中国六城市学龄儿童代谢综合征流行现状研究

Prevalence of metabolic syndrome of children and adolescent students in Chinese six cities

目的分析中国汉族学龄儿童代谢综合征（MS）流行现状，比较两种儿童青少年MS定义（中国：简称MS-CHN2012，国际糖尿病联盟：简称MS．IDF2007）在人群中的诊断效率。方法对我国北部地区（北京、天津）、东部（杭州、上海）、中西部（重庆和南宁）六城市2010年22071名（男性11638名，女性10433名）7-16岁中小学生的流行病学调查资料进行分析；分别采用上述两种定义诊断MS并比较两者诊断的一致性。结果（1）7～16岁学龄儿童中，19．9％为超重及肥胖，肥胖占8．9％，男性10．9％，女性6．6％（P〈0．001）。（2）肥胖患病率依次为：北部16．9％、中西部5．9％、东部4．9％，差异有统计学意义（X。=1．007×103，P〈0．001）。（3）两种定义界定的MS，在7～16岁学龄儿童中分别为2．4％和1．4％，在肥胖人群中分别为28．8％和16．8％；不同定义所得的患病率差异有统计学意义（P〈0．001）。（4）两种定义诊断一致率达98．9％（Kappa值为0．711，P〈0．001）。结论7—16岁学龄儿童超重及肥胖已达19．9％，需引起高度重视；MS—CHN2012和MS—IDF2007两种定义在儿童青少年MS诊断上具有较好的一致性，而MS．CHN2012定义能较早检出MS高风险儿童青少年，有利于早期实行防治措施并降低成年期MS的发生风险。

Objective To investigate the prevalence of obesity and metabolic syndrome in Chinese children and adolescents and to evaluate clinical applications of two definitions of metabolic syndrome in children and adolescents developed by The Society of Pediatrics, Chinese Medical Association in 2012 （ MS- CHN2012） and by International Diabetes Federation in 2007 （MS-IDF2007）, respectively. Method Totally 22 071children （11 638 were boys and 10 433 were girls） aged 7 to 16 years from 6 representative geographical areas, including Beijing, Tianjin, Hangzhou, Shanghai, Chongqing and Nanning, were surveyed in a random cluster sample in Chinese. Anthropometric parameters and blood pressure were determined. Fasting blood glucose, fasting blood triglyceride, total cholesterol, and high-density lipoprotein cholesterol （HDL-C） levels were measured. Then non-high-density lipoprotein cholesterol （non-HDL-C） levels were calculated. The diagnostic concordance of the two definitions for metabolic syndrome （ MS- CHN2012 and MS-IDF2007） and its individual components were estimated. Result （ 1 ） The prevalence of overweight and obesity was 19.9% in 7 - 16-year-old teenagers and the prevalence of obesity was 8.9%. The prevalence of obesity in boys was higher than in girls （10.9% vs. 6.6%, P 〈0.001）. （2） The prevalence of obesity in Northern region （Beijing, Tianjin） , Midwest region（ Chongqing and Nanning）and Eastern region （ Hangzhou, Shanghai ） were significantly different （ X2 = 1. 007 103, P 〈 0. 001 ） , the prevalence of obesity in Northern region was the highest （ 16. 9% ） , in Midwest was 5.9% and in the Eastern region was the lowest （4. 9% ）. The prevalence of obesity in boys was higher than in girls （ 10. 9%vs. 6.6% , P 〈0. 001 ）. （3） The prevalence of MS diagnosed by MS-CHN2012 and MS-IDF2007 in 7 - 16- year-old teenagers were 2. 4% and 1.4%, respectively, and in obese subjects were 28.8% and 16. 8%, respectively. The prevalence of MS diagnosed by MS-CHN2012 was higher than that diagnosed by MS- IDF2007 （P 〈 0. 001 ）. （4） The concordance between the two definitions for diagnosing metabolic syndrome was good （kappa = 0. 711 ） ; as for detecting the individual components, the Kappa concordance index was 1. 000, O. 818, O. 713, 0. 686 for hyperglycemia, cholesterol abnormality, hypertriglyceridemia and hypertension, respectively. Conclusion （ 1 ） The prevalence of overweight and obesity was 19.9% in 7 - 16-year-old teenagers and the prevalence of obesity was 8.9% , which was higher in boys than in girls. The obesity of children had uneven geographical distribution and the Northern region was higher than the other. （2） The concordance between MS-CHN2012 and MS-IDF2007 definitions for diagnosing metabolic syndrome in Chinese children and adolescents was good. Compared with MS-IDF2007 definition, MS-CHN2012 definition was more effective to detect high risk of MS in children and adolescents and to reduce the risk of the occurrence of MS in adulthood.