综合干预对肥胖青少年糖脂代谢肝肾和心血管功能的影响
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摘要
目的探讨运动结合饮食控制对肥胖青少年基本形态功能、糖脂代谢、肝肾功能和心血管功能的影响,为学校和家庭青少年肥胖的防治提供依据。方法以71名肥胖青少年为研究对象,对其进行6周运动结合饮食控制的综合干预,测定干预前后的形态功能、糖脂代谢水平、肝肾功能和心血管功能水平。结果综合干预后,在基本形态功能显著改善的基础上,肥胖青少年的胰岛素水平(FINS)[(18.76±11.46)(11.32±6.54)uU/L]、低密度脂蛋白胆固醇(LDL-C)[(2.96±0.69)(2.22±0.62)mmol/L]、三酰甘油(TG)[(1.57±0.82)(0.89±0.37)mmol/L]和总胆固醇(TC)[(4.52±0.76)(3.53±0.62)mmol/L]下降,胰岛素抵抗指数(3.92±2.54,2.40±1.63)改善(P值均<0.01);谷草转氨酶(AST)[(36.10±32.28)(22.89±7.27)U/L]、谷丙转氨酶(ALT)[(57.42±61.25)(27.86±22.12)U/L]、血清尿素(BUN)[(4.78±0.89)(3.44±0.79)mmol/L]和血清尿酸(UA)[(498.83±120.60)(471.07±120.96)mmol/L]降低(P值均<0.05);反应性充血指数(RHI)(1.34±0.28,1.69±0.45)和NO/ET-1(1.69±0.41,2.67±0.86)升高,动脉粥样硬化指数(AI)(3.06±0.96,2.58±0.80)降低(P值均<0.01)。结论 6周运动结合饮食控制的综合干预方案能够在降低肥胖青少年肥胖程度基础上,有效改善其糖脂代谢状态、肝肾功能和心血管功能。
Objective To investigate the effects of exercise combined with dietary intervention on glucose and lipid metabolism, liver and kidney function and cardiovascular function in obese adolescents. Methods Seventy-one obese adolescents were enrolled in this study. Six weeks of exercise combined with dietary intervention were performed to determine anthropometry, glucose and lipid metabolism, liver and kidney function and cardiovascular function before and after intervention. Results After 6 weeks of comprehensive intervention, in addition to significant improvement in anthropometry indicators, fasting insulin [(18.76±11.46 vs 11.32±6.54)uU/L], LDL-C [(2.96±0.69 vs 2.22±0.62)mmol/L], TG [(1.57±0.82 vs 0.89±0.37)mmol/L] and TC [(4.52±0.76 vs 3.53±0.62)mmol/L] decreased significantly and insulin resistance improved significantly. AST [(36.1±32.28 vs 22.89±7.27)U/L], ALT [(57.42±61.25 vs 27.86±22.12)U/L], blood urea nitrogen [(4.78±0.89 vs 3.44±0.79)mmol/L] and uric acid [(498.83±120.6 vs 471.07±120.96)mmol/L] were significantly decreased and the detection rates of fatty liver and kidney were significantly decreased(P<0.05), RHI(1.34±0.28 vs 1.69±0.45) and nitric oxide/endothelin-1(ET-1)(1.69±0.41 vs 2.67±0.86) significantly increased and atherogenic index(3.06±0.96 vs 2.58±0.80) significantly decreased(P<0.01). Conclusion The comprehensive intervention of exercise combined with diet can effectively improve anthropometry indicators, glycolipid metabolism, liver and kidney function as well as cardiovascular function of obese adolescents.
Objective To investigate the effects of exercise combined with dietary intervention on glucose and lipid metabolism, liver and kidney function and cardiovascular function in obese adolescents. Methods Seventy-one obese adolescents were enrolled in this study. Six weeks of exercise combined with dietary intervention were performed to determine anthropometry, glucose and lipid metabolism, liver and kidney function and cardiovascular function before and after intervention. Results After 6 weeks of comprehensive intervention, in addition to significant improvement in anthropometry indicators, fasting insulin [(18.76±11.46 vs 11.32±6.54)uU/L], LDL-C [(2.96±0.69 vs 2.22±0.62)mmol/L], TG [(1.57±0.82 vs 0.89±0.37)mmol/L] and TC [(4.52±0.76 vs 3.53±0.62)mmol/L] decreased significantly and insulin resistance improved significantly. AST [(36.1±32.28 vs 22.89±7.27)U/L], ALT [(57.42±61.25 vs 27.86±22.12)U/L], blood urea nitrogen [(4.78±0.89 vs 3.44±0.79)mmol/L] and uric acid [(498.83±120.6 vs 471.07±120.96)mmol/L] were significantly decreased and the detection rates of fatty liver and kidney were significantly decreased(P<0.05), RHI(1.34±0.28 vs 1.69±0.45) and nitric oxide/endothelin-1(ET-1)(1.69±0.41 vs 2.67±0.86) significantly increased and atherogenic index(3.06±0.96 vs 2.58±0.80) significantly decreased(P<0.01). Conclusion The comprehensive intervention of exercise combined with diet can effectively improve anthropometry indicators, glycolipid metabolism, liver and kidney function as well as cardiovascular function of obese adolescents.
引文
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[13] 王贵强,王福生,成军,等.慢性乙型肝炎防治指南(2015年更新版)[J].临床肝胆病杂志,2015,31(12):1941-1960.
[14] 杨倩春,李思宁,黎创,等.高尿酸血症与肾脏疾病关系的研究进展[J].现代生物医学进展,2018,18(13):2593-2596.
[15] 张栋武,唐爱民.肾脏功能试验及其临床评价(上)[J].中国医刊,2007(5):68-69.
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[17] DONGHUI T,SHUANG B,XULONG L,et al.Improvement of microvascular endothelial dysfunction induced by exercise and diet is associated with microRNA-126 in obese adolescents[J].Microvasc Res,2019,123:86-91.DOI:10.1016/j.mvr.2018.10.009.
[18] 郭吟,肖焕禹,王业玲,等.运动干预对肥胖老年女性身体形态和血脂的影响[J].上海体育学院学报,2011,35(5):42-45.
[19] ANDERSON T.Assessment and treatment of endothelial dysfunction in humans[J].J Am College Cardiol,1999,34(3):631-638.
[20] GOKCE N,KEANEY J F J R,HUNTER L M,et al.Risk stratification for postoperative cardiovascular events via noninvasive assessment of endothelial function:a prospective study[J].Circulation,2002,105(13):1567-1572.
[21] GOKCE N,KEANEY J F J R,HUNTER L M,et al.Predictive value of noninvasively determined endothelial dysfunction for long-term cardiovascular events in patients with peripheral vascular disease[J].J Am Coll Cardiol,2003,41(10):1769-1775.
[22] FLEGAL K M,OGDEN C L,YANOVSKI J A,et al.High adiposity and high body mass index-for-age in US children and adolescents overall and by race-ethnic group[J].Am J Clin Nutr,2010,91(4):1020-1026.
[23] EMER M,GROSSER T,WANG M,et al.Prostanoids in health and disease[J].J Lipid Res,2009,50(Suppl):S423-428.
[2] 李娟,唐东辉,陈巍.有氧运动结合抗阻训练对男性肥胖青少年心血管功能的改善及可能机制[J].体育科学,2013,33(8):37-42.
[3] 唐东辉,侯玉洁,白爽,等.运动结合饮食控制通过降低RAAS系统活性改善男性肥胖青少年血管内皮功能[J].体育科学,2017,37(9):48-54.
[4] CASTAO C,KALKO S,NOVIALS A,et al.Obesity-associated exosomal mirnas modulate glucose and lipid metabolism in mice[J].Proc Natl Acad Sci USA,2018,115(48):12158-12163.
[5] 许汪宇,陈文鹤,沈勋章.中低强度有氧运动结合饮食控制对肥胖青少年血脂和肝脏功能的影响[J].中国运动医学杂志,2011,30(8):706-711.
[6] FARPOURLAMBERTN J,AGGOUN Y,MARCHAND L M,et al.Physical activity reduces systemic blood pressure and improves early markers of atherosclerosis in pre-pubertal obese children[J].J Am Coll Cardiol,2009,54(25):2396-2397.
[7] TOUNIAN P,AGGOUN Y,DUBERN B,et al.Presence of increased stiffness of the common carotid artery and endothelial dysfunction in severely obese children:a prospective study[J].Lancet,2001,358(9291):1400-1404.
[8] WATTS K,BEYE P,SIAFARIKAS A,et al.Exercise training normalizes vascular dysfunction and improves central adiposity in obese adolescents[J].J Am Coll Cardiol,2004,43(10):1823-1827.
[9] ZHANG L,MIYAKI K,ARAKI J,et al.Interaction of angiotensin I-converting enzyme insertion-deletion polymorphism and daily salt intake influences hypertension in Japanese men[J].Hypertens Res,2006,29(10):751-758.
[10] CELERMAJER D S,SORENSEN K E,GOOCH V M,et al.Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis[J].Lancet,1992,340(8828):1111-1115.
[11] 中国肥胖问题工作组.中国学龄儿童青少年超重、肥胖筛查体重指数值分类标准[J].中国流行病学杂志,2004,25(2):97-102.
[12] 中华儿科杂志编辑委员会,中华医学会儿科学分会儿童保健学组,中华医学会儿科学分会心血管学组,等.儿童青少年血脂异常防治专家共识[J].中华儿科杂志,2009,47(6):426-428.
[13] 王贵强,王福生,成军,等.慢性乙型肝炎防治指南(2015年更新版)[J].临床肝胆病杂志,2015,31(12):1941-1960.
[14] 杨倩春,李思宁,黎创,等.高尿酸血症与肾脏疾病关系的研究进展[J].现代生物医学进展,2018,18(13):2593-2596.
[15] 张栋武,唐爱民.肾脏功能试验及其临床评价(上)[J].中国医刊,2007(5):68-69.
[16] WINDERMAN R,RABINOWITZ S S,VAIDY K,et al.Measurement of microvascular function in pediatric inflammatory bowel disease[J].J Pediatr Gastroenterol Nutr,2018.DOI:10.1097/mpg.0000000000002252.
[17] DONGHUI T,SHUANG B,XULONG L,et al.Improvement of microvascular endothelial dysfunction induced by exercise and diet is associated with microRNA-126 in obese adolescents[J].Microvasc Res,2019,123:86-91.DOI:10.1016/j.mvr.2018.10.009.
[18] 郭吟,肖焕禹,王业玲,等.运动干预对肥胖老年女性身体形态和血脂的影响[J].上海体育学院学报,2011,35(5):42-45.
[19] ANDERSON T.Assessment and treatment of endothelial dysfunction in humans[J].J Am College Cardiol,1999,34(3):631-638.
[20] GOKCE N,KEANEY J F J R,HUNTER L M,et al.Risk stratification for postoperative cardiovascular events via noninvasive assessment of endothelial function:a prospective study[J].Circulation,2002,105(13):1567-1572.
[21] GOKCE N,KEANEY J F J R,HUNTER L M,et al.Predictive value of noninvasively determined endothelial dysfunction for long-term cardiovascular events in patients with peripheral vascular disease[J].J Am Coll Cardiol,2003,41(10):1769-1775.
[22] FLEGAL K M,OGDEN C L,YANOVSKI J A,et al.High adiposity and high body mass index-for-age in US children and adolescents overall and by race-ethnic group[J].Am J Clin Nutr,2010,91(4):1020-1026.
[23] EMER M,GROSSER T,WANG M,et al.Prostanoids in health and disease[J].J Lipid Res,2009,50(Suppl):S423-428.