北京市某城区小学生肥胖与血糖表型的关联

Association of childhood obesity with glycemic phenotypes in Beijing

目的探讨儿童肥胖与血糖相关表型之间的关联及其对胰岛β细胞功能、胰岛素抵抗的影响,为早期预防和治疗糖尿病等代谢性疾病提供科学依据。方法方便选择北京市某城区8所小学2 066名6~14岁学生进行体格检查,测定空腹血糖、胰岛素水平。采用多元线性回归模型分析体质量指数(body mass index,BMI)与血糖相关表型的关联。结果不同BMI分组间,空腹血清胰岛素水平(fasting plasma insulin,FPI)、稳态模型胰岛β细胞功能指数(homeostasis model assessment of pancreatic beta cell function,HOMA-β)、稳态模型胰岛素抵抗指数(homeostasis model assessment of insulin resistance,HOMA-IR)、定量胰岛素敏感性检测指数(quantitative insulin sensitivity check index,QUICKI)差异均有统计学意义(F值分别为71.368,42.580,69.219,52.710,P值均<0.01)。多元线性回归分析结果显示,校正年龄、性别后,FPI,HOMA-β,HOMA-IR均与BMI呈正相关(β值分别为0.039,0.020,0.028,P值均<0.01),QUICKI与BMI呈负相关(β=-0.006,P<0.01)。进一步分层分析结果发现,以上关联在不同性别儿童中仍然存在,不存在性别差异。结论儿童肥胖与空腹胰岛素以及血糖相关指数均有关联,肥胖儿童存在明显的胰岛素抵抗。尽早控制和干预儿童肥胖具有重要的公共卫生学意义。

Objective The present study aims to explore the association between childhood obesity and glycemic phenotypes, and the influence of childhood obesity on islet β cell function and insulin resistance. Methods Students aged 6-14 years from 8 elementary schools in Beijing were involved in the study. Anthropometric measurements were conducted, and fasting plasma glucose（ FPG） and fasting plasma insulin（ FPI） was measured. Linear regressions were performed to assess the associations between body mass index（ BMI） and glycemic phenotypes. Results A total of 2 066 students were recruited and were divided into waste group（ 174 students）, normal-weight group（ 1 586 students）, overweight group（ 153 students） and obesity group（ 153 students）. FPI, homeostasis model assessment of pancreatic beta cell function（ HOMA-β）, homeostasis model assessment of insulin resistance（ HOMA-IR） and quantitative insulin sensitivity check index（ QUICKI） were significantly different between different BMI groups（ P〈0.01）. Linear regressions showed that after adjustment of sex and age, FPI, HOMA-β, HOMA-IR were positively associated with BMI（ FPI, β = 0.039, P〈0.01; HOMA-β, β = 0.020, P〈0.01; HOMA-IR, β = 0.028, P〈0.01）, while QUICKI was negatively associated with BMI（ β =-0.006, P〈0.01）. The associations still existed in the sex-stratified analysis, suggesting no sex difference. Conclusion Childhood obesity is significantly associated with glycemic phenotypes. Insulin resistance is common among obese children. Early control and intervention of childhood obesity is of great public health significance.