儿童青少年不同体质量指数与血压水平关联的队列研究

姚丽娟; 曲静; 姜伟伟

doi:10.16835/j.cnki.1000-9817.2023.05.030

儿童青少年不同体质量指数与血压水平关联的队列研究

doi: 10.16835/j.cnki.1000-9817.2023.05.030

1.
山东省龙口市疾病预防控制中心公共卫生科，265701
2.
山东省龙口市疾病预防控制中心食品卫生科

详细信息

作者简介:
姚丽娟(1975-)，女，山东龙口人，大学本科，副主任医师，主要研究方向为儿童青少年生长发育及影响因素

利益冲突声明 所有作者声明无利益冲突。
中图分类号: G804.49 R544 R179
计量
- 文章访问数: 391
- HTML全文浏览量: 175
- PDF下载量: 59
- 被引次数: 0
出版历程
- 收稿日期: 2022-12-24
- 修回日期: 2023-03-17
- 网络出版日期: 2023-05-25
- 刊出日期: 2023-05-25

Cohort study on different BMI and blood pressure levels in children and adolescents

1.
Department of Public Health, Longkou Center for Disease Control and Prevention, Longkou(265701), Shandong Province, China

摘要

摘要: 目的分析中小学生基线体质量指数(BMI)水平及BMI变化与随访8年后(又称“终期”)血压水平及血压偏高发生风险的关联，为开展儿童青少年血压防控工作提供依据。方法基于队列研究设计，采用2014—2022年连续8年山东省龙口市9 748名中小学生年度健康体检随访数据。采用χ²检验比较组间差异，采用广义线性模型和Logistic回归模型分析基线BMI水平及BMI变化对终期血压水平及血压偏高的影响。结果在基线非超重肥胖人群中，血压偏高率为9.1%，在基线超重肥胖人群中，血压偏高率为12.0%。在基线不同BMI状态下，男生血压偏高发生率均高于女生。与BMI-Z分≤-1组相比，随着BMI-Z分的增加，收缩压水平和血压偏高的发生风险逐渐增加；以BMI变化持续低为对照，持续高和增高组均呈现出终期血压偏高的发生风险增加(OR值分别为4.00，2.21，P值均 < 0.01)，且男生终期血压增高的发生风险更大。结论基线具有较高BMI水平以及BMI变化增加的儿童青少年血压偏高发生风险更高。应及时监测血压，采取综合有效措施控制儿童青少年儿童期血压偏高的发生。
- 人体质量指数 /
- 血压 /
- 队列研究 /
- 回归分析 /
- 儿童 /
- 青少年
Abstract: Objective To analyze the relationship between the baseline BMI level and body mass index (BMI) changes of primary and middle school students and the blood pressure level and the risk of elevated blood pressure after 8 years of follow-up(also known as the end-stage), so as to provide a basis for the prevention and control of blood pressure in children and adolescents. Methods The physical examination data of 9 748 primary and secondary school students were selected from a cohort study design in Longkou City, Shandong Province for 8 years from 2014 to 2022, and analyzed the association of baseline BMI level and BMI changes with end-stage blood pressure level and the risk of elevated blood pressure. Chi-square test was used to compare differences between groups, and the generalized linear model and Logistic regression model were used to analyze the effect of baseline BMI level and BMI changes on blood pressure level and elevated blood pressure after 8-year follow-up. Results Among non-overweight and obesity group at baseline, the prevalence of high blood pressure was 9.1%. Among the overweight and obesity group, the prevalence of high blood pressure was 12.0%. Under different BMI status at baseline, the incidence of high blood pressure in boys was higher than that in girls. Compared with the BMI-Z value≤-1 group, with the increase of BMI-Z value, the systolic blood pressure level and the risk of high blood pressure gradually increased; with the BMI change continuously low as the control, sustained high and increased groups showed an increased risk of end-stage high blood pressure (OR=4.00, 2.21, P < 0.01), and boys had a greater risk of elevated blood pressure. Conclusion Children and adolescents with higher baseline BMI level and increased BMI changes are at a higher risk of elevated blood pressure. Therefore, secondary school students should monitor the occurrence and development of blood pressure level in real time, and take comprehensive and effective measures to control the occurrence of elevated blood pressure level in childhood.
- Body mass index /
- Blood pressure /
- Cohort studies /
- Regression analysis /
- Child /
- Adolescent
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

HTML全文

表 1 不同年份儿童青少年健康指标(x±s，n=9 748)

Table 1. Health indicators of children and adolescent in different years(x±s, n=9 748)

年份	身高/cm	体重/kg	BMI/ (kg·m^-2)	收缩压/ mmHg	舒张压/ mmHg
2014—2015	134.5±9.6	32.8±9.3	17.8±3.3	101.3±6.8	65.5±5.4
2015—2016	139.4±9.7	37.3±11.4	18.9±3.9	102.0±7.2	65.0±5.8
2016—2017	145.5±10.1	42.7±12.9	19.9±4.2	104.7±6.9	66.6±5.6
2017—2018	151.6±9.9	47.6±14.0	20.4±4.4	106.6±6.5	67.8±5.4
2018—2019	157.6±9.6	53.3±15.1	21.2±4.6	108.9±7.5	69.4±6.1
2019—2020	161.6±8.9	57.8±15.5	21.9±4.7	109.8±8.2	70.5±6.5
2020—2021	164.8±8.4	62.0±16.9	22.7±5.1	110.3±7.9	70.9±6.1
2021—2022	167.1±8.5	64.2±16.6	22.9±4.9	113.0±7.5	72.7±5.9
注： 1 mmHg=0.133 kPa。

下载: 导出CSV

表 2 不同年份儿童青少年超重肥胖和血压偏高检出率(n=9 748)

Table 2. Detection rate of overweight and obesity and elevated blood pressure among children and adolescents in different years(n=9 748)

年份	超重肥胖	血压偏高
2014—2015	3 670(37.7)	992(10.2)
2015—2016	3 862(39.6)	688(7.1)
2016—2017	4 105(42.1)	831(8.5)
2017—2018	3 949(40.5)	901(9.2)
2018—2019	3 852(39.5)	1 803(18.5)
2019—2020	3 826(39.2)	2 464(25.3)
2020—2021	3 949(40.5)	2 114(21.7)
2021—2022	3 648(37.4)	3 141(32.2)
注： ()内数字为检出率/%。

下载: 导出CSV

表 3 不同性别不同年龄是否超重肥胖组学生基线和终期血压偏高检出率

Table 3. The descriptions of baseline and end-stage blood pressure by gender and age students at different BMI status

组别	选项	非超重肥胖			超重肥胖
组别	选项	人数	基线	终期	人数	基线	终期
性别	男	2 684	212(7.9)	843(31.4)	2 053	241(11.7)	1 204(58.6)
	女	3 394	341(10.0)	567(16.7)	1 617	198(12.2)	527(32.6)
基线年龄 /岁	7	2 260	176(7.8)	418(18.5)	1 557	136(8.7)	711(45.7)
	8	1 454	120(8.3)	242(16.6)	804	75(9.3)	408(50.7)
	9	1 150	124(10.8)	307(26.7)	658	99(15.0)	269(40.9)
	10	1 020	119(11.7)	370(36.3)	553	106(19.2)	274(49.5)
	11	194	14(7.2)	73(37.6)	98	23(23.5)	69(70.4)
合计		6 078	553(9.1)	1 410(23.2)	3 670	439(12.0)	1 731(47.2)
注： ()内数字为检出率/%。

下载: 导出CSV

表 4 不同性别学生在基线不同BMI状况下终期血压偏高检出率

Table 4. Investigation of end-stage blood pressure by gender at different BMI status at baseline of students

性别	基线BMI	终期非超重肥胖		终期超重肥胖		合计
性别	基线BMI	人数	血压偏高	人数	血压偏高	人数	血压偏高
男	非超重肥胖	2 152	646(30.0)	532	258(48.5)	2 684	904(33.7)
	超重肥胖	524	197(37.6)	1 529	946(61.9)	2 053	1 143(55.7)
	小计	2 676	843(31.5)	2 061	1 204(58.4)	4 737	2 047(43.2)
女	非超重肥胖	2 870	470(16.4)	524	133(25.4)	3 394	603(17.8)
	超重肥胖	554	97(17.5)	1 063	394(37.1)	1 617	491(30.4)
	小计	3 424	567(16.6)	1 587	527(33.2)	5 011	1 094(21.8)
注： ()内数字为检出率/%。

下载: 导出CSV

表 5 儿童青少年基线BMI-Z分与终期血压水平的相关性[β值(β值95%CI)]

Table 5. Correlation of baseline BMI-Z score values with blood pressure levels sure in end-stage among children and adolescents[β(β 95%CI)]

因变量	基线 BMI-Z分	统计值	男生(n=4 737)	女生(n=5 011)	总体(n=9 748)
收缩压水平	≤-1		1.00	1.00	1.00
	>-1~ < 0		0.51(-0.37~1.39)	0.76(0.08~1.45)^*	0.66(0.10~1.22)^*
	0~ < 1		1.72(0.89~2.56)^**	1.82(1.15~2.48)^**	1.93(1.39~2.47)^**
	1~ < 2		3.69(2.84~4.54)^**	3.55(2.84~4.27)^**	4.10(3.52~4.64)^**
	≥2		6.57(5.70~7.43)^**	6.54(5.71~7.38)^**	7.53(6.93~8.13)^**
		P_趋势值	＜0.01	＜0.01	＜0.01
舒张压水平	≤-1		1.00	1.00	1.00
	>-1~ < 0		0.11(-0.59~0.81)	0.43(-0.16~1.02)	0.30(-0.16~0.75)
	0~ < 1		0.88(0.22~1.54)^**	0.85(0.28~1.42)^**	0.95(0.51~1.38)^**
	1~ < 2		2.22(1.54~2.89)^**	2.01(1.40~2.62)^**	2.36(1.90~2.81)^**
	≥2		4.11(3.42~4.79)^**	4.00(3.29~4.71)^**	4.59(4.11~5.07)^**
		P_趋势值	＜0.01	＜0.01	＜0.01
注： P < 0.05，*P < 0.01。

下载: 导出CSV

表 6 基线BMI-Z分与终期血压偏高的相关性[OR值(OR值95%CI)]

Table 6. Correlation of baseline BMI-Z score and elevated blood pressure in end-stage[OR(OR 95%CI)]

基线BMI-Z分	男生(n=4 737)	女生(n=5 011)	总体(n=9 748)
≤-1	1.00	1.00	1.00
>-1~ < 0	1.23(0.92~1.63)	1.25(0.93~1.67)	1.23(1.00~1.50)^*
0~ < 1	1.56(1.19~2.04)^**	1.52(1.15~2.01)^**	1.58(1.30~1.91)^**
1~ < 2	2.48(1.89~3.25)^**	2.49(1.86~3.32)^**	2.68(2.20~3.25)^**
≥2	5.21(3.95~6.88)^**	4.01(2.93~5.48)^**	5.65(4.62~6.91)^**
P_趋势值	＜0.01	＜0.01	＜0.01
注： P < 0.05，*P < 0.01。

下载: 导出CSV

表 7 儿童青少年基线BMI分类及BMI变化与终期血压水平的相关性[β值(β值95%CI)]

Table 7. Correlation of baseline BMI classification and change with blood pressure levels among children and adolescents[β(β 95%CI)]

变量	组别	男生(n=4 737)		女生(n=5 011)		总体(n=9 748)
变量	组别	收缩压	舒张压	收缩压	舒张压	收缩压	舒张压
基线BMI	非超重肥胖	1.00	1.00	1.00	1.00	1.00	1.00
	超重肥胖	3.87(3.46~4.28)^**	2.57(2.25~2.90)^**	3.08(2.68~3.48)^**	1.93(1.59~2.27)^**	3.94(3.64~4.23)^**	2.51(2.27~2.74)^**
BMI变化	持续低	1.00	1.00	1.00	1.00	1.00	1.00
	持续高	5.78(5.32~6.23)^**	3.93(3.57~4.29)^**	5.78(5.32~6.23)^**	4.85(4.38~5.31)^**	5.88(5.55~6.22)^**	3.80(3.53~4.07)^**
	增高组	3.45(2.80~4.11)^**	2.43(1.91~2.96)^**	2.37(1.75~3.00)^**	1.41(0.88~1.93)^**	3.09(2.63~3.56)^**	2.01(1.63~2.39)^**
	降低组	1.03(0.36~1.69)^**	0.53(0.01~1.06)^**	0.77(0.16~1.37)^**	0.45(-0.07~0.96)	1.11(0.65~1.57)^**	0.60(0.23~0.97)^**
注： **P < 0.01。

下载: 导出CSV

表 8 儿童青少年基线BMI分类及BMI变化与终期血压偏高的相关性[OR值(OR值95%CI)]

Table 8. Correlation of baseline BMI classification and change with elevated blood pressure among children and adolescents[OR(OR 95%CI)]

变量	组别	男生(n=4 737)	女生(n=5 011)	总体(n=9 748)
基线BMI	非超重肥胖	1.00	1.00	1.00
	超重肥胖	2.54(2.25~2.86)^**	2.11(1.84~2.43)^**	2.51(2.29~2.74)^**
BMI变化	持续低	1.00	1.00	1.00
	持续高	4.15(3.60~4.79)^**	3.93(3.57~4.29)^**	4.00(3.61~4.44)^**
	增高组	2.52(2.06~3.07)^**	1.80(1.44~2.25)^**	2.21(1.91~2.55)^**
	降低组	1.37(1.11~1.67)^**	1.11(0.87~1.41)	1.32(1.13~1.53)^**
注： **P < 0.01。

下载: 导出CSV

参考文献(29)

[1]	ARBE G, PASTOR I, FRANCO J. Diagnostic and therapeutic approach to the hypertensive crisis[J]. Med Clin (Barc), 2018, 150(8): 317-322. doi: 10.1016/j.medcli.2017.09.027
[2]	BENMOHAMMED K, NGUYEN M T, KHENSAL S, et al. Arterial hypertension in overweight and obese Algerian adolescents: role of abdominal adiposity[J]. Diabetes Metab, 2011, 37(4): 291-297. doi: 10.1016/j.diabet.2010.10.010
[3]	REDWINE K M, ACOSTA A A, POFFENBARGER T, et al. Development of hypertension in adolescents with pre-hypertension[J]. J Pediatr, 2012, 160(1): 98-103. doi: 10.1016/j.jpeds.2011.07.010
[4]	CHEN X, WANG Y. Tracking of blood pressure from childhood to adulthood: a systematic review and Meta-regression analysis[J]. Circulation, 2008, 117(25): 3171-3180. doi: 10.1161/CIRCULATIONAHA.107.730366
[5]	DAIMEE U A, LANDE M B, TANG W, et al. Blood pressure and left ventricular mass index in healthy adolescents[J]. Blood Press Monit, 2017, 22(1): 48-50. doi: 10.1097/MBP.0000000000000219
[6]	NCD Risk Factor Collaboration. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults[J]. Lancet, 2017, 390(10113): 2627-2642. doi: 10.1016/S0140-6736(17)32129-3
[7]	NCD Risk Factor Collaboration. Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19.1 million participants[J]. Lancet, 2017, 389(10064): 37-55. doi: 10.1016/S0140-6736(16)31919-5
[8]	董彦会, 宋逸, 董彬, 等. 2014年中国7~18岁学生血压状况与营养状况的关联分析: 基于中国儿童青少年血压评价标准[J]. 北京大学学报(医学版), 2018, 50(3): 422-488. https://www.cnki.com.cn/Article/CJFDTOTAL-BYDB201803006.htm DONG Y H, SONG Y, DONG B, et al. Association between the blood pressure status and nutritional status among Chinese students aged 7-18 years in 2014: based on the national blood pressure reference for Chinese children and adolescents[J]. J Peking Univ (Health Sci), 2018, 50(3): 422-488. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-BYDB201803006.htm
[9]	黄贵民, 侯冬青, 高爱钰, 等. 北京市6~16岁儿童青少年睡眠状况与高血压的关联分析[J]. 中华预防医学杂志, 2018, 52(11): 1136-1139. HUANG G M, HOU D Q, GAO A Y, et al. The analysis of the association of sleep with high blood pressure among children and adolescents aged 6-16 years in Beijing[J]. Chin J Prev Med, 2018, 52(11): 1136-1139. (in Chinese)
[10]	RUPPERT V, MAISCH B. Genetics of human hypertension[J]. Herz, 2003, 28(8): 655-662. doi: 10.1007/s00059-003-2516-6
[11]	SINGH M, SINGH A K, PANDEY P, et al. Molecular genetics of essential hypertension[J]. Clin Exp Hypertens, 2016, 38(3): 268-277. doi: 10.3109/10641963.2015.1116543
[12]	HOMEIRA R, AZAM E, MAHMOUD L S, et al. Incidence of obesity, overweight and hypertension in children and adolescents in Ahvaz southwest of IRAN: five-years study[J]. Diabetes Metab Syndr, 2019, 13(1): 201-205. doi: 10.1016/j.dsx.2018.05.021
[13]	ZHANG Y X, WANG Z X, ZHAO J S, et al. Profiles of blood pressure among children and adolescents categorized by BMI and waist circumference[J]. Blood Press Monitor, 2016, 21(5): 295. doi: 10.1097/MBP.0000000000000203
[14]	邹志勇, 董彦会, 马军. 2014年中国7~18岁儿童青少年血压偏高情况及其相关因素[J]. 中华预防医学杂志, 2017, 51(4): 290-294. ZOU Z Y, DONG Y H, MA J, et al. High blood pressure and related factors among children and adolescents aged 7-18 in China in 2014[J]. Chin J Prev Med, 2017, 51(4): 290-294. (in Chinese)
[15]	MARIE-JEANNE B, THOMSON R J, MARKUS J, et al. Distinct child-to-adult body mass index trajectories are associated with different levels of adult cardiometabolic risk[J]. European Heart J, 2018, 39(24): 2263-2270. doi: 10.1093/eurheartj/ehy161
[16]	中华人民共和国国家卫生和计划生育委员会. 学龄儿童青少年超重与肥胖筛查: WS/T 586—2018[S]. 2018-08-01. National Health and Family Planning Commission of the PRC. Screening for overweight and obesity among school-age children and adolescents: WS/T 586-2018[S]. 2018-08-01. (in Chinese)
[17]	DEONIS M, ONYANGO A W, BORGHI E, et al. Development of a WHO growth reference for school-aged children and adolescents[J]. Bull World Health Organ, 2007, 85(9): 660-667. doi: 10.2471/BLT.07.043497
[18]	中华人民共和国国家卫生健康委员会. 7~18岁儿童青少年血压偏高筛查界值: WS/T 610—2018[S]. 2018-12-01. National Health Commission of the PRC. Reference of screening for elevated blood pressure among children and adolescents aged 7-18 years: WS/T 610-2018[S]. 2018-12-01. (in Chinese)
[19]	FREEDMAN D S, WOO J G, OGDEN C L, et al. Distance and percentage distance from median BMI as alternatives to BMI z score[J]. Br J Nutr, 2020, 124(5): 493-500. doi: 10.1017/S0007114519002046
[20]	KERKADI A, SADIG A H, BAWADI H, et al. The relationship between lifestyle factors and obesity indices among adolescents in Qatar[J]. Int J Environ Res Public Health, 2019, 16(22): 4428. doi: 10.3390/ijerph16224428
[21]	WENNBERG P, GUSTAFSSON P E, HOWARD B, et al. Television viewing over the life course and the metabolic syndrome in mid-adulthood: a longitudinal population-based study[J]. J Epidemiol Commun Health, 2014, 68(10): 928-933. doi: 10.1136/jech-2013-203504
[22]	孙莹. 中国儿童青春发动时相评定标准的建立及应用研究[D]. 合肥: 安徽医科大学, 2013. SUN Y. Research on the establishment and application of evaluation criteria for Chinese children's puberty mobilization phases[D]. Hefei: Anhui Medical University, 2013. (in Chinese)
[23]	DAI Y L, FU J F, LIANG L, et al. Association between obesity and sexual maturation in Chinese children: a muticenter study[J]. Int J Obes (Lond), 2014, 38(10): 1312-1316. doi: 10.1038/ijo.2014.116
[24]	WOOD C L, LANE L C, CHEETHAM T. Puberty: normal physiology (brief overview)[J]. Best Pract Res Clin Endocrinol Metab, 2019, 33(3): 101265. doi: 10.1016/j.beem.2019.03.001
[25]	NOKOFF N, THURSTON J, HILKIN A, et al. Sex differences in effects of obesity on reproductive hormones and glucose metabolism in early puberty[J]. J Clin Endocrinol Metab, 2019, 104(10): 4390-4397. doi: 10.1210/jc.2018-02747
[26]	赛佳明, 张亦军, 江晓路. 生长激素生物学效应的研究进展[J]. 现代生物医学进展, 2009, 9(17): 3390-3392. https://www.cnki.com.cn/Article/CJFDTOTAL-SWCX200917063.htm SAI J M, ZHANG Y J, JIANG X L. Research progress of biological effects of growth hormone[J]. Progress Mod Biomed, 2009, 9(17): 3390-3392. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-SWCX200917063.htm
[27]	葛文鑫, 谭伟良, 滕皓玥, 等. 苏州市儿童BMI-Z变化轨迹与青春晚期血压偏高的关联研究[J]. 中华流行病学杂志, 2021, 42(10): 1809-1816. GE W X, TAN W L, TENG H Y, et al. Trajectories of body mass index Z-score and risk of high blood pressure in late adolescence in Suzhou children[J]. Chin J Epidemiol, 2021, 42(10): 1809-1816. (in Chinese)
[28]	LLEWELLYN A, SIMMONDS M, OWEN C G, et al. Childhood obesity as a predictor of morbidity in adulthood: a systematic review and Meta-analysis[J]. Obes Rev, 2016, 17(1): 56-67.
[29]	WANG X, DONG B, HUANG S, et al. Body mass index trajectory and incident hypertension: results from a longitudinal cohort of Chinese children and adolescents, 2006-2016[J]. Am J Public Health, 2020, 110(11): 1689-1695.