超重肥胖患者心血管相关危险因子与体成分构成的关系

The relationship between cardiovascular risk factors and body compositions in overweight and obese patients

目的探讨超重肥胖患者常见心血管相关危险因子与体成分构成的关系。方法入选体质量指数（BMI）≥25或23-25kg/m2但腰围增加[≥90（男）、≥80cm（女）]的体检人员1341名作为超重肥胖组（男性664名,女性677名）。非肥胖组为BMI〈25kg/m^2且当BMI为23-25kg/m2时腰围无增加[〈90（男）、〈80cm（女）],共1679名作为参照。检测研究对象身高、体质量、血脂、血糖、血压。采用双能X线骨密度仪（DEXA）检测身体各部位脂肪、瘦组织质量。结果躯干脂肪/下肢脂肪质量（TF/LF）与超重肥胖组心血管相关危险因子发生的相关性（r=0.291,P〈0.01）高于全身脂肪/体质量（BF/M,r=-0.078）和躯干脂肪/体质量（TF/M,r=0.047）。BMI和TF/LF预测超重肥胖组常见心血管相关危险因子发生对应的临界值分别为26.03kg/m^2和2.09,TF/LF的预测价值高于BMI[曲线下面积（AUC）0.684±0.016比0.628±0.017,P〈0.01];BMI（OR=1.250,95%CI 1.120-1.395）,TF/LF（OR=4.498,95%CI2.818-7.181）与超重肥胖患者心血管相关危险因子的发生呈正相关,TF/LF对超重肥胖组心血管相关危险因子的发生重要性最大（b′=0.418）;与BMI〈26.03kg/m^2且TF/LF〈2.09组比较,BMI≥26.03kg/m^2且TF/LF〈2.09组心血管相关危险因子发生的风险是其2.473倍（95%CI 1.516-4.032）,BMI〈26.03kg/m^2且TF/LF≥2.09组是其2.915倍（95%CI 1.823-4.661）,BMI≥26.03kg/m^2且TF/LF≥2.09组是其3.894倍（95%CI 2.250-6.737）;风险呈增加趋势（χ^2trend=108.3,P〈0.01）。结论 TF/LF是超重肥胖患者发生常见心血管相关危险因子的一个更有力的独立关联因素。在对超重肥胖心血管相关危险因子管理上,亦应注重体成分与其关系,而体脂的分布重要性远大于BMI,超重肥胖患者TF/LF宜保持于〈2.09。

Objective To evaluate the relationship between body compositions and cardiovascular risk factors in overweight and obesity patients. Methods A total of 1341 participants with body mass index（BMI）≥25or 23-25kg/m^2 with high waist circumference（≥90cm for males and≥80cm for females）were recruited from the First Affiliated Hospital of Fujian Medical University as the overweight and obese group. 1679 participants with BMI25kg/m^2 and BMI of 23-25kg/m^2 with normal waist circumference（90cm for males and 80cm for females）were recruited as the non-obese group. Data including age,sex,body height and weight,BMI,systolic/diastolic blood pressure,blood lipids,and blood glucose were collected. Dual-energy X-ray absorptiometry was performed to measure fat and lean tissue mass. Results Correlation of trunk fat/leg fat mass（TF/LF）with cardiovascular risk factors was stronger than with body fat content（BF/mass）or trunk fat content（TF/mass）（r=0.291,-0.078 and 0.047,respectively）. Receiver operating characteristic（ROC）curve analyses indicated that the cutoff values of BMI and TF/LF were 26.03kg/m^2 and 2.09,respectively,and the predictive capability of TF/LF was higher than that of BMI（area under the curve or AUC：0.684±0.016 vs 0.628±0.017,P0.01）. Moreover,BMI（OR=1.250;95% CI1.120-1.395）and TF/LF（OR=4.498;95% CI2.818-7.181）were significantly associated with increased cardiovascular risk in overweight and obesity patients,especially for the contribution of TF/LF（b＇=0.418）. Compared with patients with BMI26.03kg/m^2 and TF/LF 2.09 simultaneously,the odds of developing cardiovascular risk factors was 2.473（95% CI1.516-4.032）in patients with BMI≥26.03kg/m^2 and TF/LF2.09,2.915（95% CI 1.823-4.661）in patients with BMI26.03kg/m2 and TF/LF≥2.09,and3.894（95% CI 2.250-6.737）in patients with BMI≥26.03kg/m^2 and TF/LF≥2.09,respectively,and there was an increasing trend（χ^2=108.3;P0.01 for trend）. Conclusions TF/LF is a powerful independent predictor for cardiovascular risk factors in overweight and obesity patients. Moving forward from the management of obesity complication,much attention should be placed on its relationship with body composition,especially for body fat distribution,which adds more weight than BMI. It is also recommended to keep the TF/LF of overweight and obesity patients below 2.09.