中国7～10岁儿童腹型肥胖与血压的关系

Association between abdominal obesity and blood pressure among 7 to 10 years old Chinese children

目的分析中国7～10岁儿童腹型肥胖与血压的关系。方法采用2010年全国学生体质与健康调研数据，选取身高、体重、腰围和血压资料完整的7～10岁儿童青少年作为研究对象，共计40495名。利用中国肥胖工作组（WGOC）制定的BMI超重、肥胖筛查标准和腰围身高比（WHtR）〉0．46判定体形，将研究对象分为正常体形、单纯腹型肥胖、腹型肥胖合并外周型肥胖（简称复合型肥胖）和其他体形；以血压高于2010年全国学生同性别、同年龄收缩压和（或）舒张压第95百分位数（P）界值判定为血压偏高。描述单纯腹型肥胖、复合型肥胖和血压偏高的检m情况；并按相同性别、年龄（相差±0．5岁）、身高（相差±0．3cm）以1：1：1相互匹配正常体形、单纯腹型肥胖、复合型肥胖3种体彤儿童青少年，每组分别为2165名，利用x2检验、方差分析及多水平模型分析腹型肥胖与血压的关系。结果40495名研究对象，包括男生20175名，女生20320名；单纯腹型肥胖检出率为6．36％（2576／40495），男生为7．41％（1494／20175），女生为5．32％（1082／20320）；复合型肥胖检出率为16．33％（6611／40495），男生为21．30％（4298／20175），女生为11．38％（2313／20320）；男女生体形分布差异有统计学意义（X2：869．0l，P〈0．01）。血压偏高检m率为9．62％（3896／40495），男生[10．05％（2028／20175）]高于女生[9．19％（1868／20320）]（x。=8．59，P〈0．01）。复合型肥胖组收缩压、舒张压数值[男生：（103．8±11．3）、（64．7±10．1）mmHg（1mmHg=0．133kPa）；女生：（102．9±12．1）、（64．5±10．0）mmHg]，高于单纯腹型肥胖组[男生：（99．5±11．2）、（61．6±9．9）mmHg；女生：（99．6±11．4）、（62．6±9．3）mmHg]高于正常体形组[男生：（97．4±10．8）、（60．5±9．4）mmHg；女生：（97．2±10．8）、（60．8±9．4）mmHg]，差异有统计学意义（男生：F值分别为113．22、62．05；女生：F值分别为54．19、32．31，P值均〈0．01）。多水平分析结果示：复合型、单纯型肥胖组较正常体形组，男生收缩压分别升高6．0、1．8himHg（Waldx。值分别为17．55、204．94，P值均〈0．01），舒张压分别升高4．0、0．9inniHg（Waldx。值分别为6．37、114．05，P值均〈0．05）；女生收缩压分别升高5．0、2．1mmHg（Waldx。值分别为16．47、92．52，P值均〈0．01），舒张压分别高3．5、1．6mmHg（Waldx。值分别为12．29、57．52，P值均〈0．01）。单纯腹型肥胖男生收缩压偏高的风险高于正常体形男生[OR：1．48（95％C1：1．06～2．06）]，复合型肥胖男[收缩压：OR=3．06（95％CI：2．28～4．11）；舒张压：OR=2．72（95％C／：1．99～3．72）]、女生[收缩压：OR=2．48（95％CI：1．75～3．53）；舒张压：0R=2．64（95％CI：1．82～3．93）]收缩压和舒张压偏高的风险均高于正常体型者。结论单纯腹型肥胖是儿童青少年血压升高的相关因素，复合型肥胖与血压升高的关系更为密切。

Objective To analyze the association between abdominal obesity and blood pressure among 7 - 10 years old Chinese children. Methods A total of 40 495 children aged 7 - 10 years with complete height, weight, waist circumference and blood pressure data were chosen from the data of 2010Chinese National Survey on Students Constitution and Health. Based on the ＂Reference Norms for Screening Overweight and Obesity in Chinese Children and Adolescents＂ developed by Working Group Obesity in China （WGOC） and the waist to height ratio reference value for children （WHtR ~〈 0. 46）, the children were divided into 4 body types （normal weight, simple abdominal obesity, combined obesity and other types）. High blood pressure was defined as the systolic blood pressure （SBP） and/or diastolic blood pressure （DBP） higher than the P^5 blood pressure value of 2010 national student of the same gender and age. The prevalence of simple abdominal obesity, combined obesity and high blood pressure were described. Three groups （with 2165 ehihtren in each） of children with normal weight, simple abdominal obesity, combined obesity respectively were selected fi＇om the chosen ones matched by gender, age （within _＋ 0. 5 years old） and height （within _＋ 0. 3 era） at the ratio of l ： 1 ： 1. The value of blood pressure and prevalence of high blood pressure were described. X2 test, analysis of variance and multilevel models were used to analyze the relationship between obesity and blood pressure. Results A total of 40 475 children were selected from the database, including 20 175 boys and 20 320 girls. The prevalence of simple abdominal obesity was 6.36% （2576/40 495 ）, the prevalence of boys and girls was 7.41% （ 1494/20 175 ） and 5.32% （ 1082/20 320） respectively. The prevalence of combined obesity was 16.33% （6611/40 495） , the prevalence of boys and girls was 21.30% （ 4298/20 175 ） and 11.38% （ 2313/20 320） respectively. There were statistical ditl^rences in the body type distribution of both boys and girls （X2 = 869.01 ,P 〈0. 01 ）. The prevalence of high blood pressure was 9. 62% （ 3896/40 495 ）, the prevalence of boys （ 10. 05% （2028/20 175 ） ） was higher than girls （9. 19% （ 1868/20 320） ） （ X2 ^- 8.59, P 〈 0. 01 ）, The value of SBP and DBP among combined obesity group （boys： （ 103.8 ＋ 11.3）, （64. 7 ＋ 10. 1） mm Hg （1 mm Hg =0. 133 kPa） ; girls： （102.9_＋12.1）, （64.5 _＋10.0） mm Hg） 〉 simple abdominal obesity group （boys： （99.5 -＋11.2）, （61.6_＋9.9） mm Hg; girls： （99.6_＋11.4）, （62.6-＋9.3） mm Hg） 〉 normal weight group （boys： （97.4_＋ 10.8）, （60.5 _＋9.4） mm Hg; girls： （97.2 ＋ 10.8）, （60.8 ＋9.4） mm Hg）, and the dillerences were statistical significant （ Fl,,v~ ： 113.22, 62.05 ; Fgi^l~ ： 54. 19, 32. 31, P 〈 0. 01 ）. According to the results of nmltilevel model, among boys, compared with the normal weight group, the SBP of combined obesity group and simple abdominal obesity group was 6. 0 and 1.8 mm Hg higher respectively （ Wahl Xz ： 17.55, 204. 94, P 〈 0.01 ） ; the DBP was 4. 0 and 0. 9 mm Hg higher respectively （ Wald X2 ： 6. 37, 114.05, P 〈 0. 05 ）. Among girls, the SBP was 5.0 and 2. 1 mm Hg higher respectively （Wald X2 ： 16.47, 92.52, P 〈 0. 01 ） ; the DBP was 3.5 and 1.6 mm Hg higher respectively （ Wald X2 ： 12. 29, 57.52, P 〈0. 01 ）. Comparing with normal group, the risk of high SBP among boys with simple abdominal obesity was higher （OR = 1.48; 95% CI： 1.06 - 2.06） , and both the boys （SBP： OR = 3.06; 95% CI： 2. 28-4.11）; DBP： 0R=2.72; 95%CI： 1.99-3.72） and girls （SBP： 0R=2.48; 95%CI： 1.75- 3.53 ; DBP： OR = 2.64 ; 95% CI： 1.82 - 3.93 ） in combined obesity group had a higher risk of high SBP and high DBP. Conclusion Simple abdominal obesity is associated with the increasing of blood pressure in children, and combined obesity has a closer ties than simple abdominal obesity.