Association between visceral adiposity index and non-alcoholic fatty liver among overweight and obese children in Beijing
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摘要:
目的 探索超重肥胖儿童内脏脂肪指数(visceral adiposity index, VAI)与非酒精性脂肪肝(non-alcoholic fatty liver disease, NAFLD)的关系，为儿童NAFLD早期预防和分层干预提供参考依据。 方法 研究对象来自北京儿童生长与健康队列(PROC)，经数据清理整合后纳入具有完整的肝脏超声和VAI数据的6~8岁超重肥胖儿童510名。采用Spearman秩相关分析探索VAI与NAFLD的相关系数，采用趋势χ2检验和Logistic回归分析确定VAI分组与NAFLD的关系。 结果 男、女童NAFLD检出率分别为25.9%(69名)和11.1%(27名)。正常组和NAFLD组男童VAI为0.43(0.31，0.61)和0.61(0.44，0.87);女童为0.74(0.56，1.07)和1.08(0.67，1.51)。男童和女童中三酰甘油(TG)、VAI和VAI三分位分组与NAFLD呈正相关(r值分别为0.19，0.26，0.29;0.16，0.16，0.18，P值均 < 0.05)，男童高密度脂蛋白胆固醇(HDL-C)与NAFLD呈负相关(r=-0.21，P < 0.05)。随着VAI分位数的增加，男女童NAFLD检出率有增加的趋势(χ趋势2值分别为21.77，7.66，P值均 < 0.01)。单因素和多因素Logistic回归结果显示，以VAI第1三分位数为参照，男童第2三分位数(cOR=2.59，95%CI=1.15~5.86;aOR=2.33，95%CI=1.01~5.36)和第3三分位数(cOR=5.73，95%CI=2.62~12.53;aOR=4.87，95%CI=2.15~11.03)患NAFLD的风险增加; 女童第3三分位数(cOR=4.43，95%CI=1.40~14.00)患NAFLD的风险增加。 结论 VAI与NAFLD呈正相关，超重肥胖儿童患NAFLD风险随VAI分位数增加而增加，可应用VAI进行NAFLD分层管理。 Abstract:Objective To examine the association between the visceral adiposity index (VAI) and nonalcoholic fatty liver disease (NAFLD) in the pediatric population in order to improve risk stratification and prevention systems for chronic liver disease. Methods A total of 510 overweight/obese children aged 6-8 years old were enrolled from the child cohort which was designed to study puberty, obesity, and cardiovascular risk (PROC), and complete data from liver ultrasounds and the VAI were obtained. Used Spearman's rank correlation coefficient, Chi-square tests, and Logistic regression analyses to explore the association between the VAI and NAFLD. Results The detection rates of NAFLD for boys and girls were 25.9% and 11.1%, respectively. VAI for normal group and the NAFLD group were 0.43(0.31, 0.61) and 0.61(0.44, 0.87) in boys, and 0.74(0.56, 1.07) and 1.08(0.67, 1.51) in girls, respectively. Spearman's correlation coefficient analysis showed that triglycerides(TG), VAI, and the third quintile VAI group were positively correlated with NAFLD in both boys and girls(r=0.19, 0.26, 0.29;0.16, 0.16, 1.18, P < 0.05), and high-density lipoprotein-cholesterol (HDL-C) was negatively correlated with NAFLD in boys (r=-0.21, P < 0.05). With advancing tertiles of VAI, the increasing trend in the NAFLD detection rate was statistically significant in boys and girls(Chi-square for trend were 21.77, 7.66, P < 0.01). The results of univariate and multivariable Logistic regression showed that, by taking the first tertile of VAI as a reference, the risk of NAFLD among boys was higher in the second tertile (cOR=2.59, 95%CI=1.15-5.86; aOR=2.33, 95%CI=1.01-5.36) and in the third tertile(cOR=5.73, 95%CI=2.62-12.53; aOR=4.87, 95%CI=2.15-11.03), where as the risk among girls was higher in the third tertile(cOR=4.43, 95%CI=1.40-14.00). Conclusion VAI is positively correlated with pediatric NAFLD. Higher tertiles of VAI were associated with an increased risk of NAFLD in overweight and obese children, which indicates that VAI can be used as an early predictor of NAFLD. -
Key words:
- Overweight /
- Obesity /
- Viscera /
- Adipose tissue /
- Fatty liver /
- Regression analysis /
- Child
1) 李印东与李梦龙为共同第一作者。 -
表 1 不同性别是否NAFLD超重肥胖儿童基本指标比较(x±s)
Table 1. Comparison of influencing factors between normal and NAFLD group by sex among children with overweight and obesity(x±s)
性别 组别 人数 统计值 年龄/岁 身高/cm 腰围/cm BMI/(kg·m-2) SBP/mm Hg DBP/mm Hg 空腹血糖/(mmol·L-1) 男 正常 197 6.7±0.3 125.3±5.1 63.6±7.0 19.0±2.3 99.8±9.2 54.0±6.9 5.2±0.5 NAFLD 69 6.7±0.3 128.0±4.2 72.2±7.7 22.3±2.9 103.6±9.7 55.8±6.7 5.2±0.3 t值 -0.85 -4.03 -8.64 -9.38 -2.86 -1.87 0.22 P值 0.40 < 0.01 < 0.01 < 0.01 < 0.01 0.06 0.82 女 正常 217 6.7±0.3 123.7±5.0 61.5±6.3 18.5±2.1 98.9±9.2 53.8±6.5 5.1±0.4 NAFLD 27 6.6±0.3 127.5±5.2 69.4±7.0 21.4±2.7 99.5±9.3 53.8±4.5 5.0±0.3 t值 0.45 -6.08 -6.08 -5.45 -0.31 0.05 0.99 P值 0.65 < 0.01 < 0.01 < 0.01 0.76 0.96 0.33 注： 1 mm Hg=0.133 kPa。 
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表 2 不同性别是否NAFLD超重肥胖儿童脂类指标比较[M(P25，P75)]
Table 2. Comparison of lipid indexes between normal and NAFLD group by sex among children with overweight and obesity [M(P25, P75)]
性别 组别 人数 统计值 TC/(mmol·L-1) LDL-C/(mmol·L-1) HDL-C/(mmol·L-1) TG/(mmol·L-1) VAI 男 正常 197 4.52(4.05, 4.96) 2.49(2.12, 2.85) 1.54(1.36, 1.75) 0.61(0.49, 0.82) 0.43(0.31, 0.61) NAFLD 69 4.37(3.91, 4.99) 2.42(1.88, 3.03) 1.41(1.26, 1.55) 0.80(0.56, 1.00) 0.61(0.44, 0.87) Z值 0.69 0.13 3.35 -3.13 -4.24 P值 0.49 0.90 < 0.01 < 0.01 < 0.01 女 正常 217 4.45(4.02, 4.91) 2.43(2.13, 2.86) 1.47(1.29, 1.70) 0.71(0.54, 0.90) 0.74(0.56, 1.07) NAFLD 27 4.76(3.86, 5.35) 2.73(2.19, 3.11) 1.37(1.23, 1.59) 0.94(0.63, 1.09) 1.08(0.67, 1.51) Z值 -0.96 -1.85 1.38 -2.43 -2.56 P值 0.34 0.06 0.17 0.02 0.01
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表 3 不同性别超重肥胖儿童多种代谢指标与NAFLD的相关性
Table 3. Correlation between metabolic indexes and NAFLD by sex among children with overweight and obesity
变量 男童(n=266) 女童(n=244) r值 P值 r值 P值 空腹血糖/(mmol·L-1) -0.03 0.65 -0.10 0.11 TC/(mmol·L-1) -0.04 0.49 0.06 0.34 LDL-C/(mmol·L-1) -0.01 0.90 0.12 0.06 HDL-C/(mmol·L-1) -0.21 < 0.01 -0.09 0.17 TG/(mmol·L-1) 0.19 < 0.01 0.16 0.02 VAI 0.26 < 0.01 0.16 0.01 VAI三分位分组 0.29 < 0.01 0.18 < 0.01
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