上海肥胖超重中小学生糖脂代谢异常干预效果评价

Characteristics and health intervention of abnormal glucosepid metabolism in obese/overweight primary and secondary school students in Shanghai

目的研究肥胖和超重学生糖、脂代谢有关的生化指标特点及肥胖项目干预后的变化,为探索有效的肥胖干预效果评价指标提供依据。方法在上海市健康示范学院抽取1所小学和1所初级中学,筛查出55名肥胖学生,在超重、正常学生中按肥胖学生的年龄、性别进行配对;然后在未开展健康示范的学校中按干预学校学生的年龄、性别分别确定肥胖、超重学生各55名。各组对象均用相同年龄、性别的1∶1配对t检验分析。检测生化指标包括谷丙转氨酶(ALT)、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)、空腹血糖(FG)、空腹胰岛素(F ins)、HOMA胰岛素抵抗指数(HOMA-IR)。结果干预前,肥胖、超重学生的ALT、TG、空腹胰岛素、HOMA-IR均明显高于正常学生。ALT在肥胖、超重、正常学生分别为32,24,15 U/L,TG分别为1.03,0.92,0.80mmol/L,空腹胰岛素分别为14.70,12.34,5.97 IU,HOMA-IR分别为2.97,2.49,1.20。干预后,干预学校肥胖、超重学生的ALT、TG、空腹胰岛素、HOMA-IR均明显下降,肥胖组分别为20 U/L,0.90 mmol/L,11.93 IU,2.42,超重组分别为13 U/L,0.85 mmol/L,10.30 IU,2.05。同期对照学校干预后与干预前,肥胖学生ALT、空腹胰岛素、HOMA-IR明显上升,分别为32 U/L和26 U/L,20.76 IU和12.77 IU,4.57和2.56。结论肥胖、超重学生中存在明显的糖、脂代谢紊乱。健康示范学校创建项目能有效改善糖、脂代谢紊乱。在减肥评估中,除体重指标外,可增加一些生化指标,如ALT、HOMA-IR。

Objective To investigate biochemical characteristics of glucosepid metabolism in obese/overweight primary and secondary school students,observe changes after health intervention,discuss effective indices for evaluating the outcome of health intervention.Methods A total of 275 subjects,of whom 55 students were normal-weight students who only participated in baseline investigation,and the remaining 220 students were obsess/overweight students who participated in both baseline and intervention investigations.Subjects in all groups were analyzed by 1∶1 paired t test in terms of matched age and sex.Physical indices included height（H）,weight（W） and body mass index（BMI）,and biochemical indices included alanine aminotransferase（ALT）,total cholesterol（TC）,triglyceride（TG）,high-density lipoprotein cholesterol（HDL-C）,low-density lipoprotein cholesterol（LDL-C）,fasting glucose（FG）,fasting insulin（Fins）,and HOM-AIR.Results ALT,TG,Fins and HOMA-IR levels in obese/overweight students were significantly higher than those in normal-weight students before intervention.In obese,overweight and normal-weight students,ALT was 32,24 and 15 U/L;TG was 1.03,0.92 and 0.80mmol/L;Fins was 14.70,12.34 and 5.97IU;and HOMA-IR was 2.97,2.49 and 1.20,respectively.ALT,TG,Fins and HOMA-IR levels in obese/overweight students of intervention schools decreased significantly as compared with those before intervention.ALT,TG,Fins and HOMA-IR in obese group were 20U/L,0.90mmol/L,11.93 IU and 2.42;in overweight group were 13 U/L,0.85 mmol/L,2.05,respectively.ALT,Fins and HOMA-IR levels in obese students of the control schools increased significantly from 26U/L,12.77 IU and 2.56 to 32U/L,20.76IU and 4.57.Conclusion There is an evidence of glucosepid metabolism abnormalities in obese and overweight students.The intervention measures in the health demonstration schools are able to improve glucosepid metabolism abnormalities.In addition to body weight,certain biochemical indices such as ALT and HOMA-IR could also be used as evaluation indices.