基于限制性立方样条模型分析银川市青少年内脏脂肪指数和脂质蓄积指数与骨矿物含量的关系

Analysis Based on Restricted Cubic Spline of the Relationship between Visceral Adiposity Index,Lipid Accumulation Product and Bone Mineral Content in Yinchuan Adolescents

目的探讨银川市青少年内脏脂肪指数(visceral adiposity index,VAI)和脂质蓄积指数(lipid accumulation product,LAP)与骨矿物质含量(bone mineral content,BMC)的关系,为青少年及成人骨疾病的防治提供理论依据。方法采用分层整群随机抽样的方法抽取银川市1340名12~18岁的青少年作为研究对象,通过问卷调查、体格检查及实验室检测收集相关数据并计算VAI、LAP指标。应用Logistic回归和限制性立方样条(restricted cubic spline,RCS)模型分析VAI、LAP与骨量低下的剂量-反应关系。结果在调整混杂因素后,VAI、LAP最高四分位数受试者骨量低下的发生风险均低于VAI、LAP最低四分位数的受试者[(OR_(VAI(Q4))=0.51,95%CI:0.33~0.80,P<0.05;OR_(LAP(Q4))=0.28;95%CI:0.18~0.45,P<0.001)]。RCS性别分层显示,VAI_(男)、LAP_(男)、LAP_(女)与骨量低下之间均存在线性剂量-反应关系(P_(总趋势)均<0.05,P_(非线性)均>0.05),且VAI、LAP对骨矿物质含量的影响存在性别差异;大于临界值(0.80_(VAI男)、0.31_(LAP男)、0.58_(LAP女))时,骨量低下的发生风险随着VAI、LAP的升高逐渐降低。结论内脏脂肪与脂质蓄积量是骨量低下的保护因素,随着VAI、LAP的升高,青少年骨量低下的发生风险降低,合理的VAI与LAP有益于青少年及成人骨健康。

Objective To investigate the relationship between visceral adiposity index(VAI)as well as lipid accumulation product(LAP)and bone mineral content(BMC)in adolescents in Yinchuan,so as to provide a rationale for the prevention and control of low bone mass in adolescents.Methods A total of 1340 subjects aged 12-18 years from Yinchuan by stratified cluster sampling,VAI,LAP and related data were collected by questionnaire,body composition determination and laboratory testing.Binary logistic regression and restricted cubic spline(RCS)were applied to explore the dose-response relationship VAI(Q4)between VAI,LAP and low bone mass.Results After adjusting for confounders,subjects in the highest quartile of VAI and LAP had significantly higher LAR(Q4)levels of bone mineral content than in the lowest quartile[OR_(VAI(Q4))=0.51,95%CI(0.33,0.80),P<0.05;OR_(LAP(Q4))=0.28;95%CI(0.18,0.45),P<0.001)].The RCS by gender stratification showed that there was a linear dose-response relationship between VAI_(male),LAP_(male) and LAP_(female) and low bone mass(P_(total trend) all<0.05,P_(ton-linear) all>0.05),and there were gender differences in the effects of VAI and LAP on bone mineral content;at values greater than the threshold(0.80_(VAI male),0.31_(LAP male),0.58_(LAP female)),the risk of developing low bone mass gradually decreased with increasing VAI and LAP.Conclusion VAI and LAP are protective factors for low bone mass,and the risk of developing low bone mass in adolescents decreases with increasing VAI and LAP,and reasonable VAI and LAP are beneficial for adolescent and adult bone health.