Cumulative influence of preadolescent lifestyles on the prevalence of elevated blood pressure among children
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摘要:
目的 分析青春期前生活方式对儿童血压偏高检出率和新发率影响的累积作用，为儿童血压偏高的早期干预提供依据。 方法 2017年在福建省厦门市4所九年一贯制学校建立青春期发育研究队列，对所有符合纳入标准的二、三年级女生和三、四年级男生进行体格检查和问卷调查。随访2年，选择2017和2019年数据完整的1 316名学生为研究对象。根据2017年基线调查结果评估青春期前生活方式状况。根据2019年血压水平进行血压偏高检出率和新发率的判定。调整混杂因素后采用Logistic回归模型，分析健康生活方式对血压偏高新发率和血压偏高检出率的影响。 结果 2017和2019年血压偏高检出率分别为25.0%和23.3%，血压偏高新发率为18.9%。具备健康生活方式的儿童血压偏高新发率和检出率偏低。Logistic回归分析结果显示，儿童满足健康生活方式因素越多，血压偏高检出率的风险越小(P < 0.05)。与满足0~2个健康生活方式因素学生相比，满足4~5个健康生活方式因素的学生血压偏高检出率低(OR=0.52, 95%CI=0.30~0.90)，血压偏高新发率低(RR=0.60，95%CI=0.29~1.22)。其中，超重肥胖学生血压偏高检出率风险明显更低(OR=0.29, 95%CI=0.10~0.81)。 结论 儿童青春期前生活方式对血压偏高检出率具有累积作用，维持健康生活方式对降低血压偏高风险具有积极作用，超重肥胖儿童采取综合的健康生活方式获益更大。 Abstract:Objective To analyze the cumulative effect of preadolescent lifestyles on the prevalence and incidence of elevated blood pressure (EBP) in children, and to provide evidence for early hypertensive intervention. Methods In 2017, a cohort study on pubertal development was conducted in Xiamen, Fujian Province. Participants underwent a physical examination and questionnaire survey. Between 2017 and 2019, this study carried out a 2-year follow-up of 1 316 students whose complete data were obtained. Preadolescent lifestyles were assessed by referring to baseline survey results obtained in 2017, and the prevalence and incidence of EBP were determined according to blood pressure levels that were determined in 2019. The logistic regression model was used to analyze the influence of healthy lifestyles on the prevalence and incidence of EBP after adjusted for confounding factors. Results The prevalence of EBP in 2017 and 2019 was 25.0% and 23.3%, respectively, and its incidence was 18.9% after the 2-year follow-up. Children with a healthy lifestyle had a lower prevalence and incidence of EBP. The regression analysis showed that children who have more healthy lifestyle factors were at a lower risk of EBP (P < 0.05). Compared with students with 0-2 healthy lifestyle factors, the OR value of EBP prevalence was 0.52 (95%CI=0.30-0.90) and the RR value of EBP incidence was 0.60(95%CI=0.29-1.22) in children with 4-5 healthy lifestyle factors. Among them, children who were overweight or obese were at a significantly lower risk of EBP prevalence (OR=0.29, 95%CI=0.10-0.81). Conclusion Preadolescent lifestyles seemed to have a cumulative effect on the occurrence of EBP. Maintaining a healthy lifestyle had a positive effect on reducing the risk of EBP, particularly in overweight and obese children, and this was due to their adoption of a comprehensive healthy lifestyle. -
Key words:
- Lifestyle /
- Blood pressure /
- Prevalence /
- Regression analysis /
- Child
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表 1 不同性别学生2019年年龄及基本指标比较(x±s)
Table 1. Comparison of age and basic indictors of students of different genders in 2019(x±s)
性别 人数 年龄/岁 身高/cm 体重/kg 收缩压/
mm Hg舒张压/
mm Hg男 644 11.2±0.6 148.4±7.4 42.5±10.5 112.1±9.7 62.0±6.5 女 672 10.2±0.6 141.8±6.7 32.3±6.4 106.6±8.9 61.5±6.4 合计 1 316 10.7±0.8 145.1±7.8 37.3±10.1 109.3±9.7 61.8±6.5 t值 31.24 16.99 21.20 10.66 1.34 P值 < 0.01 < 0.01 < 0.01 < 0.01 0.18 注： 1 mm Hg=0.133 kPa。 
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表 2 研究对象基本特征性别间分布比较
Table 2. Comparison of generd chanderstics of subjects of different gender
变量 男生
(n=644)女生
(n=672)合计
(n=1 316)χ2值 P值 一般情况 城市 598(94.5) 620(95.1) 1 218(94.8) 0.25 0.62 家庭月收入≥15 000元 211(58.1) 266(65.7) 477(62.1) 4.64 0.03 高血压家族史 324(54.8) 376(58.0) 700(56.5) 1.29 0.26 2019年儿童青春期发育分期 Ⅰ期 267(41.5) 252(37.5) 519(39.4) 129.99 < 0.01 Ⅱ期 295(45.8) 162(24.1) 457(34.7) Ⅲ期 68(10.6) 206(30.7) 274(20.8) Ⅳ期 14(2.2) 52(7.7) 66(5.0) 良好膳食 200(34.5) 218(35.9) 418(35.2) 0.24 0.62 日均水果摄入≥3份 38(6.1) 42(6.5) 80(6.3) 0.09 0.77 日均蔬菜摄入≥4份 56(9.0) 38(5.9) 94(7.4) 4.57 0.03 日均肉制品摄入2~3份 168(26.6) 119(18.4) 287(22.4) 12.53 < 0.01 含糖饮料 < 1份 332(54.3) 401(62.3) 733(58.4) 8.12 < 0.01 在外就餐≤2次/周 375(59.8) 450(69.3) 825(64.7) 12.67 < 0.01 几乎不吃咸菜 333(52.3) 347(52.8) 680(52.6) 0.04 0.85 充足户外活动 417(70.8) 361(62.6) 778(66.7) 8.90 < 0.01 不吸烟 611(97.6) 633(97.7) 1244(97.6) 0.01 0.92 不饮酒 590(95.3) 620(96.0) 1210(95.7) 0.33 0.57 充足睡眠 224(35.8) 202(31.2) 426(33.4) 3.04 0.08 儿童健康生活方式因素/个 0 0 2(0.4) 2(0.2) 11.41 0.04 1 8(1.6) 3(0.6) 11(1.1) 2 75(14.7) 104(20.0) 179(17.3) 3 192(37.6) 206(39.5) 398(38.6) 4 176(34.4) 154(29.6) 330(32.0) 5 60(11.7) 52(10.0) 112(10.9) 血压偏高新发人数 100(22.5) 87(16.1) 187(18.9) 6.56 < 0.01 基线血压偏高检出人数 199(30.9) 130(19.3) 329(25.0) 23.42 < 0.01 随访血压偏高检出人数 179(27.8) 128(19.0) 307(23.3) 14.07 < 0.01 注： ()内数字为构成比或检出率/%；部分项目数据有缺失。
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表 3 儿童生活方式与血压偏高新发率和检出率的关系
Table 3. Relationship between lifestyle and incidence and prevalence of elevated blood pressure in children
生活方式 人数 血压偏高新发人数 血压偏高检出人数 新发人数 新发率/% RR值(RR值95%CI) 检出人数 检出率/% OR值(OR值95%CI) 良好膳食 418 53 17.5 0.67(0.38~1.19) 91 21.8 0.78(0.51~1.20) 良好户外运动 778 112 19.3 0.78(0.46~1.32) 180 23.1 0.83(0.55~1.25) 充足睡眠 426 65 20.4 0.91(0.54~1.54) 103 24.2 0.71(0.47~1.08) 不吸烟 1 244 179 19.2 0.50(0.10~2.60) 291 23.4 0.34(0.11~1.07) 不喝酒 1 210 173 19.1 0.68(0.23~1.99) 285 23.6 0.73(0.30~1.77) 健康生活方式因素/个 0~2 192 29 20.6 1.00 54 28.1 1.00 3 398 57 19.0 0.60(0.29~1.22) 92 23.1 0.56(0.32~0.97)* 4~5 442 63 19.4 0.60(0.29~1.22) 102 23.1 0.52(0.30~0.90)* 注：模型调整了年龄、性别、身高、体重、居住地、青春期发育分期、高血压家族史及家庭收入; * P < 0.05。
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表 4 不同营养状况儿童生活方式与血压偏高新发率和检出率的关系
Table 4. Relationship between lifestyle and incidence and prevalence of elevated blood pressure in children with different nutritional status
是否超重肥胖 健康生活方式因素/个 人数 血压偏高新发人数 血压偏高检出人数 新发人数 新发率/% RR值(RR值95%CI) 检出人数 检出率/% OR值(OR值95%CI) 否 0~2 152 23 18.9 1.00 35 23.0 1.00 3 305 41 16.3 0.73(0.31~1.68) 58 19.0 0.77(0.39~1.51) 4~5 327 41 16.0 0.78(0.34~1.79) 60 18.3 0.71(0.36~1.41) 是 0~2 40 6 31.6 1.00 19 47.5 1.00 3 93 16 32.7 0.29(0.05~1.69) 34 36.6 0.32(0.11~0.94)* 4~5 115 22 32.4 0.21(0.04~1.17) 42 36.5 0.29(0.10~0.81)* 注： * P < 0.05。
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