四种标准下儿童青少年不同肥胖代谢表型检出率比较

Comparison of the Detection Rates of Different Obesity Metabolic Phenotypes in Children and Adolescents under the Four Criteria

目的采用4种不同代谢异常标准,描述银川市城区学龄儿童青少年不同肥胖代谢表型检出情况,为儿童青少年肥胖及相关代谢性疾病的防控和代谢异常标准的制定提供科学依据。方法采取现况研究的设计,以整群抽样的方法抽取银川市城区1362名10~18岁儿童青少年作为研究对象。选取4种儿童青少年代谢异常诊断标准联合体质量指数(BMI)肥胖分度将研究对象诊断为6种表型,其中包括代谢正常肥胖(metabolically healthy with obesity,MHO)和代谢异常肥胖(metabolically unhealthy with obesity,MUO)等。采用中国第六次人口普查的年龄构成对检出率进行标准化。结果应用4种诊断标准得MHO标化检出率为2.3%~7.7%,MUO标化检出率为1.9%~7.2%。采用中华医学儿科学标准和国际糖尿病联盟(International Diabetes Federation,IDF)标准得出10~14岁MHO检出率均高于15~18岁(χ^(2)值分别为4.82和7.55,P均<0.05);采用中华医学儿科学分会标准、妇幼健康会标准和Damanhoury标准均得出10~14岁MUO检出率高于15~18岁(χ^(2)值分别为5.50、14.73和14.73,P均<0.05)。中华医学儿科学分会标准与IDF标准诊断中心性肥胖、高血糖及MHO一致性较好,但其余代谢异常组分和MUO一致性中度一致;妇幼健康会标准与Damanhoury标准诊断各代谢异常组分,MHO及MUO一致性均较好。结论应用不同标准下银川市城区学龄儿童青少年MHO和MUO检出率总体上呈中低等水平,且MHO和MUO检出率存在年龄差异,因此应根据不同肥胖代谢表型采取有针对性防治措施。

Objective To describe the prevalence of different obesity metabolic phenotypes in school-age children and adolescents in Yinchuan city using four different metabolic abnormalities diagnosis,and to provide scientific basis for the prevention and control of obesity and related metabolic diseases in children and adolescents and the formulation of metabolic abnormalities standards.Methods A total of 1362 children and adolescents aged 10-18 years old in urban area of Yinchuan city were included in the present study by using the method of cluster sampling method according to a cross-sectional research.The selection of four diagnostic criteria for metabolic abnormalities in children and adolescents combined with body mass index(BMI)obesity to form six phenotypes,including MHOW(metabolically healthy with overweight),MHO(metabolically healthy with obesity),and MUO(metabolically with unhealthy with obesity).The age composition of China's sixth census was used to standardize the prevalence.Results Using the four diagnostic criteria,the standard prevalence of MHO was 2.3%-7.7%,and the prevalence of MUO standardization was 1.9%-7.2%.The detection rate of MHO was higher in 10-14 years than in 15-18 years using the Chinese academy of medical pediatrics criteria and the International diabetes federation(IDF)criteria(χ^(2) were 4.82 and 7.55,respectively;P all<0.05);the detection rate of MUO was higher in 10-14 years than in 15-18 years using the Chinese academy of medical pediatrics criteria,the Association for maternal and child health study criteria,and the Damanhoury criteria(χ^(2) were 5.50,14.73,and 14.73,respectively;P all<0.05).The Chinese Academy of Medical Pediatrics criteria and IDF criteria were in good agreement for the diagnosis of central obesity,hyperglycemia and MHO,but the remaining metabolic abnormal components and MUO were in moderate agreement;the Association for maternal and child health study criteria and Damanhoury criteria were in good agreement for the diagnosis of each metabolic abnormal component,MHO and MUO.Conclusion The prevalence of MHO and MUO in school-age children and adolescents in Yinchuan City's urban areas under different standards are generally low and medium,and the prevalence of MHO and MUO differ by age,so targeted prevention and treatment measures should be taken according to different obesity metabolic phenotypes.