Association between growth patterns and blood pressure in children and adolescents with different nutritional status: cross-sectional data from seven provinces and cities in China
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摘要:
目的 探讨不同营养状况下儿童青少年生长模式与血压之间的关联，为促进中国儿童青少年正常生长发育和身心健康提供依据。 方法 采用分层整群抽样方法，于2012年纳入6~18岁儿童青少年38 839名。采用《美国儿科学会2017指南》评价个体的血压状况，采用美国2000年CDC标准判定不同的生长模式，采用WHO于2007年发布的儿童青少年生长发育标准评价个体营养状况。不同营养状况和生长模式下收缩压和舒张压水平之间比较采用方差分析，检出率之间的比较采用χ2检验；采用多因素Logistic回归模型分析不同营养状况下生长模式与血压之间的关联。 结果 青少年正常性生长、追赶性生长和迟缓性生长占比分别为33.2%，41.6%和25.2%。在不同生长模式下，追赶性生长的收缩压(105.17±12.33)mm Hg和舒张压(66.55±8.75)mm Hg均高于正常性生长和迟缓性生长。在超重肥胖的儿童青少年中，追赶性生长的高血压检出率(24.9%)、高收缩压检出率(18.9%)和高舒张压检出率(15.0%)均高于正常性生长(21.6%，16.2%，12.9%)和迟缓性生长(20.1%，14.7%，12.5%)，差异均有统计学意义(χ2值分别为24.24，22.05，11.13，P值均＜0.05)。超重肥胖儿童青少年追赶性生长对发生高血压(OR=1.18，95%CI=1.06~1.31)的危险程度大于正常体重的儿童青少年(OR=1.15，95%CI=1.05~1.27)。 结论 追赶性生长的儿童青少年血压水平较高，高血压、高收缩压和高舒张压检出率也较高。追赶性生长的超重肥胖儿童青少年比正常儿童青少年发生高血压的危险性更高。 Abstract:Objective To explore the association between growth patterns and blood pressure in children and adolescents with different nutritional status. Methods A total of 38 839 children and adolescents aged 6 to 8 years old were included in this study by stratified cluster sampling. The American Academy of Pediatrics 2017 Guideline was used to evaluate the blood pressure, the US 2000 CDC standard was used to determine different growth patterns, and the WHO Child and Adolescent Growth and Development Standard issued in 2007 was used to evaluate nutritional status. Variance analyses were used to compare the levels of systolic and diastolic blood pressure and growth patterns by nutritional status, and χ2 test was used to compare the difference of prevalence. Multivariate Logistic regression model was used to analyze the association between growth patterns and blood pressure. Results The proportion of normal growth, catch-up growth and catch-down growth was 33.2%, 41.6% and 25.2%, respectively. Under different growth patterns, systolic blood pressure (105.17±12.33) mm Hg and diastolic blood pressure (66.55±8.75) mm Hg of catch-up growth were higher than those of normal growth and catch-down growth. In overweight and obesity, the prevalence of hypertension (24.9%), high systolic blood pressure (18.9%) and high diastolic blood pressure (15.0%) in catch-up growth were higher than those in normal growth and catch-down growth (P < 0.05). The risk of catch-up growth to hypertension was higher in overweight and obesity (OR=1.18, 95%CI=1.06-1.31) than in normal children and adolescents (OR=1.15, 95%CI=1.05-1.27). Conclusion In catch-up growth children and adolescents, hypertension and high blood pressure are higher than normal growth and catch-down growth. Overweight and obesity than normal children and adolescents have a higher risk of hypertension. -
Key words:
- Growth and development /
- Blood pressure /
- Nutritional status /
- Regression analysis /
- Child /
- Adolescent
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表 1 不同人口统计学特征儿童青少年生长模式分布比较
Table 1. Comparison of the distribution of different growth patterns of children and adolescents
人口统计学指标 选项 人数 正常性生长 追赶性生长 迟缓性生长 χ2值 P值 性别 男 19 512 6 225(31.9) 8 954(45.9) 4 333(22.2) 331.76 < 0.01 女 19 327 6 676(34.5) 7 203(37.3) 5 448(28.2) 城乡 城市 22 814 7 531(33.0) 9 981(43.9) 5 302(23.2) 145.04 ＜0.01 乡村 16 025 5 370(33.5) 6 176(38.5) 4 479(28.0) 年龄/岁 6~12 26 923 8 966(33.3) 11 932(44.3) 6 025(22.4) 484.59 ＜0.01 13~15 8 251 2 658(32.2) 3 103(37.6) 2 490(30.2) 16~18 3 665 1 277(34.8) 1 122(30.6) 1 266(34.5) 营养状况 消瘦 1 109 410(37.0) 363(32.7) 336(30.3) 681.86 ＜0.01 正常 27 103 9 469(34.9) 10 264(37.9) 7 370(27.2) 超重肥胖 10 627 3 022(28.4) 5 530(52.0) 2 075(19.5) 注： ()内数字为构成比/%。 
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表 2 不同生长模式各营养状况青少年收缩压/ 舒张压比较(x ±s，mm Hg)
Table 2. Comparison of systolic blood pressure and diastolic blood pressure among different nutritional status and growth patterns(x ±s, mm Hg)
营养状况 生长模式 人数 统计值 收缩压 舒张压 消瘦 正常 410 98.50±11.02 63.97±8.09 追赶 363 100.71±12.16 64.32±8.94 迟缓 336 99.50±9.58 63.34±7.60 F值 19.46 9.59 P值 ＜0.01 ＜0.05 正常 正常 9 469 101.93±11.49 64.77±8.22 追赶 10 264 103.36±11.52 65.56±8.48 迟缓 7 370 102.85±11.36 65.30±8.39 F值 1.79 9.53 P值 >0.05 ＜0.05 超重肥胖 正常 3 022 107.57±12.87 68.22±8.95 追赶 5 530 108.81±12.94 68.52±8.89 迟缓 2 075 108.65±12.65 68.78±9.05 F值 1.62 0.96 P值 >0.05 >0.05 合计 正常 12 901 103.14±12.08 65.52±8.53 追赶 16 157 105.17±12.33 66.55±8.75 迟缓 9 781 103.96±11.86 65.97±8.64 F值 19.17 9.11 P值 ＜0.01 ＜0.05
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表 3 各营养状况下不同生长模式儿童青少年高血压、高收缩压和高舒张压检出率比较
Table 3. Comparison of growth patterns and incidence rates of hypertension, high systolic blood pressure and high diastolic blood pressure under different nutritional conditions
营养状况 生长模式 人数 统计值 高血压 高收缩压 高舒张压 消瘦 正常性生长 410 20(4.9) 15(3.7) 14(3.4) 追赶性生长 363 29(8.0) 15(4.1) 21(5.8) 迟缓性生长 336 9(2.7) 5(4.13) 5(1.5) χ2值 10.09* 4.53 9.34* 正常 正常性生长 9 469 849(9.0) 551(5.8) 545(5.8) 追赶性生长 10 264 1 052(10.3) 636(6.2) 693(6.8) 迟缓性生长 7 370 660(9.0) 434(5.9) 435(5.9) χ2值 12.37* 1.40 9.72* 超重肥胖 正常性生长 3 022 653(21.6) 488(16.2) 391(12.9) 追赶性生长 5 530 1 376(24.9) 1 043(18.9) 828(15.0) 迟缓性生长 2 075 417(20.1) 305(14.7) 259(12.5) χ2值 24.24** 22.05** 11.13** 合计 正常性生长 12 901 1 522(11.8) 1 054(8.2) 950(7.4) 追赶性生长 16 157 2457(15.2) 1 694(10.5) 1 542(9.5) 迟缓性生长 9 781 1 086(11.1) 744(7.6) 699(7.2) χ2值 116.82** 77.59** 65.04** 注： ()内数字为检出率/%；*P＜0.05，**P＜0.01。
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表 4 各营养状况下儿童青少年生长模式与血压关系的多因素Logistic回归分析[OR值(OR值95%CI)]
Table 4. Multivariate Logistic regression model analysis of the relationship between growth pattern and blood pressure under different nutritional status[OR(95%CI)]
营养状况 生长模式 人数 高血压 高收缩压 高舒张压 模型1 模型2 模型1 模型2 模型1 模型2 消瘦 追赶性生长 363 1.69(0.94~3.05) 1.74(0.95~3.18) 1.14(0.55~2.36) 1.25(0.59~2.65) 1.74(0.87~3.47) 1.73(0.85~3.51) 迟缓性生长 336 0.54(0.24~1.20) 0.63(0.28~1.43) 0.40(0.14~1.11) 0.47(0.16~1.32) 0.43(0.15~1.20) 0.49(0.17~1.40) 正常 追赶性生长 10 264 1.16(1.05~1.28)* 1.15(1.05~1.27)* 1.07(0.95~1.20) 1.06(0.94~1.19) 1.19(1.06~1.33)* 1.19(1.06~1.34)* 迟缓性生长 7 370 1.00(0.90~1.11) 1.03(0.93~1.15) 1.01(0.89~1.15) 1.02(0.90~1.17) 1.03(0.90~1.17) 1.10(0.96~1.25) 超重肥胖 追赶性生长 5 530 1.20(1.08~1.34)* 1.18(1.06~1.31)* 1.21(1.07~1.36)* 1.21(1.07~1.36)* 1.19(1.04~1.35)* 1.09(0.96~1.24) 迟缓性生长 2 075 0.91(0.80~1.05) 0.91(0.80~1.05) 0.90(0.77~1.05) 0.87(0.75~1.02) 0.96(0.81~1.14) 1.03(0.87~1.23) 合计 追赶性生长 16 157 1.34(1.25~1.44)** 1.28(1.19~1.37)** 1.32(1.22~1.43)** 1.25(1.15~1.36)** 1.33(1.22~1.44)** 1.27(1.16~1.38)** 迟缓性生长 9 781 0.93(0.86~1.01) 0.97(0.89~1.05) 0.93(0.84~1.02) 0.94(0.85~1.03) 0.97(0.88~1.07) 1.05(0.94~1.16) 注：模型1不调整任何变量，模型2调整了性别、城乡、年龄、出生体重、父母亲文化程度；*P＜0.05, **P＜0.01。
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