Page 79 - 2023-05-中国全科医学

·592· http: //www.chinagp.net E-mail: zgqkyx@chinagp.net.cn February 2023, Vol.26 No.5

2.Department of Dermatology，Liaobu Hospital of Dongguan，Dongguan 523400，China
*
Corresponding author：HE Yuqing，Researcher，Doctoral supervisor；E-mail：dr.hyq@hotmail.com
【Abstract】 Background Protein-energy malnutrition （PEM） is a common nutritional deficiency. With the change
of lifestyle and eating habits，people pay increasing attention to nutritional health problems，and PEM may have different effects
on the health of different age groups. Objective To analyze the overall and age-specific trends of PEM incidence in 1990-
2019 and to predict its incidence in 2020-2029 in China. Methods The data of this study were derived from the Global Burden
of Disease Study 2019，involving mortality indicators，and incidence indicators in 18 age groups（ranged from 0 to over 85
years grouped by an interval of 5 years） of PEM in China from 1990 to 2019. The age-standardized rates were calculated using
the world standard population. Joinpoint regression analysis was used to calculate the annual percentage change （APC） and
annual average percentage change （AAPC） of the incidence rate and 95% confidence interval，and to describe the temporal
trend. The autoregressive integrated moving average （ARIMA） model was used to predict the incidence of PEM in China from
2020 to 2029. Results （1）In 2019，the standardized incidence ratio（SIR） of PEM in the whole population of China was
1 996.5/100 000，and that in males （2 444.7/100 000） was higher than that in females（1 536.0/100 000）. The SIR of PEM
in the whole population in China was lower than that of the world standard population（2 099.4/100 000），and that of PEM
in Chinese males was higher than that in the world standard male population（2 304.0/100 000）. The incidence of PEM was
highest in <5 years old group （4 402.5/100 000），followed by 80-84 years old group（2 417.7/100 000）. After 5 years old，
the incidence of PEM in both males and females increased with age，but that was still higher in males.（2）The SIR of PEM in
China from 1999 to 2019 generally showed six inflection points，which were in 1995，2006，2010，2014，2017 and 2019，
respectively. The SIR of PEM in China showed a downward trend in periods from 1990 to 1995（APC=-1.3%） and from 2010
to 2014（APC=-2.3%）（P<0.05）. But from 1995 to 2006 and 2006 to 2010，it showed an upward trend，with APC of 0.9%
in 1995，and of 2.5% in 2010，respectively （P<0.05）. The growth trend of the SIR of PEM was the most obvious in 2017-
2019，with an APC of 8.9% （P<0.05）. The SIR of PEM in China increased at an average annual rate of 0.7% from 1999 to
2019 （AAPC=0.7%，P<0.05）.（3）The age-specific incidence of PEM in China from 1999 to 2019 showed that the incidence
of PEM decreased at an average annual rate of 2.1% in the population under 5 years old，but showed a steady upward trend in
other 17 groups（P<0.05）. In age groups of 75-79 and 80-84，the incidence of PEM increased at each time interval from 1999
to 2019（P<0.05）.（4）The ARIMA model-based prediction showed that the incidence of PEM in China might continue to rise
from 2020 to 2029，reaching 7 280.06/100 000 in 2029. Conclusion In 2019，the SIR of PEM in the whole population in China
（1 996.5/100 000） was lower than that in the world standard population （2 099.4/100 000），but that of PEM in Chinese
males was higher than that in the world standard male population （2 304.0/100 000）. The SIR of PEM in China increased at an
average annual rate of 0.7% from 1999 to 2019，and it might continue to rise until 2029.
【Key words】 Protein-energy malnutrition；Nutritional and metabolic diseases；Morbidity；Trends；Joinpoint
regression model；ARIMA model；Global Burden of Disease Study 2019

世界卫生组织（WHO）将营养不良定义为一种细 为 PEM 的预防提供依据。
胞失衡的状态。营养不良对发展中国家产生了不利影 1 资料与方法
响，也是造成全球居民疾病和死亡的风险因素。蛋白质 1.1 一般资料 本研究数据来源于 GBD 2019（https://
能量营养不良（protein-energy malnutrition，PEM）是常 vizhub.healthdata.org/gbd-results/）， 该 数 据 库 提 供 了
见的营养缺乏症之一，一般影响 1~5 岁的婴幼儿，由于 1990—2019 年 204 个国家和地区因 369 种疾病和伤害、
大脑和神经发育不良使得这种影响会持续到成年，长久 87 个危险因素和危险因素组合而分列的伤残寿命损失
的能量和营养物质的供应不足也增加了感染的概率，甚 年（YLD）、早死亡寿命损失年（YLL）和伤残调整寿
至导致死亡 ［1］ 。PEM 患者出现类似低血糖、体温过低、 命年（DALY）。依据世界标准人口计算年龄标化率。
严重感染和电解质紊乱等问题的风险较高。PEM 也会 从该数据库中获取 1990—2019 年中国不同年龄段的
导致早产、传染性疾病和寄生虫病等。人体测量指标， PEM 发病指标。
如身高、体质量、皮肤褶皱厚度和手臂围等，被认为是 1.2 疾病定义和编码 PEM 包括中度和重度急性营养
PEM 的重要指标 ［2］ 。本研究利用 2019 年全球疾病负担 不良，通常被称为“消瘦”，并以 WHO 2006 年儿童生
研究（GBD 2019）数据，分析 2019 年中国 PEM 疾病现状， 长标准的体质量 - 身高 Z 值（WHZ）来定义 ［3］ 。将非
估计 1990—2019 年的发病趋势，并预测 2020—2029 年 致命性 PEM 的负担量化为 4 个相互排斥和共同详尽的
中国 PEM 的未来趋势，旨在为制订相关政策提供参考， 类别，具体为：中度消瘦而无水肿，中度消瘦伴水肿，