A follow-up study of body fat distribution and blood pressure among 6-9 years old children in Beijing
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摘要:
目的 探索儿童体脂肪量及其分布指标体脂百分比(FMP)、内脏脂肪面积(VFA)和躯干脂肪质量百分比(%TFM)与血压的关系，为儿童血压的早期健康管理提供参考依据。 方法 依托北京儿童生长与健康队列(PROC)，于2018年10—11月和2020年9月在北京市顺义区开展儿童生活方式问卷调查及基线和随访体格检查，采用生物电阻抗法(BIA)测量儿童体成分，共纳入1 098名参与者。分性别建立线性混合效应模型，分析体脂肪分布指标与血压之间的关系。 结果 随着年龄增长，男、女童体脂肪指标和血压均有所增加。基线FMP、VFA和%TFM在男、女童之间的差异无统计学意义，随访时男童FMP、VFA和%TFM均高于女童(t值分别为2.73，3.76，3.41，P值均 < 0.01)。线性混合效应模型结果显示，无论是否调整年龄、标化身高和生活方式，男女童体脂肪指标与血压的关联均有统计学意义(β=0.64~3.48，P值均 < 0.05)。其中与收缩压的关联强度排序在男、女童中均为%TFM>FMP>VFA；与舒张压的关联强度排序在男童中为FMP>%TFM>VFA，女童中为VFA>FMP>%TFM。 结论 儿童体脂肪分布与血压存在纵向关联，关注不同部位体脂肪的累积有助于实现儿童血压零级预防。 Abstract:Objective To explore the association of body fat mass and distribution indices including fat mass percentage (FMP), visceral fat area (VFA) and percentage of trunk fat mass (%TFM) with blood pressure in children to inform early management of blood pressure in children. Methods Based on the Beijing Child Growth and Health Cohort in Shunyi District, lifestyle questionnaire survey, baseline and follow-up physical examination were conducted among children from October to November 2018 and September 2020. Bioelectrical impedance analysis (BIA) was used to measure the body composition, and 1 098 participants with completed data were finally included. Results Both body fat indices and blood pressure increased with age in boys and girls. For FMP, VFA, and %TFM, no significant differences presented between sex at baseline, while FMP, VFA, and %TFM were significantly higher in boys than girls at follow-up (t=2.73, 3.76, 3.41, P < 0.01). Before and after adjusting for age, height and lifestyles or not, linear mixed-effect models showed longitudinal associations existing between body fat indices and blood pressure in both boys and girls (β=0.64-3.48, P < 0.05). The association coefficients of body fat indices with systolic blood pressure were ranked as %TFM>FMP>VFA in both boys and girls. The association coefficients of body fat indices with diastolic blood pressure were ranked sequentially as FMP>%TFM>VFA in boys, and VFA>FMP>%TFM in girls. Conclusion Longitudinal associations are observed between body fat indices and blood pressure in children. Primordial prevention of high pressure should pay attention on body fat distribution. -
Key words:
- Adipose tissue /
- Blood pressure /
- Follow-up studies /
- Linear models /
- Child
1) 利益冲突声明 所有作者声明无利益冲突。2) 奴比娅·阿马尔江与江晓峰为共同第一作者。 -
表 1 不同性别儿童不同时间体脂肪指标及血压比较(x±s)
Table 1. Comparison of body fat indices and blood pressure in children by sex at different visit(x±s)
性别 时间 人数 统计值 FMP/% VFA/cm %TFM 收缩压/mmHg 舒张压/mmHg 男 基线 548 22.0±8.7 27.0±23.5 23.5±14.8 101.9±11.8 55.3±9.4 随访 548 27.3±9.7 49.7±35.3 35.5±12.7 110.1±8.6 62.4±6.8 t值 -9.54 -12.55 -14.41 -13.09 -14.35 P值 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 女 基线 550 22.5±7.8 25.5±19.0 22.9±14.1 99.8±11.4 55.6±10.0 随访 550 25.7±8.8 42.4±28.5 32.9±13.1 106.6±9.5 61.6±6.8 t值 -6.45 -11.55 -12.10 -10.75 -11.65 P值 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 合计 基线 1 098 22.2±8.2 26.2±21.4 23.2±14.4 100.9±11.7 55.4±9.7 随访 1 098 26.5±9.3 46.0±32.3 34.2±13.0 108.4±9.3 62.0±6.8 t值 -11.38 -16.95 -18.72 -16.70 -18.34 P值 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 注： 1 mmHg=0.133 kPa。 
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表 2 北京市6~9岁儿童体脂肪指标与收缩压混合效应模型
Table 2. Linear mixed-effect model of body fat indices and systolic blood pressure in children aged 6-9 in Beijing
性别 自变量 调整前 调整后 β值
(β值95%CI)标准误 P值 β值
(β值95%CI)标准误 P值 男
(n=548)FMP 3.23(2.57~3.88) 0.34 < 0.01 2.53(1.87~3.20) 0.34 < 0.01 VFA 2.99(2.33~3.65) 0.34 < 0.01 2.12(1.43~2.81) 0.35 < 0.01 %TFM 3.47(2.82~4.12) 0.33 < 0.01 2.69(1.99~3.39) 0.36 < 0.01 女
(n=550)FMP 3.15(2.47~3.83) 0.35 < 0.01 2.46(1.77~3.15) 0.35 < 0.01 VFA 2.88(2.19~3.56) 0.35 < 0.01 1.90(1.16~2.65) 0.38 < 0.01 %TFM 3.48(2.82~4.15) 0.34 < 0.01 2.66(1.93~3.40) 0.37 < 0.01
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表 3 北京市6~9岁儿童体脂肪指标与舒张压混合效应模型
Table 3. Linear mixed-effect model of body fat indices and diastolic blood pressure in children aged 6-9 in Beijing
性别 自变量 调整前 调整后 β值
(β值95%CI)标准误 P值 β值
(β值95%CI)标准误 P值 男
(n=548)FMP 1.48(0.94~2.01) 0.27 < 0.01 1.21(0.65~1.77) 0.29 < 0.01 VFA 1.35(0.81~1.89) 0.27 < 0.01 1.01(0.44~1.59) 0.29 < 0.01 %TFM 1.41(0.87~1.94) 0.27 < 0.01 1.16(0.57~1.75) 0.30 < 0.01 女
(n=550)FMP 1.11(0.55~1.67) 0.28 < 0.01 0.68(0.11~1.26) 0.29 0.02 VFA 1.25(0.69~1.81) 0.28 < 0.01 0.70(0.08~1.31) 0.31 0.03 %TFM 1.23(0.68~1.79) 0.28 < 0.01 0.64(0.02~1.26) 0.32 0.04
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