中国肥胖人群体脂分布特点及其与心血管危险因素的关系

Body Fat Distribution: Its Characteristics and Relationship to Cardiovascular Risk Factors in Obese Chinese

目的 探讨中国肥胖人群体脂分布特点及其与心血管危险因素的关系。方法 横断面研究 ,体脂分布采用计算机断层扫描对 30 9例志愿受试者在腰椎 4～ 5间隙水平进行腹壁皮下脂肪面积 (SA)及腹腔内脏器脂肪面积 (VA)的测量 ,并计算 VA与 SA的比值 (VSR) ,同时测量收缩压 (SBP)、舒张压 (DBP) ,空腹甘油三酯 (TG)、胆固醇 (TC)、高密度脂蛋白胆固醇 (HDL - c)、低密度脂蛋白胆固醇 (L DL - c) ,血尿酸 (UA ) ,体质量 (W)、身高 (H) ,并计算体重指数 (BMI)。结果 1无论男女 ,其 VSR均高于欧美肥胖人群 ;内脏型肥胖 (VFO)的年龄、TG及 L DL- c均显著的高于腹壁皮下型肥胖 (SFO) ;在男性 ,VFO的 TC、UA高于 SFO。 2以 VSR在男女两组配对分析 ,发现男性 U A、TG水平均高于女性受试者。3偏相关分析 ,在校正年龄和 BMI后 ,无论男女 ,VSR与 TG、L DL- c呈正相关 ,SA与 L DL- c呈负相关 ;在男性 ,VA与 SBP呈正相关 ,SA与 TG呈负相关 ;在女性 ,VA与 TG、L DL- c呈正相关 ,SA与 L DL- c负相关 ,与 HDL- c、UA呈正相关。 4多元逐步回归分析显示 ,在男性受试者 ,SA、VA和 VSR分别是 TG和 L DL - c、SBP以及 TC的独立危险因素 ;在女性受试者 ,BMI和 SA是影响 SBP、U A和 HDL - c的重要因素 ,VSR是 TG、L DL -

Objective To investigate the distribution of body fat and analyze its characteristics and relationship with metabolic variables in obese Chinese. Methods In this observational, cross sectional study, the total body fat mass was measured using body mass index (BMI), and as an index of intra-abdominal fat accumulation, the ratio of the visceral (VA) to abdominal subcutaneous(SA) adipose area (VSR) was determined using a computed tomography (CT) scans made at the level of L4/L5 in 309 obese human subjects (male 88; female 221).Blood pressure(BP),fasting serum lipids such as triglycerides(TG), total cholesterol(TC), high density lipoprotein(HDL-c), low density lipoprotein(LDL-c), and serum uric acid(UA) were also determined. Results ① There were no differences between the male and the female subjects in regard to age, BMI, SBP, LDL-c and HDL-c. SA was significantly greater in women, whereas VA and VSR were significantly greater in men; DBP, UA, TC and TG were significantly higher in men than in women. ② In both men and women, VSR was significantly higher in obese Chinese than in obese European and Americans. Age, TG and LDL-c were higher in subjects with visceral fat obesity (VFO) than in those with subcutaneous fat obesity (SFO). In males, TC,UA were significantly higher in VFO than in SFO. ③ 57 paired cases of male and female subjects matched for VSR were studied, and significant higher levels of serum UA and TG were noted in the male than in the female subjects. ④ After being adjusted for age and BMI, the analyses of partial correlation showed that in both men and women, VSR was positively correlated with TG and LDL-c, and SA was negatively correlated with LDL-c. In men, VA was positively correlated with SBP, and SA was negatively correlated with TG. In women, VA was positively correlated with TG, LDL-c; SA was negatively with LDL-c, but it was positively correlated with HDL-c and UA. ⑤ Stepwise multiple regression analysis showed that SA, VA, VSR were independent predictor for TG and LDL-c, SBP, and TC respectively (adjusting R 2=0.079, 0.193, 0.122, 0.072, P=0.005, 0.000, 0 001, 0 007, respectively) in males. In females. VSR was an independent predictor for TG and LDL-c (adjusting R 2=0 024, 0.113, P=0.012, 0.000 respectively); both BMI and SA were important predictors for UA and HDL-c, and SA was an important predictor for SBP. Conclusion The above data suggest that in obese Chinese, the body fat distribution is characterized by central obesity, the cardiovascular risk factors are not only associated with general obesity but more closely associated with regional body fat distribution (VFO), and the relationships between regional body fat distribution and metabolic variables vary with gender.