18～69岁普通人群24 h尿钠与肥胖的相关性研究
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摘要
目的分析18～69岁普通人群24 h尿钠与肥胖的相关性。方法 2013-2014年在山东省和江苏省4个项目县,采用多阶段整群随机抽样的方法,选取2 400名18～69岁调查对象进行问卷调查、体格测量和24 h尿液收集。采用多因素线性回归和Logistic回归模型分析尿钠和肥胖的关系。结果最终纳入分析的2 275名研究对象肥胖率19. 1%(95%CI:17. 4%～20. 6%),24 h尿钠为(166. 4±71. 5) mmol/d。肥胖、按腰围身高比(waist-to-height ratio,WHtR)计算的向心性肥胖人群24 h尿钠水平高于非肥胖人群,差异均有统计学意义(均有P <0. 05)。多元线性回归分析调整相关因素后,24 h尿钠与体重指数(body mass index,BMI)、腰围(waist circumference,WC)和WHtR呈正相关关系。多因素Logistic回归分析结果显示,调整年龄、性别、教育程度、吸烟、饮酒、身体活动、高血压和糖尿病后,与尿钠水平最低组相比,尿钠水平最高组患肥胖、向心性肥胖(按WC计算)、向心性肥胖(按WHtR计算)风险的OR(95%CI)值分别为1. 61(1. 18～2. 20)、2. 01 (1. 39～2. 89)和1. 47 (1. 15～1. 89)。结论 24 h尿钠与肥胖呈正相关,高钠摄入是肥胖的重要危险因素。
Objective To analyze the association between 24-hour urinary sodium excretion and obesity in a general Chinese population aged from 18 to 69 years old. Methods 2 400 from 18 to 69 year-old subjects were selected from four counties in Shandong Province and Jiangsu Province from 2013 to 2014 by using multi-stage stratified cluster random sampling method. Questionnaire survey,physical measurement and 24-hour urine collection were conducted. The relationship between urinary sodium and obesity was analyzed by multivariate linear regression and Logistic regression analysis. Results 2 275 subjects were finally included in the analysis. Obesity rate of the subjects was 19. 1%( 95% CI: 17. 4%-20. 6%) and 24-hour urinary sodium was( 166. 4 ± 71. 5) mmol/d. The urinary sodium in obese,and central obesity population calculated according to waist-to-height ratio( WHtR) were higher than the normal population,respectively( All P < 0. 05). Multivariate linear regression analysis showed that after adjusting for relevant factors,24-hour urinary sodium was positively correlated with body mass index( BMI),waist circumference( WC) and WHtR. Multivariate Logistic regression analysis showed that compared to population in the lowest quantile,population in highest quantile had an increased risk of being the obesity,abdominal obesity( calculated according to WC) and abdominal obesity( calculated according to WHtR) with OR( 95% CI) of 1. 61( 1. 18-2. 20),2. 01( 1. 39-2. 89) and 1. 47( 1. 15-1. 89),respectively,after adjusting for age,gender,education,smoking,alcohol consumption,physical activity,hypertension and diabetes. Conclusions High sodium is independently associated with obesity.Sodium intake is a potential and important risk factor for obesity.
Objective To analyze the association between 24-hour urinary sodium excretion and obesity in a general Chinese population aged from 18 to 69 years old. Methods 2 400 from 18 to 69 year-old subjects were selected from four counties in Shandong Province and Jiangsu Province from 2013 to 2014 by using multi-stage stratified cluster random sampling method. Questionnaire survey,physical measurement and 24-hour urine collection were conducted. The relationship between urinary sodium and obesity was analyzed by multivariate linear regression and Logistic regression analysis. Results 2 275 subjects were finally included in the analysis. Obesity rate of the subjects was 19. 1%( 95% CI: 17. 4%-20. 6%) and 24-hour urinary sodium was( 166. 4 ± 71. 5) mmol/d. The urinary sodium in obese,and central obesity population calculated according to waist-to-height ratio( WHtR) were higher than the normal population,respectively( All P < 0. 05). Multivariate linear regression analysis showed that after adjusting for relevant factors,24-hour urinary sodium was positively correlated with body mass index( BMI),waist circumference( WC) and WHtR. Multivariate Logistic regression analysis showed that compared to population in the lowest quantile,population in highest quantile had an increased risk of being the obesity,abdominal obesity( calculated according to WC) and abdominal obesity( calculated according to WHtR) with OR( 95% CI) of 1. 61( 1. 18-2. 20),2. 01( 1. 39-2. 89) and 1. 47( 1. 15-1. 89),respectively,after adjusting for age,gender,education,smoking,alcohol consumption,physical activity,hypertension and diabetes. Conclusions High sodium is independently associated with obesity.Sodium intake is a potential and important risk factor for obesity.
引文
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[12]黄超,秦雪英,胡永华.代谢正常型肥胖的流行病学研究进展[J].中华疾病控制杂志,2017,21(8):846-850.DOI:10.16462/j.cnki.zhjbkz.2017.08.022.Huang C,Qin XY,Hu YH.The research progress of the epidemiology on metabolically healthy obesity[J].Chin J Dis Control Prev,2017,21(8):846-850.DOI:10.16462/j.cnki.zhjbkz.2017.08.022.
[13]刘小云,伯坚,王杨,等.中国高血压人群中24 h尿钠排泄量与肥胖程度对血压的影响[J].中国循环杂志,2017,32(1):9.Liu XY,Bo J,Wang Y,et al.Effects of 24-hour urinary sodium excretion and obesity on blood pressure in Chinese hypertensive population[J].Chinese Circulation Journal,2017,32(1):9.
[14]Ge Z,Zhang J,Chen X,et al.Are 24 h urinary sodium excretion and sodium:potassium independently associated with obesity in Chinese adults[J].Public Health Nutr,2016,19(6):1074-1080.DOI:10.1017/S136898001500230X.
[15]Yoon YS,Oh SW.Sodium density and obesity,the Korea national health and nutrition examination survey 2007-2010[J].Eur JClin Nutr,2013,67(2):141-146.DOI:10.1038/ejcn.2012.204.
[16]Lee J,Hwang Y,Kim K,et al.Associations of urinary sodium levels with overweight and central obesity in a population with a sodium intake[J].BMC Nutrition,2018,4:47.DOI:10.1186/s40795-018-0255-6.
[17]Woodruff SJ,Fryer K,Campbell T,et al.Associations among blood pressure,salt consumption and body weight status of students from south-western Ontario[J].Public Health Nutr,2014,17(5):1114-1119.DOI:10.1017/S1368980013000335.
[18]Larsen SC,Angquist L,Sorensen TI,et al.24h urinary sodium excretion and subsequent change in weight,waist circumference and body composition[J].PLo S One,2013,8(7):e69689.DOI:10.1371/journal.pone.
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[2]NCD Risk Factor Collaboration(NCD-RisC).Trends in adult body-mass index in 200 countries from 1975 to 2014:a pooled analysis of 1698 population-based measurement studies with 19.2million participants[J].Lancet,2016,387(10026):1377-1396.DOI:10.1016/S0140-6736(16)30054-X.
[3]He FJ,Zhang P,Li Y,et al.Action on salt China[J].Lancet,2018,392(10141):7-9.DOI:10.1016/S0140-6736(18)31138-3.
[4]Song HJ,Cho YG,Lee HJ.Dietary sodium intake and prevalence of overweight in adults[J].Metabolism,2013,62(5):703-708.DOI:10.1016/j.metabol.2012.11.009.
[5]Moosavian SP,Haghighatdoost F,Surkan PJ,et al.Salt and obesity:a systematic review and meta-analysis of observational studies[J].Int J Food Sci Nutr,2017,68(3):265-277.DOI:10.1080/09637486.2016.1239700.
[6]李园,骆蓉,张普洪.减盐防控慢性病进展[J].中华预防医学杂志,2018,52(7):757-760.DOI:10.3760/cma.j.issn.0253-9624.2018.07.016.Li Y,Luo R,Zhang PH.Progress on salt reduction and prevention of chronic non-communicable disease[J].Chin J Prev Med,2018,52(7):757-760.DOI:10.3760/cma.j.issn.0253-9624.2018.07.016.
[7]《中国高血压基层管理指南》修订委员会.中国高血压基层管理指南(2014年修订版)[J].中华健康管理学杂志,2015,9(1):10-30.DOI:10.3760/cma.j.issn.1674-0815.2015.01.004.Revision Committee of Chinese Guidelines for the Management of Hypertension.Chinese guidelines for the management of hypertension(revised 2014)[J].Chin J Health Manage,2015,9(1):10-30.DOI:10.3760/cma.j.issn.1674-0815.2015.01.004.
[8]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017年版)[J].中华糖尿病杂志,2018,10(1):4-67.DOI:10.3760/cma.j.issn.1674-5809.2018.01.003.Chinese Diabetes Society.Chinese guidelines on prevention and treatment of type 2 diabetes(2017)[J].Chin J Diabetes Mellitus,2018,10(1):4-67.DOI:10.3760/cma.j.issn.1674-5809.2018.01.003.
[9]中国肥胖问题工作组数据汇总分析协作组.我国成人体重指数和腰围对相关疾病危险因素异常的预测价值:适宜体重指数和腰围切点的研究[J].中华流行病学杂志,2002,23(1):5-10.DOI:10.3760/j.issn:0254-6450.2002.01.003.Cooperative Meta-analysis Group of China Obesity Task Force.Predictive values of body mass index and waist circumference to risk factors of related diseases in Chinese adult population[J].Chin J Epidemiol,2002,23(1):5-10.DOI:10.3760/j.issn:0254-6450.2002.01.003.
[10]Ashwell M,Gibson S.A proposal for a primary screening tool:keep your waist circumference to less than half your height[J].BMC Med,2014,12(1):207.DOI:10.1186/s12916-014-0207-1.
[11]Xu J,Chen X,Ge Z,et al.Associations of Usual 24-Hour Sodium and potassium intakes with blood pressure and risk of hypertension among adults in China’s Shandong and Jiangsu Provinces[J].Kidney Blood Press Res,2017,42(1):188-200.DOI:10.1159/000475486.
[12]黄超,秦雪英,胡永华.代谢正常型肥胖的流行病学研究进展[J].中华疾病控制杂志,2017,21(8):846-850.DOI:10.16462/j.cnki.zhjbkz.2017.08.022.Huang C,Qin XY,Hu YH.The research progress of the epidemiology on metabolically healthy obesity[J].Chin J Dis Control Prev,2017,21(8):846-850.DOI:10.16462/j.cnki.zhjbkz.2017.08.022.
[13]刘小云,伯坚,王杨,等.中国高血压人群中24 h尿钠排泄量与肥胖程度对血压的影响[J].中国循环杂志,2017,32(1):9.Liu XY,Bo J,Wang Y,et al.Effects of 24-hour urinary sodium excretion and obesity on blood pressure in Chinese hypertensive population[J].Chinese Circulation Journal,2017,32(1):9.
[14]Ge Z,Zhang J,Chen X,et al.Are 24 h urinary sodium excretion and sodium:potassium independently associated with obesity in Chinese adults[J].Public Health Nutr,2016,19(6):1074-1080.DOI:10.1017/S136898001500230X.
[15]Yoon YS,Oh SW.Sodium density and obesity,the Korea national health and nutrition examination survey 2007-2010[J].Eur JClin Nutr,2013,67(2):141-146.DOI:10.1038/ejcn.2012.204.
[16]Lee J,Hwang Y,Kim K,et al.Associations of urinary sodium levels with overweight and central obesity in a population with a sodium intake[J].BMC Nutrition,2018,4:47.DOI:10.1186/s40795-018-0255-6.
[17]Woodruff SJ,Fryer K,Campbell T,et al.Associations among blood pressure,salt consumption and body weight status of students from south-western Ontario[J].Public Health Nutr,2014,17(5):1114-1119.DOI:10.1017/S1368980013000335.
[18]Larsen SC,Angquist L,Sorensen TI,et al.24h urinary sodium excretion and subsequent change in weight,waist circumference and body composition[J].PLo S One,2013,8(7):e69689.DOI:10.1371/journal.pone.
[19]Ma Y,He FJ,Mac Gregor GA.High salt intake:independent risk factor for obesity[J].Hypertension,2015,66(4):843-849.DOI:10.1161/HYPERTENSIONAHA.115.05948.