儿童青少年生命早期因素与心血管代谢风险的关联

蒋家诺; 张奕; 陈力; 刘婕妤; 袁雯; 郭桐君; 马军; 董彦会

doi:10.16835/j.cnki.1000-9817.2023.10.004

儿童青少年生命早期因素与心血管代谢风险的关联

doi: 10.16835/j.cnki.1000-9817.2023.10.004

北京大学公共卫生学院/北京大学儿童青少年卫生研究所, 100191

基金项目:

国家自然科学基金项目 82103865

北京市自然科学基金项目 7222244

详细信息

作者简介:
蒋家诺(1999-), 女, 陕西省人, 在读硕士, 主要研究方向为儿童青少年慢性病及其影响因素

通讯作者:
董彦会, E-mail: dongyanhui@bjmu.edu.cn

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R714.252 R179 R195
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出版历程
- 收稿日期: 2023-06-02
- 修回日期: 2023-09-06
- 网络出版日期: 2023-10-27
- 刊出日期: 2023-10-25

Association between early-life factors and cardiometabolic risk factors in children and adolescents

Institute of Child and Adolescent Health/School of Public Health, Peking University, Beijing (100191), China

摘要

摘要: 目的了解影响儿童青少年心血管代谢风险的生命早期因素，为抑制儿童青少年高血压、糖尿病等心血管代谢危险因素提供有效措施。方法选取“厦门市青春期发育队列”2020年随访调查中体格检查信息及血生化检测信息完整，且有生命早期信息的研究对象1 197名。生命早期信息与社会人口学信息通过问卷调查获得，心血管代谢指标通过体格检查和血生化检测获得。调整性别、年龄、家族史后，采用Logistic回归分析影响心血管代谢风险的生命早期因素。结果厦门市儿童青少年心血管代谢风险聚集的检出率为17.96%，男生(26.67%)高于女生(9.64%)，差异有统计学意义(χ²=57.69，P＜0.01)。每增加1项生命早期危险因素，发生一般性肥胖的风险增加0.35倍(OR=1.35，95%CI=1.03~1.78，P＜0.05)。过期妊娠是心血管代谢风险的主要生命早期因素，与心血管代谢风险聚集(OR=2.45，95%CI=1.11~5.41)和高三酰甘油(OR=3.25，95%CI=1.39~7.61)的风险增加相关(P值均＜0.05)。结论儿童青少年心血管代谢风险升高与生命早期不利因素相关。应重点关注过期妊娠这一生命早期因素、肥胖这一心血管代谢风险，控制生命早期不利因素可以促进心脑血管疾病的零级预防。
- 生命周期各时期 /
- 心血管系统 /
- 回归分析 /
- 儿童 /
- 青少年
Abstract: Objective To understand the early-life factors that influence cardiometabolic risk factors in children and adolescents, so as to provide effective measures to curb cardiometabolic risk factors such as hypertension and diabetes in children and adolescents. Methods Data were sourced from the 2020 follow-up survey of the Xiamen Adolescent Development Cohort. The study involved 1 197 subjects for whom completed anthropometric examination and blood biochemistry testing data, as well as early-life data. Early-life and sociodemographic data were obtained through questionnaire surveys, while cardiometabolic indicator data were sourced through physical examinations and blood testing. Logistic regression analysis was performed to analyze the impact of early-life factors on the cardiometabolic risk factors after adjusting for gender, age, and family history. Results The prevalence rate of cardiometabolic risk factors clustering in children and adolescents in Xiamen was 17.96%, with boys (26.67%) reporting higher rates than girls (9.64%), and the difference was statistically significant (χ²=57.69, P < 0.01). For every additional early-life risk factor, the risk factors of obesity increased 0.35 times (OR=1.35, 95%CI=1.03-1.78, P < 0.05). Post-term pregnancy may be a primary early-life risk factors for cardiometabolic risk factors, and it was associated with an increased risk of cardiometabolic risk factors clustering (OR=2.45, 95% CI=1.11-5.41) and high triglycerides (OR=3.25, 95%CI=1.39-7.61)(P < 0.05). Conclusion Increased cardiometabolic risk factors in youth is associated with early-life adverse factors. It is crucial to pay greater attention to post-term pregnancy as an early-life factor and to consider obesity as a cardiometabolic risk factors. Controlling early-life adverse factors is important for the prevention of cardiovascular disease.
- Life cycle stages /
- Cardiovascular system /
- Regression analysis /
- Child /
- Adolescent
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表 1 不同性别儿童青少年心血管代谢风险指标检出情况比较

Table 1. Comparison of prevalence of cardiometabolic risk factors in children and adolescents between different genders

性别	人数	CMRF聚集	一般性肥胖	中心性肥胖	高血压	低HDL-C	高non-HDL-C	高TG	高血糖
男	585	156(26.67)	119(20.34)	151(25.81)	88(15.04)	20(3.42)	63(10.77)	72(12.31)	35(5.98)
女	612	59(9.64)	25(4.08)	38(6.21)	88(14.38)	8(1.31)	44(7.19)	54(8.82)	22(3.59)
χ²值		57.69	73.17	84.97	0.06	4.95	4.28	3.49	3.25
P值		＜0.01	＜0.01	＜0.01	0.81	0.03	0.04	0.06	0.07
注：()内数字为检出率/%。

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表 2 不同性别儿童青少年体格检查指标比较(x±s)

Table 2. Comparison of physical examination indicators in children and adolescents between different genders (x±s)

性别	人数	BMI/ (kg·m^-2)	腰围/cm	收缩压/ mmHg	舒张压/ mmHg	HDL-C/ (mmol·L^-1)	non-HDL-C/ (mmol·L^-1)	TG/ (mmol·L^-1)	空腹血糖/ (mmol·L^-1)
男	585	20.43±3.79	70.04±10.69	115.00±10.53	62.12±6.77	1.49±0.28	2.82±0.74	1.02±0.40	4.99±0.40
女	612	16.89±2.63	58.91±6.76	109.47±10.50	62.25±6.75	1.58±0.29	2.79±0.71	0.98±0.33	4.87±0.41
合计	1 197	18.62±3.70	64.35±10.49	112.17±10.87	62.19±6.75	1.53±0.29	2.81±0.72	1.00±0.37	4.92±0.41
t值		18.72	21.43	9.09	-0.34	-5.63	0.78	1.47	5.13
P值		＜0.01	＜0.01	＜0.01	0.74	＜0.01	0.44	0.14	＜0.01
注：1 mmHg=0.133 kPa。

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表 3 儿童青少年心血管代谢风险的生命早期单因素分析

Table 3. Univariate analysis of early life factors for cardiometabolic risk factors in children and adolescents

影响因素	选项	人数	有CMRF聚集	χ²值	P值
家族史	有	779	133(17.07)	0.37	0.54
	无	324	61(18.83)
胎龄	早产	89	11(12.36)	9.19	0.01
	正常	1 017	175(17.21)
	过期妊娠	34	12(35.29)
出生体重	低出生体重儿	44	3(6.82)	4.01	0.14
	正常	1 071	197(18.39)
	巨大儿	65	13(20.00)
母乳喂养	是	1 006	174(17.30)	1.19	0.28
	否	181	38(20.99)
分娩方式	顺产	668	115(17.22)	0.39	0.53
	剖宫产	516	97(18.80)
生命早期危险因素数^a	0	477	80(16.77)	6.05	0.11
	1	412	74(17.96)
	2	103	24(23.30)
	3	13	5(38.46)
注：()内数字为检出率/%；数据均存在缺失值；a包括过期妊娠、巨大儿、非母乳喂养和剖宫产。

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表 4 儿童青少年心血管代谢风险的生命早期因素Logistic回归分析[OR值(95%CI)，n=1 197]

Table 4. Logistic regression analysis of early life factors for cardiometabolic risk factors in children and adolescents [OR(95%CI), n=1 197]

自变量	选项	CMRF聚集	一般性肥胖	中心性肥胖	高血压	低HDL-C	高non-HDL-C	高TG	高血糖
胎龄	早产	0.79(0.39~1.59)	0.90(0.39~2.06)	0.82(0.39~1.73)	0.75(0.37~1.54)	0.60(0.08~4.55)	0.53(0.19~1.49)	1.09(0.51~2.35)	0.56(0.13~2.37)
	过期妊娠	2.45(1.11~5.41)^*	2.04(0.82~5.09)	1.06(0.41~2.74)	2.08(0.91~4.77)	3.03(0.65~14.05)	1.56(0.53~4.65)	3.25(1.39~7.61)^**	1.28(0.29~5.65)
出生体重	低出生体重儿	0.26(0.06~1.10)	0.45(0.10~1.92)	0.49(0.14~1.65)	1.22(0.53~2.82)	-	0.83(0.25~2.76)	0.23(0.03~1.70)	0.54(0.07~4.03)
	巨大儿	1.12(0.58~2.16)	1.86(0.95~3.67)	1.47(0.76~2.83)	0.57(0.22~1.46)	2.92(0.95~9.01)	0.48(0.15~1.59)	1.30(0.60~2.85)	0.68(0.16~2.89)
母乳喂养	非母乳喂养	1.10(0.70~1.71)	1.10(0.65~1.86)	0.85(0.51~1.40)	0.91(0.55~1.49)	1.20(0.40~3.62)	1.03(0.58~1.85)	1.45(0.88~2.39)	1.08(0.50~2.35)
分娩方式	剖宫产	1.04(0.75~1.44)	1.18(0.81~1.74)	0.91(0.64~1.28)	0.83(0.58~1.18)	0.81(0.35~1.87)	0.89(0.58~1.37)	1.24(0.84~1.83)	0.80(0.44~1.43)
生命早期危险因素数^a		1.13(0.89~1.43)	1.35(1.03~1.78)^*	0.97(0.76~1.25)	0.91(0.70~1.18)	1.12(0.64~1.98)	0.81(0.58~1.13)	1.28(0.97~1.69)	0.98(0.64~1.49)
注：模型调整了性别、年龄、家族史；a包括过期妊娠、巨大儿、非母乳喂养和剖宫产；低HDL-C组无低出生体重儿；P＜0.05，*P＜0.01。

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