银川市儿童青少年体脂百分比腰围与心血管病危险因素的关联
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摘要
目的分析银川市学龄儿童青少年体脂百分比(fat mass percentage,FMP)和腰围(waist circumference,WC)与心血管病危险因素的关联性,为防治儿童青少年心血管病发生提供依据。方法采用方便整群抽样的方法,抽取银川市1 043名12～18岁学龄儿童青少年,进行问卷调查、体格检查、体成分测定及生化检测。结果 FMP和WC均可预测儿童青少年发生血压偏高、高三酰甘油(TG)血症的风险(P值均<0.01),FMP和WC对心血管代谢异常的预测风险能力分别是心血管代谢正常组的1.14～2.36和1.32～2.09倍。FMP和WC结合对心血管病危险因素变异的解释(4.9%～22.1%)大于FMP或WC单独对其的解释(3.5%～22.0%),FMP对总胆固醇(TC)和低密度脂蛋白(LDL-C)的标准化回归系数(0.25和0.22)大于WC(0.17和0.14),FMP对收缩压(SBP),舒张压(DBP),TG,高密度脂蛋白(HDL-C)的标准化回归系数的绝对值小于WC。FMP肥胖联合WC肥胖组对血压偏高、高TG血症、高TC血症、低HDL-C血症和高LDL-C血症的预测风险分别是2个指标均正常组的3.67(95%CI=2.42～5.56)、3.09(95%CI=2.04～4.69)、3.37(95%CI=1.38～8.28)、2.00(95%CI=1.35～2.98)和4.73(95%CI=2.15～10.44)倍(P值均<0.01),高于其他不同组合对心血管病危险因素的风险预测。结论FMP和WC均可作为预测学龄儿童青少年心血管病危险因素的检测指标。建议将FMP与WC结合起来预测学龄儿童青少年罹患心血管疾病的风险。
Objective To analyze the association between fat mass percentage(FMP) and waist circumference(WC) with cardiovascular risk factors in children and adolescents in Yinchuan City, and to provide a reference for preventing and contyolling the risk factors of cardiovascular diseases among children and adolescents. Methods A questionnaire survey, physical examination, body composition determination and biochemical tests were conducted among 1 043 children aged 12-18 years in Yinchuan selected through a convenient cluster sampling method. Results Among boys and girls, both FMP and WC were associated with high rate of high blood pressure and high TG in children and adolescents(P<0.01). The increased risk of metabolic abnormalities by FMP and WC were 1.14-2.36 times and 1.32-2.09 times, respectively. About 4.9%-22.1% of cardiovascular disease risk was explained by the combination of FMP and WC, which was significantly higher than separate interpretation of FMP or WC(3.5%-22.0%). Standardized regression coefficient for TC and LDL-C(0.25 and 0.22) was greater than WC(0.17 and 0.14) by FMP, and the absolute value of the standardized regression coefficient for SBP, DBP, TG, HDL-C was less than WC by FMP. The predictive risk for high blood pressure, high TG, high TC, low HDL-C and high LDL-C by combination of FMP and WC was 3.67(95%CI=2.42-5.56), 3.09(95%CI=2.04-4.69), 3.37(95%CI=1.38-8.28), 2.00(95%CI=1.35-2.98) and 4.73(95%CI=2.15-10.44) times higher than different combinations risk groups(P<0.01). Conclusion The ability of fat mass percentage and waist circumference to predict the risk of cardiovascular risk factors is similar. It might be used as a predictor of cardiovascular risk factors in children and adolescents. It is recommended to combine FMP with WC to predict the risk of cardiovascular disease among children and adolescents.
Objective To analyze the association between fat mass percentage(FMP) and waist circumference(WC) with cardiovascular risk factors in children and adolescents in Yinchuan City, and to provide a reference for preventing and contyolling the risk factors of cardiovascular diseases among children and adolescents. Methods A questionnaire survey, physical examination, body composition determination and biochemical tests were conducted among 1 043 children aged 12-18 years in Yinchuan selected through a convenient cluster sampling method. Results Among boys and girls, both FMP and WC were associated with high rate of high blood pressure and high TG in children and adolescents(P<0.01). The increased risk of metabolic abnormalities by FMP and WC were 1.14-2.36 times and 1.32-2.09 times, respectively. About 4.9%-22.1% of cardiovascular disease risk was explained by the combination of FMP and WC, which was significantly higher than separate interpretation of FMP or WC(3.5%-22.0%). Standardized regression coefficient for TC and LDL-C(0.25 and 0.22) was greater than WC(0.17 and 0.14) by FMP, and the absolute value of the standardized regression coefficient for SBP, DBP, TG, HDL-C was less than WC by FMP. The predictive risk for high blood pressure, high TG, high TC, low HDL-C and high LDL-C by combination of FMP and WC was 3.67(95%CI=2.42-5.56), 3.09(95%CI=2.04-4.69), 3.37(95%CI=1.38-8.28), 2.00(95%CI=1.35-2.98) and 4.73(95%CI=2.15-10.44) times higher than different combinations risk groups(P<0.01). Conclusion The ability of fat mass percentage and waist circumference to predict the risk of cardiovascular risk factors is similar. It might be used as a predictor of cardiovascular risk factors in children and adolescents. It is recommended to combine FMP with WC to predict the risk of cardiovascular disease among children and adolescents.
引文
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[16] 张艳芬,佟伟军,刘洋,等.代谢综合征与心脑血管病及死亡前瞻性队列研[J].中国公共卫生,2013,29(10):1405-1409.
[17] 李晶晶,吴旭龙,王玲,等.肥胖儿童身体测量指标及体脂率与心血管代谢指标的关联[J].中国儿童保健杂志,2014,22(11):1130-1133.
[18] 杜松明,李艳平,房红芸,等.不同类型肥胖与心血管疾病危险因素关联的比较[J].中华流行病学杂志,2010,31(6):626-632.
[19] THOMAS G N,HO S Y,LAM K S,et al.Impact of obesity and body fat distribution on cardiovascular risk factors in Hong Kong Chinese[J].Obes Res,2004,12(11):1805-1813.
[20] 陶瑞文,万宇辉,张辉,等.安徽省儿童青少年高血压与体脂百分比关联性研究[J].中华流行病学杂志,2016,37(2):178-182.
[21] ZHANG Y X,WANG S R.Relationship between body composition index and blood pressure among children aged 7-12[J].Chin J Epidemiol,2010,31(10):1135-1138.
[22] 刘笑.儿童青少年腰围的研究进展[J].当代体育科技,2018,8(33):229-230.
[23] 荣右明,程宁,何彩丽,等.体质量指数、腰围与高血压的关系[J].中华高血压杂志,2018,26(4):379-383.
[2] CHUNG S T,ONUZURUIKE A U,MAGGE S N.Cardiometabolic risk in obese children[J].Ann New York Acad Sci,2018,1411(1):166-183.
[3] SEO Y,CHOI M,KANG J,et al.Cardiovascular disease risk factor clustering in children and adolescents:a prospective cohort study[J].Arch Dis Child,2018,103(10):968-973.
[4] KOSKINEN J,MAGNUSSEN C G,SINAIKO A,et al.Childhood age and associations between childhood metabolic syndrome and adult risk for metabolic syndrome,type 2 diabetes mellitus and carotid intima media thickness:the international childhood cardiovascular cohort consortium[J].J Am Heart Assoc,2017,6(8):e005632.
[5] 姜勇,赵文华.成人肥胖的评价方法、指标及标准在公共卫生中应用的研究进展[J].卫生研究,2013,42(4):701-705,711.
[6] SHEIBANI H,ESMAEILI H,TAYEFI M,et al.A comparison of body mass index and percent body fat as predictors of cardiovascular risk factors[J].Diab Metab Syndr,2019,13(1):570-575.
[7] 全国学生体质与健康调研组.2014年全国学生体质与健康调研手册[M].北京:高等教育出版社,2014.
[8] FALKNER B,DANIELS S R.Summary of the fourth report on the diagnosis,evaluation,and treatment of high blood pressure in children and adolescents[J].Hypertension,2004,44(4):387-388.
[9] 马冠生,季成叶,马军,等.中国7～18岁学龄儿童青少年腰围界限值研究[J].中华流行病学杂志,2010,31(6):609-615.
[10] 范晖,闫银坤,米杰.中国3～17岁儿童性别、年龄别和身高别血压参照标准[J].中华高血压杂志,2017,25(5):428-435.
[11] American Academy of Pediatrics.Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents:summary report[J].Pediatrics,2011,125(S5):213-256.
[12] CORNIER M,DESPRéS J,DAVIS N,et al.Assessing adiposity:a scientific statement from the American heart association[J].Circulation,2011,124(18):1996-2019.
[13] WAN C S,WARD L C,HALIM J,et al.Bioelectrical impedance analysis to estimate body composition,and change in adiposity,in overweight and obese adolescents:comparison with dual-energy x-ray absorptiometry[J].BMC Pediatr,2014,14(1):249.
[14] ANDAKI A C R,MENDES E L,SANTOS A,et al.Waist circumference percentile curves as a screening tool to predict cardiovascular risk factors and metabolic syndrome risk in Brazilian children[J].Cad Saúd Públic,2018,34(9):e105317.
[15] BROWNING L M,HSIEH S D,ASHWELL M.A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes:0.5 could be a suitable global boundary value[J].Nutr Res Rev,2010,23(2):247-269.
[16] 张艳芬,佟伟军,刘洋,等.代谢综合征与心脑血管病及死亡前瞻性队列研[J].中国公共卫生,2013,29(10):1405-1409.
[17] 李晶晶,吴旭龙,王玲,等.肥胖儿童身体测量指标及体脂率与心血管代谢指标的关联[J].中国儿童保健杂志,2014,22(11):1130-1133.
[18] 杜松明,李艳平,房红芸,等.不同类型肥胖与心血管疾病危险因素关联的比较[J].中华流行病学杂志,2010,31(6):626-632.
[19] THOMAS G N,HO S Y,LAM K S,et al.Impact of obesity and body fat distribution on cardiovascular risk factors in Hong Kong Chinese[J].Obes Res,2004,12(11):1805-1813.
[20] 陶瑞文,万宇辉,张辉,等.安徽省儿童青少年高血压与体脂百分比关联性研究[J].中华流行病学杂志,2016,37(2):178-182.
[21] ZHANG Y X,WANG S R.Relationship between body composition index and blood pressure among children aged 7-12[J].Chin J Epidemiol,2010,31(10):1135-1138.
[22] 刘笑.儿童青少年腰围的研究进展[J].当代体育科技,2018,8(33):229-230.
[23] 荣右明,程宁,何彩丽,等.体质量指数、腰围与高血压的关系[J].中华高血压杂志,2018,26(4):379-383.