不同肥胖程度儿童罹患心血管代谢异常风险的横断面调查

The cross-sectional study of cardiom etabolic risk factors in obese children and adolescents

目的通过对肥胖学生健康评估体检,了解不同肥胖程度儿童青少年罹患高血压、高血糖和血脂异常等心血管代谢异常风险现况。方法采用现况调查方法,对北京市西城区、海淀区和密云县17所中小学2012至2013年度参加学校常规年度体检并以BMI为评价指标筛查为肥胖的学生,进行以健康风险评估为目的的临床体检,体检内容包括体量(身高、体重及体质成分),血压,空腹血糖,血脂(总胆固醇、三酰甘油、高密度脂蛋白和低密度脂蛋白)等指标。采用中国肥胖问题工作组(WGOC)制定的BMI超重、肥胖筛查标准判定肥胖状态;采用中国儿童青少年血压参照标准评定儿童高血压;采用儿童青少年血脂异常防治专家共识推荐的中国2岁以上儿童青少年血脂异常诊断标准判断血脂异常;以空腹血糖作为评价指标,采用美国糖尿病联盟推荐糖尿病诊断和分类标准进行评价。结果 1 809/3 227名(56.1%)肥胖学龄儿童青少年完成了现况调查且具有完整体检数据,平均年龄12.2岁。肥胖学生心血管代谢异常指标检出率分别为:高血压30.8%,血脂异常43.3%,糖尿病和空腹血糖受损66.6%,肝功能异常11.6%,脂肪肝16.0%,黑棘皮症21.9%。肥胖男生高血压、空腹血糖受损、肝功能异常、脂肪肝和2项及以上心血管代谢异常检出率均高于肥胖女生。重度肥胖占总肥胖人数的29.9%,协方差分析调整年龄和性别后,重度肥胖学生高血压、肝功能异常、脂肪肝、黑棘皮症和2项及以上心血管代谢异常检出率均高于轻中度肥胖学生。结论肥胖儿童青少年高血压、高血糖和血脂代谢紊乱等心血管代谢异常高发,心血管代谢异常随肥胖程度增加呈上升趋势;儿童肥胖相关心血管代谢异常高发需要得到更广泛关注。

Objective To determine the prevalence of cardiometabolic risk factors such as hypertension, diabetes and dyslipidemia through health assessment examination among obese children and adolescents. This study was based on 1 809obese children and adolescents, aged 7 to 17 years from 17 schools in Beijing. The data of anthropometric measurements were collected, including weight, height , body composition and age. All subjects had a clinic examination containing a fasting blood, blood pressure and liver ultrasonography. Overweight, obesity- and severe obesity- were assessed by WGOC criteria with BMI. Results： A total of 1 809 children and adolescents were recruited in the examination. The prevalence of hypertensnion, dyslipidemia and impaired fasting glucose （ IFG） was 30.8% ,43.3% and 66.6% while the prevalence of dysfunction of liver, non-alcohol fatty- liver, and acanthosis nigricans was 11.6% , 16.0% and 21.9% , the prevalence of hypertension,IFG, dysfunction of liver,non-alcohol fatty- liver and the proportion of children with 2 or more cardiometabolic risk factors in males was higher than that in females. Severe obesity- contributed 29. 9% to the obese children and adolescents, the prevalence of hypertension, dyslipidemia, hepatic dysfunction and non-alcohol fatty- liver in severe obesity- was higher than that in moderate obesity. The proportion of children with 2 or more cardiometabolic risk factors in severe obese children was higher than that in moderate obese children. Cardiometabolic risk factors （such as hypertension, diabetes and IFG, dyslipidemia） are common in obese children, the prevalence increases with obese degree. The cardiovascular metabolic dysfunction should be highly noticed.