tap chi y hoc thanh pho ho chi minh

Y Hc TP. H Ch Minh * Tp 12 * Ph bn ca S 4 * 2008 Nghin cu Y hc

Chuyn Y T Cng Cng v Y Hc D Phng 1

T L THA CN, BO PH V CC YU T LIN QUAN CA HC SINH MU GIO T 4-6 TUI TI QUN 5 THNH PH H CH MINH 2006

Phng c Nht* v cs

TM TT t vn : Bo ph l mt dch bnh mi gia tng v c th xem nh mt vn dinh dng khn cp vi

1,6 t ngi ln mc phi trn ton cu. y cng l yu t nguy c tim n cho cc bnh khng ly khc nh i tho ng, tng huyt p, bnh l tim mch, ung th tr b tha cn bo ph khi tr ln ln.

Mc tiu nghin cu: Nghin cu ny nhm xc nh t l tr tha cn bo ph v mi lin quan vi cc yu t nguy c tr t 4 n 6 tui ti cc trng mm non mu gio trn a bn qun 5, thnh ph H Ch Minh.

Phng php nghin cu: iu tra ct ngang vi 1650 tr ti cc trng mm non mu gio trn a bn qun 5, thnh ph H Ch Minh.

Kt qu: T l tr tha cn bo ph l 21,2% (trong 13,2% l tha cn v 8% l bo ph). Gii l n, thi quen n nhanh c lin quan n nguy c cao tha cn bo ph tr mm non mu gio. Tr tha cn c khuynh hng thch s dng thc phm c cht bo nhiu hn v t thch s dng thc phm c cht ngt so vi tr khng tha cn. M ca cc tr bo ph c t l hiu bit rng tng cng hot ng th lc v gim cht bo trong thc n gip gim tha cn bo ph cao hn so vi m ca cc tr bnh thng. Tuy nhin, c mt t l cao cc b m tin rng thc n nhanh v cc loi nc ngt l tt hn cc loi thc phm thng thng, v tin rng tr mp mp th khe mnh hn so vi tr thng thng.

Kt lun: Tha cn bo ph tr l mt vn sc khe mi ny sinh Vit Nam v c th pht trin thnh dch trong tng lai khng xa. Gio dc sc khe v hot ng nng cao sc khe cn c thc hin tch cc hn nhm kim sat v phng nga i dch mi ny.

ABSTRACT THE PREVALENCE OF OVERWEIGHT AND ITS RELATED FACTORS IN KINDERGARTEN

CHILDREN FROM 4 TO 6 YEARS OLD IN DISTRICT 5, HO CHI MINH CITY, 2006.

Phung Duc Nhat * Y Hoc TP. Ho Chi Minh * Vol. 12 - Supplement of No 4 - 2008: 152 - 157

Introduction: Obesity is a new emerging epidemic and can be considered as a new nutrition emergency with 1.6 billions of obese adults worldwide. It is also an underlying risk factor to develop non-communicable diseases such as diabetes, hypertension, cardio-vascular diseases, and cancer in adults.

Objectives: This study aims to determine the prevalence of obesity and its related risk factors among children 4 to 6 years old at kindergartens in district 5, Ho Chi Minh city.

Methods: A cross sectional study of 1650 children 4 to 6 years old was conducted at kindergartens in district 5, Ho Chi Minh city.

Results: The prevalence of overweight and obesity was 21.2% (in which 13.2% was overweight and 8% obesity).Girls and fast eating habit were related to a higher risk of obesity in kindergarten children. Overweight children were more likely to consume fatty food and less likely to consume sweet stuff, compared to normal children. The percentage of obese childrenmothers knowing about the role of physical activity and less fatty diet in preventing obesity was higher than that of normal children mothers. However, there was a high percentage of

* Vi n V sinh Y t cng cng - Thnh ph H Ch Minh



mothers who believed that fast food and beverages could be better than normal food and that overweight children were healthier than normal ones.

Conclusions: Obesity in children is a new health problem in Viet Nam and can develop to be an epidemic in the near future. Health education and health promotion campaigns should be implemented in an active way to control and prevent this new epidemic.

T VN Theo c tnh ca T chc Y t Th gii

(WHO) trn ton th gii n nm 2005 c khang 1,6 t ngi trn 15 tui tha cn, trong t nht 400 triu ngi ln b bo ph. Bo ph l i dch khng ch gii hn cc nc cng nghip, m n 115 triu ngi bo ph l cc nc ang pht trin(6). Ring tr em, 22 triu tr di 5 tui ang b tha cn trn th gii. Tha cn, bo ph c nguy c trn cc bnh nh tiu ng type 2, bnh l tim mch, t qu, v mt s ung th ti ti mt, tuyn v, i trng, tin lit tuyn v thn(1).

Ti Vit Nam, cc cuc iu tra nhn khu trc nm 1995 cho thy t l tha cn khng ng k. Nhng n nm 2000 iu tra ti cc thnh ph ln cho thy t l tha cn la tui hc sinh tiu hc H ni l 10%, thnh ph H Ch Minh l 12%(2). Ring ti thnh ph H Ch Minh, iu tra ca Nguyn Th Kim Hng qua cc nm cho thy t l tha cn 4-5 tui vo cc nm 1995, 2000, 2001 tng ng l 2,5%; 3,1% v 3,3%(4). Nghin cu tnh trng tha cn v bo ph ca dn c thnh ph H Ch Minh t 1996 n 2001, Trn Th Hng Loan ghi nhn s gia tng t l tha cn ca tr di 5 tui: 2,0% nm 1996; 2,1% nm 1999; 3,1% nm 2000; 3,4% nm 2001. Ring hc sinh nh tr, mu gio trong nin hc 2000 - 2001 qun ven G vp c t l bo ph 7,9%. Cn hc sinh cp I (6-11 tui) qun 1 ni thnh nm 1997 c t l bo ph 12,2%(5). iu tra tnh trng dinh dng nm 2006 ca Vin Dinh dng cho t l 16,3% ngi Vit Nam t 25-64 tui b tha cn, bo ph.

Phn ln cc trng hp tha cn bo ph l do tng nng lng khu phn n hoc gim hot ng th lc hoc kt hp c hai yu t . Nhn thc y l vn y t cng cng mi,

nhiu nghin cu v bo ph c tin hnh v cc yu t nguy c cng c cp. Tuy vy vn cha c nhiu nghin cu cp n mi lin quan ca cc yu t nguy c v tha cn bo ph cng nh xc nh t l tha cn bo ph ca la tui mu gio 4-6 tui ti thnh ph H Ch Minh. iu ny thc y chng ti tin hnh nghin cu ti ny.

Mc tiu nghin cu Xc nh t l tha cn, bo ph hc sinh

mu gio t 4-6 tui ti qun 5 thnh ph H Ch Minh.

Xc nh mi lin quan gia cc yu t nguy c vi tnh trng tha cn, bo ph ca nhm tr c nghin cu.

I TNG - PHNG PHP NGHIN CU i tng nghin cu

1650 tr 4-6 tui theo hc ti cc trng mm non, mu gio ti qun 5 v cha m tr. La tui tr c chn l 4 n 6 tui, tng ng vi la tui mu gio (lp mm, lp chi, lp l) trong cc trng mm non, mu gio.

Thi gian nghin cu Thng 4 - 5 nm 2006.

Thu thp thng tin Tr c cn bng cn in t TANITA ca

Nht (chnh xc n 100g). Tr c o chiu cao bng thc Microtoise ca M (chnh xc n 0,1 cm). Ph huynh hc sinh c phng vn qua bng cu hi.

Nhp v x l s liu Kt qu nghin cu c nhp v x l trn

cc phn mm: EpiData 3.0, chng trnh Epinut ca EpiInfo 6.04, SPSS 11.5.



Tiu chun nh gi Theo hng dn ca T chc Y t Th gii

(1985), vi tr di 9 tui ch tiu nh gi tha cn tr em l cn nng/chiu cao (CN/CC) so snh vi qun th tham kho NCHS (National Center for Health Statistics). Trong nghin cu ny chn ch tiu nh gi theo CN/CC nh sau:

< - 2 SD Suy dinh d ng Suy dinh d ng - 2 SD n + 2 SD Bnh thng Bnh thng

> + 2 SD n + 3SD tha cn 1 Tha cn > + 3 SD n + 4 SD tha cn 2

> + 4 SD tha cn 3 Bo ph

Phng php nghin cu iu tra ct ngang m t

C mu iu tra

2

)2/1(2 )1(**

d

ppzn

=

vi z=1,96; p=0,12; d=0,04, th n= 255.

Chn 3 nhm tui, v h s thit k l 2, d tr mt mu 10%. C mu N = 255*3*2 + 10%, khong 1650.

Bc 1: Khung mu l tt c hc sinh cc trng mm non mu gio trong qun 5.

Bc 2: Chn 30 cm: khang cch mu k=7701/30.

Bc 3: Chn ngu nhin cc tr ti cc trng trong mi cm sao cho mi cm c khong 18 tr 4 tui, 18 tr 5 tui, 18 tr 6 tui.

KT QU c im mu iu tra Bng 1: c im tr tham gia nghin cu

c tnh T n s (n=1650) T l (%) Nam 808 49,0

Gii N 842 51,0

4 tui 558 33,8 5 tui 564 34,2 Nhm tui

6 tui 528 32,0 Kinh 1089 67,5 Hoa 514 31,2 Dn tc

Khc 47 1,3

T l nam n gn bng nhau. T l tr trong ba nhm tui xp x nhau. Dn tc Kinh chim a s (67,5%), dn tc Hoa c t l 31,2%.

Bng 2: c im ph huynh ca tr tham gia nghin cu

M Cha c tnh Tn s

(n=1650) T l (%)

Tn s (n=1650)

T l (%)

Cha ht cp 1 83 5,0 98 6,0

Cp 1 106 6,4 82 5,0 Cp 2 478 29,0 380 23,0 Cp 3 468 28,4 472 28,6

H tr ln 325 19,7 388 23,5

Trnh hc vn

Khng tr li 190 11,5 230 13,9

Bun bn nh 411 24,9 314 19,0

CB-VC 324 19,6 357 21,6 Cng nhn 474 10,5 305 18,5 Nng dn 2 0,1 2 0,1 Ch DN 51 3,1 84 5,1 Ngh t

do 174 10,5 239 14,5

Ngh nghip

Khc 514 31,3 349 21,2

V m, hn mt na s b m tham gia nghin cu nm trong nhm tui t 31-40 tui. Hc vn a s trn cp 2 chim 77,1% trong t l i hc tr ln l 19,7%. Ngh nghip bun bn nh chim khong 25%. Khong 1/5 l ngi Hoa. V cha, a s c trnh trn cp 2 (75,1%). Cc ngh chnh l cn b vin chc (21,6%), bun bn nh (19%), cng nhn (18,5%). Khong 1/3 l ngi Hoa.

c im dinh dng v vn ng tr nghin cu

Tnh trng dinh dng ca tr tham gia nghin cu theo ch s cn nng/chiu cao (CN/CC). C 350 tr tha cn bo ph chim 21,2%, trong tr tha cn l 13,2%, bo ph l 8%, tr bnh thng l 77,9% v tr suy dinh dng l 0,8%.

Mc vn ng trung bnh ca tr nh sau:

Bng 3: Mc vn ng ca tr

Hot ng Thi gian trung bnh (gi/ngy)

Xem tivi 2,1 1,3 Chi my vi tnh 1,3 1,0

Chi tr chi in t 1,2 0,9 Hc bi 1,4 1,1

Tnh ti

T mu, v tranh, 1,2 1,0



Hot ng Thi gian trung bnh (gi/ngy) hc n

ng Chi a vi bn 1,7 1,3

Xc nh mi lin quan gia cc yu t ng uy c vi tnh trng tha cn bo ph ca tr

S dng php kim chi-bnh phng phn tch mi lin quan cho kt qu

Bng 4: Mi lin quan gia tnh trng tha cn ca tr vi cc c tnh ca tr

c tnh Khng th a cn (n %) Tha cn

(n %) P

Nam 605 (74,9) 203 (25,1) 0,000 Gii

N 695 (82,5) 147 (17,5) 1 (*) 4 tui 347 (29,2) 88 (26,6) 5 tui 439 (37,0) 116 (35,0)

Nhm tui

6 tui 401 (33,8) 127 (38,4)

0,292

Cha thy s khc bit gia cc nhm tui, dn tc ca tr vi tnh trng tha cn-bo ph. C s khc bit c ngha thng k v t l bo ph gia tr trai v gi: tr trai c t l bo ph cao hn tr gi (25,1% so vi 17,5%).

Bng 5: Mi lin quan gia tnh trng tha cn ca tr vi thi quen, s thch n ung ca tr

c tnh Khng th a cn (n %) Tha cn

(n %) p

Nhanh 90 (7,8) 90(28,2) Bnh thng 640 (55,6) 202 (63,6) Tc n

Chm 423 (36,6) 26 (8,2)

0,0001 (*)

Thch 189 (17,8) 67 (22,6) Bnh thng 475 (44,6) 128 (43,1) Khng thch 221 (20,8) 54 (18,2)

Thc n bo

Khng tr li 179 (16,8) 48 (16,1)

0,284


Thc n ngt

Khng tr li 105 (9,7) 37 (12,4)

0,017 (*)


Nc ngt

Khng tr li 124 (11,5) 37 (12,5)

0,076

Tr tha cn-bo ph c khuynh hng n nhanh (p = 0,001) cao hn tr bnh thng, s khc bit ny c ngha thng k. Tr tha cn - bo ph c t l thch n thc n bo cao hn so vi tr bnh thng (22,6% so vi 17,8%) tuy

nhin s khc bit khng c ngha thng k. Tr bnh thng thch n ngt cao hn c ngha thng k so vi tr tha cn bo ph (p = 0,017).

Bng 6: Kin thc ca b m v dinh dng

ng Khng ng

Khng kin

Ung nhiu nc tri cy tt cho sc khe

90,0% 5,6% 4,4%

Nc ngt tt cho sc khe ca tr 4,0% 87,5% 8,5%

Thc n ch bin sn (khoai ty chin, bp rang, bnh ngt, bnh snack, m gi,) tt cho

sc khe ca tr.

10,8% 82,5% 6,7%

Thc n nhanh (bnh Kinh , bnh c Pht, g rn,

pizza,..) c thnh phn dinh dng tt hn thc n ch nu.

7,8% 71,0% 5,8%

Thc n ng hp tt hn thc n ti sng 3,6% 40,5% 5,9%

Cho du m nhiu trong thc n th tt cho sc khe

7,6% 85,0% 7,4%

Tr mp th xinh xn, ng yu hn

50,5% 42,3% 7,1%

Tr mp th khe hn tr bnh thng 14,5% 77,6% 7,9%

Tr chi vn ng ngai tri tt hn chi trong nh

80,9% 11,3% 5,8%

Bng 7: Kin thc b m v cch phng chng bo ph

ng Khng ng

n hp l gip tr trnh tha cn bo ph

80,1% 19,9%

n va theo la tui gip tr trnh tha cn bo ph 66,8% 33,2%

Tng vn ng cho tr gip tr trnh tha cn bo ph

78,7% 21,3%

Gim thc n c du m gip tr trnh tha cn bo ph

64,6% 35,6%

Gim n cc loi thc n nhanh gip tr trnh tha cn bo ph 52,6% 47,4%

Cho tr n nhiu tri cy gip tr trnh tha cn bo ph

75,8% 24,2%

Bng 8: Mi lin quan gia kin thc v phng trnh tha cn bo ph v tnh trng tha cn bo ph ca tr

Kin thc Bnh thng Tha cn -

Bo ph p

ng 80,8% 77,5% n hp l

Khng 19,2% 22,5% 0,20

ng 77,2% 84,3% Tng vn ng cho tr Khng 22,8% 15,7%

0,009 (*)

ng 62,8% 70,3% Gim thc n du m Khng 37,2% 29,7%

0,017 (*)



Kin thc Bnh thng Tha cn -

Bo ph p

ng 51,7% 56,0% Gim thc n nhanh Khng 48,3% 44,0%

0,19

BN LUN nh gi tnh trng tha cn bo ph ca tr

theo ch s cn nng/chiu cao (CN/CC) c t l l 21,2% v t l tr suy dinh dng tng ng l 0,8% Trong t l tha cn l 13,2% v bo ph l 8,0%. y l mt con s cao ng bo ng.

Thi gian hot ng trung bnh ca tr khong 1,7 gi/ngy dnh chi a vi bn. Trong khi , thi gian tnh ti ca tr l 7,2 gi/ngy dnh cho vic xem tivi, chi my vi tnh, chi tr chi in t, hc bi, t mu, v tranh hn gp ba ln thi gian dnh cho hot ng. Li sng tnh ti ngy cng ph bin v l nguyn nhn gia tng t l tha cn - bo ph th.

So snh vi nghin cu ca L Th Hi tr cp 1 ti H ni, chng ti thy thi quen n nhanh ca tr c mi lin quan c ngha thng k vi tnh trng tha cn bo ph ca tr. Nhng khc vi nghin cu ca Nguyn Th Hi, tr mu gio qun 5 tnh trng n vt li khng c mi lin quan c ngha thng k(3).

Khi kho st thi quen n ung ca tr, thi quen n ngt (p = 0,017) v ung nc ngt (p = 0,076) ca tr c mi lin quan nghch c ngha thng k vi tnh trng tha cn bo ph ca tr. Nhng tr bnh thng c thi quen n ngt v ung nc ngt cao hn tr tha cn bo ph. C th l do gia nh tr bo ph c thc hn ch thc n ngt cho con em. Cha thy c mi lin quan gia n thc phm nhiu cht bo vi tnh trng tha cn bo ph ca tr. iu ny khc vi nghin cu trc y ca L Th Hi cho thy c lin quan gia n cht bo v tha cn bo ph.

Kho st kin thc chung v dinh dng ca b m cho thy vi thc n ch bin, thc n nhanh ngy cng sn c v ph bin, vn cn mt t l kh cao t 7,8% n 10,8% cc b m cho rng cc thc n ny tt cho sc kho ca tr

hoc tt hn thc n nu ti gia nh. Vn cn 4% b m cho rng nc ngt tt cho sc kho ca tr, y l iu cn quan tm v nc ngt l mi nguy him thm lng trong vic gy ra bo ph v t ai tm v nhn din n nh mt mi nguy c.

V thi vi tr bo, mc d a s b m (77,6%) khng ng rng tr bo kho hn tr bnh thng, nhng hn 50% b m vn thch tr bo v tr mp (bo) th xinh xn, ng yu hn. iu ny cho thy vic cung cp kin thc cho b m th d dng hn vic thay i thi ca b m v mong mun c mt tr mp mp ng yu.

Nhm b m c con tha cn bo ph c kin thc ng rng: tr tha cn nn tng vn ng (p = 0,009), gim thc n c du m, cht bo (p = 0,017) cao hn nhm b m c con bnh thng v s khc bit c ngha thng k. Kin thc v phng chng bo ph bng vic gim thc n nhanh v n nhiu tri cy ca nhm b m c con tha cn bo ph cao hn nhm b m c con bnh thng (tng ng l 56% v 51,7%, 78,2% v 75,1%).

KT LUN Nghin cu gip xc nh c t l tr tha

cn bo ph ti cc trng mu gio qun 5 l kh cao: 21,2% theo ch s cn nng/chiu cao (trong 13,2% l tha cn, v 8% l bo ph), 18,7% theo ch s cn nng / tui, 3,6% theo ch s chiu cao / tui.

Cc yu t lin quan thun ca tnh trng tha cn bo ph ca tr mu gio t 4 - 6 tui ti qun 5 l: tr gi, c m l ngi Kinh, tr thng n nhanh.

C mi lin quan gia kin thc ca b m v tnh trng tha cn bo ph ca tr trong hai nhm b m c tr bo ph v khng c tr bo ph.

C mi lin quan gia kin thc v phng trnh tha cn bo ph ca b m bng cch tng vn ng cho tr v gim thc n du m vi tnh trng tha cn bo ph ca tr.



V dinh dng: Mt s b m cn cho rng nc ngt tt cho sc kho ca tr. Hu ht cc b m khng ng thc n ng hp l tt cho sc kho ca tr nhng i vi cc loi thc n nhanh v thc n ch bin sn vn cn mt t l kh cao cc b m chn loi thc n ny cho tr v cho rng cc thc n nhanh c thnh phn dinh dng tt hn thc n nu ti gia nh v thc n ch bin sn th tt cho sc kho.

KIN NGH Trong vic phng chng bo ph trng

mm non, mu gio chng ti xut cc bin php sau:

Tng cng vic phng nga tha cn bo ph tr la tui mu gio bng cc hnh thc truyn thng gao dc, nng cao sc kho ph hp. p dng cc hnh thc gio dc truyn thng sng to v a dng.

Truyn thng thng xuyn cho ph huynh v tc hi ca bo ph v cc nguyn nhn bo ph cng nh cc phng chng thch hp. ng thi cn nu tc hi ca cc loi thc n nhanh, thc n ch bin sn, cc loi nc ngt trong thng tin cho cc bc ph huynh.

Cn o tr thng xuyn sm pht hin du hiu tng cn, tha cn ca tr v c bin php tch cc ngay t u trnh cho tr t giai on tha cn chuyn sang bo ph.

Thm cc loi hnh hot ng vn ng ph hp la tui tr dnh ring cho tr tha cn ng thi tng cng thi lng vn ng cho tr.

TI LIU THAM KHO 1. H Huy Khi, Nguyn Cng Khn. Tha cn v bo ph

mt vn sc khe cng ng mi nc ta. Tp ch Y hc Thc hnh 418:5-9

2. H Huy Khi (1996). My vn dinh dng trong thi k chuyn tip. Nh xut bn Y hc. Tr 68-88

3. L Th Hi (1998). Tm hiu mt s yu t nguy c bnh bo ph hc sinh hai trng tiu hc ti H ni. Vin Dinh Dng.

4. Nguyn Th Kim Hng (2003). Tnh trng tha cn v cc yu t lin quan hc sinh 6-11 tui ti qun 1 thnh ph H Ch Minh nm 2003. Trung tm Dinh Dng thnh ph H Ch Minh.

5. Trn Th Hng Loan (2003). Tnh trng tha cn v bo ph cc tng lp dn c thnh ph H Ch Minh nm 1996-2001. Trung tm Dinh Dng thnh ph H Ch Minh.

6. WHO. Controlling the global obesity epidemic. www.who.int/dietphysicalactivity/goals/en/print.html

7. WHO. Obesity and overweight fact sheet. www.who.int/dietphysicalactivity/publications/facts/obesity/en/

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