成年期腰围个体内变异与新发高血压关联的纵向队列研究

Association between adult waist circumference intra-individual variability and incident hypertension:a longitudinal cohort study

目的研究成年人腰围动态变化与新发高血压之间的关联性,为肥胖的健康管理、高血压早期预防政策制定提供证据。方法基于“中国健康与营养调查”1989—2011年纵向队列数据,选取年龄20~60岁具有高血压患病前4次以上腰围测量5723名对象;平均随访11.6年,新发高血压1415名;计算标准差、变异系数、极差和线性斜率腰围变异指标;采用多因素logistic回归分析腰围变异与新发高血压的关联。结果校正基线腰围水平等协变量,腰围变异指标与新发高血压的关联均具有统计学意义,腰围的标准差、变异系数、极差和线性斜率的标准化OR分别为1.02(95%CI:1.01~1.03)、1.01(95%CI:1.00~1.03)、1.01(95%CI:1.00~1.03)和1.05(95%CI:1.04~1.06)。腰围的线性斜率上三分位组(Q_(2)、Q_(3)、Q_(4))与参考组(Q_(1))相比OR值分别是1.06、1.11和1.14,具有线性趋势(P_(trend)<0.05)。结论成年早期较大的腰围变化速率和变异与高血压风险的增加有关,而且该关联独立于腰围的水平。

Objective To explore the association between adult waist circumference(WC)variability and incident hypertension,and to provide evidence for the health management of obesity and the early prevention of hypertension.Methods Based on the longitudinal cohort data of China health and nutrition survey from 1989 to 2011,5723 subjects aged 20-60 years old with more than 4 times of WC measurements before onset of hypertension were selected.The mean follow-up period was 11.6 years,during which 1415 incident hypertension patients were observed.Four WC variability indexes were calculated,including standard deviation,coefficient of variation,range and linear slope.Multivariate logistic regression was used to analyze the association between WC variability and incident hypertension.Results After adjusting for the covariates(including baseline waist circumference level),the association between WC variability and incident hypertension was statistically significant.The standardized OR of WC standard deviation,coefficient of variation,range and linear slope were 1.02(95%CI:1.01-1.03),1.01(95%CI:1.00-1.03),1.01(95%CI:1.00-1.03)and 1.05(95%CI:1.04-1.06),respectively.Compared with the reference group(Q_(1)),the OR value for upper three quartiles(Q_(2)-Q_(4))of the WC linear slope was 1.06,1.11 and 1.14,respectively,which showed a significant linear trend(P_(trend)<0.05).Conclusion Rapid increase and great variability in waist circumference during early adulthood appear to be independent risk factors for hypertension,which is independent of waist circumference level.