不同糖代谢状态人群静息能量消耗变化及影响因素分析

Changes and influence factors of resting energy expenditure among population of different glucose tolerance status

目的比较不同糖代谢状态人群静息能量消耗(resting energy expenditure,REE)变化特点及影响因素。方法以2016年10月~2017年10月解放军总医院健康管理研究院接受健康体检的533例为研究对象,平均年龄(49.8±8.1)岁,男性384例,女性149例。进行一般体格检查,测定身高、体重、腰围、臀围、体脂肪量和体脂肪率,检测血生化指标空腹血糖、餐后2h血糖、糖化血红蛋白、血脂和血清尿酸水平,采用代谢仪测量静息能量消耗,对比正常血糖组、糖尿病前期组和糖尿病组的REE变化特点。结果糖尿病组静息能量消耗值(1615.1±125.6)kJ/d高于正常血糖组(1523.4±142.6)kJ/d和糖尿病前期组(1534±157.5)kJ/d,差异有统计学意义(P<0.05)。随着年龄的增加,静息能量消耗值减低,相同年龄段糖尿病组静息能量消耗值升高显著,男性静息能量消耗明显高于女性,肥胖者静息能量消耗明显升高,差异有统计学意义(P<0.001)。多元线性回归分析,影响正常血糖组静息能量消耗的因素有年龄、体重、收缩压、总胆固醇、空腹血糖;影响糖尿病前期组静息能量消耗的因素有年龄、体重;影响糖尿病组静息能量消耗的因素有年龄、体重和臀围。结论不同糖代谢状态人群REE有差异,血糖升高增加能量消耗,正常血糖人群饮食运动管理需结合体重、血压、血脂和血糖进行早期综合管理,糖尿病前期和糖尿病患者需要更重视体重管理。

Objective To investigate the resting energy expenditure(REE) feature and its influence factors among population of different glucose tolerance status. Methods A total of 533 adults(384 males and 149 females) at the age of(49.8 ± 8.1)years were enrolled in this study. They had health examination in health management institute of PLA General Hospital between October 2016 and October 2017. Their body height,body weight,waist circumference (WC),hip circumference (HC),fat mass (FM),fat ratio (FR),biochemical indications level were measured. Their resting energy expenditure(REE) was assayed by indirect calorimetry (MedGem). Distribution characteristics of REE between hypertension group and control group were analyzed. Results There were 153 adults in normal glucose tolerance group (101 males and 52 females) at the age of (47.9 ± 7.9)years. There were 120 adults (72 males and 48 females) at the age of(50.7 ± 7.6) years in prediabetes group. There were 260 adults (211males and 49 females) at the age of(52.4 ± 8.0) years in diabetes group. Patients with diabetes had higher level of REE compared with normal glucose tolerance group (1615.1 ± 125.6 vs. 1523.4 ± 142.6kJ/d,P < 0.05),and prediabetes group(1615.1 ± 125.6 vs. 1534 ± 157.5kJ/d,P < 0.05). The older adults had lower level of REE. The male adults had higher level of REE compared with female(P < 0.001). The obesity adults had higher level of REE(P < 0.001). Multivariate linear regression analysis showed that age,body weight,SBP,TC,FPG were influence factors of REE of normal glucose tolerance group,and age,body weight for prediabetes group,and age,body weight,hip circumference for diabetes group. Conclusion The level of REE is changed between different glucose tolerance status. The level of REE increases with the blood glucose. The management of diet and exercise for normal glucose tolerance group should be combined with the weight,blood pressure,blood lipid and blood glucose management. Diabetes and prediabetes patients need to pay more attention to weight management.