儿童单纯性肥胖对心血管的影响及高危因素分析
|
摘要
第一部分:肥胖的流行病学调查及危险因素分析
目的 调查上海儿童肥胖发病率,探讨导致儿童肥胖的危险因素。 方法 采用整群随机抽样,横断面调查上海市徐汇区六所中小学5425名学生,测量身高、体重,计算体重指数。应用标准问卷调查儿童饮食习惯,运动锻炼,父母、祖父母及外祖父母的体形和糖尿病、高血脂以及心脑血管疾病史,母亲饮食行为。肥胖的定义采用根据国际大样本人群资料确定的体重指数标准(国际肥胖工作小组提出的分年龄、性别BMI临界值)。 结果 上海市徐汇区6~14岁中小学生肥胖检出率为5.5%.超重检出率为18.6%,肥胖和超重呈男性高于女性,呈小年龄组显著高于高年龄组。肥胖儿童表现为过度饮食和缺少活动。父母亲肥胖、高出生体重儿童易患肥胖。肥胖儿童母亲与非肥胖儿童母亲饮食行为有显著差别。 结论 本组儿童肥胖发病率高,过度饮食和缺少活动是引起肥胖的主要原因。肥胖有家庭集聚趋势,父母肥胖儿童易患肥胖,母亲饮食行为对儿童肥胖有重要影响。
第二部分:肥胖儿童心血管疾病危险因素分析
一、血液生化检查
目的 了解肥胖儿童血脂、脂蛋白、胰岛素的分布特征,探讨肥胖儿童心血管疾病的代谢危险因素。 方法 对155名肥胖儿童和145名正常体重儿童进行空腹血糖、胰岛素、甘油三脂、胆固醇、低密度脂蛋白、高密度脂蛋白、载脂蛋白A-I、载脂蛋白B检测。 结果 肥胖儿童与非肥胖儿童相比,空腹胰岛素、甘油三脂、低密度脂蛋白、载脂蛋白B显著增高,胰岛素与血糖比、低密度脂蛋白与高密度脂蛋白比显著增高,载脂蛋白A与载脂蛋白B比值显著降低。 结论 肥胖儿童存在明显的动脉粥样硬化性心血管疾病危险因素。
二、脂蛋白酯酶基因多态性分析
目的 了解脂蛋白酯酶基因外显子常见突变与肥胖儿童心血管疾病危险因素的关系。 方法 用聚合酶链反应加限制性片段长度多态性检测脂蛋白酯酶外显子常见的三个突变位点D9N、N291S和S447X,同时检测血脂。比较肥胖儿童与非肥胖儿童基因突变率的差异,以及不同基因型血脂的分布差异。 结果 332名肥胖及非肥胖儿童中未检测出D9N和N291S突变,S447X突变在肥胖与非肥胖儿童中分布无明显差异,S447与X447两种基因型间血脂无明显差异。 结论 我国儿童D9N与N291S基因突变率低,S447X突变对肥胖儿童心血管危险因素可能影响不大。
第三部分:肥胖儿童心功能检测
一、肥胖儿童心率变异性分析
目的 了解肥胖儿童心率变异性的特征 方法 用Holter对62例单纯性肥胖儿童和61例非肥胖儿童连续记录24小时心电信号,进行心率变异性分析 结果 肥胖儿童心率变异性的频域指标:窦性心律RR间期标准差(SDNN)和相邻窦性心律RR间期差的均方根(rMSSD)低于非肥胖儿童;频域指标:高频功率(HF)和低频功率(LF)低于非肥胖儿童。结果有统计学意义 结论 肥胖儿童心率变异性减小,迷走神经功能降低。
二、肥胖儿童平板运动试验
目的 评价肥胖儿童运动能力,运动时心率改变。 方法 用改良Bruse方案对213名正常体重儿童、56名超重儿童和106名肥胖儿童进行平板运动试验,比较分析肥胖儿童运动能力、运动对心率及血压影响。 结果 运动耐受时间男孩长于女孩,肥胖儿童明显短于非肥胖儿童,运动耐受时间与体重指数成反比;肥胖儿童收缩压明显高于非肥胖儿童,终止运动即刻收缩压高于非肥胖儿童,血压增加幅度亦高于非肥胖儿童,收缩压随体重指数增大而增高;肥胖儿童运动所达到的最大心率降低。 结论 肥胖儿童有明显的高血压表现,运动能力下降。
三、超声心动图评价肥胖儿童心脏结构和功能
目的 探讨儿童单纯性肥胖对于心脏结构和功能的影响。 方法 应用超
声心动图测定98例6~15岁单纯性肥胖儿童和85例正常体重儿童左心室结构、左心室收缩功能与舒张功能、右心室舒张功能参数。分析两组间参数差别。 结果 肥胖儿童比非肥胖儿童:1、左心室舒张末径、左心室收缩末径有增大趋势,但无统计学意义,主动脉内径、左心室质量显著增大,左心室质量指数无差别,标化左心室质量明显增大,并与体重指数正相关。2、左心室短轴缩短率、环周缩短率、左室射血分数有降低趋势,但无统计学意义,每搏量、心输出量无明显差别,但心搏指数、心脏指数、主动脉流速积分、主动脉最大血流速度降低。3、左心室等容舒张时间,二尖瓣E峰、二尖瓣A峰、E/A比值无明显差别,但E峰流速积分、A峰流速积分降低。4、三尖瓣E峰、三尖瓣A峰、E/A比值无明显差别,但E峰流速积分、A峰流速积分降低。 结论 肥胖儿童心脏结构有明显改变,心功能有降低的趋势。
Part One
Epidemiological investigation of obesity and assessment of risk factors in children aged 6~14 years in Xuhui district, Shanghai
Objective To investigate the prevalence of obesity in children aged 6~14 years in one of local districts in Shanghai, to evaluate risk factors associated with childhood obesity. Methods With cluster sampling, 5425 children aged 6~14 years were selected randomly, measurement of height and weight was taken to calculate body mass index, standard structured questionnaire was used to investigate children’s eating habits, physical exercise habits, familial cardiovascular disease history and mothers` eating behavior. A child was defined as being obese or overweight according to a standard definition for child overweight and obesity based on an international survey of six large nationally representative cross sectional growth studies(BMI cutoff values of International Obesity Task Force). Results On average, the prevalence of obesity was 5.5%(7.8% in male, 3.2% in female), with prevalence of overweight 8.6%(22.9% in male, 14.6% in female). The prevalence of obesity was higher in younger children than in older children. Obesity was correlated with excess eating, lack of physical activity, obese parents, born weight and mother’s eating behavior. Conclusion the prevalence of overweight is higher in children aged 6~14 years old, and tends to increase gradually. Excess eating and lack of physical activity are main causes of obesity. Mother’s eating behavior has a significant impact on child obesity. The probability of obesity in children may increase in the presence of obesity in the child’s parents.
Part Two
Assessment of high risk factors for cardiovascular diseases in obese children
Ⅰ Biochemical examination
Objective To investigate the profile of plasma lipid, lipoprotein, glucose and insulin to explore high risk factors of cardiovascular diseases in children with simple obesity. Methods The study group consisted of 255 simple obese children. Control group consisted of 145 healthy children. Glucose, insulin, triglyceride, total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, apolipoprotein A-I and B levels were measured. Results The level of insulin, triglyceride, low density lipoprotein cholesterol and apolipoprotein B were significantly higher in obesity group than in control group. The ratio of insulin to glucose and LDL to HDL was significantly higher in obesity group than in control group. The ratio of apolipoprotein A-I to B was significantly lower in obese children than in controls. Conclusion Simple obese children present significant insulin resistance and disturbances in lipid metabolism, manifested by increased serum triglyceride, low density lipoprotein cholesterol and apolipoprotein B. Unfavourable lipid metabolism and insulin resistance may be high risk factors for atherosclerosis.
Ⅱ Evaluation of single nucleotide polymorphisms of
lipoprotein lipase gene in simple obese children
Objective This study inquired into the relationship between lipoprotein lipase (LPL) gene D9N, N291S and S447X polymorphisms and risk factors of cardiovascular disease in obese children. Methods The polymerase chain reaction (PCR) and restriction fragment length polymorphism(RLFP) techniques were used to detect the three common mutation of LPL gene exon D9N N291S and S447X in 157 obese children and 175 normal controls. The levels of the plasma lipid and lipoprotein were also measured. Results The D9N and N291S gene mutation were not detected in two groups. There was no significant difference in the frequency of S447 gene mutation between obese group and control group. There is no significant difference in the levels of the plasma lipid and lipoprotein between children with S447 genotype and children with X447 genotype. Conclusion The frequency of
D9N and N291S gene mutation is low in Chinese children. It is possible that S447X gene mutation does not play an important role in the development o
目的 调查上海儿童肥胖发病率,探讨导致儿童肥胖的危险因素。 方法 采用整群随机抽样,横断面调查上海市徐汇区六所中小学5425名学生,测量身高、体重,计算体重指数。应用标准问卷调查儿童饮食习惯,运动锻炼,父母、祖父母及外祖父母的体形和糖尿病、高血脂以及心脑血管疾病史,母亲饮食行为。肥胖的定义采用根据国际大样本人群资料确定的体重指数标准(国际肥胖工作小组提出的分年龄、性别BMI临界值)。 结果 上海市徐汇区6~14岁中小学生肥胖检出率为5.5%.超重检出率为18.6%,肥胖和超重呈男性高于女性,呈小年龄组显著高于高年龄组。肥胖儿童表现为过度饮食和缺少活动。父母亲肥胖、高出生体重儿童易患肥胖。肥胖儿童母亲与非肥胖儿童母亲饮食行为有显著差别。 结论 本组儿童肥胖发病率高,过度饮食和缺少活动是引起肥胖的主要原因。肥胖有家庭集聚趋势,父母肥胖儿童易患肥胖,母亲饮食行为对儿童肥胖有重要影响。
第二部分:肥胖儿童心血管疾病危险因素分析
一、血液生化检查
目的 了解肥胖儿童血脂、脂蛋白、胰岛素的分布特征,探讨肥胖儿童心血管疾病的代谢危险因素。 方法 对155名肥胖儿童和145名正常体重儿童进行空腹血糖、胰岛素、甘油三脂、胆固醇、低密度脂蛋白、高密度脂蛋白、载脂蛋白A-I、载脂蛋白B检测。 结果 肥胖儿童与非肥胖儿童相比,空腹胰岛素、甘油三脂、低密度脂蛋白、载脂蛋白B显著增高,胰岛素与血糖比、低密度脂蛋白与高密度脂蛋白比显著增高,载脂蛋白A与载脂蛋白B比值显著降低。 结论 肥胖儿童存在明显的动脉粥样硬化性心血管疾病危险因素。
二、脂蛋白酯酶基因多态性分析
目的 了解脂蛋白酯酶基因外显子常见突变与肥胖儿童心血管疾病危险因素的关系。 方法 用聚合酶链反应加限制性片段长度多态性检测脂蛋白酯酶外显子常见的三个突变位点D9N、N291S和S447X,同时检测血脂。比较肥胖儿童与非肥胖儿童基因突变率的差异,以及不同基因型血脂的分布差异。 结果 332名肥胖及非肥胖儿童中未检测出D9N和N291S突变,S447X突变在肥胖与非肥胖儿童中分布无明显差异,S447与X447两种基因型间血脂无明显差异。 结论 我国儿童D9N与N291S基因突变率低,S447X突变对肥胖儿童心血管危险因素可能影响不大。
第三部分:肥胖儿童心功能检测
一、肥胖儿童心率变异性分析
目的 了解肥胖儿童心率变异性的特征 方法 用Holter对62例单纯性肥胖儿童和61例非肥胖儿童连续记录24小时心电信号,进行心率变异性分析 结果 肥胖儿童心率变异性的频域指标:窦性心律RR间期标准差(SDNN)和相邻窦性心律RR间期差的均方根(rMSSD)低于非肥胖儿童;频域指标:高频功率(HF)和低频功率(LF)低于非肥胖儿童。结果有统计学意义 结论 肥胖儿童心率变异性减小,迷走神经功能降低。
二、肥胖儿童平板运动试验
目的 评价肥胖儿童运动能力,运动时心率改变。 方法 用改良Bruse方案对213名正常体重儿童、56名超重儿童和106名肥胖儿童进行平板运动试验,比较分析肥胖儿童运动能力、运动对心率及血压影响。 结果 运动耐受时间男孩长于女孩,肥胖儿童明显短于非肥胖儿童,运动耐受时间与体重指数成反比;肥胖儿童收缩压明显高于非肥胖儿童,终止运动即刻收缩压高于非肥胖儿童,血压增加幅度亦高于非肥胖儿童,收缩压随体重指数增大而增高;肥胖儿童运动所达到的最大心率降低。 结论 肥胖儿童有明显的高血压表现,运动能力下降。
三、超声心动图评价肥胖儿童心脏结构和功能
目的 探讨儿童单纯性肥胖对于心脏结构和功能的影响。 方法 应用超
声心动图测定98例6~15岁单纯性肥胖儿童和85例正常体重儿童左心室结构、左心室收缩功能与舒张功能、右心室舒张功能参数。分析两组间参数差别。 结果 肥胖儿童比非肥胖儿童:1、左心室舒张末径、左心室收缩末径有增大趋势,但无统计学意义,主动脉内径、左心室质量显著增大,左心室质量指数无差别,标化左心室质量明显增大,并与体重指数正相关。2、左心室短轴缩短率、环周缩短率、左室射血分数有降低趋势,但无统计学意义,每搏量、心输出量无明显差别,但心搏指数、心脏指数、主动脉流速积分、主动脉最大血流速度降低。3、左心室等容舒张时间,二尖瓣E峰、二尖瓣A峰、E/A比值无明显差别,但E峰流速积分、A峰流速积分降低。4、三尖瓣E峰、三尖瓣A峰、E/A比值无明显差别,但E峰流速积分、A峰流速积分降低。 结论 肥胖儿童心脏结构有明显改变,心功能有降低的趋势。
Part One
Epidemiological investigation of obesity and assessment of risk factors in children aged 6~14 years in Xuhui district, Shanghai
Objective To investigate the prevalence of obesity in children aged 6~14 years in one of local districts in Shanghai, to evaluate risk factors associated with childhood obesity. Methods With cluster sampling, 5425 children aged 6~14 years were selected randomly, measurement of height and weight was taken to calculate body mass index, standard structured questionnaire was used to investigate children’s eating habits, physical exercise habits, familial cardiovascular disease history and mothers` eating behavior. A child was defined as being obese or overweight according to a standard definition for child overweight and obesity based on an international survey of six large nationally representative cross sectional growth studies(BMI cutoff values of International Obesity Task Force). Results On average, the prevalence of obesity was 5.5%(7.8% in male, 3.2% in female), with prevalence of overweight 8.6%(22.9% in male, 14.6% in female). The prevalence of obesity was higher in younger children than in older children. Obesity was correlated with excess eating, lack of physical activity, obese parents, born weight and mother’s eating behavior. Conclusion the prevalence of overweight is higher in children aged 6~14 years old, and tends to increase gradually. Excess eating and lack of physical activity are main causes of obesity. Mother’s eating behavior has a significant impact on child obesity. The probability of obesity in children may increase in the presence of obesity in the child’s parents.
Part Two
Assessment of high risk factors for cardiovascular diseases in obese children
Ⅰ Biochemical examination
Objective To investigate the profile of plasma lipid, lipoprotein, glucose and insulin to explore high risk factors of cardiovascular diseases in children with simple obesity. Methods The study group consisted of 255 simple obese children. Control group consisted of 145 healthy children. Glucose, insulin, triglyceride, total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, apolipoprotein A-I and B levels were measured. Results The level of insulin, triglyceride, low density lipoprotein cholesterol and apolipoprotein B were significantly higher in obesity group than in control group. The ratio of insulin to glucose and LDL to HDL was significantly higher in obesity group than in control group. The ratio of apolipoprotein A-I to B was significantly lower in obese children than in controls. Conclusion Simple obese children present significant insulin resistance and disturbances in lipid metabolism, manifested by increased serum triglyceride, low density lipoprotein cholesterol and apolipoprotein B. Unfavourable lipid metabolism and insulin resistance may be high risk factors for atherosclerosis.
Ⅱ Evaluation of single nucleotide polymorphisms of
lipoprotein lipase gene in simple obese children
Objective This study inquired into the relationship between lipoprotein lipase (LPL) gene D9N, N291S and S447X polymorphisms and risk factors of cardiovascular disease in obese children. Methods The polymerase chain reaction (PCR) and restriction fragment length polymorphism(RLFP) techniques were used to detect the three common mutation of LPL gene exon D9N N291S and S447X in 157 obese children and 175 normal controls. The levels of the plasma lipid and lipoprotein were also measured. Results The D9N and N291S gene mutation were not detected in two groups. There was no significant difference in the frequency of S447 gene mutation between obese group and control group. There is no significant difference in the levels of the plasma lipid and lipoprotein between children with S447 genotype and children with X447 genotype. Conclusion The frequency of
D9N and N291S gene mutation is low in Chinese children. It is possible that S447X gene mutation does not play an important role in the development o
引文
1、Stettler N, Zemel BS, Kumanyika S, et al. Infant weight gain and childhood overweight status in a multicenter, cohort study. Pediatrics, 2002,109(2):194-199.
2、丁宗一,何清,樊征鸿,等. 城市0~7岁儿童单纯肥胖症流行病学研究. 中华医学杂志,1998,78(2):121-123.
3、蔡美琴,王少墨,张晓敏,等.上海市中小学生肥胖流行情况及影响因素的相关分析.上海第二医科大学学报,2002,22(1):74-77.
4、Schulte H, Cullen P, Assmann G. Obesity, mortality and cardiovascular disease in the Munster Heart Study (PROCAM). Atherosclerosis, 1999,144(1):199-209.
5、Whitaker RC, Wright JA, Pepe MS, et al. Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med, 1997,337(13):869-873.
6、Berenson GS, Srinivasan SR, Bao W, Newman WP 3rd, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med, 1998, 338(23): 1650-1656.
7、Enos WF, Holmes RH, Beyer J. Coronary disease among United States soldiers killed in action in Korea; preliminary report. J Am Med Assoc. 1953, 152(12): 1090-1093.
8、Kortelainen ML. Adiposity, cardiac size and precursors of coronary atherosclerosis in 5 to 15 year old children: a retrospective study of 210 violent deaths. Int J Obesity, 1997, 21: 691-697.
9、Must A, Jacques P, Dallal G, Bajema CJ, Dietz WH. Long term morbidity and mortality of overweight adolescents: a follow-up of the Harvard Growth Study of 1922 to 1935. N Engl J Med, 1992, 327:1350–1355.
10、Gunnell DJ, Frankel SJ, Nanchahal K, Peters TJ, Davey Smith G. Childhood obesity and adult cardiovascular mortality: a 57-year follow-up study based on the Boyd Orr cohort. Am J Clin Nutr, 1998, 67: 1111–1118.
11、Freedman DS, Dietz WH, Srinivasan SR, et al. The relation of overweight to cardiovascular risk factors among children and adolescents: the bogalusa heart study. Pediatrics, 1999,103(6):1175-1182.
12、Santamarina-Fojo S, Dugi KA. Structure, function and role of lipoprotein lipase in
lipoprotein metabolism. Curr Opin Lipidol, 1994, 5(2):117-125.
13、Oka K, Tkalcevic GT, Nakano T, et al. Structure and polymorphic map of human lipoprotein lipase gene.Biochim Biophys Acta. 1990, 1049(1):21-26.
14、郭锡熔, 陈荣华, 莫宝庆, 等. 脂蛋白酯酶基因多态性对单纯肥胖症儿童血脂、体重指数及皮下脂肪分布的影响. 中华医学遗传学, 2000,17(2):105-107.
15、毛霞, 马沛然, 牛峰海, 等. 小儿单纯性肥胖脂蛋白酯酶基因的多态性研究. 临床儿科杂志, 2000, 18(5):259-261.
16、Humphries SE, Nicaud V, Margalef J, Tiret L, Talmud PJ. Lipoprotein lipase gene variation is associated with a paternal history of premature coronary artery disease and fasting and postprandial plasma triglycerides: the European Atherosclerosis Research Study (EARS). Arterioscler Thromb Vasc Biol. 1998, 18(4):526-534.
17、蒋竞雄,夏秀兰,吴光驰,等.北京市朝阳区2377名小学生肥胖检出率及原因分析.中国儿童保健杂志,1999,7(3):155-156.
18、Barlow SE, Dietz WH. Obesity evaluation and treatment: expert committee recommendations, Pediatrics, 1998, 102:e29.
19、Cole TJ, Bellizzi MC, Flegal KM, et al. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ, 2000,320:1240–1243.
20、Saarilehto S, Keskinen S, Lapinleimu H, et al. Connections between parental eating attitudes and children`s meager eating: questionnaire findings. Acta Paediatr, 2001, 90:333-338.
21、Dietz WH, Robinson TN. Use of the body mass index (BMI) as a measure of overweight in children and adolescents.J Pediatr, 1998, 132(2):191-193.
22、Dietz WH, Bellizzi MC. Introduction: the use of body mass index to assess obesity in children. Am J Clin Nutr, 1999, 70(1):123S-125S.
23、Clarke WR, Woolson RF, Lauer RM Changes in ponderosity and blood pressure in childhood: the Muscatine Study. Am J Epidemiol, 1986, 124(2):195-206.
24、Gidding SS, Bao W, Srinivasan SR, Berenson GS. Effects of secular trends in obesity on coronary risk factors in children: the Bogalusa Heart Study, J Pediatr, 1995, 127(6):868-874.
25、Must A. Morbidity and mortality associated with elevated body weight in children and adolescents. Am J Clin Nutr, 1996, 63(3 Suppl):445S-447S.
26、Sardinha LB, Going SB, Teixeira PJ, Lohman TG. Receiver operating characteristic analysis of body mass index, triceps skinfold thickness, and arm
girth for obesity screening in children and adolescents. Am J Clin Nutr, 1999, 70(6):1090-1095.
27、Hui L, Bell AC. Overweight and obesity in children from Shenzhen, Peoples Republic of China. Health Place. 2003;9(4):371-376.
28、Ramachandran A, Snehalatha C, Vinitha R, et al. Prevalence of overweight in urban Indian adolescent school children. Diabetes Research and Clinical Practice 2002,57 :185–190.
29、Chinn S, Rona RJ. International definitions of overweight and obesity for children: a lasting solution? Ann Hum Biol, 2002 ,29(3):306-313.
30、Flegal KM, Ogden CL, Wei R, Kuczmarski RL, Johnson CL. Prevalence of overweigh t in US children: comparison of US growth charts from the Centers for Disease Control and Prevention with other reference values for body mass index. Am J Clin Nutr, 2001, 73:1086-1093.
31、Katzmarzyk PT, Tremblay A, Perusse L, et al. The utility of the international child and adolescent overweight guidelines for predicting coronary heart disease risk factors. Journal of Clinical Epidemiology 2003,56: 456–462.
32、蒋建华, 刘金萍, 郭金兰, 等.学龄儿童单纯肥胖症的危险因素. 疾病控制杂志, 2002, 6(4): 397-399
33、Moussa MA, Skaik MB, Selwanes SB, et al. Factors associated with obesity in school children. Int J Obes Relat Metab Disord. 1994, 18(7):513-515.
34、Gnavi R, Spagnoli TD, Galotto C, et al. Socioeconomic status, overweight and obesity in prepuberal children: a study in an area of Northern Italy. Eur J Epidemiol. 2000;16(9):797-803.
35、Fisher JO, Birch LL. Restricting access to palatable foods affects children’s behavioral response, food selection, and intake. Am J Clin Nutr. 1999;69:1264 –1272.
36、Birch LL, Fisher JO. Development of eating behaviors among children and adolescents.Pediatrics 1998, 101:539-549.
37、Cara B Ebbeling, Dorota B Pawlak, David S Ludwig. Childhood obesity: public-health crisis, common sense cure. Lancet 2002, 360: 473–482.
38、Johnson SL, Birch LL. Parents` and children`s adiposity and eating style. Pediatrics 1994,94(5):653-661
39、Whitaker RC. Understanding the complex journey to obesity in early adulthood. Am Intern Med. 2002;136:923–925.
40、Kannel WB. Metabolic risk factors for coronary heart disease in women: perspective from the Framingham study. Am Heart J, 1987, 114: 413-419.
41、Dietz WH. Health consequences of obesity in youth: childhood predictors of adult disease. Pediatrics. 1998, 101(3 Pt 2):518-525.
42、陈月嫦, 刘锋, 陈卫红, 等. 单纯性肥胖症儿童血脂、脂蛋白及载脂蛋白的变化. 广东医学, 2002, 23(5):474-475.
43、Moussa MA, Shaltout AA, Nkansa-Dwamena D, Mourad M, Alsheikh N, Agha N, Galal DO. Factors associated with obesity in Kuwaiti children.Eur J Epidemiol. 1999,15(1):41-49.
44、St-Pierre AC, Ruel IL, Cantin B, Dagenais GR, Bernard PM, Despres JP, Lamarche B. Comparison of various electrophoretic characteristics of LDL particles and their relationship to the risk of ischemic heart disease. Circulation, 2001, 104(19):2295-2299.
45、Stein E. Laboratory surrogates for anti-atherosclerotic drug development. Am J Cardiol, 2001, 87(4A):21A-26A.
46、Lamarche B, Tchernof A, Mauriege P, Cantin B, Dagenais GR, Lupien PJ, Despres JP. Fasting insulin and apolipoprotein B levels and low-density lipoprotein particle size as risk factors for ischemic heart disease. JAMA, 1998, 279(24):1955-1961.
47、Ballantyne CM, Hoogeveen RC. Role of lipid and lipoprotein profiles in risk assessment and therapy. Am Heart J, 2003, 146(2):227-233.
48、Reaven GM, Lithell H, Landsberg L. Hypertension and associated metabolic abnormalities: the role of insulin resistance and sympathetic adrenal system. N Engl J Med. 1996,334:374 –381.
49、Hunter SJ, Garvey T. Insulin action and insulin resistance: diseases involving defects in insulin receptors, signal transduction and glucose transport effector system. Am J Med. 1998,5:331–346.
50、Taittonen L, Uhari M, Nuutinen M, Turtinen J, Pokka T, Akerblom HK. Insulin and blood pressure among healthy children: cardiovascular risk in young Finns. Am J Hypertens. 1996,9:193–199.
51、McFarlane SI, Banerji M, Sowers JR. Insulin resistance and cardiovascular disease. J Clin Endocrinol Metab. 2001,86(2):713-718.
52、Tchernof A, Lamarchi B, Prud’homme A. The dense LDL phenotype:association with plasma lipoprotein levels, visceral obesity, and hyperinsulinemia in men.
Diabetes Care. 1996,19:629–637.
53、Banerji MA, Lebowitz J, Chaiken RL, Gordon D, Kral J, Lebowitz H. Relationships of visceral adipose tissue and glucose disposal in independent of sex in black NIDDM subjects. Am J Physiol. 1997,273:E425–E432.
54、Sowers JR. Hypertension in type II diabetes: update on therapy. J Clin Hypertens. 1999,1:41– 47.
55、Steinberger J, Daniels SR. Obesity, insulin resistance, diabetes, and cardiovascular risk in children: an American Heart Association scientific statement from the Atherosclerosis, Hypertension, and Obesity in the Young Committee (Council on Cardiovascular Disease in the Young) and the Diabetes Committee (Council on Nutrition, Physical Activity, and Metabolism). Circulation, 2003,107(10):1448-53.
56、Wittrup HH, Tybj?rg-Hansen A, Steffensen R, et al. Mutations in the lipoprotein lipase gene associated with ischemic heart disease in men. The Copenhagen City Heart Study. Arterioscler Thromb Vasc Biol 1999;19(6):1535–1540.
57、Zhang H, Reymer PWA, Liu MS, Forsythe IJ, Groenemeyer BE, Frohlich J, et al. Patients with apoE3 deficiency (E2/2, E3/2, and E4/2) who manifest with hyperlipidemia have increased frequency of an Asn 291 Ser mutation in the human LPL gene. Arterioscler Thromb Vasc Biol. 1995,15(10):1695–1703.
58、Kuivenhoven JA, Groenemeyer BE, Boer JM, Reymer PW, Berghuis R, Bruin T, et al: Ser447stop mutation in lipoprotein lipase is associated with elevated HDL cholesterol levels in normolipidemic males. Arterioscler Thromb 1997,17(3): 595 – 599
59、Groenemeijer BE, Hallman MD, Reymer PWA, et al., on behalf of the REGRESS study group. Genetic variant showing a positive interaction with _-blocking agents with a beneficial influence on lipoprotein lipase activity, HDL cholesterol, and triglyceride levels in coronary artery disease patients. The Ser447-Stop substitution in the lipoprotein lipase gene. Circulation 1997,95(12):2628–2635.
60、Fisher RM, Humphries SE, Talmud PJ. Common variation in the lipoprotein lipase gene: effects on plasma lipids and risk of atherosclerosis. Atherosclerosis. 1997, 135(2):145-159.
61、Gerdes C, Fisher RM, Nicaud V, Boer J, Humphries SE, Talmud PJ, Faergeman O. Lipoprotein lipase variants D9N and N291S are associated with increased plasma triglyceride and lower high-density lipoprotein cholesterol concentrations: studies in the fasting and postprandial states: the European Atherosclerosis Research
Studies. Circulation. 1997,96(3):733-740.
62、Mailly F, Tugrul Y, Reymer PW, Bruin T, et al. A common variant in the gene for lipoprotein lipase (Asp9-->Asn). Functional implications and prevalence in normal and hyperlipidemic subjects. Arterioscler Thromb Vasc Biol. 1995, 15(4):468-478
63、Fisher RM, Mailly F, Peacock RE, Hamsten A, Seed M, et al. Interaction of the lipoprotein lipase asparagine 291-->serine mutation with body mass index determines elevated plasma triacylglycerol concentrations: a study in hyperlipidemic subjects, myocardial infarction survivors, and healthy adults. J Lipid Res. 1995, 36(10):2104-2112
64、Jukema JW, van Boven AJ, Groenemeijer B, Zwinderman AH, et al. The Asp9 Asn mutation in the lipoprotein lipase gene is associated with increased progression of coronary atherosclerosis. REGRESS Study Group, Interuniversity Cardiology Institute, Utrecht, The Netherlands. Regression Growth Evaluation Statin Study. Circulation. 1996, 94(8):1913-1918.
65、Wittrup HH, Tybjaerg-Hansen A, Abildgaard S, Steffensen R, Schnohr P, Nordestgaard BG. A common substitution (Asn291Ser) in lipoprotein lipase is associated with increased risk of ischemic heart disease.J Clin Invest. 1997 , 99(7):1606-1613.
66、Chen W, Srinivasan SR, Elkasabany A, et al. Influence of lipoprotein lipase serine 447 stop polymorphism on tracking of triglycerides and HDL cholesterol from childhood to adulthood and familial risk of coronary artery disease: the Bogalusa Heart Study. Atherosclerosis, 2001, 159: 367–373.
67、Snieder H, van Doornen LJP, Boomsma DI. Dissecting the genetic architecture of lipids, lipoproteins, and apolipoproteins: lessons from twin studies. Arterioscler Thromb Vasc Biol. 1999, 19(12):2826-2834.
68、Jarvik GP, Goode EL, Austin MA, Auwerx J, Deeb S, Schellenberg GD, Reed T. Evidence that the apolipoprotein E-genotype effects on lipid levels can change with age in males: a longitudinal analysis. Am J Hum Genet, 1997, 61(1):171-181.
69、Sawano M, Watanabe Y, Ohmura H, et al. Potentially Protective Effects of the Ser447-Ter Mutation of the Lipoprotein Lipase Gene Against the Development of Coronary Artery Disease in Japanese Subjects Via a Beneficial Lipid Profile. Jpn Circ J. 2001, 65: 310–314.
70、Wittrup HH, Tybjaerg-Hansen A, Nordestgaard BG.Lipoprotein Lipase Mutations,
Plasma Lipids and Lipoproteins, and Risk of Ischemic Heart Disease. A Meta-Analysis. Circulation, 1999, 99:2901-2907.
71、Hayano J, Sakakibara Y, Yamada A, et al. Accuracy of assessment of cardiac vagal tone by heart rate variability in normal subjects. Am J Cardiol,1991,67:199-204.
72、Kleiger RE, Miller JP, Bigger JT, et al. Decreased HRV and its association with increased mortality after acute myocardial infarction. Am J Cardiol, 1987,59:256-262.
73、Brouwer J, van Veldhuisen DJ, Man in’t Veld AJ, et al. Prognostic value of HRV during long-term follow-up in patients with mild to moderate heart failure. J Am Coll Cardiol, 1996,28:1183-1189.
74 Rich MW, Saini JS, Kleiger RE, et al. Correlation of HRV with clinical and angiographic variables and late mortality after coronary angiography. Am J Cardiol ,1988,62:714 –717.
75 Stein KM, Bores JS, Hochreites C, et al. Prognostic value and physiologic correlates of HRV in chronic severe mitral regurgitation. Circulation, 1993,88:127-135.
76 Karason K, Molgaard H, Wikstrand J, et al. Heart rate variability in obesity and the effect of weight loss. Am J Cardiol, 1999,83:1242-1247
77 Gutin B, Owens S, Slavens G,et al. Effect of physical training on heart-period variability in obese children. J Pediatr, 1997,139:938-943.
78 Gutin B, Barbeau P, Litaker MS, et al. Heart rate variability in obese children: relations to total body and visceral adiposity, and changes with physical training and detraining. Obes Res, 2000, 8:12-19.
79 Stettler N, Zemel BS, Kumanyika S, el at. Infant weight gain and childrenhood overweight status in a multicenter, cohort study. Pediatrics, 2002,109:194-199.
80王玉林, 孙杰, 马沛然. 心力衰竭患儿的心率变异性及与交感神经和RAAS的关系. 中华儿科杂志,2000,38:29-31.
81刘芳, 魏建西, 王增春, 等. 短时心率变异测量辅助诊断儿童心血管神经机能症. 临床儿科杂志, 2000,18(1):47-49.
82陆再英, 屈建石. 心率变异性. 见:陈新主编. 临床心律失常学――电生理和治疗. 第1版, 北京:人民卫生出版社,2000:249-291。
83 Galeev AR, Igisheva LN, Kazin EM. Heart Rate Variability in Healthy Six- to Sixteen-Year-Old Children. Human Physiology, 2002,28:428-432.
84 Task Force of the European Society of Cardiology and the North American Society
of Pacing and Electrophysiology. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Circulation, 1996,93:1043-1065.
85 Dundaroz MR, Denli M, Uzun M, et al. Analysis of heart rate variability in children with primary nocturnal enuresis. Int Urol Nephrol,2001,32:393-397.
86 Peterson HR, Rothschild M, Weinberg CR, et al. Body fat and the activity of the autonomic nervous system. N Engl J Med, 1988,318:1077-1083.
87 Bruse R. Exercise testing in patients with coronary artery disease. Ann Clin Res, 1971;3(4):323-325
88 Adams FH, Eengtsson E, Berven H, et al. The physical working capacity of normal school children. Pediatrics, 1961;28(2):243-258
89 Owens S, Gutin B. Exercise testing of the children with obesity. Pediatr Cardiol, 1999,20:79-83
90 Maffeis C, Schena F, Zaffanello M, Zoccante L, Schutz Y, Pinelli L. Maximal aerobic power during running and cycling in obese and non-obese children. Acta Paediatr, 1994, 83(1):113-116.
91 Zanconato S, Baraldi E, Santuz P, Rigon F, Vido L, Da Dalt L, Zacchello F. Gas exchange during exercise in obese children. Eur J Pediatr, 1989, 148(7):614-617.
92 Reybrouck T, Weymans M, Vinckx J, Stijns H, Vanderschueren-Lodeweyckx M. Cardiorespiratory function during exercise in obese children. Acta Paediatr Scand, 1987, 76(2):342-348.
93陆国平, 刘豫阳, 盛锋, 等. 健康学龄儿童平板运动时心率、血压变化及耐量测定. 中国实用儿科杂志, 2001, 16(8):492-495.
94郭颖, 周爱卿, 高伟, 等. 上海地区294例健康儿童平板运动试验的生理指标评价. 中华儿科杂志, 2003, 41(5):338-343.
95 Driscoll DJ. Exercise testing. In:Allen HD,Clark EB,Gutgesell HP, Driscoll DJ.eds.Moss and Adams` heart disease in infants,children,and adolescents: including the fetus and young adult.6th ed. Philadelphia: LWW, 2001. 264-275.
96 Nakajima T, Fujioka S, Tokunaga K, Matsuzawa Y, Tarui S. Correlation of intra-abdominal fat accumulation and left ventricular performance in obesity. Am J Cardiol, 1989, 64:369-373.
97 Alaud-din A, Meterissian S, Lisbona R, MacLean LD, Forse RA. Assessment of cardiac function in patients who were morbidly obese. Surgery, 1990,108:809-818.
98 Giordano U, Ciampalini P, Turchetta A, et al. Cardiovascular Hemodynamics:
Relationships with Insulin Resistance in Obese Children. Pediatr Cardiol, 2003, 24:548-552.
99 Reybrouck T, Mertens L, Schepers D, Vinckx J, Gewillig M. Assessment of cardiorespiratory exercise function in obese children and adolescents by body mass-independent parameters. Eur J Appl Physiol, 1997, 75: 478-483.
100 Kissebah AH, Krakower GR. Regional adiposity and morbidity. Physiol Rev, 1994, 74: 761-811.
101 Babb TG, Korzick D, Meador M, Hodgson JL, Buskirk ER. Ventilatory response of moderately obese women to submaximal exercise. Int J Obes, 1991,15:59-65.
102 Maffeis C, Schutz Y, Schena F, Za.aneloo M, Pinelli L. Energy expenditure during walking and running in obese and nonobese prepubertal children. J Pediatr, 1993, 123:193-199.
103 Urbina EM, Gidding SS, Bao W, Pickoff AS, Berdusis K, Berenson GS. Effect of body size, ponderosity, and blood pressure on left ventricular growth in children and young adults in the Bogalusa Heart Study. Circulation, 1995, 91: 2400–2406.
104 Verdecchia P, Schillaci G, Borgioni C, Ciucci A, Gattobigio R, Zampi I, Reboldi G, Porcellati C. Prognostic significance of serial changes in left ventricular mass in essential hypertension. Circulation, 1998, 97:48–54.
105 Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath CW Jr. Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med,1999, 341: 1097–1105.
106 de Simone G, Devereux RB, Daniels SR, Koren MJ, Meyer RA, Laragh JH.Effect of growth on variability of left ventricular mass: assessment of allometric signals in adults and children and their capacity to predict cardiovascular risk. J Am Coll Cardiol, 1995, 25:1056–1062.
107 Alpert MA. Obesity cardiomyopathy: pathophysiology and evolution of the clinical syndrome. Am J Med Sci, 2001, 321(4):225-236.
108毛霞, 马沛然, 金超, 等. 应用传统超声和多普勒组织显像检测单纯性肥胖小儿左心结构和左心功能. 中国当代儿科杂志, 1999, 1(2): 71-74.
109郭文彬, 刘传玺, 梁皓, 等. 超声心动图评价单纯肥胖对心脏结构及功能的影响. 医学影像学杂志, 1999, 9(2): 100-102.
110 Lauer MS, Anderson KM, Levy D. Separate and joint influences of obesity and mild hypertension on left ventricular mass and geometry: the Framingham Heart Study. J Am Coll Cardiol, 1992 ,19(1):130-134.
111 de Simone G, Devereux RB, Roman MJ, Alderman MH, Laragh JH. Relation of obesity and gender to left ventricular hypertrophy in normotensive and hypertensive adults.Hypertension, 1994, 23(5):600-606.
112Pascual M, Pascual DA, Soria F, Vicente T, Hernandez AM, Tebar FJ, Valdes M. Effects of isolated obesity on systolic and diastolic left ventricular function. Heart, 2003, 89(10):1152-1156.
113 Zarich SW, Kowalchuk GJ, McGuire MP, Benotti PN, Mascioli EA, Nesto RW. Left ventricular filling abnormalities in asymptomatic morbid obesity. Am J Cardiol, 1991, 68(4):377-381.
114 Chakko S, Mayor M, Allison MD, Kessler KM, Materson BJ, Myerburg RJ. Abnormal left ventricular diastolic filling in eccentric left ventricular hypertrophy of obesity. Am J Cardiol, 1991, 68(1):95-98.
115 Stoddard MF, Tseuda K, Thomas M, Dillon S, Kupersmith J. The influence of obesity on left ventricular filling and systolic function. Am Heart J, 1992, 124(3):694-699.
116 Fischer M, Baessler A, Hense HW, Hengstenberg C, Muscholl M, Holmer S, Doring A, Broeckel U, Riegger G, Schunkert H. Prevalence of left ventricular diastolic dysfunction in the community. Results from a Doppler echocardiographic-based survey of a population sample. Eur Heart J, 2003, 24(4):320-328.
117 Ailhaud G, Fukamizu A, Massiera F, Negrel R, Saint-Marc P, Teboul M.Angiotensinogen, angiotensin II and adipose tissue development. Int J Obes Relat Metab Disord, 2000, 24(suppl 4):S33–S35.
118 Giachetti G, Faloia E, Sardu C, et al. Gene expression of angiotensinogen in adipose tissue of obese patients. Int J Obes Relat Metab Disord, 2000, 24(suppl 2):S142–S143.
119 Karlsson C, Lindell K, Ottosson M, Sjostrom L, Carlsson LM. Human adipose tissue expresses angiotensinogen and enzymes required for its conversion to angiotensin II. J Clin Endocrinol Metab, 1998,83:3925–3929.
120 Cooper R, McFarlane-Anderson N, Bennett FI, et al. ACE, angiotensinogen and obesity: a potential pathway leading to hypertension. J Hum Hypertens, 1997, 11:107–111.
121 Weber MA, Smith DH, Neutel JM. Differing roles of body mass and the renin-angiotensin system in mediating the hypertension syndrome. Am J Nephrol,
2000,20:169–174.
122 Nickola MW, Wold LE, Colligan PB, Wang GJ, Samson WK, Ren J. Leptin attenuates cardiac contraction in rat ventricular myocytes: role of NO. Hypertension, 2000,36:501–505.
123 Liao Y, Cooper RS, Durazo-Arvizu R, Mensah GA, Ghali JK. Prediction of mortality risk by different methods of indexation for left ventricular mass. J Am Coll Cardiol, 1997,29:641–647.
124 Mitchell BM, Gutin B, Kapuku G, et al. Left Ventricular Structure and Function in Obese Adolescents: Relations to Cardiovascular Fitness, Percent Body Fat, and Visceral Adiposity, and Effects of Physical Training. Pediatrics, 2002,109(5): e73
125 Karason K, Wallentin I, Larsson B, Sj?str?m L. Effects of obesity and weight loss on left ventricular mass and relative wall thickness: survey and intervention study. BMJ, 1997, 315: 912-916.
126 Guo SS, Wu W, Chumlea WC, Roche AF. Predicting overweight and obesity in adulthood from body mass index values in childhood and adolescence. Am J Clin Nutr, 2002, 76(3):653-658.
2、丁宗一,何清,樊征鸿,等. 城市0~7岁儿童单纯肥胖症流行病学研究. 中华医学杂志,1998,78(2):121-123.
3、蔡美琴,王少墨,张晓敏,等.上海市中小学生肥胖流行情况及影响因素的相关分析.上海第二医科大学学报,2002,22(1):74-77.
4、Schulte H, Cullen P, Assmann G. Obesity, mortality and cardiovascular disease in the Munster Heart Study (PROCAM). Atherosclerosis, 1999,144(1):199-209.
5、Whitaker RC, Wright JA, Pepe MS, et al. Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med, 1997,337(13):869-873.
6、Berenson GS, Srinivasan SR, Bao W, Newman WP 3rd, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med, 1998, 338(23): 1650-1656.
7、Enos WF, Holmes RH, Beyer J. Coronary disease among United States soldiers killed in action in Korea; preliminary report. J Am Med Assoc. 1953, 152(12): 1090-1093.
8、Kortelainen ML. Adiposity, cardiac size and precursors of coronary atherosclerosis in 5 to 15 year old children: a retrospective study of 210 violent deaths. Int J Obesity, 1997, 21: 691-697.
9、Must A, Jacques P, Dallal G, Bajema CJ, Dietz WH. Long term morbidity and mortality of overweight adolescents: a follow-up of the Harvard Growth Study of 1922 to 1935. N Engl J Med, 1992, 327:1350–1355.
10、Gunnell DJ, Frankel SJ, Nanchahal K, Peters TJ, Davey Smith G. Childhood obesity and adult cardiovascular mortality: a 57-year follow-up study based on the Boyd Orr cohort. Am J Clin Nutr, 1998, 67: 1111–1118.
11、Freedman DS, Dietz WH, Srinivasan SR, et al. The relation of overweight to cardiovascular risk factors among children and adolescents: the bogalusa heart study. Pediatrics, 1999,103(6):1175-1182.
12、Santamarina-Fojo S, Dugi KA. Structure, function and role of lipoprotein lipase in
lipoprotein metabolism. Curr Opin Lipidol, 1994, 5(2):117-125.
13、Oka K, Tkalcevic GT, Nakano T, et al. Structure and polymorphic map of human lipoprotein lipase gene.Biochim Biophys Acta. 1990, 1049(1):21-26.
14、郭锡熔, 陈荣华, 莫宝庆, 等. 脂蛋白酯酶基因多态性对单纯肥胖症儿童血脂、体重指数及皮下脂肪分布的影响. 中华医学遗传学, 2000,17(2):105-107.
15、毛霞, 马沛然, 牛峰海, 等. 小儿单纯性肥胖脂蛋白酯酶基因的多态性研究. 临床儿科杂志, 2000, 18(5):259-261.
16、Humphries SE, Nicaud V, Margalef J, Tiret L, Talmud PJ. Lipoprotein lipase gene variation is associated with a paternal history of premature coronary artery disease and fasting and postprandial plasma triglycerides: the European Atherosclerosis Research Study (EARS). Arterioscler Thromb Vasc Biol. 1998, 18(4):526-534.
17、蒋竞雄,夏秀兰,吴光驰,等.北京市朝阳区2377名小学生肥胖检出率及原因分析.中国儿童保健杂志,1999,7(3):155-156.
18、Barlow SE, Dietz WH. Obesity evaluation and treatment: expert committee recommendations, Pediatrics, 1998, 102:e29.
19、Cole TJ, Bellizzi MC, Flegal KM, et al. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ, 2000,320:1240–1243.
20、Saarilehto S, Keskinen S, Lapinleimu H, et al. Connections between parental eating attitudes and children`s meager eating: questionnaire findings. Acta Paediatr, 2001, 90:333-338.
21、Dietz WH, Robinson TN. Use of the body mass index (BMI) as a measure of overweight in children and adolescents.J Pediatr, 1998, 132(2):191-193.
22、Dietz WH, Bellizzi MC. Introduction: the use of body mass index to assess obesity in children. Am J Clin Nutr, 1999, 70(1):123S-125S.
23、Clarke WR, Woolson RF, Lauer RM Changes in ponderosity and blood pressure in childhood: the Muscatine Study. Am J Epidemiol, 1986, 124(2):195-206.
24、Gidding SS, Bao W, Srinivasan SR, Berenson GS. Effects of secular trends in obesity on coronary risk factors in children: the Bogalusa Heart Study, J Pediatr, 1995, 127(6):868-874.
25、Must A. Morbidity and mortality associated with elevated body weight in children and adolescents. Am J Clin Nutr, 1996, 63(3 Suppl):445S-447S.
26、Sardinha LB, Going SB, Teixeira PJ, Lohman TG. Receiver operating characteristic analysis of body mass index, triceps skinfold thickness, and arm
girth for obesity screening in children and adolescents. Am J Clin Nutr, 1999, 70(6):1090-1095.
27、Hui L, Bell AC. Overweight and obesity in children from Shenzhen, Peoples Republic of China. Health Place. 2003;9(4):371-376.
28、Ramachandran A, Snehalatha C, Vinitha R, et al. Prevalence of overweight in urban Indian adolescent school children. Diabetes Research and Clinical Practice 2002,57 :185–190.
29、Chinn S, Rona RJ. International definitions of overweight and obesity for children: a lasting solution? Ann Hum Biol, 2002 ,29(3):306-313.
30、Flegal KM, Ogden CL, Wei R, Kuczmarski RL, Johnson CL. Prevalence of overweigh t in US children: comparison of US growth charts from the Centers for Disease Control and Prevention with other reference values for body mass index. Am J Clin Nutr, 2001, 73:1086-1093.
31、Katzmarzyk PT, Tremblay A, Perusse L, et al. The utility of the international child and adolescent overweight guidelines for predicting coronary heart disease risk factors. Journal of Clinical Epidemiology 2003,56: 456–462.
32、蒋建华, 刘金萍, 郭金兰, 等.学龄儿童单纯肥胖症的危险因素. 疾病控制杂志, 2002, 6(4): 397-399
33、Moussa MA, Skaik MB, Selwanes SB, et al. Factors associated with obesity in school children. Int J Obes Relat Metab Disord. 1994, 18(7):513-515.
34、Gnavi R, Spagnoli TD, Galotto C, et al. Socioeconomic status, overweight and obesity in prepuberal children: a study in an area of Northern Italy. Eur J Epidemiol. 2000;16(9):797-803.
35、Fisher JO, Birch LL. Restricting access to palatable foods affects children’s behavioral response, food selection, and intake. Am J Clin Nutr. 1999;69:1264 –1272.
36、Birch LL, Fisher JO. Development of eating behaviors among children and adolescents.Pediatrics 1998, 101:539-549.
37、Cara B Ebbeling, Dorota B Pawlak, David S Ludwig. Childhood obesity: public-health crisis, common sense cure. Lancet 2002, 360: 473–482.
38、Johnson SL, Birch LL. Parents` and children`s adiposity and eating style. Pediatrics 1994,94(5):653-661
39、Whitaker RC. Understanding the complex journey to obesity in early adulthood. Am Intern Med. 2002;136:923–925.
40、Kannel WB. Metabolic risk factors for coronary heart disease in women: perspective from the Framingham study. Am Heart J, 1987, 114: 413-419.
41、Dietz WH. Health consequences of obesity in youth: childhood predictors of adult disease. Pediatrics. 1998, 101(3 Pt 2):518-525.
42、陈月嫦, 刘锋, 陈卫红, 等. 单纯性肥胖症儿童血脂、脂蛋白及载脂蛋白的变化. 广东医学, 2002, 23(5):474-475.
43、Moussa MA, Shaltout AA, Nkansa-Dwamena D, Mourad M, Alsheikh N, Agha N, Galal DO. Factors associated with obesity in Kuwaiti children.Eur J Epidemiol. 1999,15(1):41-49.
44、St-Pierre AC, Ruel IL, Cantin B, Dagenais GR, Bernard PM, Despres JP, Lamarche B. Comparison of various electrophoretic characteristics of LDL particles and their relationship to the risk of ischemic heart disease. Circulation, 2001, 104(19):2295-2299.
45、Stein E. Laboratory surrogates for anti-atherosclerotic drug development. Am J Cardiol, 2001, 87(4A):21A-26A.
46、Lamarche B, Tchernof A, Mauriege P, Cantin B, Dagenais GR, Lupien PJ, Despres JP. Fasting insulin and apolipoprotein B levels and low-density lipoprotein particle size as risk factors for ischemic heart disease. JAMA, 1998, 279(24):1955-1961.
47、Ballantyne CM, Hoogeveen RC. Role of lipid and lipoprotein profiles in risk assessment and therapy. Am Heart J, 2003, 146(2):227-233.
48、Reaven GM, Lithell H, Landsberg L. Hypertension and associated metabolic abnormalities: the role of insulin resistance and sympathetic adrenal system. N Engl J Med. 1996,334:374 –381.
49、Hunter SJ, Garvey T. Insulin action and insulin resistance: diseases involving defects in insulin receptors, signal transduction and glucose transport effector system. Am J Med. 1998,5:331–346.
50、Taittonen L, Uhari M, Nuutinen M, Turtinen J, Pokka T, Akerblom HK. Insulin and blood pressure among healthy children: cardiovascular risk in young Finns. Am J Hypertens. 1996,9:193–199.
51、McFarlane SI, Banerji M, Sowers JR. Insulin resistance and cardiovascular disease. J Clin Endocrinol Metab. 2001,86(2):713-718.
52、Tchernof A, Lamarchi B, Prud’homme A. The dense LDL phenotype:association with plasma lipoprotein levels, visceral obesity, and hyperinsulinemia in men.
Diabetes Care. 1996,19:629–637.
53、Banerji MA, Lebowitz J, Chaiken RL, Gordon D, Kral J, Lebowitz H. Relationships of visceral adipose tissue and glucose disposal in independent of sex in black NIDDM subjects. Am J Physiol. 1997,273:E425–E432.
54、Sowers JR. Hypertension in type II diabetes: update on therapy. J Clin Hypertens. 1999,1:41– 47.
55、Steinberger J, Daniels SR. Obesity, insulin resistance, diabetes, and cardiovascular risk in children: an American Heart Association scientific statement from the Atherosclerosis, Hypertension, and Obesity in the Young Committee (Council on Cardiovascular Disease in the Young) and the Diabetes Committee (Council on Nutrition, Physical Activity, and Metabolism). Circulation, 2003,107(10):1448-53.
56、Wittrup HH, Tybj?rg-Hansen A, Steffensen R, et al. Mutations in the lipoprotein lipase gene associated with ischemic heart disease in men. The Copenhagen City Heart Study. Arterioscler Thromb Vasc Biol 1999;19(6):1535–1540.
57、Zhang H, Reymer PWA, Liu MS, Forsythe IJ, Groenemeyer BE, Frohlich J, et al. Patients with apoE3 deficiency (E2/2, E3/2, and E4/2) who manifest with hyperlipidemia have increased frequency of an Asn 291 Ser mutation in the human LPL gene. Arterioscler Thromb Vasc Biol. 1995,15(10):1695–1703.
58、Kuivenhoven JA, Groenemeyer BE, Boer JM, Reymer PW, Berghuis R, Bruin T, et al: Ser447stop mutation in lipoprotein lipase is associated with elevated HDL cholesterol levels in normolipidemic males. Arterioscler Thromb 1997,17(3): 595 – 599
59、Groenemeijer BE, Hallman MD, Reymer PWA, et al., on behalf of the REGRESS study group. Genetic variant showing a positive interaction with _-blocking agents with a beneficial influence on lipoprotein lipase activity, HDL cholesterol, and triglyceride levels in coronary artery disease patients. The Ser447-Stop substitution in the lipoprotein lipase gene. Circulation 1997,95(12):2628–2635.
60、Fisher RM, Humphries SE, Talmud PJ. Common variation in the lipoprotein lipase gene: effects on plasma lipids and risk of atherosclerosis. Atherosclerosis. 1997, 135(2):145-159.
61、Gerdes C, Fisher RM, Nicaud V, Boer J, Humphries SE, Talmud PJ, Faergeman O. Lipoprotein lipase variants D9N and N291S are associated with increased plasma triglyceride and lower high-density lipoprotein cholesterol concentrations: studies in the fasting and postprandial states: the European Atherosclerosis Research
Studies. Circulation. 1997,96(3):733-740.
62、Mailly F, Tugrul Y, Reymer PW, Bruin T, et al. A common variant in the gene for lipoprotein lipase (Asp9-->Asn). Functional implications and prevalence in normal and hyperlipidemic subjects. Arterioscler Thromb Vasc Biol. 1995, 15(4):468-478
63、Fisher RM, Mailly F, Peacock RE, Hamsten A, Seed M, et al. Interaction of the lipoprotein lipase asparagine 291-->serine mutation with body mass index determines elevated plasma triacylglycerol concentrations: a study in hyperlipidemic subjects, myocardial infarction survivors, and healthy adults. J Lipid Res. 1995, 36(10):2104-2112
64、Jukema JW, van Boven AJ, Groenemeijer B, Zwinderman AH, et al. The Asp9 Asn mutation in the lipoprotein lipase gene is associated with increased progression of coronary atherosclerosis. REGRESS Study Group, Interuniversity Cardiology Institute, Utrecht, The Netherlands. Regression Growth Evaluation Statin Study. Circulation. 1996, 94(8):1913-1918.
65、Wittrup HH, Tybjaerg-Hansen A, Abildgaard S, Steffensen R, Schnohr P, Nordestgaard BG. A common substitution (Asn291Ser) in lipoprotein lipase is associated with increased risk of ischemic heart disease.J Clin Invest. 1997 , 99(7):1606-1613.
66、Chen W, Srinivasan SR, Elkasabany A, et al. Influence of lipoprotein lipase serine 447 stop polymorphism on tracking of triglycerides and HDL cholesterol from childhood to adulthood and familial risk of coronary artery disease: the Bogalusa Heart Study. Atherosclerosis, 2001, 159: 367–373.
67、Snieder H, van Doornen LJP, Boomsma DI. Dissecting the genetic architecture of lipids, lipoproteins, and apolipoproteins: lessons from twin studies. Arterioscler Thromb Vasc Biol. 1999, 19(12):2826-2834.
68、Jarvik GP, Goode EL, Austin MA, Auwerx J, Deeb S, Schellenberg GD, Reed T. Evidence that the apolipoprotein E-genotype effects on lipid levels can change with age in males: a longitudinal analysis. Am J Hum Genet, 1997, 61(1):171-181.
69、Sawano M, Watanabe Y, Ohmura H, et al. Potentially Protective Effects of the Ser447-Ter Mutation of the Lipoprotein Lipase Gene Against the Development of Coronary Artery Disease in Japanese Subjects Via a Beneficial Lipid Profile. Jpn Circ J. 2001, 65: 310–314.
70、Wittrup HH, Tybjaerg-Hansen A, Nordestgaard BG.Lipoprotein Lipase Mutations,
Plasma Lipids and Lipoproteins, and Risk of Ischemic Heart Disease. A Meta-Analysis. Circulation, 1999, 99:2901-2907.
71、Hayano J, Sakakibara Y, Yamada A, et al. Accuracy of assessment of cardiac vagal tone by heart rate variability in normal subjects. Am J Cardiol,1991,67:199-204.
72、Kleiger RE, Miller JP, Bigger JT, et al. Decreased HRV and its association with increased mortality after acute myocardial infarction. Am J Cardiol, 1987,59:256-262.
73、Brouwer J, van Veldhuisen DJ, Man in’t Veld AJ, et al. Prognostic value of HRV during long-term follow-up in patients with mild to moderate heart failure. J Am Coll Cardiol, 1996,28:1183-1189.
74 Rich MW, Saini JS, Kleiger RE, et al. Correlation of HRV with clinical and angiographic variables and late mortality after coronary angiography. Am J Cardiol ,1988,62:714 –717.
75 Stein KM, Bores JS, Hochreites C, et al. Prognostic value and physiologic correlates of HRV in chronic severe mitral regurgitation. Circulation, 1993,88:127-135.
76 Karason K, Molgaard H, Wikstrand J, et al. Heart rate variability in obesity and the effect of weight loss. Am J Cardiol, 1999,83:1242-1247
77 Gutin B, Owens S, Slavens G,et al. Effect of physical training on heart-period variability in obese children. J Pediatr, 1997,139:938-943.
78 Gutin B, Barbeau P, Litaker MS, et al. Heart rate variability in obese children: relations to total body and visceral adiposity, and changes with physical training and detraining. Obes Res, 2000, 8:12-19.
79 Stettler N, Zemel BS, Kumanyika S, el at. Infant weight gain and childrenhood overweight status in a multicenter, cohort study. Pediatrics, 2002,109:194-199.
80王玉林, 孙杰, 马沛然. 心力衰竭患儿的心率变异性及与交感神经和RAAS的关系. 中华儿科杂志,2000,38:29-31.
81刘芳, 魏建西, 王增春, 等. 短时心率变异测量辅助诊断儿童心血管神经机能症. 临床儿科杂志, 2000,18(1):47-49.
82陆再英, 屈建石. 心率变异性. 见:陈新主编. 临床心律失常学――电生理和治疗. 第1版, 北京:人民卫生出版社,2000:249-291。
83 Galeev AR, Igisheva LN, Kazin EM. Heart Rate Variability in Healthy Six- to Sixteen-Year-Old Children. Human Physiology, 2002,28:428-432.
84 Task Force of the European Society of Cardiology and the North American Society
of Pacing and Electrophysiology. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Circulation, 1996,93:1043-1065.
85 Dundaroz MR, Denli M, Uzun M, et al. Analysis of heart rate variability in children with primary nocturnal enuresis. Int Urol Nephrol,2001,32:393-397.
86 Peterson HR, Rothschild M, Weinberg CR, et al. Body fat and the activity of the autonomic nervous system. N Engl J Med, 1988,318:1077-1083.
87 Bruse R. Exercise testing in patients with coronary artery disease. Ann Clin Res, 1971;3(4):323-325
88 Adams FH, Eengtsson E, Berven H, et al. The physical working capacity of normal school children. Pediatrics, 1961;28(2):243-258
89 Owens S, Gutin B. Exercise testing of the children with obesity. Pediatr Cardiol, 1999,20:79-83
90 Maffeis C, Schena F, Zaffanello M, Zoccante L, Schutz Y, Pinelli L. Maximal aerobic power during running and cycling in obese and non-obese children. Acta Paediatr, 1994, 83(1):113-116.
91 Zanconato S, Baraldi E, Santuz P, Rigon F, Vido L, Da Dalt L, Zacchello F. Gas exchange during exercise in obese children. Eur J Pediatr, 1989, 148(7):614-617.
92 Reybrouck T, Weymans M, Vinckx J, Stijns H, Vanderschueren-Lodeweyckx M. Cardiorespiratory function during exercise in obese children. Acta Paediatr Scand, 1987, 76(2):342-348.
93陆国平, 刘豫阳, 盛锋, 等. 健康学龄儿童平板运动时心率、血压变化及耐量测定. 中国实用儿科杂志, 2001, 16(8):492-495.
94郭颖, 周爱卿, 高伟, 等. 上海地区294例健康儿童平板运动试验的生理指标评价. 中华儿科杂志, 2003, 41(5):338-343.
95 Driscoll DJ. Exercise testing. In:Allen HD,Clark EB,Gutgesell HP, Driscoll DJ.eds.Moss and Adams` heart disease in infants,children,and adolescents: including the fetus and young adult.6th ed. Philadelphia: LWW, 2001. 264-275.
96 Nakajima T, Fujioka S, Tokunaga K, Matsuzawa Y, Tarui S. Correlation of intra-abdominal fat accumulation and left ventricular performance in obesity. Am J Cardiol, 1989, 64:369-373.
97 Alaud-din A, Meterissian S, Lisbona R, MacLean LD, Forse RA. Assessment of cardiac function in patients who were morbidly obese. Surgery, 1990,108:809-818.
98 Giordano U, Ciampalini P, Turchetta A, et al. Cardiovascular Hemodynamics:
Relationships with Insulin Resistance in Obese Children. Pediatr Cardiol, 2003, 24:548-552.
99 Reybrouck T, Mertens L, Schepers D, Vinckx J, Gewillig M. Assessment of cardiorespiratory exercise function in obese children and adolescents by body mass-independent parameters. Eur J Appl Physiol, 1997, 75: 478-483.
100 Kissebah AH, Krakower GR. Regional adiposity and morbidity. Physiol Rev, 1994, 74: 761-811.
101 Babb TG, Korzick D, Meador M, Hodgson JL, Buskirk ER. Ventilatory response of moderately obese women to submaximal exercise. Int J Obes, 1991,15:59-65.
102 Maffeis C, Schutz Y, Schena F, Za.aneloo M, Pinelli L. Energy expenditure during walking and running in obese and nonobese prepubertal children. J Pediatr, 1993, 123:193-199.
103 Urbina EM, Gidding SS, Bao W, Pickoff AS, Berdusis K, Berenson GS. Effect of body size, ponderosity, and blood pressure on left ventricular growth in children and young adults in the Bogalusa Heart Study. Circulation, 1995, 91: 2400–2406.
104 Verdecchia P, Schillaci G, Borgioni C, Ciucci A, Gattobigio R, Zampi I, Reboldi G, Porcellati C. Prognostic significance of serial changes in left ventricular mass in essential hypertension. Circulation, 1998, 97:48–54.
105 Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath CW Jr. Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med,1999, 341: 1097–1105.
106 de Simone G, Devereux RB, Daniels SR, Koren MJ, Meyer RA, Laragh JH.Effect of growth on variability of left ventricular mass: assessment of allometric signals in adults and children and their capacity to predict cardiovascular risk. J Am Coll Cardiol, 1995, 25:1056–1062.
107 Alpert MA. Obesity cardiomyopathy: pathophysiology and evolution of the clinical syndrome. Am J Med Sci, 2001, 321(4):225-236.
108毛霞, 马沛然, 金超, 等. 应用传统超声和多普勒组织显像检测单纯性肥胖小儿左心结构和左心功能. 中国当代儿科杂志, 1999, 1(2): 71-74.
109郭文彬, 刘传玺, 梁皓, 等. 超声心动图评价单纯肥胖对心脏结构及功能的影响. 医学影像学杂志, 1999, 9(2): 100-102.
110 Lauer MS, Anderson KM, Levy D. Separate and joint influences of obesity and mild hypertension on left ventricular mass and geometry: the Framingham Heart Study. J Am Coll Cardiol, 1992 ,19(1):130-134.
111 de Simone G, Devereux RB, Roman MJ, Alderman MH, Laragh JH. Relation of obesity and gender to left ventricular hypertrophy in normotensive and hypertensive adults.Hypertension, 1994, 23(5):600-606.
112Pascual M, Pascual DA, Soria F, Vicente T, Hernandez AM, Tebar FJ, Valdes M. Effects of isolated obesity on systolic and diastolic left ventricular function. Heart, 2003, 89(10):1152-1156.
113 Zarich SW, Kowalchuk GJ, McGuire MP, Benotti PN, Mascioli EA, Nesto RW. Left ventricular filling abnormalities in asymptomatic morbid obesity. Am J Cardiol, 1991, 68(4):377-381.
114 Chakko S, Mayor M, Allison MD, Kessler KM, Materson BJ, Myerburg RJ. Abnormal left ventricular diastolic filling in eccentric left ventricular hypertrophy of obesity. Am J Cardiol, 1991, 68(1):95-98.
115 Stoddard MF, Tseuda K, Thomas M, Dillon S, Kupersmith J. The influence of obesity on left ventricular filling and systolic function. Am Heart J, 1992, 124(3):694-699.
116 Fischer M, Baessler A, Hense HW, Hengstenberg C, Muscholl M, Holmer S, Doring A, Broeckel U, Riegger G, Schunkert H. Prevalence of left ventricular diastolic dysfunction in the community. Results from a Doppler echocardiographic-based survey of a population sample. Eur Heart J, 2003, 24(4):320-328.
117 Ailhaud G, Fukamizu A, Massiera F, Negrel R, Saint-Marc P, Teboul M.Angiotensinogen, angiotensin II and adipose tissue development. Int J Obes Relat Metab Disord, 2000, 24(suppl 4):S33–S35.
118 Giachetti G, Faloia E, Sardu C, et al. Gene expression of angiotensinogen in adipose tissue of obese patients. Int J Obes Relat Metab Disord, 2000, 24(suppl 2):S142–S143.
119 Karlsson C, Lindell K, Ottosson M, Sjostrom L, Carlsson LM. Human adipose tissue expresses angiotensinogen and enzymes required for its conversion to angiotensin II. J Clin Endocrinol Metab, 1998,83:3925–3929.
120 Cooper R, McFarlane-Anderson N, Bennett FI, et al. ACE, angiotensinogen and obesity: a potential pathway leading to hypertension. J Hum Hypertens, 1997, 11:107–111.
121 Weber MA, Smith DH, Neutel JM. Differing roles of body mass and the renin-angiotensin system in mediating the hypertension syndrome. Am J Nephrol,
2000,20:169–174.
122 Nickola MW, Wold LE, Colligan PB, Wang GJ, Samson WK, Ren J. Leptin attenuates cardiac contraction in rat ventricular myocytes: role of NO. Hypertension, 2000,36:501–505.
123 Liao Y, Cooper RS, Durazo-Arvizu R, Mensah GA, Ghali JK. Prediction of mortality risk by different methods of indexation for left ventricular mass. J Am Coll Cardiol, 1997,29:641–647.
124 Mitchell BM, Gutin B, Kapuku G, et al. Left Ventricular Structure and Function in Obese Adolescents: Relations to Cardiovascular Fitness, Percent Body Fat, and Visceral Adiposity, and Effects of Physical Training. Pediatrics, 2002,109(5): e73
125 Karason K, Wallentin I, Larsson B, Sj?str?m L. Effects of obesity and weight loss on left ventricular mass and relative wall thickness: survey and intervention study. BMJ, 1997, 315: 912-916.
126 Guo SS, Wu W, Chumlea WC, Roche AF. Predicting overweight and obesity in adulthood from body mass index values in childhood and adolescence. Am J Clin Nutr, 2002, 76(3):653-658.