BMI的长期负担对远期心脏代谢表型的影响:30年的队列随访研究

Effect of long-term burden of BMI on late cardiometabolic phenotype: a 30-year prospective cohort follow-up study

目的探讨从儿童到成人体质量指数(BMI)的长期负担及纵向趋势对远期心脏代谢表型的影响。方法 1987年对陕西省汉中市农村6~15岁在校学生进行身高、体重、血压等基线调查。并于1989年、1992年、1995年、2005年、2013年及2017年进行随访。其中1 553人从基线调查开始至少接受了4次检查,被纳入该研究中。使用随机效应模型拟合个体的BMI生长曲线,用曲线下面积(AUC)计算BMI的长期负担及纵向趋势。采用二元Logistic回归分析BMI的长期负担及纵向趋势与远期心脏代谢表型的关系。结果代谢异常组较代谢健康组有更高的BMI长期负担(t=-10.012,P<0.001)及纵向趋势(Z=-8.871,P<0.001)。BMI长期负担较高组发生心脏代谢异常的比例明显高于BMI长期负担正常组(52.1%vs.31.3%,χ^(2)=53.967,P<0.001);BMI纵向趋势较高组发生心脏代谢异常的比例也高于BMI纵向趋势正常组(53.9%vs.30.7%,χ^(2)=67.214,P<0.001)。Logistic回归分析结果显示,BMI长期负担较高组发生心脏代谢异常的风险约为BMI长期负担正常组的2.6倍(OR=2.593,95%CI:2.003~3.358,P<0.001);BMI纵向趋势较高组发生心脏代谢异常的风险约为BMI纵向趋势正常组的3.1倍(OR=3.126,95%CI:2.428~4.024,P<0.001)。BMI长期负担及纵向趋势与远期高血压、糖尿病及高脂血症均有关(P<0.001)。结论从儿童到成人较高的BMI长期负担及纵向趋势会增加远期心脏代谢异常的风险。从儿童时期开始控制体重对远期心脏代谢健康具有重要意义。

Objective To investigate effect of long-term burden and longitudinal trend of body mass index(BMI) from childhood to adulthood on late cardiometabolic phenotype.Methods In 1987,a baseline survey of height, weight and blood pressure was conducted among school children aged 6~15 years in Hanzhong rural areas, Shaanxi province.Then the pupils and students were followed-up in years 1989,1992,1995,2005,2013 and 2017 respectively.A total of 1,553 subjects who received 4 or more times of survey since the baseline survey were included in our study.Growth curves of BMI were constructed using an individual-fitting random-effects model.The long-term burdens and longitudinal trends of BMI were calculated using the area under the curve(AUC).Logistic regression was used to analyze relationships of long-term burden and longitudinal trend of BMI with late cardiometabolic phenotype.Results These individuals with abnormal cardiac metabolism had experienced a heavier long-term BMI burden(t=-10.012,P<0.001) and BMI longitudinal trend(Z=-8.871,P<0.001).The proportion of abnormal cardiac metabolism in individuals with heavy BMI long-term burden was significantly higher than that in those normal individuals(52.1% vs.31.3%,χ^(2)=53.967,P<0.001);and the proportion of abnormal cardiac metabolism in individuals with heavier BMI longitudinal trend was significantly higher than that in normal individuals(53.9% vs.30.7%,χ^(2)=67.214,P<0.001).The results of logistic regression analysis showed that the risk of abnormal cardiac metabolism in these individuals with heavier BMI long-term burden was 2.6 times of that in the normal individuals(OR=2.593,95% CI:2.003~3.358,P<0.001);and the risk of abnormal cardiac metabolism in these individuals with higher BMI longitudinal trend was 3.1 times of that in the normal individuals(OR=3.126,95%CI:2.428~4.024,P<0.001).In addition, the long-term burden and longitudinal trend of BMI were associated with late hypertension, diabetes mellitus(DM) and hyperlipidemia(all P<0.01).Conclusion The long-term burden and heavy longitudinal trend of BMI from childhood to adulthood increase the risk of late abnormal cardiac metabolism.Weight control from childhood is important for late cardiac metabolic health.