青岛市市北区中小学生血压偏高与体质量指数的剂量反应关系

王春辉; 胡宝翠; 任志盛; 陈暕; 贺倩倩

doi:10.16835/j.cnki.1000-9817.2024249

青岛市市北区中小学生血压偏高与体质量指数的剂量反应关系

doi: 10.16835/j.cnki.1000-9817.2024249

1.
山东省青岛市市北区疾病预防控制中心卫生应急办公室，266011
2.
青岛市疾病预防控制中心学校卫生所

基金项目:

山东省人文社会科学课题项目 2022-ZXJK-23

详细信息

作者简介:
王春辉(1981-)，男，山东淄博人，大学本科，副主任医师，主要从事疾病控制和卫生应急处置工作

通讯作者:
贺倩倩，E-mail：1981209618@qq.com

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R179 R544.1 R194.3
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- 被引次数: 0
出版历程
- 收稿日期: 2024-03-21
- 修回日期: 2024-06-19
- 网络出版日期: 2024-08-31
- 刊出日期: 2024-08-25

Dose-response relationship between elevated blood pressure and body mass index in primary and secondary school students in Shibei District, Qingdao

1.
Health Emergency Department, Shibei District Center for Disease Control and Prevention, Qingdao (266011), Shandong Province, China

摘要

摘要: 目的探讨青岛市市北区中小学生血压偏高患病风险与体质量指数(BMI)的剂量反应关系，为采取精准干预措施提供参考依据。方法对青岛市市北区2022年92 091名中小学生健康体检数据进行统计分析，应用《学龄儿童青少年超重与肥胖筛查》标准对超重与肥胖进行评估；应用《7~18岁儿童青少年血压偏高筛查界值》对血压等级进行评定。运用方差分析、χ²检验、多因素Logistic回归以及结合限制性立方样条分析BMI与血压偏高的关系。结果根据不同年龄性别下的标准化评分，将BMI分为5类，与BMI-Z分0~ < 1组相比，随着BMI-Z分的减少，血压偏高风险逐渐降低(OR值分别为0.55，0.53)；随着BMI-Z分增加，血压偏高风险不断增大(OR值分别为1.90，3.71)(P值均 < 0.05)。分层分析表明，BMI在不同性别(男、女)、年龄(7~8，9~11，12~14，15~16岁)、腰臀比(≤0.83，>0.83)下与血压偏高患病风险均呈正相关(OR值分别为1.18，1.19，1.15，1.22，1.19，1.18，1.19，1.18，P值均 < 0.01)。BMI和性别、BMI和年龄、BMI和腰臀比之间均存在相乘交互作用(OR值分别为1.53，1.08，2.31，P值均 < 0.01)。限制性立方样条分析表明，随着BMI水平的上升，7，10~16岁人群发生血压偏高的风险均呈非线性增高趋势(χ²值分别为27.56，10.69，6.10，27.26，18.32，25.71，10.53，6.14，P值均 < 0.05)。结论随着BMI增高，中小学生血压偏高的风险随之增大，基本呈非线性剂量-反应关系。应及时开展监测，采取综合有效防控措施预防儿童青少年血压偏高。
- 血压 /
- 人体质量指数 /
- 回归分析 /
- 学生
Abstract: Objective To investigate the dose-response relationship between the risk of elevated blood pressure and body mass index (BMI) in primary and secondary school students in Shibei District, Qingdao, so as to provide a reference for precise interventions of elevated blood pressure. Methods Statistical analysis was conducted on the health examination data of 92 091 primary and secondary school students in Shibei District, Qingdao, in 2022. Overweight and obesity were assessed using the standards from the Screening for Overweight and Obesity among School-aged Children and Adolescents, and blood pressure levels were evaluated using the Reference of Screening for Elevated Blood Pressure among Children and Adolescents Aged 7-18 Years. The relationship between BMI and elevated blood pressure was examined using analysis of variance, Chi-square test, multifactorial Logistic regression, and a combination of restricted cubic spline after data cleaning. Results Based on the standardized scores under different age and gender, BMI was classified into 5 categories. Compared with the group of BMI-Z scores 0- < 1, the risk of developing high blood pressure gradually decreased with BMI-Z scores (OR=0.55, 0.53, P < 0.05). Conversely, the risk of developing high blood pressure increased with increasing BMI-Z scores (OR=1.90, 3.71, P < 0.05). Stratified analyses showed that BMI was positively associated with elevated blood pressure by gender (male, female), age (aged 7-8, 9-11, 12-14, 15-16), and waist-to-hip ratio (≤0.83, >0.83) (OR=1.18, 1.19, 1.15, 1.22, 1.19, 1.18, 1.19, 1.18, P < 0.01). There were multiplicative interactions between BMI and gender, between BMI and age, between BMI and waist-to-hip ratio (OR=1.53, 1.08, 2.31, P < 0.01). Restricted cubic spline analysis showed that as BMI levels increased, the risk of developing elevated blood pressure showed a non-linear increasing trend in both the 7-year-old and the 10 to 16-year-old (χ²=27.56, 10.69, 6.10, 27.26, 18.32, 25.71, 10.53, 6.14, P < 0.05). Conclusions The risk of elevated blood pressure in primary and secondary school students increases with BMI, showing a non-linear dose-response relationship. The blood pressure should be monitored regularly, and comprehensive and effective measures should be implemented to control elevated blood pressure in children and adolescents.
- Blood pressure /
- Body mass index /
- Regression analysis /
- Students
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

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图 1 7~16岁中小学生BMI与血压偏高风险的关系

Figure 1. Relationship between BMI and risk of elevated blood pressure among primary and secondary school students from 7 to 16 years old

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表 1 不同BMI分组中小学生基本指标比较(x±s)

Table 1. Comparison of basic indicators of primary and secondary school students among different BMI subgroups(x±s)

BMI分组	人数	年龄/岁	身高/cm	体重/kg	腰围/cm	臀围/cm	舒张压/mmHg	收缩压/mmHg	腰臀比
T1	1 833	10.09±2.62	144.49±15.64	28.69±8.33	58.06±6.59	70.77±8.31	65.38±9.14	100.84±12.09	0.82±0.08
T2	2 192	10.79±2.49	148.62±16.02	33.09±9.33	59.85±6.66	73.74±8.61	66.06±8.78	104.22±12.75	0.82±0.07
T3	52 702	10.24±2.64	146.93±16.64	38.57±12.48	63.67±7.74	77.85±10.35	66.75±8.86	106.75±13.38	0.82±0.07
T4	15 693	10.48±2.62	150.73±16.51	50.08±15.75	72.04±9.13	85.89±11.24	68.45±9.04	112.61±14.20	0.84±0.07
T5	19 671	10.15±2.51	151.56±15.86	61.08±20.55	81.71±11.85	92.81±12.57	70.44±9.51	116.93±15.42	0.88±0.07
F值		63.87	76.08	9 412.79	6 348.41	7 974.64	151.84	712.92	22.86
P值		< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01
注： 1 mmHg=0.133 kPa。

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表 2 BMI-Z分与中小学生血压偏高的相关性[OR值(95%CI)]

Table 2. Correlation of BMI-Z scores and elevated blood pressure among primary and secondary school students[OR(95%CI)]

BMI分组	男生(n=48 343)	女生(n=43 748)	总体(n=92 091)
T1	0.44(0.29~0.67)^*	0.68(0.49~0.95)^*	0.55(0.43~0.71)^*
T2	0.47(0.33~0.66)^*	0.69(0.51~0.93)^*	0.53(0.42~0.66)^*
T3	1.00	1.00	1.00
T4	1.75(1.61~1.90)^*	2.06(1.90~2.23)^*	1.90(1.80~2.01)^*
T5	3.56(3.32~3.83)^*	3.64(3.38~3.92)^*	3.71(3.52~3.90)^*
χ_趋势²	4 723.75	3 956.50	8 310.22
P值	< 0.01	< 0.01	< 0.01
注： *P < 0.05。

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表 3 不同性别、年龄、腰臀比分层下中小学生BMI和血压偏高的Logistic回归分析

Table 3. Logistic regression analysis of BMI and elevated blood pressure among primary and secondary school students by sex, age and waist-to-hip ratio

自变量	选项	血压偏高数	β值	标准误	Wald χ²值	OR值(95%CI)	P值
性别	男	48 343	0.18	0.00	49.68	1.18(1.17~1.19)	< 0.01
	女	43 748	0.18	0.00	45.69	1.19(1.18~1.20)	< 0.01
年龄/岁	7~8	28 445	0.14	0.01	26.38	1.15(1.14~1.17)	< 0.01
	9~11	31 893	0.20	0.01	40.84	1.22(1.21~1.24)	< 0.01
	12~14	26 511	0.18	0.00	45.24	1.19(1.18~2.00)	< 0.01
	15~16	5 242	0.16	0.01	20.34	1.18(1.16~1.19)	< 0.01
腰臀比	≤0.83	53 213	0.18	0.00	49.79	1.19(1.19~1.20)	< 0.01
	>0.83	38 878	0.17	0.00	47.68	1.18(1.17~1.19)	< 0.01
注：年龄根据四分位数分组，腰臀比根据中位数分组；调整变量为性别、年龄、腰臀比，分层组不调整自身；BMI为自变量，按照连续变量处理。

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