代谢相关指标在儿童超重肥胖与左心室肥厚关联间的中介作用

李慧平; 杨丽丽; 赵敏; 席波

doi:10.16835/j.cnki.1000-9817.2024033

代谢相关指标在儿童超重肥胖与左心室肥厚关联间的中介作用

doi: 10.16835/j.cnki.1000-9817.2024033

李慧平¹,
杨丽丽¹,
赵敏²,
席波^1, ,

1.
山东大学齐鲁医学院公共卫生学院流行病学系/山东大学儿童心血管研究中心，济南 250012
2.
山东大学齐鲁医学院公共卫生学院营养与食品卫生学系

基金项目:

国家自然科学基金项目 81673195

详细信息

作者简介:
李慧平(1998-)，女，安徽合肥人，在读硕士，主要研究方向为儿童心血管病流行病学

通讯作者:
席波，E-mail：xibo2010@sdu.edu.cn

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R179 R723.14 R714.252 R364.2
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- 被引次数: 0
出版历程
- 收稿日期: 2023-11-08
- 修回日期: 2024-01-10
- 网络出版日期: 2024-02-01
- 刊出日期: 2024-01-25

Mediating effects of metabolic-related indicators on the association between childhood overweight/obesity and left ventricular hypertrophy

LI Huiping¹,
YANG Lili¹,
ZHAO Min²,
XI Bo^{1
, ,}

1.
Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University/Children Cardiovascular Research Center of Shandong University, Jinan (250012), Shandong Province, China

摘要

摘要: 目的探讨血压、血糖、血脂和血清尿酸在儿童超重肥胖与左心室肥厚(LVH)间的中介作用，为心血管疾病儿童早期防控提供科学依据。方法采用方便整群抽样方法，于2017年11月至2018年1月在山东省淄博市桓台县1所公立学校选取1 400名6~11岁儿童开展基线调查。根据体质量指数(BMI)分类标准，将研究对象分为非超重肥胖组(787名)和超重肥胖组(613名)。采用R软件的mediation包分析代谢相关指标在儿童超重肥胖与LVH关联间的中介作用。结果超重肥胖组儿童的BMI-Z评分(2.0±0.8)、收缩压(SBP)(109.1±8.9)mmHg、舒张压(DBP)(65.4±6.8)mmHg、空腹血糖(FPG)(4.8±0.5)mmol/L、胰岛素(INS)(11.3±7.6)μU/mL、载脂蛋白B(ApoB)(0.7±0.2)g/L、低密度脂蛋白胆固醇(LDL-C)(2.4±0.7)mmol/L、总胆固醇(TC)(4.2±0.9)mmol/L、甘油三酯(TG)(0.9±0.4)mmol/L、血清尿酸(SUA)(321.2±91.4)μmol/L水平均高于非超重肥胖组[(-0.2±0.7)、(104.3±8.8)mmHg、(62.2±6.2)mmHg、(4.7±0.6)mmol/L、(6.1±4.2)μU/mL、(0.6±0.2)g/L、(2.2±0.6)mmol/L、(4.1±0.7)mmol/L、(0.7±0.2)mmol/L、(278.6±74.7)μmol/L]，超重肥胖组儿童的高密度脂蛋白胆固醇(HDL-C)水平(1.5±0.3)mmol/L低于非超重肥胖组(1.7±0.4)mmol/L，差异均有统计学意义(t值分别为53.66，9.88，9.19，3.60，16.32，7.36，5.11，2.55，11.08，9.58，-10.31，P值均 < 0.05)。调整性别、年龄、睡眠时间、运动时间、视屏时间、蔬果和碳酸饮料摄入量等潜在混杂因素后，超重肥胖儿童发生LVH的风险是非超重肥胖儿童的8.72倍(OR=8.72，95%CI=5.45~14.66，P < 0.01)。中介分析显示，INS、HDL-C、LDL-C、TG、ApoB、SUA部分介导了儿童超重肥胖与LVH之间的关联，其中INS和TG中介效应相对较大，占比分别为28.05%和13.71%。结论 INS、HDL-C、LDL-C、TG、ApoB和SUA是儿童超重肥胖与LVH关联间的中间危险因素。控制儿童期代谢指标处于健康水平可能有利于减轻超重肥胖儿童的心血管疾病负担。
- 代谢 /
- 超重 /
- 肥胖症 /
- 肥大，左心室 /
- 回归分析 /
- 儿童
Abstract: Objective To examine the mediating effects of blood pressure, glucose, lipids, and serum uric acid on the association between childhood overweight/obesity and left ventricular hypertrophy (LVH), and to provide scientific evidence for the prevention and control of cardiovascular diseases during childhood. Methods One public school in Huantai County, Zibo City was selected to conduct the baseline survey from November 2017 to January 2018 using a convenient cluster sampling method. A total of 1 400 children aged 6 to 11 were included in the study. According to the classification criteria based on body mass index (BMI), participants were divided into the non-overweight/obese group (n=787) and the overweight/obese group (n=613). The mediating effects of metabolic variables on the association between childhood overweight/obesity and left ventricular hypertrophy (LVH) were analyzed using the "mediation" package in R software. Results Children who were overweight/obese had higher levels of BMI-Z score (2.0±0.8), systolic blood pressure (SBP) (109.1±8.9 mmHg), diastolic blood pressure (DBP) (65.4±6.8 mmHg), fasting plasma glucose (FPG) (4.8±0.5 mmol/L), insulin (INS) (11.3±7.6 μU/mL), apolipoprotein B (ApoB) (0.7±0.2 g/L), low-density lipoprotein cholesterol (LDL-C) (2.4±0.7 mmol/L), total cholesterol (TC) (4.2±0.9 mmol/L), triglycerides (TG) (0.9±0.4 mmol/L), and serum uric acid (SUA) (321.2±91.4 μmol/L) compared to those who were non-overweight/obese [the corresponding values were (-0.2±0.7), (104.3±8.8) mmHg, (62.2±6.2) mmHg, (4.7±0.6) mmol/L, (6.1±4.2) μU/mL, (0.6±0.2) g/L, (2.2±0.6) mmol/L, (4.1±0.7) mmol/L, (0.7±0.2) mmol/L, and (278.6±74.7) μmol/L, respectively], whereas the levels of high-density lipoprotein cholesterol (HDL-C) were lower in overweight/obese children (1.5±0.3 mmol/L) than in non-overweight/obese children (1.7±0.4 mmol/L). All differences were statistically significant (t=53.66, 9.88, 9.19, 3.60, 16.32, 7.36, 5.11, 2.55, 11.08, 9.58, -10.31, P < 0.05). After adjusting for potential covariates, overweight/obese children had 8.72 times increased risk of developing LVH compared to the non-overweight/obese children (OR=8.72, 95%CI=5.45-14.66, P < 0.01). Mediation analysis showed that INS, HDL-C, LDL-C, TG, ApoB, and SUA partially mediated the association between childhood overweight/obesity and LVH, and among these, INS and TG had relatively strong mediating effects, accounting for 28.05% and 13.71% of the total effects, respectively. Conclusions INS, HDL-C, LDL-C, TG, ApoB, and SUA are intermediate risk factors on the association between childhood overweight/obesity and LVH. Keeping metabolic indicators (especially INS and TG) at healthy levels is particularly important for reducing the burden of cardiovascular diseases in overweight/obese children.
- Metabolism /
- Overweight /
- Obesity /
- Hypertrophy, left ventricular /
- Regression analysis /
- Child
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

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表 1 非超重肥胖组与超重肥胖组儿童BMI-Z评分、代谢相关指标比较(x±s)

Table 1. Comparison of BMI-Z scores and metabolism-related indicators between normal body group and overweight and obese group in children(x±s)

组别	人数	BMI-Z	SBP/mmHg	DBP/mmHg	FPG/(mmol·L^-1)	INS/(μU·mL^-1)	ApoB/(g·L^-1)	HDL-C/(mmol·L^-1)	LDL-C/(mmol·L^-1)	TC/(mmol·L^-1)	TG/(mmol·L^-1)	SUA/(μmol·L^-1)
非超重肥胖	787	-0.2±0.7	104.3±8.8	62.2±6.2	4.7±0.6	6.1±4.2	0.6±0.2	1.7±0.4	2.2±0.6	4.1±0.7	0.7±0.2	278.6±74.7
超重肥胖	613	2.0±0.8	109.1±8.9	65.4±6.8	4.8±0.5	11.3±7.6	0.7±0.2	1.5±0.3	2.4±0.7	4.2±0.9	0.9±0.4	321.2±91.4
t值		53.66	9.88	9.19	3.60	16.32	7.36	-10.31	5.11	2.55	11.08	9.58
P值		< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01

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表 2 儿童超重肥胖与代谢相关指标的多元线性回归分析(n=1 400)

Table 2. Multiple linear regression analysis of overweight/obesity and metabolism-related indicators in children(n=1 400)

代谢相关指标	模型1		模型2
代谢相关指标	β值(95%CI)	P值	β值(95%CI)	P值
SBP	0.53(0.43~0.62)	< 0.01	0.53(0.43~0.62)	< 0.01
DBP	0.51(0.41~0.62)	< 0.01	0.51(0.41~0.61)	< 0.01
FPG	0.20(0.10~0.29)	< 0.01	0.20(0.10~0.30)	< 0.01
INS	0.92(0.83~1.00)	< 0.01	0.92(0.84~1.00)	< 0.01
ApoB	0.39(0.28~0.49)	< 0.01	0.38(0.28~0.49)	< 0.01
HDL-C	-0.58(-0.68~-0.48)	< 0.01	-0.58(-0.68~-0.48)	< 0.01
LDL-C	0.29(0.17~0.38)	< 0.01	0.27(0.17~0.38)	< 0.01
TC	0.13(0.02~0.23)	0.02	0.13(0.02~0.23)	0.02
TG	0.61(0.51~0.71)	< 0.01	0.61(0.52~0.71)	< 0.01
SUA	0.53(0.44~0.62)	< 0.01	0.53(0.43~0.62)	< 0.01
注：模型1调整年龄、性别；模型2在模型1基础上调整睡眠时间、运动时间、视屏时间、蔬果摄入和碳酸饮料摄入量。

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表 3 儿童超重肥胖与LVH的二元Logistic回归分析[OR值(95%CI)，n=1 400]

Table 3. Binary Logistic regression analysis of overweight and obesity with LVH in children[OR(95%CI), n=1 400]

自变量	模型1	模型2
基线
正常体重组	1.00	1.00
超重肥胖组	8.86(5.54~14.89)	8.72(5.45~14.66)
额外调整^a
SBP	8.60(5.31~14.60)	8.50(5.24~14.46)
DBP	8.59(5.31~14.56)	8.50(5.25~14.42)
FPG	8.71(5.44~14.65)	8.54(5.33~14.38)
INS	5.26(3.14~9.17)	5.12(3.06~8.93)
ApoB	7.90(4.91~13.33)	7.82(4.86~13.20)
HDL-C	7.95(4.91~13.48)	7.79(4.81~13.23)
LDL-C	8.39(5.23~14.12)	8.29(5.17~13.97)
TC	8.71(5.44~14.64)	8.60(5.37~14.72)
TG	6.92(4.26~11.78)	6.81(4.19~11.60)
SUA	7.65(4.73~12.99)	7.56(4.67~12.83)
注：模型1调整年龄、性别；模型2在模型1基础上调整睡眠时间、运动时间、视屏时间、蔬果和碳酸饮料摄入量；a在模型1和模型2的基础上分别调整SBP、DBP、FPG、INS、ApoB、HDL-C、LDL-C、TC、TG、SUA。P值均 < 0.01。

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表 4 代谢相关指标在儿童超重肥胖和LVH关联间的中介效应(n=1 400)

Table 4. Mediating effects of metabolic-related indicators on the association between childhood overweight/obesity and LVH in children(n=1 400)

中介变量	总效应^a	直接效应^a	间接效应^a	中介效应百分比/%
SBP	0.16(0.13~0.19)^*	0.16(0.12~0.19)^*	0.00(-0.01~0.01)	—
DBP	0.16(0.13~0.19)^*	0.16(0.12~0.19)^*	0.00(-0.01~0.01)	—
FPG	0.16(0.13~0.19)^*	0.16(0.12~0.19)^*	0.00(-0.00~0.01)	—
INS	0.16(0.13~0.19)^*	0.11(0.09~0.14)^*	0.04(0.03~0.06)^*	28.05
ApoB	0.16(0.13~0.19)^*	0.15(0.12~0.18)^*	0.01(0.01~0.02)^*	6.95
HDL-C	0.16(0.12~0.19)^*	0.15(0.12~0.18)^*	0.01(0.01~0.02)^*	6.35
LDL-C	0.16(0.13~0.19)^*	0.15(0.12~0.18)^*	0.01(0.00~0.01)^*	3.46
TC	0.16(0.13~0.19)^*	0.16(0.13~0.19)^*	0.00(-0.00~0.01)	—
TG	0.16(0.13~0.19)^*	0.14(0.11~0.16)^*	0.02(0.01~0.03)^*	13.71
SUA	0.16(0.13~0.19)^*	0.14(0.11~0.17)^*	0.01(0.00~0.02)^*	8.22
注： a采用β值(95%CI)描述；各个路径均调整了年龄、性别、睡眠时间、运动时间、视屏时间、蔬果摄入和碳酸饮料摄入量。*P < 0.05。

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