Y HQC VIET NAM THANG 5 - SO DAC BIET/2Q12 Saijo M, Takahashi S,Kokubo M,Saino
T, In-Yaku F, Ishii T, Takimoto M, Takahashi Y (1994), "The role of respiratoiy syncytial virus in acute bronchiolitis in small children in northern iapan",ActaPaediatrJpn, 36(4), pp. 371-374.
Saijo M, Ishii T.Kokubo M,Murono K, Takimoto M, Fujita K (1996), "White blood cell count, C-reactive protein and erythrocyte sedimentation rate in respiratory syncytial virus infection of the lower respiratory tract". Acta Paediatr Jpn, 38(6), pp. 596-600.
NGHIEN CUfU TINH HJNH THOA CAN - BEO PHI or HOC SINH TIEU HOC THI XA NINH HOA, TINH KHANH HOA
Trmh Tien Khoa*, Truong Tan Minh**, Tran Huru Dang***
TOM TAT
Aft/c tieu: Xac djnh ty le va mot sd yeu td nguy cd cd lien quan den tinh trang thiVa can - beo phi d tre tiT 6 den 10 tuoi tai cac tru'dng tieu hpc, thi xa Ninh Hoa, tinh Khanh Hoa.
Phu'dng phap: QAB] doan 1: dieu tra ngang 1950 hpc sinh tieu hpc tu" 6 - 10 tuoi tai thj xa Ninh Hda, tinh Khanh Hda, tu" 01/10/2010 den 30/11/2010 de xac dinh ty le thCm can-beo phi.;
Giai doan 2: nghien ciiu benh chu'ng (278 hpc sinh) de xac djnh miic dp ket hdp nhan qua bang ty suat chenh.
Ketgua:T)f le thii^ can - beo phi la 7,13%
(95% CI: 5,99- 8,42%), trong dd cd 3,74% la beo phi (95% CI: 2,93- 4,71%). Ty le thiTa can - beo phi d hoc sinh nam cao hdn hpc sinh ni?
(8,96% so vdi 5,18%, p<0,001). Ty le thLfa can - beo phi cao nhat d 9 tudi (9,61%), thap nhat d 7 tuoi (5,37%). Miic dp thu^a can da sd la miic dp nhe (76,25%), thCra can mu'c dp trung binh va nang la 23,75%. Cac yeu to nguy cO cd lien quan gom: tre cd bo va/hoac me thCra can; Bd me lam nghe budn ban; Bd me khdng nhan biet du'dc
tinh trang dinh duSng cua tre. Tre cd thdi quen an nhieu va an nhanh, hay an vat, an biJa phu tru'dc ngii dem; Che dp an giau nang lu'dng; It hoat dpng the liic (<ia gid/tuan); Hoat dpng tinh >20 gid/tuan.
Ket luan: Ket qua cua chiing tdi gdp phan cho thay ty le thijia can - beo phi d hpc sinh tieu hpc tai Khanh Hda ngay cang gia tang va can thiet cd bien phap can thiep cac yeu to nguy cd de bao ve su'c khde cho tre va cong ddng.
SUMMARY
Objectives: Determine the rate and risk factors related to overweight - obesity in children aged 6 to 10 years in primary schools, town of Ninh Hoa, Khanh Hoa province.
Methods: Phase 1: 1950-level investigation of primary pupils from 6-10 years old In the town of Ninh Hoa, Khanh Hoa province, from 01/10/2010 to 30/11/2010 to detennine the percentage of overweight-obese. Phase 2: case-control studies (278 students) to detennine cause and effect associated with differential rates.
* Trung tam y teNinh Hoa;
'* Ddi hQc y Du^ Hue
*'Sd y te Khanh Hoa
CHUYEN DE: HOI NGHj KHOA HOC NGANH Y T ^ ' T I N H KHANH HOA - LAN THLTII Results: The percentage of overweight -
obesity was 7.13% (95% CI: 5.99 to 8.42%), of which 3.74% are obese ( 9 5 % CI: 2.93 to 4.71
% ) . The rate of overweight - obese high school boys than girls (8.96% versus 5.18%, p <0.001).
The rate of overweight - obesity is highest in 9 years (9.61%), lowest in 7 years (5.37%). The degree of ovenweight mostly mild (76.25%), moderate overweight and weight is 23.75%. The risk factors involved including children whose fathers and/or overweight mothers; trafficking parents do the job; parents do not recognize children's nutritional status. Children with eating habits and fast food, snack, eating snacks before bed night diet rich in energy, less physical activity (<10 hours/week) static activity > 20 hours/week.
Conclusion: Our Results show that the rate contribute to overweight - obesity among primary school children in Khanh Hoa and increasingly necessary interventions for the risk factors for child protection and public health contract.
I. OAT VAN of
Thira can - beo phi dugc biet den nhu mpt vSn de sue khde cong ddng quan trpng d nhieu nude ddng Au, tay Au, bac My va nam My, noi ty le beo phi d ngudi trudng thanh dao ddng len den 30- 40%. Ci khu vuc Chau A Thai Binh Duong, thira can - beo phi
ciing cd xu hudng tang nhanh. Dang chu y la, su gia tang thira can - beo phi thirdng keo theo su tang nhanh mot sd benh man tinh khdng lay nhiem nhu dai thao dudng, hdi chung chuyen hda, benh tui mat, benh tim mach, ung thu... da va dang gay ra hau qua nghiem trpng ve sue khde con ngudi ciing nhu ganh nang cho nen kinh te [2], [8].
(y Viet Nam, thira can - beo phi ciing cd xu hudng gia tang nhanh chdng, chi trong vdng 10 nam tit 1992- 2002, ty le thita can da tang len gap ddi (tir 2% len den 5,7%). Nam 2005, ty le nay tang len 16,3% [8], [12].
Tai Khanh Hoa, nghien cuu d thanh phd Nha Trang nam 1997 ghi nhan ty le thira can - beo phi hpc sinh tieu hpc la 2,7%, den nam 2001 da tang len 5,8% [1], [13]. Tuy nhien, van de thira can - beo phi tai thi xa Ninh Hda cho den nay chua cd cdng trinh nghien cuu nao khao sat, danh gia. Vi vay, chiing tdi tien hanh nghien cmi de tai nay vdi muc tieu:
1. Xac dinh ty le thica cdn - beo phi d tre tu 6 den 10 tuoi tgi cdc truong tieu hoc, thi xd Ninh Hod, tinh Khanh Hoa;
2. Tim hieu mot so yeu to lien quan den tinh trang thica cdn - beo phi cua tre em tai cdc truong neu tren.
II. Do'l TUpNG VA PHUONG PHAP NGHIEN COU
2.1. Giai doan 1: Dieu tra ngang 1950 hpc sinh cac trudng tilu hpc, iiia tudi tir 6 -10, t^i thi xa Ninh Hoa, tmh Khanh Hda, theo phuong thiic chgn mau tang cho khdi trudng va khdi Idp, vdi cdng thiic tinh co mau:
y2 P(l-P)
n Z. (l-a/2) ,2
2.2. Giai doan 2
Nghien ciru benh chung de tim yeu to nguy ca, ap dung cong thuc cua Schlesselman:
[ ZaV 2u (1- u) + ZpVf(l-f) + pq]^
52
Y HOC VIET NAM THANG 5 - SO BAC BIET/2012
Tinh dugc n = 84 hpc sinh
- Nhdm thira can - beo phi: nhiing hoc sinh dugc kham d giai doan 1 ma cd can nang/ chi6u cao > +2 SD hoac cd BMI > 85 bach phan vi. Kk qua giai doan 1 cd 139 hoc sinh TC-BP nen giai doan 2 chung tdi kham toan bd 139 em.
- Nhdm chumg: 139 hoc sinh cd ciing tudi, gidi, dia du, dan tdc vdi nhdm thira can - beo phi va cd CN/ CC hoac BMI trong gidi ban binh thudng.
- Bd me cua hpc smh ca 2 nhdm neu tren.
2.3. Thoi diem nghien cmi Tir 01/10/2010 ddn 30/11/2010 2.4. Cac chi tieu de danh gia va phan loai thira can, beo phi
2.4.1. Danh gid thira cdn
Doi vdi tre diroi 9 tuoi, chieu cao < 145 cm (nam) hoSc < 137 cm (nii). Dua vao chi sd can nang theo chieu cao (CN/ CC), phan loai nhu sau:
> + 2 SD : Thira can
> + 2 SD dSn + 3 SD : Thira can nhe
> + 3SD dgn + 4 SD: Thira can trung binh
> + 4 SD : Thira can nang
* Doi vol tre tir 9 tuoi den 10 tu^i, hoac tre cd chieu cao vugt qua gidi han ap dung chi tieu CN/ CC cOa WHO thi dira vao bach phan vi BMI theo tudi va gidi cua tre nhu sau:
> 85 den < 95 bach phan vi: Thira can nhe
> 95 bach phan vi: Thira can trung binh vanang
2.4.2. Danh gid beo phi Theo tieu chuin ciia WHO Beo phi = Thira can + Thira md Beo phi nhe ^ Thira can nhe + Thira ma Beo phi trung binh va nang = Thira can trung binh va nang + Thira md
Thira mo'; khi be day nep gap da ca tam dau va CO gdc dudi xuong ba vai > 90 bach phan vi theo tudi va gidi so vdi quan the tham khao NCHS/ WHO.
* Doi vdi ngirM Ion (phu huynh hoc sinh trong nhdm nghien ciiu), danh gia thira can - beo phi dua vao BMI.
2.4.3. Tieu chuan loai trir
Loai trir cac beo phi thii phat: beo phi do nguyen nhan ndi tiet, do khiSm khuydt di tmyen, do diing thudc ...Do vay, nhung hoc sinh cd chieu cao theo tudi thap hon 5 bach phan vj, chiing tdi khdng dira vao nghien cuu.
2.5 Xir ly so lieu: Bang phuong phap thdng ke Y hoc vdi sir ho tro cua phan mkm EXCEL, SPSS 16.0. Trong nghien cuu md ta, sir dung sd do ty le phan tram. Trong nghien ciiu benh chiing, su dung ty suat chenh (OR:
Odds Ratio); test khi binh phuong (test z') va miic y nghia ciia sir khac biet.
III. KET QUA
3.1. Ty If thirn cSn - beo phi of hoc sinh tieu hoc thj xa Ninh Hda Bang 3.1. Ty le thura can - beo phi theo tudi va gidi
Tuoi
6
Gi6i
Nam Nir Chunq
Nam N
249 220 469 196
ThIJ'a can CN/CC >+2SD
n 18
8 26 11
Tv le »/o 7,23 3,64 5,54 5,61
Beo phi Thiya can + BDNGD > 90 BPV
n 12
0 12
3
Tv le % 4,82 0,00 2,56 1,53
53
CHUYEN BE: HOI NGHj KHOA HOC NGANH Y TE TJNH KHANH HOA - LAN T H O II 7
8
T u o i
9
10
Tong NO' Chunq
Nam Nff Chunq
Gidi
Nam Nii Chunq
Nam Nii Chunq
Nam Nif Chunq
195 391 217 180 397
N
198 187 385 144 164 308 1004 946 1950
10 21 19 15 34
B M I >
n 27 10 37 15 6 21 90 49 139
5,13 5,37 8,76 8,33 8,56 8 5 t h
»/o 13,64
5,35 9,61 10,42 3,66 6,82 8,96 5,18 7,13
6 9 7 10 17
3,08 2,30 3,23 5,56 4,28 Thu*a c a n + BDNGD > 9 0 BPV
n 12 10 22 7 6 13 41 32 73
0/0 6,06 5,35 5,71 4,86 3,66 4,22 4,08 3,38 3,74
NItgn phi chiem vdi 5,18%,
Bang
xet: Ty le tre thira can - beo phi chiem 7,13% (95%CI: 5,99- 8,42%), trong do beo ty le 3,74% (95%C1: 2,93- 4,71%). Ty le tre nam TC - BP cao hem nil (8,96% so p<0,001). Ty le tre TC - BP cao nhit a 9 tu6i (9,61%,), thap nhat ct 7 tu6i (5,37%) 3.2. Muc do thira can theo tuoi va giai
N h o m t u o i
6
7
8
9
10
Gidi
Nam Nil- Chunq
Nam Nif Chunq
Nam Nil- Chung
Nam Nil- Chunq
Nam Nil- Chunq
Nam
ThCra c a n n h e n 14 8 22 11 7 18 17 13 30 24 0 24 10 2 12 76
T y l e 5,62 3,64 4,69 5,61 3,59 4,60 7,83 7,22 7,56 1,12 0,00 6,23 6,94 1,22 3,90 7,57
ThCra c a n t r u n g b i n h va n a n g n 4 0 4 0 3 3 2 2 4 3 10 13 5 4 9 14
T y l e 1,61 0,00 0,85 0,00 1,54 0,77 0,92 1,11 1,01 1,52 5,35 3,38 3,47 2,44 2,92 1,39
T o n g N 18 8 26 11 10 21 19 15 34 27 10 37 15 6 21 90
T v i e 7,23 3,64 5,54 5,61 5,13 5,37 8,75 8,33 8,57 2,63 5,35 9,61 10,41 3,66 6,82 8,96
Y HQC V I E T NAM THANG 5 - SO DAC BieT/2012
Tong Nii-
Chunq
30 1 3,17 106 1 7 6 , 2 5
19 33
2,01 2 3 , 7 5
49 139
5,18 100 Nhan xet: T h i r a can nhe ( 7 6 , 2 5 % ) , thira can t r u n g b i n h va nang c h i c h i ^ m 2 3 , 7 5 % . B a n g 3.3. M i r c dp beo p h i theo t u o i va g i o i
Nhom
6
7
8
9
10
Tong Gidi
Nam Nii- Chunq
Nam NiT Chunq
Nam NO- Chunq
Nam Nif Chunq
Nam Ni?
Chunq Nam
Nii- Chunq
Beo phi nhe n 8 0 8 3 3 6 5 8 13 9 0 9 2 2 4 27 13 40
T v I e 3,21 0,00 1,71 1,53 1,54 1,53 2,30 4,44 3,27 4,55 0,00 2,34 1,39 1,22 1,30 2,69 1,37 5 4 , 7 9
Beo phi trung binh va n i n q n 4 0 4 0 3 3 2 2 4 3 10 13 5 4 9 14 19 33
T v I e 1,61 0,00 0,85 0,00 1,54 0,77 0,92 1,11 1,01 1,52 5,35 3,38 3,47 2,44 2,92 1,39 2,01 4 5 , 2 1
Tong N 12 0 12
3 6 9 7 10 17 12 10 22 7 6 13 41 32 73
T y l e 4,82 0,00 2,41 1,53 3,08 2,30 3,22 5,55 4,28 6,07 5,35 5,72 4,86 3,66 4,22 4,08 3,38 100
Nhan xet: Ty le BP nhe cao nhat o 8 taoi (3,27%), thap nhat a 10 tuoi (1,30%). Ty le BP trung binh va nang cao nhit ct 9 tu6i (3,38%i), thap nhat a 7 tu6i (0,77%).
Trong s6 73 tre beo phi dugc khao sat, beo phi nhe chiSm 54,79%; beo phi trung binh va nang chiem 45,21%.
3.2. Cac yeu to lien quan flen tinh trang thira can - beo phi
Bang 3.4. Lien quan giiia ylu t6 ngh6 nghiep cua bo me va thira can -beo phi.
Nghe nghiep
Buon ban Lao donq CBVC
Bo ThCta can n 15
106
18
»/o 10,79
76,26
12,95
Chu'ng n 6
122
11
°/o 4,32
87,77
7,91 OR
P 2,68
<0,05 0,44
>0,05 1,70
>0,C5
M e ThCra can n 28
97
14
»/o 20,15
69,78
10,07
Chu'ng n 15
107
17
»/o 10,79
76,98
12,23 OR
P 2,08
<0,05 0,64
>0,C5 0,75
>0,05
CHUYEN P g : HOI NGHj KHOA HOC NGANH Y TE T I N H KHANH HOA - LAN TH(f II
Nhan xet: Nguy ca thira can cua tre co bd budn ban cao gdp 2,68 l§n, cd me budn ban cao gap 2,08 lan so vdi tre cd bd me lam nghe khac.
Bang 3.5. Tinh trang thira can cua bd me vdi thua can - beo phi cua con
Yeu to
Thira can
BS
Me
Nhom thCra can - beo phi n 70
42
%
50,36 30,22
Nhom chu'ng n 42 24
%
30,21
17,278 OR (SSO/oCI)
2,34 (1,42-3,93)
2,07 (1,17-3,66)
P
<0,001
<0,05
Nhan xet: Nguy co thua can d tre cd bd thua can cao gap 2,34 lan, d tre cd me thira can cao gap 2,07 lan so vdi tre cd bd va/ hoac me khdng thira can.
Bang 3.6. Nhan hih diing cua bd me ddi vdi tinh trang dinh duong cua tre d nhdm thira can - beo phi.
Nhan biet tinh t r a n g dinh du'dng Thieu can Binh thu'dnq Beo Khonq biet
Nh$n biet tinh trang dinh dirdng
Khonq biet Biet
Nhom thCra can - beo phi n 8 93 4 34
%
5,76 66,91
2,88 24,46 Nhdm thCia can -
beo phi n 34 105
%
24,46 75,54
Nhom
n 5 130
0 4 Nhdm
n 4 135
chu'ng
%
3,59 93,52
0,00 2,88 chu'ng
o/o 2,88 97,12
P
<0,001
OR ( 9 5 % C I ) P 10,92 (3,76 - 31,76)
<0,001
Nhan xet: Nguy co thira can d nhdm tre cd phu huynh khdng nhan biet duoc tinh trang dinh duong cua tre cao gap 10,92 lan so vdi nhdm phu huynh biet tinh trang dinh duong ciia tre.
Bdng 3.7. Mdi lien quan den tien su nuoi dudng va thira can - beo phi.
Yeu t o Can nanq luc sinh Bu me hoan toan (thanq) Cai siia
An bot tir thanq An chao A n c d m
Nhdm TC-BP 3,04±0,97 3,66±1,31 18,39±4,32 3,66±1,31 7,45±2,38 12,88±4,04
Nhdm chu-nq 2,90±0,87 4,12±1,25 17,02±5,71
4,12±1,25 7,46±2,26 12,35±3,78
P
>0,05
< 0 , 0 1
< 0 , 0 5
< 0 , 0 1
>0,05
>0,05
Nhan xet: Tre thira can beo phi cd thdi gian bu me hoan toan it hon, cai sira mudn hon va an d ^ sdm hon so vdi nhdm chiing.
Bang 3.8. Lien quan giiia thdi quen an udng cua tre vdi tinh trang TC-BP
Y Hpc VIST NAM THANG 5 - SO BAC BIET/2012
Yeu to
Nhdm TC - BP (n=139)
n 1 %
Nhdm chu'ng (n=139) n 1 »/o
OR P
Tre hau an (an nhieu va an nhanh) Co
Khong
89 50
64,03 35,07
72 67
51,79
48,21 1,66 <0,05 An vat
Co Khonq
87 52
62,59 37,41
69 70
49,64
50,36 1,69 <0,05 An bii-a phu tru'dc ngu dem
Co Khonq
90 49
64,75 35,25
73 66
52,51
47,49 1,66 <0,05 Nhan xet: Ty 1? tre cd thdi quen hau an, hay an vat va an biia phu trudc khi ngu dem d nhdm TC-BP cao hon nhdm chung, cd y nghTa thdng ke vdi p<0,05.
Bang 3.9. Lien quan giGa chg dp an udng ciia tre vdi tinh trang thira can - beo phi.
Yeu to Nhdm TC - BP
n 0/0
Nhdm chu'ng
n 1 % OR P
An nhi'eu chat beo Cd
Khonq
58 81
41,73 58,27
42 97
30,21
69,79 1,65 <0,05 An nhieu chat ngot
Cd Khonq
21 118
15,11 84,89
10 129
7,19
92,01 2,18 <0,05 An nhieu thu'c an nhanh
Co Khonq
22 117
15,83 84,17
11 128
7,91
92,09 2,21 <0,05 An nhieu rau, qua
Co Khonq
9 130
6,47 93,53
7 132
5,03
94,97 1,30 >0,05 Nhgn xet: Ty le tre co che dp an nhieu chat beo, nhieu chat ngot, an nhieu thiic an nhanh a nhom TC-BP cao hon nhom chirng, co y nghia thong ke vol p<0,05;
Khong CO m6i lien quan giira cha do nhi6u rau qua vcri tinh trang TC-BP 6 tre (p>0,05).
Bang 3.10. Lien quan giOa thai gian boat dpng the luc cua tre yeii thira can - beo phi
Hoat dong the lire
< 10 qid/tuan
> 10 qld/tuan
Nhdm TC-BP n 79 60
%
56,83 43,17
Nhdm chu'ng n 57 82
»/o 41,01 58,99
OR C95»/oCI)
1,89 1,17-3,05
P
<0,01 Nhdn xet: Nguy co TC-BP a nhom tre it hoat dpng the luc (<10 gia/tuan) cao gap i lan so vol tre boat dpng the lire >10 gio/tuin.
57
CHUYEN BE: HQI NGHI KHOA HOC NGANH Y Tg TJNH KHANH HOA - LAN THlf II
Bang 3.11. Lien quan giira thoi gian hoat dpng tinh (xem truyen, xem tivi, choi game) ciia tre voi thira can - beo phi
Hoat dpng tinh
>20 qid/tuan
<20 qicJ/tuan Tonq
Nhdm TC-BP N 63 43 106
" / o 59,43 40,57 100
Nhdm chCinq n 38 49 87
»/o 43,68 56,32 100
OR (95»/oCI)
1,89 1,06-3,35
P
<0,05
Nhan xet: Nguy ca TC-BP d nhom tre hoat ddng tTnh >20 gid/tuan cao gap 1,89 lan so vdi tre boat ddng tinh < 20 gid/tuan.
Bang 3.12. Lien quan giira thdi gian ngu trong ngay va dem ciia tre vdi thira caii - beo phi
Thdi gian ngu
> 9 qid/nqay dem
<9 qid/nqav dem
Nhdm TC-BP N 76 63
»/o 54,67 45,33
Nhdm chu'ng n 65 74
%
46,76 53,24
OR (95»/oCI)
1,37 0,86-2,20
P
>o,os Nhdn xet: Thdi gian ngu dem cua tre d 2 nhdm khac biet khdng cd y nghTa thdng ke (p> 0,05).
IV. BAN LUAN
4.1. Ty le thu-a can - beo phi ciia hoc sinh tieu hoc thi xa Ninh Hoa
Qua nghien cuu 1950 hoc sinh tieu hoc tir 6 - 10 tudi tai thi xa Ninh Hda, tinh Khanh Hda, chung tdi cd mpt sd ket qua va nhan xet sau:
4.1.1. Ty le thira cdn ~ beo pill Ty le thira can - beo phi d hpc sinh tieu hpc thi xa Ninh Hda la 7,13%, trong do ty le beo phi chiem 3,74%.
Theo ket qua nghien ciru cua cac tac gia trong nude, tir nam 2002 den nay tai cac dia phuong mien Bac, thay ty le TC-BP la 6,2%
[5]; 4,1% [7]; 9,9% [6]; 4,1% [3]. Tai khu vuc mien Trung, khao sat d hoc sinh tieu hpc thanh phd Nha Trang nam 1997 thay ty le TC-BP la 2,7% [13], nam 2001 tang len 5,88% (p<0,001) [1]; Nghien cim tai Hud (2005) thdy TC-BP chidm 6,4%, trong dd BP chiem 3,1% [11]. Tai tp Hd Chi Minh, nghien cim nam 1998 thky ty le thira can la 12,2% [9]
va den nam 2003 khao sat lai thay ty le TC-BP tang len 22,7% (gan gap ddi); Mpt nghien cuu khac Hoang Thi Mai nam 2008 thay ty le TC- BP la 26,1% (n= 1745) [10].
So sanh vdi cac ket qua nghien cuu trong nude tren day va d cung dp tudi, ty le TC-BP trong nghien cuu cua chiing tdi tuong ddng vdi ty le TC-BP ciia cac tac gia mien Bac, mien Trung va thap hon khu vuc phia Nam.
Tuy thdi gian va dia diem nghien cuu thuc hien tai nhimg vung cd dieu kien kinh te khac nhau, nhung deu toat len dupe y nghTa la ty le TC-BP ngay cang gia tang, ty le TC-BP d hpc sinh tieu hpc thanh phd Hd Chi Minh cao hon tre cung tudi d cac viing khac. DSc biet tai Khanh Hda, ty le TC-BP tang d4n tir 2,7%
nam 2001, tang len 5,88% nam 2001 (d tp Nha Trang) va tang din 7,13% nam 2011 (d thi xa Ninh Hda).
Theo WHO, tren toan the gidi tinh hinh beo phi da tang len gap ddi ke tir nam 1980.
Trong nam 2010, gan 43 trieu tre em dudi 5 tuoi bi thira can, khoang 65% dan sd thi gidi sdng d cac nude noi ma thira can - beo phi giet chet nhieu ngudi hon la thieu can va it nhdt cd 2,8 trieu ngudi chet mdi nam do bdi TC-BP. Ngoai ra, 44% ganh nang benh dai thao dudng, 23% ganh nang benh tim thiiu mau cue bp va tir 7- 41% ganh nang benh ung
58
Y HOC VI$T NAM THANG 5 - SO DAC BIET/2012
thu la do thira can - beo phi.
Cho den nay, tai thi xa Ninh Hda tinh Khanh Hda chua cd nghien cihi nao danh gia tinh hinh thira can - beo phi. Mac dii nhieu nam qua, chinh quyen dia phuong va nganh y te thi x5 luon quan tam dieu tra, danh gia va cd ke hoach phdng chdng suy dinh dudng cho tre dudi 5 tudi, vdi ket qua khich le la giam tre suy dinh duong dudi 5 tuoi cdn 8,4% vao cudi nam 2010, thap hon ty le suy dinh dudng cua tinh (10%) va toan qudc.
Qua nghien cim cua chung tdi, hpc sinh tieu hoc cd ty le TC-BP la 7,13%, ben canh dd suy dinh duong van cdn ty le la 6,92%. B'lhu nay canh bdo cho nganh y te Ninh Hda cung nhu chinh quyen dia phuong phai cd ke hoach song hanh vdi viec phdng chdng suy dinh duong tre em la chien lupc phdng chdng beo phi de bao v? sue khde tre em, nhung ngudi lam chu tuong lai cua dat nude ta.
4.1.2. Mifc do thua can - beo phi Miic dp thira can d hpc sinh tieu hoc thi xa Ninh Hda chii yeu la thira can nhe chiem 76,25%, thira can trung binh va nang chiem 23,75%. Vh muc dp beo phi, hpc sinh beo phi nhe chiim ty le 54,79%, beo phi trung binh va nang chiem ty le 45,21%.
Kit qua nay phii hop vdi ket qua nghien ciru cua cac tac gia trong nude [11], [10], [9].
Nhin chung, mpi ngudi thira nhan rang beo phi d tre em thudng lien quan tdi beo phi khi trudng thanh. Vi vay, chung ta c4n can thiep sdm va ddng bp de cd the giai quyit beo phi d tre cd hieu qua hon khi ma muc dp beo phi chua trd nen tram trpng.
4.2. Cac y^u to lien quan den tinh trang thira can - beo phi
4.2.1. Yiutdgia^tnh 4.2.1.1. Bd me ire co thira cdn Nhiiu nghien ciiu da ghi nhan beo phi cd tinh gia dinh, nhung khd phan biet dupe dau
la yeu td di truyen, dau la anh hudng cua thdi quen gia dinh cimg che dp, sd thich an udng.... Nghien ciiu ciia chiing tdi nhan thiy tre thira can cd ti le bd va/ hoac me thira can cao hon nhdm chiing. Nguy co thira can d tre cd bd thira can cao gap 2,34 Idn, d tre cd me thira can cao gap 2,07 lan so vdi tre cd bd va/
hoac me khdng thira can. Ket qua nay phii hpp vdi nhieu nghien ciru cua cac tac gia trongnudc[3], [5], [11], [10].
4.2 1.2. Nghe nghiep cua bo me Ket qua cua chung tdi thay tre thira can cd bd va/ hoac me lam nghe budn ban chiem ti le cao hon nhdm chiing. Nguy co thira can cua tre cd bd budn ban cao gap 2,68 lan, cd me budn bao cao gap 2,08 lan so vdi tre cd bd me lam nghe khac (p<0,05). Mpt sd nghien cuu [11], [12] cijng thay rang nhimg tre cd bd me lam nghe budn ban thi nguy co bi thira can - beo phi cao hon cd y nghTa thdng ke so vdi nhiing tre cd bd me lam nghe khac.
Phai chang la do ban rdn vdi cdng viec budn ban, bd me khdng du thdi gian cham sdc con cai va/ hoac cd the do kinh te kha gia nen cac gia dinh nay thudng cho con an nhieu ciing nhu cho con tien tieu vat, ddng thdi lai khdng kiem soat dupe viec an udng cua con minh.
4.2.1.3. Nhdn biet ciia bo me ve thica cdn - beo phi a tre
Ti le phu huynh khdng nhan biet dugc tinh trang dinh duong ciia tre d nhdm thira can - beo phi cao hon cd y nghia so vdi nhdm chiing (24,46% so vdi 2,88%, p<0,001), nguy CO thira can ciia tre cao gap 10,92 lan so vdi nhdm phu huynh biet tinh trang dinh dudng cua tre.
K6t qua cua Tran Thi Phiic Nguyet va cdng su cung cho thay, khi ba me danh gia sai v6 tinh trang dinh duong cua con minh thi tre se cd nguy co bi thira can gap 4,2 Idn.
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CHUYEN BE: HOI NGH| KHOA HOC NGANH Y TE TINH KHANH HOA - LAN THLf II
4.2.2. Yiu td ban than tre
Kdt qua can nang liic sinh ciia tre d nhdm TC-BP va nhdm chiing khdng cd sy khac biet dang Vk (3,04±0,97 so vdi 2,90±0,87, p> 0,05).
Kit qua nay phii hpp vdi nghien cihi ciia cac tac gia khac [11], dai da sd tre khi sinh ra co can nang binh thudng, nhung sau mpt thdi gian dupe nudi dudng an udng qua nhu cau khuyen nghi, tre da bi thira can.
Tuy nhien, ket qua nghien ciiu thay tre TC-BP cd thdi gian bii me hoan toan it hon, thdi gian an dam sdm hon va cai sira mudn hon nhdm chimg (p< 0,05).
Ve mdi lien he nay cd rat nhieu y kien trai ngupc nhau va hieu qua trong viec ngan ngira beo phi ciia viec nudi con bang siia me van cdn ban cai. Mpt sd nghien ciiu da chiing minh siia me la yeu td quan trpng bao ve tre khdng bi beo phi bdi viec dinh dang sdm kieu an va hoat dpng d tre. Tre dupe nudi bdng sita bd cd nguy co TC-BP cao hon tre bii me, vl thirc an nhan tao glau protein va mudi lam tang ap lire tham thau, gay cam giac khat kich thich tre an udng nhieu hon.
4.2.3. Moi lien quan giira thoi quen dn udng ciia tre vdi thira cdn - beo phi
Theo ghi nhan ciia Td chiic Lucmg thuc va Ndng nghiep the gidi va Td chiic Y te the gidi (FAO/WHO) cho thay nude cd thu nhap qudc dan dau ngudi gia tang thi trong co cau khau phan (tinh theo % nang luong) ty le nSng luong tir lipid cung tang.
Ci nude ta, theo dieu tra ciia Vi?n Dinh dudng, miic tieu thu lipid trung binh tang tir 12g/ngudi/ngay vao nam 1985 len 25g/ngudi/ngay vao nam 2000, dua din khuynh hudng TC-BP ciia ngudi trudng thanh tai dd thi tang tir 0,4% (1984) len 10%
(2000) [12].
Ket qua nghien ciiu ciia chung tdi, cac thdi quen an nhieu va an nhanh, hay an vat va
an biia phu trudc khi ngu dem d nhdm tre TC-BP chiem uu thi hon so vdi nhdm chiing (p<0,05). Vi chi dp an udng, tre TC-BP cd che dp an giau chat beo, chat ngpt va thiic an nhanh cao hem nhdm chiing (p<0,05) va nguy CO TC-BP tang len gap 2 Idn; tuong ddng vdi ket qua nghien cim ciia cac tac gia khac [3], [9], [10], [11]^
4.2.4. Moi lien quan giu'a ho^t dong cua tre vdi thua can - beo phi
4.2.4.1. Hoat dpng the luc
Ket qua nghien ciiu ve cac hoat ddng the lire (choi bdng da, da cau, cdu long, tap vd, boi Idi, chay, nhay day, tap miia, the due budi sang...) cd lien quan den tinh trang thira cdn - beo phi cua tre. Nguy co TC-BP d nhdm tre it boat dpng the lire (<10 gid/tudn) cao gdp 1,89 lan so vdi tre boat dpng the lire >10 gid/tudn. Nhdn dinh nay phii hop vdi hdu het cac nghien ciiu ciia nhieu tac gia khac deu nhdn thay giam hoat ddng the luc lam tang nguy CO thira cdn - beo phi d tre em [3], [5], [7], [10], [11].
4.2.4.2. Hoat dpng tinh
Trong nghien ciiu, thoi gian tre TC-BP cd cac boat ddng tTnh tai nhu: choi game, xem truyen, xem tivi nhieu hon nhdm chiing.
Nguy CO TC-BP d nhdm tre boat ddng tinh cao gdp 1,91 lan so vdi tre khdng tham gia boat dpng ndy (p<0,05).
Cdc hoat ddng tinh nhu xem tivi ddng nghia vdi tang thdi gian tinh tai, giam hoat dpng the luc, lam gidm chuyen hda co ban [11]. Cd nhieu nghien ciiu da chiing minh anh hudng tieu cue cua viec xem tivi qua nhieu den tre em, ma hien tuong gia tang tinh trang beo phi chi la mpt hau qua trong sd dd [5], [20].
4.2.4.3. Moi lien quan giiia thai gian ngu cua tre vai tinh trang thita can - beo phi
Nghien ctiu ciia chung toi Ichong thiy sy lien quan giira thai gian ngii voi tinh trang
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Y HOC V l | T NAM THANG 5 - SO DAC BIET/2012
thira can - beo phi d tre (OR=l,37; p> 0,05), phii hpp vdi ket qua ciia Hoang Thj Mai, Phan Thi Bich Ngoc [10], [11].
Tir Idu, mpi ngudi thudng nghT rang an nhieu ngu nhieu se beo. Nghien ciiu cua Saraswathi Y.S va cdng su d An Dp cho thdy ngu nhieu >10 gid/ ngay la yeu td nguy co cua beo phi, nghien ciiu ciia Biii Van Bao cho thay 17% tre thira can beo phi ngu nhieu [1]. Nghien ciiu ciia Trdn Thi Hdng Loan thay ngu it <8 gid/ ngay cflng dupe xem la mpt yeu td nguy co ciia beo [9]. Cac tac gia deu giai thich do boat ddng tieu md ciia CO the la tdi da ve dem va sir ngii it lam giam tieu md ndi chung, cdn ngu nhieu cung dnh hudng den hoEit dpng the luc cua tre, lam giam su tieu md do tieu hao nang lupng gidm.
V. KiT LUiSkN
1. Ty le thira c3n - beo phi fr hoc sinh tieu hoc thj xa Ninh Hda
- Ty le thira can - beo phi d hpc sinh tiiu hpc thi xa Ninh Hda la 7,13% (95%CI: 5,99- 8,42%), trong dd cd 3,74% (95%CI: 2,93- 4,71%) la beo phi.
- Ty le thira can - beo phi d hpc sinh nam cao hon hpc sinh nii (8,96% so vdi 5,18%, p<0,001).
- Ty le thira can - beo phi cao nhdt d 9 tuoi (9,61%), thdp nhdt d 7 tudi (5,37%).
- Miic dp thira can da sd la miic dp nhe (76,25%), thira can mirc do trung binh va nang la 23,75%.
• 2. Mgt s^ yeu to lien quan den tinh trgng thua can - b6o phi cua tre em
2.1, Yeu to gia mh
- Nguy CO thira can a tre cd bd thira cdn cao gdp 2,34 lln, d tre cd me thira can cao gSp 2,07 lan so vdi tre cd bd vd/ hoac me khdng thira can (p<0.01).
- Nguy CO thira can ciia tre cd bd budn
ban cao gap 2,68 Idn, cd me budn ban cao gap 2,08 lan so vdi tre cd bd me lam nghi khac (p<0,05).
- Nguy CO thira can d nhdm ire cd phu huynh khong nhdn biet dupe tinh trang dinh duong ciia tre cao gap 10,92 Idn so vdi nhdm phu huynh biet tinh trang dinh duong cua tre.
2.2. Yeu to bdn than tre
-Tre thira cdn - beo phi cd thdi gian an dam sdm hon va cai siia mudn hon nhdm chimg (p<0,05).
- Thdi quen an udng nhu an nhieu va an nhanh, hay an vat, an biia phu trudc ngu dem la nhirng thdi quen cd lien quan den tinh trang thira can - beo phi d tre em.
- Che dp an giau nang lupng: nhieu chat beo, nhieu chat ngpt, an thirc dn nhanh che bien san cd lien quan den tinh trang thira cdn - beo phi d tre em.
- Tre it hoat ddng the luc cd nguy co thira can - beo phi cao gap 1,89 lan (95% CI:
1,17-3,05) so vdi tre hoat ddng the luc >10 gid/tudn.
- Tre cd thdi glan hoat dpng tTnh >20 gid/tuan cd nguy co thira can - beo phi cao gdp 1,89 Idn (95% CI: 1,06-3,35) so vdi tre boat ddng tinh < 20 gid/tuan.
TAI LIEU THAM K H A O
1. Biii Van Bao, Le Nghj, Nguyen Thin (2002), "Mpt sd dien biin cua b?nh thira can beo phi tre em tieu hoc thuoc thanh phd Nha Trang", Tdi lieu Hdi nghi khoa hoc thira cdn vd beo phi vdi sue khde cdng ddng. Bp Y te, tr. 137-147.
2. Tran Hihi Dang va CS (2007), "Beo phi can benh cua thdi dai, cac hiiu biet mdi va mpt so nghien ciiu d Hu6", Ky yeu Hoi nghj idioa hoc thira cdn beo phi- mdi nguy ca cua cdc benh thai dai, Sd Y ti tp Hd Chi Minh, tr. 48-54.
3. Le Thi Hai va CS (2002), "Tim hieu mot so
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CHUYEN DE: H Q I NGHj KHOA HOC NGANH Y TE TJNH KHANH HOA - L A N T H Q II yeu to nguy ca benh beo phi d hpc sinh 6-
11 tuoi tai hai trudng tieu hpc npi thanh Ha Npi", Tdi lieu Hoi nghi khoa hoc thira cdn vd beo phi vai sire khde cdng ddng, Bp Y te, tr.229-245.
Dang Thi Dieu Hien va CS (2008), "Tinh hinh beo phi va lang huyet ap d nhan dan xa Hirong Long, thanh pho Hue", Tap chi Y HQC thuc hdnh, (616-6! 7), tr. 549-561.
Nguyen Thi Thu Hien va CS (2002),
"Nghien cCru tinh trang beo phi, cac yeu to lien quan d lira tuoi 6- 11 tai mpt quan npi thanh Hai phong", Tdi li^u Hoi nghi khoa hpc thira cdn vd beo phi vdi sire khde CQng ddng. Bo y ti, XX. 159-165.
Vu Himg Hieu, Le Thi Hffp (2002), "Thirc trang va mpt sd yeu to nguy ca anh hudng tdi tinh trang thira can cua hpc sinh tieu hoc qu^n Ddng Da- Ha Npi", Tdi lieu Hoi nghi khoa hpc thica cdn vd beo phi vdi sue khde CQng dong. Bp Y ti, tr. 166-176 Le Thj HiroTig, Ha Huy Khoi (2002),
"Tinh trang dinh duang va mpt so yeu to lien quan cua tre em hai trudng lieu hpc npi ngoai thanh Ha Npi", Tdi li^u Hdi nghi khoa hoc thira cdn vd beo phi vdi sice khde CQng ddng. BpYti.tt-. 178-187
Ha Huy Khoi (2002), "Thira can va beo phi, mgt van de siic khoe cong dong mdi d nude la", Tdi li?u Hoi nghi khoa hQc thira cdn vd beo phi vdi sice khde cdng ddng. Bo Y li, tr.
5-M.
Tran Thj Hong Loan (1998), Tmh trang thira cdn vd cdc yiu to nguy ca d hoc sinh 6- 11 tudi tgi mot quan ndi thdnh- tp. Hd Chi Minh, Luan van Thac sT dinh duang cong ddng, Tru'dng Dai hpc Y khoa Ha Npi.
. Hoang Thj Mai (2008), Nghien cicu tinh hinh vd mot sdyeu td lien quan thica cdn beo phi a hoc sinh tieu hoc tgi Quan 5 thdnh pho Ho Chi Minh, Luan an chuyen khoa cap 11,
Trudng Dai hpc Y Duac Hui.
. Phan Thi Bich Ngoc (2005), Nghien cuu tinh hinh vd mol sd yiu td nguy ca thica cdn beo phi d hoc sinh lieu hoc tgi Thdnh pho Hue nam 2004, Luan an chuyen khoa cap II, Tnrdng Dai hpc Y khoa Hue.
. Le Thj Kim Qui (2007), "Thira can- beo phi: ganh nang ciia dinh duang va sire khoe hien nay", Ky yeu Hdi nghi khoa hgc thira cdn beo phi- mdi nguy ca cua cdc benh thai dgi, Sd Y l i tp Hd Chi Minh, tr. 1-5.
. Nguyen Thin va CS (2002), "Tinh trang thira can beo phi d hoc sinh tuoi mau giao va lieu hpc tai noi thanh, Ihanh pho Nha Trang", Tdi li^ii Hdi nghi khoa hoc thica cdn vd beo phi vdi siec kfide cdng ddng, Bp Y ti, tr. 89-95.
. Bhardwaj S, et al (2008), "Childhood obesity in Asian Indians: a burgeoning cause of insulin resistance, diabetes and sub- clinical inflammation", Asia Pac J CUn Nutr. 17(1), pp. 172-175.
. Cuevas-Nasu L et al (2009), "Overweight and obesity in school children aged 5 to II years participating iii food assistance programs in Mexico", Mexico Public Health, 5\iS4), pp. 630-631.
. Davis MM, McGonagle K, Schoeni RF, Stafford F (2008), "Grandparental and Parental Obesity Influences on Childhood Overweight: Implications for Primaiy Care Practice", The Journal of the American Board of Family Medicine, 21(6), pp. 549-554 '. Ford AL, et al (2010), 'Treatment of
childhood obesity by retraining eating behaviour: randomised controlled trial", BMJ, 340, pp 5388-5395.
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Y HQC VigT NAM THANG 5 - SO BAC BIET/2Q12 population-based case-control study".
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1528-1536.
20. Hu FB, Li TY, Colditz GA et al (2003),
"Television Watching and Other Sedentary Behaviors in Relation to Risk of Obesity and Type 2 Diabetes Mellitus in Women", JAMA, 2Z9, pp. 1785-1791,
21. Kimani-Murage EW (2011), "Child Obesity", International Encyclopedia of Rehabilitation, University at Buffalo, The State University of New York, pp. 1-18.
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Pediatric, 28(3), pp. 290-295.
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27. Walls JL, Peeters A, Son PT, Quang NN, Hoai NT, Loi do D, Viet NL, Khai PG, Reid CM et al (2009), "Prevalence of underweight, overweight and obesity in urban Hanoi. Vietnam". Asia Pac J Clin Nutr. 18(2), pp. 234-239.
DANH GIA HIEU QUA DIEU TRj LIET CHI DO TAI BIEN LAN BANG OXY CAO AP
BiJi Minh Thuan*, Thieu Long*, Tran Dinh Tri*, Doan Quoc Hung*
TOM TAT
Benh giam ap !a benh xay ra chu yeu doi vdi nguSi lan du'cii nu'dc, nhat la nhiing ngUdi lam nghe I3n danh b3t hai san thi nguy cd bj benh cang cao do kem SI/ hieu biet hole vl ke muU sinh. Tai bien lan co the t i i vong hoac de lai di chiTng khong phuc hoi, gay anh hu'dng cho ca nhan va xa hoi. Lieu phap oxy cao ap (OXCA) la phu'dng phap dieu trj dac hieu ddi vdi
benh giam ap, lam giam cac di chu'ng tai bien do lan gay ra.Tii thang 2/2009 den thang 2/2011, Benh vien Dieu du9ng - Phuc hoi chiic nang Khanh Hoa da Oiu dung dieu tn 53 benh nhan bj iiet do lan bang OXCA.
Ket qua cho thay co 34 ca tot (64,2%); 12 ca kha (22,6%); 2 ca trung binh (3,8%); 4 ca kem (7,9%) va 01 ca khong ket qua (1,9%). Khong co tru'dng hpp nao bi cac tai bien do dieu tri bang OXCA gay nen.
*Benh vien Dieu du'dng - Phuc hoi chut nang Khanh Hoa
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