学龄儿童ADHD症状与多维肥胖表型的关联：不良饮食行为的潜在中介作用*

doi:10.3870/j.issn.1672-0741.26.02.013

摘要/Abstract

摘要： 目的探讨学龄儿童注意缺陷多动障碍（attention-deficit/hyperactivity disorder,ADHD）症状与多维肥胖表型（基于体质量指数及体成分指标）的关联,并分析不良饮食行为在其中的潜在中介作用。方法采用横断面设计,通过分层整群抽样法纳入珠海市2023年6至18岁学龄儿童6624名。测量其身高、体重,计算体质量指数（BMI）,采用生物电阻抗分析法测量体脂率、躯干体脂率和腰臀比。通过父母版斯诺佩评估量表（Swanson Nolan and Pelham-Ⅳ,SNAP-Ⅳ）评估ADHD症状,通过儿童自评版荷兰饮食行为问卷评估不良饮食行为。四种肥胖表型包括：BMI定义的肥胖;肥胖伴高腰臀比;肥胖伴高体脂率;肥胖伴高躯干体脂率。采用多水平逻辑回归进行关联分析,Bootstrap法检验中介效应。结果 ADHD症状筛查阳性率为6.9%,肥胖检出率为10.3%。受试总体的多动冲动症状得分与肥胖（OR=1.31）和肥胖伴高腰臀比（OR=1.31）呈正相关。女生的多动冲动症状得分还与肥胖伴高体脂率（OR=1.40）和肥胖伴高躯干体脂率（OR=1.38）显著相关;男生中未见上述指标显著关联。限制性饮食得分在上述关联中有潜在中介效应,中介效应占比在总体中为61.0%~72.2%,在女生中为35.9%~39.1%。结论学龄儿童ADHD症状,尤其是多动冲动症状,不仅与BMI定义的肥胖相关,更与以中心性肥胖为特征的多维肥胖表型相关,且在女生中更为突出;限制性饮食可能在两者关联中发挥重要的潜在中介作用。肥胖防控中可关注伴多动冲动症状的儿童及其饮食行为特征,体成分指标有助于更精细的表型描述,其在常规监测中的应用价值仍需前瞻性研究验证。

关键词: 注意缺陷多动障碍, 学龄儿童, 肥胖, 体脂率, 不良饮食行为

Abstract: Objective To explore the association between attention-deficit/hyperactivity disorder （ADHD） symptoms and multidimensional obesity phenotypes defined by BMI and body composition indicators in school-aged children, and further analyze the potential mediating role of unhealthy eating behaviors. Methods A cross-sectional study was conducted among 6624 children aged 6–18 years from Zhuhai, China, recruited via stratified cluster sampling in 2023. Height and weight were measured to calculate BMI, and body composition indicators, including body fat percentage and waist-to-hip ratio, were assessed by bioelectrical impedance analysis. ADHD symptoms were evaluated with the parent-rated Swanson Nolan and Pelham-Ⅳ （SNAP-Ⅳ）, while eating behaviors were assessed with the children's self-reported Dutch Eating Behavior Questionnaire. Four obesity phenotypes were defined：obesity by BMI;obesity with a high waist-to-hip ratio;obesity with high body fat percentage; and obesity with high trunk fat percentage. Multilevel logistic regression was performed for association analysis, and mediation effects were tested using the bootstrap method. Results The positive screening rate for ADHD symptoms was 6.9%, and the detection rate of obesity was 10.3%. Among all participants,hyperactive-impulsive symptom scores were positively associated with obesity （OR=1.31） and obesity with a high waist-to-hip ratio （OR=1.31）. Among girls, these scores were also significantly positively associated with obesity with high body fat percentage （OR=1.40） and obesity with high trunk fat percentage （OR=1.38）,whereas no significant associations of these indicators were found in boys. Restrained eating scores showed a potential mediating effect in these associations, explaining 61.0%-72.2% of the total effect in the overall sample and 35.9%-39.1% in girls. Conclusion ADHD symptoms in school-aged children are associated not only with the risk of obesity but also with multidimensional obesity phenotypes characterized by central fat accumulation. Restrained eating may be an important potential mediator in this association. For obesity prevention and control, attention should be paid to children with hyperactive-impulsive symptoms and their eating behaviors. Body composition indicators may facilitate refined phenotyping, yet their value in routine monitoring requires validation in prospective studies.

Key words: attention-deficit/hyperactivity disorder, school-aged children, obesity, body fat percentage, unhealthy eating behaviors

中图分类号:

R749.94

张曾珍, 宁婷, 邓唯希, 郑欣怡, 夏雯琪, 陈凤燕, 邹亚玲, 张建端. 学龄儿童ADHD症状与多维肥胖表型的关联：不良饮食行为的潜在中介作用^*[J]. 华中科技大学学报（医学版）, 2026, 55(5): 659-665.

Zhang Zengzhen, Ning Ting, Deng Weixi et al. Relationship Between ADHD Symptoms and Multidimensional Obesity Phenotypes in School-Aged Children： The Potential Mediating Role of Unhealthy Eating Behaviors[J]. Acta Medicinae Universitatis Scientiae et Technologiae Huazhong, 2026, 55(5): 659-665.

参考文献

[1] Posner J,Polanczyk G V,Sonuga-Barke E.Attention-deficit hyperactivity disorder[J].Lancet,2020,395(10222):450-462.
[2] Wolraich M L,Hagan J F Jr,Allan C,et al.Clinical practice guideline for the diagnosis,evaluation,and treatment of attention-deficit/hyperactivity disorder in children and adolescents[J].Pediatrics,2019,144(4):e20192528.
[3] Li F,Cui Y,Li Y,et al.Prevalence of mental disorders in school children and adolescents in China:Diagnostic data from detailed clinical assessments of 17,524 individuals[J].J Child Psychol Psychiatry,2022,63(1):34-46.
[4] 刘芮卓,陈立.儿童注意缺陷多动障碍与肥胖的相关性研究[J].中国儿童保健杂志,2023,31(4):412-415.
Liu R Z,Chen L.Research progress in the correlation between attention-deficit hyperactivity disorder and obesity in children[J].Chinese Journal of Child Health Care,2023,31(4):412-415.
[5] 张瀚月,马璐,孔振兴,等.2016—2020年我国学生超重、肥胖和营养不良状况的流行趋势与防控策略[J].北京体育大学学报,2023,46(11):118-131.
Zhang H Y,Ma L,Kong Z X,et al.Prevalence trends and prevention strategy of overweight,obesity and malnutrition among Chinese students from 2016 to 2020[J].Journal of Beijing Sport University,2023,46(11):118-131.
[6] GBD 2021 Adolescent BMI Collaborators.Global,regional,and national prevalence of child and adolescent overweight and obesity,1990-2021,with forecasts to 2050:A forecasting study for the Global Burden of Disease Study 2021BD 2021 Adolescent BMI Collaborators.Global,regional,and national prevalence of child and adolescent overweight and obesity,1990-2021,with forecasts to 2050:A forecasting study for the Global Burden of Disease Study 2021[J].Lancet,2025,405(10481):785-812.
[7] Cortese S,Moreira-Maia C R,St Fleur D,et al.Association between ADHD and obesity:A systematic review and meta-analysis[J].Am J Psychiatry,2016,173(1):34-43.
[8] Zhang S,Huang Y,Zaid M,et al.ADHD symptoms and obesity in Chinese children and adolescents:A longitudinal study with abnormal eating behaviors as moderating factors[J].J Atten Disord,2022,26(11):1452-1463.
[9] Khalife N,Kantomaa M,Glover V,et al.Childhood attention-deficit/hyperactivity disorder symptoms are risk factors for obesity and physical inactivity in adolescence[J].J Am Acad Child Adolesc Psychiatry,2014,53(4):425-436.
[10] Biederman J,Spencer T J,Monuteaux M C,et al.A naturalistic 10-year prospective study of height and weight in children with attention-deficit hyperactivity disorder grown up:Sex and treatment effects[J].J Pediatr,2010,157(4):635-640,640.
[11] Martins-Silva T,dos Santos Vaz J,Hutz M H,et al.Assessing causality in the association between attention-deficit/hyperactivity disorder and obesity:A Mendelian randomization study[J].Int J Obes,2019,43(12):2500-2508.
[12] Tyson N,Frank M.Childhood and adolescent obesity definitions as related to BMI,evaluation and management options[J].Best Pract Res Clin Obstet Gynaecol,2018,48:158-164.
[13] Seo Y G,Kim J H,Kim Y,et al.Validation of body composition using bioelectrical impedance analysis in children according to the degree of obesity[J].Scand J Med Sci Sports, 2018, 28(10):2207-2215.
[14] 李颂婷,钟燕.体成分分析在学龄儿童超重肥胖筛查中的应用价值[J].中国儿童保健杂志,2022,30(5):540-543,552.
Li S T,Zhong Y.Application of body composition analysis in screening overweight and obesity of school-age children[J].Chinese Journal of Child Health Care,2022,30(5):540-543,552.
[15] Rubino F,Cummings D E,Eckel R H,et al.Definition and diagnostic criteria of clinical obesity[J].Lancet Diabetes Endocrinol,2025,13(3):221-262.
[16] Nigg J T,Johnstone J M,Musser E D,et al.Attention-deficit/hyperactivity disorder (ADHD) and being overweight/obesity:New data and meta-analysis[J].Clin Psychol Rev,2016,43:67-79.
[17] Jahrami H,AlAnsari A M,Janahi A I,et al.The risk of eating disorders among children and adolescents with attention deficit hyperactivity disorder:Results of a matched cohort study[J].Int J Pediatr Adolesc Med,2021,8(2):102-106.
[18] Tanofsky-Kraff M,Cohen M L,Yanovski S Z,et al.A prospective study of psychological predictors of body fat gain among children at high risk for adult obesity[J].Pediatrics,2006,117(4):1203-1209.
[19] Tong L,Shi H,Li X.Associations among ADHD,Abnormal Eating and Overweight in a non-clinical sample of Asian children[J].Sci Rep,2017,7(1):2844.
[20] Coghill D,Du Y,Jiang W,et al.A novel school-based approach to screening for attention deficit hyperactivity disorder[J].Eur Child Adolesc Psychiatry,2022,31(6):909-917.
[21] Wu S,Cai T,Luo X.Validation of the Dutch eating behavior questionnaire (DEBQ) in a sample of Chinese adolescents[J]. Psychol Health Med, 2017, 22(3):282-288.
[22] Aguirre Castaneda R L,Kumar S,Voigt R G,et al.Childhood attention-deficit/hyperactivity disorder,sex,and obesity a longitudinal population-based study[J].Mayo Clinic Proc,2016,91(3):352-361.
[23] Fliers E A,Buitelaar J K,Maras A,et al.ADHD is a risk factor for overweight and obesity in children[J].J Dev Behav Pediatr,2013,34(8):566-574.
[24] Sinclair D,Purves-Tyson T D,Allen K M,et al.Impacts of stress and sex hormones on dopamine neurotransmission in the adolescent brain[J].Psychopharmacology,2014,231(8):1581-1599.
[25] Chang J P,Su K P,Mondelli V,et al.Cortisol and inflammatory biomarker levels in youths with attention deficit hyperactivity disorder (ADHD):Evidence from a systematic review with meta-analysis[J].Transl Psychiatry,2021,11(1):430.
[26] Hochgraf A K,McHale S M,Fosco G M.Interparental conflict and gender moderate the prospective link between parents'perceptions of adolescents'weight and weight concerns[J].Int J Eat Disord,2019,52(8):904-913.
[27] Lowe M R,Levine A S.Eating motives and the controversy over dieting:Eating less than needed versus less than wanted[J].Obes Res,2005,13(5):797-806.
[28] 王劭睿,陈红.为何越减越肥?——限制性饮食者过度进食的心理机制及影响因素[J].心理科学进展,2019,27(2):322-328.
Wang S R,Chen H.Why trying to lose weight brings fat? Psychological mechanisms and influencing factors of overeating among restrained eaters[J].Advances in Psychological Science,2019,27(2):322-328.
[29] Jalo E,Konttinen H,Vepsäläinen H,et al.Emotional eating,health behaviours,and obesity in children:A 12-country cross-sectional study[J].Nutrients,2019,11(2):351.
[30] Wu Z M,Bralten J,Cao Q J,et al.White matter microstructural alterations in children with ADHD:Categorical and dimensional perspectives[J].Neuropsychopharmacology,2017,42(2):572-580.
[31] Bennett J P,Cataldi D,Liu Y E,et al.Variations in bioelectrical impedance devices impact raw measures comparisons and subsequent prediction of body composition using recommended estimation equations[J].Clin Nutr ESPEN,2024,63:540-550.

学龄儿童ADHD症状与多维肥胖表型的关联：不良饮食行为的潜在中介作用^*

Relationship Between ADHD Symptoms and Multidimensional Obesity Phenotypes in School-Aged Children： The Potential Mediating Role of Unhealthy Eating Behaviors

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