北京某三甲医院体检人群不同肥胖类型与骨密度及握力的相关性分析

Correlation of obesity type with bone mineral density and grip strength in health check-up population

目的探讨不同肥胖类型对骨密度和握力的影响。方法基于解放军总医院第一医学中心健康体检中心2018-2019年北京地区1026例健康体检人员,按照不同肥胖类型分组。肥胖的评价依据体质量指数(BMI≥24.0 kg/m^2)及腰围(男性WC≥90 cm、女性WC≥85 cm),将样本分为非肥胖组、单纯外周型肥胖组、单纯中心型肥胖组及外周合并中心型肥胖组。采用MEDIX90 X线双能骨密度仪进行骨密度测定,采用CAMRY EH101型握力计进行握力测定。比较不同肥胖类型人群骨密度和握力的差异。结果1026例体检者,男性537例(52.3%),平均年龄为(50.06±15.34)岁,平均BMI为24.29 kg/m^2,平均腰围为83.83 cm。握力测量值平均值为32.90 kg,骨密度测量值T值和Z值分别为-1.03和-0.51。BMI(r=0.437,P<0.001)和腰围(r=0.501,P<0.001)均与握力呈正相关,但与骨密度的相关性不大(仅骨密度Z值与腰围呈弱相关)。以BMI为标准,相对于体质量正常者,超重及肥胖者的握力较高[(30.19±8.43)kg vs(35.13±9.89)kg,P<0.001]、骨密度T值、Z值差异无统计学意义(P>0.05)。以腰围为标准,中心型肥胖者骨密度T值(Md:1.34 vs 0.92)和握力[(35.16±9.97)kg vs(31.51±9.06)kg,P<0.001]显著高于其他人群,但骨密度Z值差异无统计学意义(P>0.05)。合并BMI和腰围两个指标进行细分后发现,与非肥胖者、外周肥胖者、外周合并中心性肥胖者比较,单纯中心型肥胖者握力[(30.16±8.45)kg vs(30.78±8.25)kg、(34.50±9.64)kg和(35.48±10.01)kg]、骨密度T值(Md:-2.03 vs-0.92、-0.93和-1.26)、Z值(-1.19 vs-0.56、-0.38和-0.50)均为最低,差异均有统计学意义(P<0.05)。结论单纯中心型肥胖者,握力和骨密度均较差。

Objective To investigate the relationship of different obesity types with bone density and grip strength.Methods Totally 1026 participants undergoing health check-up in the First Medical Center of Chinese PLA General Hospital were included in the analysis.Obesity was defined according to body mass index(BMI≥24.0 kg/m^2)and waist circumstance(WC≥90 cm in male or≥85 cm in female),and then the sample was divided into non-obese,peripheral obese,central obese,peripheral and central obese groups.Bone mineral density(BMD)was measured by medix 90 X-ray dual energy bone densitometer,and grip strength was measured by CAMRY EH101 grip strength meter.Both of the two indicators were compared between the different obesity groups.Results There were 537 males and 489 females with the mean age of 50.06 years.The mean BMI was 24.29 kg/m^2 and the mean waist circumference was 83.83 cm.The mean value of grip strength was 32.90 kg,and the median value of T and Z values of BMD were-1.03 and-0.51,respectively.Grip strength were significantly correlated with BMI and WC(r=0.437 and 0.501,respectively),but BMD almost had no relationship with BMI and WC.Stratified by BMI,people in the overweight and obese group had significantly higher grip strength([30.19±8.43]kg vs[35.13±9.89]kg,P<0.001),similar BMD T value and BMD Z value(P>0.05).Stratified by WC,people in the central obese group had significantly higher BMD T value(Md:1.34 vs 0.92,P<0.01)and grip strengh([35.16±9.97]kg vs[31.51±9.06]kg,P<0.001).Stratified by both BMI and WC,people in the central obese group had the lowest grip strength([30.16±8.45]kg vs[30.78±8.25]kg,[34.50±9.64]kg,[35.48±10.01]kg),BMD T value(Md:-2.03 vs-0.92,-0.93,-1.26)and BMD Z value(Md:-1.19 vs-0.56,-0.38,-0.50)compared with the non-obese group,the peripheral obese group and the central and peripheral obese group(P<0.05,respectively).Conclusion Central obesity has greater impact on BMD and grip strength.