有氧运动对不同肥胖亚型儿童心血管危险因素的干预效果

Effects of Aerobic Exercise on Cardiovascular Risk Factors among Children with Different Obesity Subtypes

目的:分析代谢正常型肥胖(MHO)和代谢异常型肥胖(MUO)儿童心血管危险因素的差异,观察有氧运动对不同肥胖亚型儿童心血管危险因素的影响。方法:选取全封闭减肥夏令营肥胖儿童75名,平均年龄12.79±1.74岁,平均体重73.32±17.94 kg。实验前测试受试者的身体形态学指标、安静血压、安静心率、空腹血糖、胰岛素及血脂四项的基础值,分为MHO组(n=43)和MUO组(n=32)。对两组受试者进行为期4周的有氧运动干预,以心率作为运动强度的监控指标,目标心率为安静心率加储备心率的20%~40%,运动方式选择游泳、慢跑、快走等。干预结束后再测试上述指标,比较干预前后组间的差异和组内指标的变化。结果:(1)干预前,MUO组儿童的身体质量指数(BMI)、腰围(WC)、收缩压(SBP)、舒张压(DBP)、甘油三酯(TG)、动脉粥样硬化指数(AI)、非高密度脂蛋白胆固醇(nonHDL-C)高于MHO组(P<0.01),腰围身高比(WHtR)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)高于MHO组(P<0.05);胰岛素敏感性指数(ISI)、高密度脂蛋白胆固醇(HDL-C)低于MHO组(P<0.05)。(2)运动干预后,65.7%的MUO过渡为MHO,两组受试者的体重、BMI、体脂百分比(FAT%)、WC、WHtR、腰臀比(WHR)、DBP、TG、AI、nonHDL-C、TC、LDL-C、FINS、HOMA-IR均显著下降(P<0.01),ISI均显著升高(P<0.01),MHO组和MUO组的SBP显著下降(P<0.05,P<0.01);MHO组的空腹血糖(FPG)无明显变化,MUO组的FPG显著下降(P<0.01);MUO组的AI仍显著高于MHO组(P<0.05),HDL-C则显著低于MHO组(P<0.05)。结论:代谢异常型肥胖儿童具有更高的心血管危险因素。4周有氧运动可以使大部分受试者从代谢异常型肥胖过渡为代谢正常型肥胖,从而降低代谢异常型肥胖者的心血管病风险,运动干预应该尽早地在无代谢异常时介入。

Objective To analyze the differences in cardiovascular risk factors between children with metabolically healthy obesity(MHO)and those with metabolically unhealthy obesity(MUO),and explore the effect of aerobic exercise on their cardiovascular risk factors.Methods Totally 75 obese children in a weight loss summer camp were selected with an average age of 12.79±1.74 years and an average weight of 73.32±17.94 kg.They were measured body morphological indices,blood pressure,resting heart rate,fasting plasma glucose(FPG),fasting insulin and blood lipids,and divided into MHO group(n=43)and MUO group(n=32)accordingly.The two groups underwent 4-week aerobic exercise,such as swimming,jogging or fast walking,with the heart rate as the monitoring index of exercise intensity.The target heart rate was 20%~40%of the reserve heart rate plus the resting heart rate.Then,the above indices were tested and compared.Results(1)Before the intervention,the average body mass index(BMI),waist circumference(WC),systolic blood pressure(SBP),diastolic blood pressure(DBP),triglycerides(TG),atherosclerosis index(AI),and non-high-density lipoprotein cholesterol(nonHDLC),as well as the average waist circumference height ratio(WHtR),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),fasting insulin(FINS),and insulin resistance index(HOMA-IR)of the MUO group were significantly higher than the MHO group(P<0.01),while the average insulin sensitivity index(ISI),and high-density lipoprotein cholesterol(HDL-C)were significantly lower than the latter group(P<0.05).(2)After the intervention,65.7%of MUO children became MHO ones.The average body weight,BMI,percentage of body fat(FAT%),WC,WHtR,waist-to-hip ratio(WHR),DBP,TG,AI,nonHDL-C,TC,LDL-C,FINS,HOMA-IR and SBP decreased significantly(P<0.01),while the average ISI increased significantly(P<0.01)in both groups.Significant decrease was observed in the average FPG of the MHO group,but not in that of the MUO group(P<0.01).Moreover,the average AI of the MUO group was significantly higher than the MHO group(P<0.05),while the average HDL-C of the former was significantly lower than that of the latter group(P<0.05).Conclusion Children with metabolically unhealthy obesity have more cardiovascular risk factors.Four-week aerobic exercise can turn most MUO children into MHO ones,lowering their risks of having cardiovascular diseases.Therefore,exercise intervention should be involved as soon as possible when there is no metabolically unhealthy obesity.