超重肥胖中小学生糖脂代谢紊乱的流行病学研究

Epidemiologic Study of Glucose and Lipid Metabolic Disturbances in Obese and Overweight Primary and Secondary School Students in Shanghai

目的研究肥胖和超重学生糖脂代谢紊乱的特点,为干预儿童青少年肥胖、超重提供依据。方法选取营养监测点学校546名肥胖、超重、正常学生,按照1∶1∶1配对,检测空腹血糖(FG)、胰岛素(Fins)、胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、谷丙转氨酶(ALT),肝脏B超检查脂肪沉积,计算胰岛素抵抗指数(HOMA-IR),分析代谢异常的年龄、性别分布以及检测结果与BMI值的相关性。结果肥胖、超重学生的Fins明显高于对照组,但未出现明显的高胰岛素血症;肥胖、超重学生的HOMA-IR明显高于对照组,出现明显的胰岛素抵抗(IR)。肥胖、超重学生的TG明显高于对照组,并出现明显异常;肥胖学生的HDL-C降低,但未出现明显异常。肥胖、超重学生肝脏脂肪沉积率及ALT明显高于对照组,肥胖学生出现明显的ALT异常,超重学生尚未出现明显的ALT异常。IR异常、TG异常、肝脏脂肪沉积、ALT异常中学生高于小学生。肝脏脂肪沉积、ALT异常表现为男生高于女生。HOMA-IR,TG,ALT与BMI值呈正相关,HDL-C与BMI值呈负相关,未发现FG,TC,LDL-C与BMI值相关。结论肥胖、超重学生存在明显的IR和TG升高、肝脏脂肪沉积,代谢紊乱对肝脏的损害男生高于女生。年龄越大、BMI值越高,代谢紊乱越明显。必须尽早干预儿童青少年肥胖、超重,才能有效预防代谢综合征。

Objective To investigate characteristics of glucose and lipid metabolic disturbances in obese and overweight primary and secondary school students in Shanghai,and address the importance of intervention on obesity and overweight in children and adolescents.Methods FG,Fins,TC,TG,HDL-C,LDL-C and ALT were detected in 546 obesity/normal control and overweight/normal control paired students.In addition,liver fat precipitation was assessed by B type ultrasound,and HOMA-IR was calculated.Age and sex distribution of metabolic abnormality was analyzed.The correlation between the results obtained and BMI was studied.Results Fins of obese and overweight students was significantly higher than that of normal control students,though no significant hyper insulinemia occurred;HOMA-IR of obese and overweight students was significantly higher than that of normal control students,and insulin resistance（IR） was apparent in these students.TG of obese and overweight students was significantly and abnormally higher than that of normal control students;HDL-C of obese students was decreased,though not significantly abnormal;B type ultrasound reveled that liver fat precipitation of obese and overweight students was significantly higher than that of normal control students;ALT of the former was significantly higher than that of the latter;ALT abnormality was detected in obsess students.The percentage of IR,TG,liver fat precipitation and ALT abnormality was higher in secondary school students than that in primary school students;The percentage of liver precipitation and abnormal ALT was higher in male students than that in female students.HOMA-IR,TG and ALT were positively correlated with BMI;HDL-C was negatively correlated with BMI;no significant correlation was found between FG,TC,LDL-C and BMI.Conclusion IR,TG and liver fat precipitation are significantly increased in obese and overweight students.Liver impairment from metabolic disturbance in male students is more severe than that in female students.The older the age,the higher the BMI value,and the more evident the metabolic disturbance.Early intervention on obesity and overweight in children and adolescents should be addressed to prevent metabolic disturbances and related terminal events from occurring.