dinh dudng eung tdt ban so vdi gia dinh nhilu con. Do dd, nhiing tre nay cd ti le beo phi se cao ban.
Bdng 7. Mdi lien quan giOa nhdn thuc ciia phu huynh ve each khac phue tinh trang beo phi va tinh trang beo phi cua tre
Nh|n thii'c cua phu huynh
Cho tre Sn thi/c ddn khoa hoc An theo sd thich ciia tre
Tinh trang dinh du'dng ciia tre Beo phi
12 15
Binh thu'dng 28 47
OR
2,15 0,72 < OR < 6,54 Bang s6 lieu tren cho thiy, ti le tre co nguy co bi beo phi 6 cac gia dinh cho tre an theo sir thich cao hon 2,15 lin so voi 6 nhiing gia dinh cho tre an theo so thich (OR = 2,15; 0,72 < OR < 6,54). Siy thich an uong co anh hudng Ion den ti le beo phi 6 tre. Neu tre thich an d6 an beo va ngpt va dupe an bit cir liic nao tre muSn, thi nguy co beo phi cao hon 1,3 din 3 lin so voi tre dupe an theo thuc don khoa hgc [10, 11].
Bdng S. M6i lien quan giOa tinh Tinh trang beo phi cua cha me tre
Cha Me
Beo phi Binh thUdnq
Beo phi Binh thUdnq
trang beo phi cua cha me vol tinh trang beo phi ciia tre Tinh trang dinh du'dnq ciia tre
Beo phi 7 20 9 18
Binh thu'dng 21 54 23 52
OR 16,45 1,80 < OR < 379,80
4,30 1,10 < OR < 17,49
CHUYDN OE: HJHH T H A I HQC VA C 6 N G NGHg T H 6 N G TIN
Bang 8 eho thdy, cd mdi lien quan giiia tinh t r ^ g beo phi eiia cha me vdi nguy e a b^o phi d tre. Cu thi, nhflng tre ed cha beo phi s6 cd nguy co beo phi cao gap 16.45 lan so vdi nhflng tre cd cha khdng bi beo phi (OR = 16,45; 1,80 < OR < 379,80). Nhung tre ed me beo phi se cd nguy c a b^o phi cao gdp 4,30 lan so vdi nhung tre ed me khdng bi beo phi (OR - 4,30; 1,10 < OR ^ 17,49).
Dilu nay phii hop vdi mpt sd nghien ciiu gdn ddy cho thdy nhflng tre cd cha me bi beo phi sS cd nguy co beo phi cao hon so vdi nhung trd: khac. Nghien curu ciia WHO cdn chi ra rang nlu m? bi beo phi thi nguy co con gai beo phi cao gdp 10 lan so vdi tre khdng ed me beo phi. Cdn vdi bd va con trai thi ti le nay la 6 ldn. Me beo phi thi con trai it cd nguy CO beo phi; bd beo phi eon gai cung it cd nguy co beo phi [2].
IV. KET LUAN VA KIE'N NGHj
Tre 3 - 5 tudi tai dia ban nghien ciiu cd tinh trang beo phi kha cao, len tdi 13,04%.
Ddy la mot dieu dang bao dpng trong van de sue khde va su phat trien the chdt eua tre 3 - 5 tudi. Cae yeu td anh hudng ldn den tinh trang beo phi cua tre trong dp tudi 3 - 5 tudi bao gdm: (l)Yeu td dinh duong; (2) Yeu td v^n dpng; (3) Yeu td di truyen. Phdn mem WHO Anthro 2.04 la phan mem rat hiiu ich trong viec nghien ciixi danh gia su phat trien CO the eua tre d gia dinh va trudng mam non ma CO sd ha tang ve cdng nghe thdng tin cho phep.
TAI LIEU THAM KHAO
1. Onis M.D., Blossner M., Borghi E. Global prevalence and trends of overweight and obesity among preschool children. American
Journal of Clinical Nutrition, 2010, 92, pp.
57-64.
2. Word Health Organization (WHO). WHO Global Database on Child Grovrth and Malnutrition. Geneva, 2007.
3. Amartruda J.M., Welle S. Obesity.
Endocrinology and metabolism, 1995, 87, pp.
1271-1304.
4. Lacard E., Maimelle N., Munoz F. Risk factors of obesity in 5 y e a r - o l d population.
Parental versus environmental factors.
International Journal of obesity, 1992, pp.
16-19.
5. Cao Quoc Vift. Beo phi d tre em: nguyen nhan, dilu trj va phong b?nh. Vi?n Bao v?
Siic khoe Tre em, 1995.
6. Ta Van Binh. B^nb beo phi. Nhd xudt ban Y hpc. Ha Npi, 2004.
7. Ha Huy Khoi. Phuang phdp djch tl hpc dinh dudng. Nha xudt ban Y hpc. Ha Npi, 1997.
8. Bui Thj Thiet. Budc dau tim hiiu thirc trang va mpt so yeu to lien quan den tinh trang beo phi cua tre mdu giao 3 - 6 tudi, Khda luan tot nghidp D^i hpc, Khoa Giao dgc Mam non, Trudng DHSP Ha Npi. 2012.
9. Vifn Dinh duong. Ket qua tong dilu tra dinh dudng toan qudc nim 2010 va chien lupc quoc gia dinh dudng giai do^n 2011-2020. Bao cao tdm tdt dilu Ua dinh dudng nam 2009-2010.
Vi?n Dinh duong. Bp Y tl, 2010.
10. PhiJng Dijc Nhat va cs. Nghien cuu b^nh chirng cac yeu tdt nguy ca thira can, beo phi ciia hpc sinh mau giao ciia hpc sinh 4-6 tudi tai qu^n 5, thanh ph6 Ho Chi Minh. Y hpc TP. Ho Chi Minh, 2008, 12, tr. 1 - 5.
11. Vu Thi Thir va cs. Dieu tra th^e Vr^ng thira can, beo phi va mpt sd yiu td lien quan d hpc sinh 8-11 tudi cua mpt sd trudng tieu hpc t^i Ha Npi. Tap chf KHK.T Ndng nghiep, 2003,1.
