儿童体脂水平和胰岛素抵抗的联合作用与血脂异常的关联

王佳妮; 杨慧; 赵敏; 席波

doi:10.16835/j.cnki.1000-9817.2024312

儿童体脂水平和胰岛素抵抗的联合作用与血脂异常的关联

doi: 10.16835/j.cnki.1000-9817.2024312

王佳妮^{1, 2},
杨慧^{1, 2},
赵敏³,
席波^{1, 2, ,}

1.
山东大学齐鲁医学院公共卫生学院流行病学系/儿少卫生与妇幼保健学系，济南 250012
2.
山东大学儿童心血管研究中心
3.
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

国家自然科学基金项目 82173538

详细信息

作者简介:
王佳妮(1998-)，女，山东潍坊人，在读硕士，主要研究方向为儿童心血管流行病学

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 R977.1⁺⁵ R446.11⁺²
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- 被引次数: 0
出版历程
- 收稿日期: 2024-05-07
- 修回日期: 2024-06-18
- 网络出版日期: 2024-11-02
- 刊出日期: 2024-10-25

Joint effects between body fat mass and insulin resistance with dyslipidemia in children

WANG Jiani^{1, 2},
YANG Hui^{1, 2},
ZHAO Min³,
XI Bo^{1, 2
, ,}

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

摘要

摘要: 目的探讨儿童体脂水平和胰岛素抵抗(IR)的联合作用与血脂异常的关联，为儿童血脂异常的防治提供科学依据。方法数据来源于“桓台儿童心血管健康随访队列”2021年第2次随访，纳入有完整采集信息的儿童1 322名，采用多因素Logistic回归模型分析体脂肪率(FMP)、脂肪质量指数(FMI)、皮下脂肪质量(SFM)和内脏脂肪质量(VFM)增高与血脂异常的关联，采用限制性立方样条模型探索4种体脂水平与血脂异常的剂量反应关系，采用多因素Logistic回归模型分析体脂水平和IR的联合作用与血脂异常的关联。结果男生VFM和空腹血糖(FPG)水平更高，而FMP、FMI、SFM、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)水平均低于女生(t/Z值分别为3.22，2.58，-15.85，-7.35，-6.49，-2.40，-4.05，-2.40，P值均 < 0.05)。调整相关协变量后，与FMP正常组相比，FMP较高的儿童出现高TG(OR=4.26，95%CI=2.58~7.09)及低HDL-C(OR=4.10，95%CI=2.51~6.76)的可能性增加；FMI、SFM和VFM观察到与FMP相似结果(P值均 < 0.05)。相加交互作用分析结果显示，4种体脂指标较高均与IR存在协同作用，增加出现高TG的可能性(P值均 < 0.05)。4种体脂指标与血脂异常存在线性或非线性剂量反应关系。结论儿童体脂水平与血脂异常存在正向关联，若体脂水平较高儿童同时伴有IR则血脂异常可能性进一步增加。建议加强对高体脂和IR儿童的关注，预防儿童血脂异常的发生。
- 体脂分布 /
- 胰岛素抵抗 /
- 血脂异常 /
- 回归分析 /
- 儿童
Abstract: Objective To explore joint effects between body fat mass and insulin resistance with dyslipidemia in children, in order to provide scientific evidence for the prevention and treatment of dyslipidemia in children. Methods Data was derived from the second follow-up survey (2021) of the Huantai Childhood Cardiovascular Health Cohort. The complete information of a total of 1 322 children was included in the study. Multivariate Logistic regression model was used to analyze the association among fat mass percentage (FMP), fat mass index (FMI), subcutaneous fat mass (SFM) and visceral fat mass (VFM) and dyslipidemia. Restrictive cubic spline model was used to analyze dose-response relationship between levels of each of the four body fat mass indicators and dyslipidemia. Multivariate Logistic regression model was used to analyze the association of interaction of body fat mass indicators and insulin resistance (IR) with dyslipidemia. Results Boys had higher VFM and fasting plasma glucose (FPG) levels, while FMP, FMI, SFM, total cholesterol (TC), triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C) levels were all lower than those of girls (t/Z=3.22, 2.58, -15.85, -7.35, -6.49, -2.40, -4.05, -2.40, P < 0.05). After adjusting for all covariates, compared with children with normal FMP, those with higher FMP had an increased likelihood of elevated triglyceride levels (OR=4.26, 95%CI=2.58-7.09) and low HDL-C levels (OR=4.10, 95%CI=2.51-6.76). FMI, SFM, and VFM observed similar results to FMP (P < 0.05). Additionally, the additive interaction analyses showed that all four indicators of elevated body fat mass interacted with IR, increasing the likelihood of dyslipidemia in children (P < 0.05). There were linear or nonlinear dose-response association between each of four body fat mass indicators and dyslipidemia. Conclusions Elevated body fat mass increases the likelihood of dyslipidemia in children, and the likelihood of dyslipidemia further would increase if children have concomitant IR. Therefore, it is necessary to pay more attention to children with elevated body fat mass and IR to prevent the occurrence of dyslipidemia.
- Body fat distribution /
- Insulin resistance /
- Dyslipidemias /
- 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 不同性别儿童体脂和血脂指标水平比较(x±s)

Table 1. Comparison of different levels of body fat and blood lipid indexes by sex(x±s)

性别	人数	FMP/%	FMI/(kg·m^-2)	SFM/kg	VFM/kg	TC/ (mmol·L^-1)	TG/ (mmol·L^-1)^a	HDL-C/ (mmol·L^-1)	LDL-C/ (mmol·L^-1)	FPG/ (mmol·L^-1)	FINS/ (mU·L^-1)^a
男	697	18.29±8.35	4.35±2.80	10.07±6.63	1.61±1.37	4.21±0.82	0.80(0.60, 1.08)	1.50±0.35	2.23±0.67	4.88±0.49	12.07(8.25, 19.18)
女	625	24.87±6.51	5.44±2.53	12.33±5.99	1.39±1.00	4.31±0.78	0.86(0.68, 1.14)	1.55±0.35	2.28±0.60	4.81±0.45	13.68(9.78, 20.02)
t/Z值		-15.85	-7.35	-6.49	3.22	2.40	-4.05	-2.40	-1.42	2.58	-3.31
P值		< 0.01	< 0.01	< 0.01	< 0.01	0.02	< 0.01	0.02	0.16	0.01	< 0.01
注：^a不符合正态分布，采用M(P₂₅，P₇₅)描述。

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表 2 儿童FMP、FMI、SFM和VFM较高与血脂异常的关联[OR值(95%CI)]

Table 2. Association between higher FMP, FMI, SFM and VFM levels and dyslipidemia[OR(95%CI)]

性别	自变量	高TC	高TG	低HDL-C	高LDL-C
男生	FMP	1.96(1.11~3.41)^*	5.91(2.83~12.87)^**	5.04(2.67~9.70)^**	3.52(1.70~7.30)^**
(n=697)	FMI	1.65(0.91~2.90)	6.38(3.06~13.91)^**	4.82(2.56~9.22)^**	2.87(1.37~5.92)^**
	SFM	1.57 (0.87~2.76)	7.10(3.37~15.80)^**	5.74(3.03~11.12)^**	2.39 (1.13~4.93)^*
	VFM	1.91(1.08~3.33)^*	6.09(2.91~13.29)^**	5.08(2.69~9.77)^**	3.00(1.45~6.18)^**
女生	FMP	0.68 (0.35~1.25)	2.82(1.39~5.73)^**	3.10(1.36~7.14)^**	0.84(0.27~2.23)
(n=625)	FMI	0.71(0.36~1.31)	2.94(1.45~5.97)^**	3.85(1.68~8.96)^**	0.87(0.28~2.31)
	SFM	0.85(0.45~1.54)	2.79(1.37~5.69)^**	4.53(1.97~10.80)^**	0.88(0.28~2.37)
	VFM	0.83(0.44~1.51)	3.11(1.53~6.37)^**	4.50(1.94~10.77)^**	1.11(0.38~2.86)
总体	FMP	1.21(0.80~1.81)	4.26(2.58~7.09)^**	4.10(2.51~6.76)^**	1.99(1.12~3.47)^*
(n=1 322)	FMI	1.12(0.73~1.69)	4.50(2.72~7.49)^**	4.34(2.65~7.17)^**	1.78(0.99~3.12)
	SFM	1.19(0.78~1.78)	4.58(2.77~7.65)^**	5.05(3.08~8.41)^**	1.57(0.86~2.76)
	VFM	1.32(0.87~1.96)	4.53(2.74~7.57)^**	4.66(2.84~7.72)^**	1.96(1.10~3.40)^*
注：^P < 0.05，^*P < 0.01；各自变量均以正常为参照组，因变量分别以低TC、低TG、高HDL-C和低LDL-C为参照组。

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表 3 儿童体脂水平和胰岛素与血脂异常的相加交互作用分析(n=1 322)

Table 3. Analysis of the additive interaction of body fat levels and insulin resistance with dyslipidemia among children(n=1 322)

体脂水平和胰岛素	血脂	RERI值(95%CI)	AP值(95%CI)	S值(95%CI)
FMP-FINS	高TC	0.73(-0.24~1.71)	0.44(-0.08~0.96)	-9.21
	高TG	6.53(0.12~12.93)^*	0.54(0.22~0.86)^*	2.46(1.05~5.80)^*
	低HDL-C	2.51(-1.62~6.65)	0.36(-0.15~0.87)	1.72(0.62~4.79)
	高LDL-C	1.42(-0.47~3.31)	0.55(-0.06~1.17)	9.91(0.00~288 550.20)
FMI-FINS	高TC	0.71(-0.22~1.65)	0.45(-0.07~0.98)	-4.07
	高TG	7.01(0.29~13.74)^*	0.56(0.25~0.87)^*	2.57(1.08~6.17)^*
	低HDL-C	2.43(-2.01~6.87)	0.33(-0.21~0.88)	1.63(0.59~4.57)
	高LDL-C	0.85(-1.13~2.84)	0.36(-0.41~1.13)	2.68(0.08~93.85)
SFM-FINS	高TC	0.93(0.02~1.85)^*	0.56(0.10~1.03)^*	-2.47
	高TG	7.41(0.62~14.21)^*	0.59(0.30~0.89)^*	2.80(1.14~6.88)^*
	低HDL-C	2.65(-2.27~7.58)^*	0.32(-0.21~0.87)	1.60(0.60~4.27)
	高LDL-C	1.31(-0.28~2.90)	0.59(0.00~1.18)^*	-11.67
VFM-FINS	高TC	0.94(-0.04~1.92)	0.52(0.05~1.01)^*	-4.71
	高TG	7.34(0.62~14.07)^*	0.59(0.30~0.89)^*	2.79(1.14~6.82)^*
	低HDL-C	2.08(-2.72~6.89)	0.27(-0.30~0.84)	1.45(0.56~3.75)
	高LDL-C	1.38(-0.49~3.25)	0.54(-0.08~1.16)	9.47(0.00~211 714.40)
注：RERI，交互作用相对超额危险度；AP，交互作用归因比；S，协同指数；^*P < 0.05。

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表 4 儿童体脂水平和胰岛素的联合作用与血脂异常的关联(n=1 322)

Table 4. Association of interaction of body fat levels and insulin resistance with dyslipidemia among children(n=1 322)

联合组别	人数	高TC		高TG		低HDL-C		高LDL-C
联合组别	人数	检出人数	OR值(95%CI)	检出人数	OR值(95%CI)	检出人数	OR值(95%CI)	检出人数	OR值(95%CI)
FMP和FINS联合分组
FMP正常+FINS正常	703	71	1.00	12	1.00	19	1.00	27	1.00
FMP较高+FINS正常	75	5	0.45(0.11~1.29)	2	1.02(0.06~5.51)	5	2.74(0.76~7.89)	3	0.84(0.13~3.00)
FMP正常+IR	278	43	1.48(0.93~2.32)	22	5.44(2.54~12.38)^*	18	2.73(1.32~5.64)^*	15	1.32(0.62~2.67)
FMP较高+IR	266	42	1.66(1.04~2.62)^*	47	11.99(6.04~26.02)^*	47	6.99(3.81~13.33)^*	26	2.59(1.36~4.87)^*
FMI和FINS联合分组
FMI正常+FINS正常	706	72	1.00	12	1.00	19	1.00	27	1.00
FMI较高+FINS正常	72	4	0.32(0.05~1.09)	2	1.11(0.06~6.00)	5	3.10(0.86~8.96)	3	0.96(0.15~3.42)
FMI正常+IR	283	42	1.54(0.98~2.39)	22	5.33(2.49~12.13)^*	18	2.71(1.31~5.59)^*	17	1.55(0.76~3.07)
FMI较高+IR	261	39	1.57(0.98~2.49)	47	12.46(6.27~27.06)^*	47	7.24(3.95~13.82)^*	24	2.36(1.22~4.51)^*
SFM和FINS联合分组
SFM正常+FINS正常	703	72	1.00	12	1.00	18	1.00	28	1.00
SFM较高+FINS正常	75	4	0.30(0.05~1.00)	2	1.01(0.06~5.48)	6	3.90(1.22~10.66)^*	2	0.41(0.02~2.01)
SFM正常+IR	282	44	1.43(0.90~2.25)	21	5.09(2.36~11.65)^*	16	2.53(1.18~5.40)^*	17	1.49(0.73~2.93)
SFM较高+IR	262	41	1.67(1.05~2.62)^*	48	12.52(6.31~27.17)^*	49	8.08(4.38~15.62)^*	24	2.21(1.14~4.20)^*
VFM和FINS联合分组
VFM正常+FINS正常	703	71	1.00	12	1.00	18	1.00	27	1.00
VFM较高+FINS正常	75	5	0.45(0.11~1.30)	2	0.97(0.05~5.22)	6	3.85(1.20~10.55)^*	3	0.83(0.13~2.96)
VFM正常+IR	276	42	1.38(0.86~2.18)	21	4.98(2.31~11.39)^*	17	2.75(1.31~5.82)^*	15	1.33(0.63~2.71)
VFM较高+IR	268	43	1.78(1.12~2.78)^*	48	12.14(6.12~26.34)^*	48	7.70(4.17~14.90)^*	26	2.55(1.34~4.80)^*
注：^*P < 0.05。

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参考文献(25)

[1]	PIRILLO A, CASULA M, OLMASTRONI E, et al. Global epidemiology of dyslipidaemias[J]. Nat Rev Cardiol, 2021, 18(10): 689-700. doi: 10.1038/s41569-021-00541-4
[2]	DROZDZ D, ALVAREZ-PITTI J, WÓJCIK M, et al. Obesity and cardiometabolic risk factors: from childhood to adulthood[J]. Nutrients, 2021, 13(11): 4176. doi: 10.3390/nu13114176
[3]	QUADROS T M B, GORDIA A P, SILVA R C R, et al. Predictive capacity of anthropometric indicators for dyslipidemia screening in children and adolescents[J]. J Pediatr (Rio J), 2015, 91(5): 455-463. doi: 10.1016/j.jped.2014.11.006
[4]	DANIELS S R. Lipid concentrations in children and adolescents: it is not all about obesity[J]. Am J Clin Nutr, 2011, 94(3): 699-700. doi: 10.3945/ajcn.111.022483
[5]	吴容, 尤映彬, 吴龙飞, 等. 深圳市某区6~9岁儿童体脂成分与高血压和血脂异常的关系[J]. 疾病预防控制通报, 2022, 37(2): 17-21. WU R, YOU Y B, WU L F, et al. Relationship between body fat composition and hypertension and dyslipidemia among the children aged 6-9 years in a district of Shenzhen[J]. Bull Dis Control Prev, 2022, 37(2): 17-21. (in Chinese)
[6]	SHASHAJ B, BEDOGNI G, GRAZIANI M P, et al. Origin of cardiovascular risk in overweight preschool children: a cohort study of cardiometabolic risk factors at the onset of obesity[J]. JAMA Pediatr, 2014, 168(10): 917-924. doi: 10.1001/jamapediatrics.2014.900
[7]	杨丽丽, 张茜, 张艳青, 等. 山东省淄博市桓台儿童心血管健康随访队列设计方案[J]. 中华预防医学杂志, 2020, 54(12): 1461-1464. doi: 10.3760/cma.j.cn112150-20200610-00857 YANG L L, ZHANG Q, ZHANG Y Q, et al. Design of Huantai childhood cardiovascular health cohort study[J]. Chin J Prev Med, 2020, 54(12): 1461-1464. (in Chinese) doi: 10.3760/cma.j.cn112150-20200610-00857
[8]	World Health Organization. Global recommendations on physical activity for health[EB/OL]. (2010-01-01)[2023-10-12]. https://www.who.int/news-room/fact-sheets/detail/physical-activity.
[9]	PARUTHI S, BROOKS L J, D'AMBROSIO C, et al. Recommended amount of sleep for pediatric populations: a consensus statement of the American Academy of Sleep Medicine[J]. J Clin Sleep Med, 2016, 12(6): 785-786. doi: 10.5664/jcsm.5866
[10]	WHO. Global strategy on diet, physical activity and health[EB/OL]. (2004-03-22)[2023-10-13]. https://iris.who.int/handle/10665/43035.
[11]	LAMB M M, OGDEN C L, CARROLL M D, et al. Association of body fat percentage with lipid concentrations in children and adolescents: United States, 1999-2004[J]. Am J Clin Nutr, 2011, 94(3): 877-883. doi: 10.3945/ajcn.111.015776
[12]	向伟. 中国儿童青少年血脂防治专家共识[J]. 中国热带医学, 2008, 8(1): 124-127. doi: 10.3969/j.issn.1009-9727.2008.01.069 XIANG W. Chinese experts consensus for prevention and treatment of dyslipidemia in children and adolescents[J]. China Trop Med, 2008, 8(1): 124-127. (in Chinese) doi: 10.3969/j.issn.1009-9727.2008.01.069
[13]	KESKIN M, KURTOGLU S, KENDIRCI M, et al. Homeostasis model assessment is more reliable than the fasting glucose/insulin ratio and quantitative insulin sensitivity check index for assessing insulin resistance among obese children and adolescents[J]. Pediatrics, 2005, 115(4): e500-503. doi: 10.1542/peds.2004-1921
[14]	LIM S M, CHOI D P, RHEE Y, et al. Association between obesity indices and insulin resistance among healthy Korean adolescents: the JS high school study[J]. PLoS One, 2015, 10(5): e0125238. doi: 10.1371/journal.pone.0125238
[15]	JAGO R, HARRELL J S, MCMURRAY R G, et al. Prevalence of abnormal lipid and blood pressure values among an ethnically diverse population of eighth-grade adolescents and screening implications[J]. Pediatrics, 2006, 117(6): 2065-2073. doi: 10.1542/peds.2005-1716
[16]	Centers for Disease Control and Prevention (CDC). Prevalence of abnormal lipid levels among youths: United States, 1999-2006[J]. MMWR, 2010, 59(2): 29-33.
[17]	CASTOLDI A, DE SOUZA C N, CÂMARA N O S, et al. The macrophage switch in obesity development[J]. Front Immunol, 2016, 6: 637.
[18]	BLVHER M. Adipose tissue dysfunction contributes to obesity related metabolic diseases[J]. Best Pract Res Clin Endocrinol Metab, 2013, 27(2): 163-177. doi: 10.1016/j.beem.2013.02.005
[19]	CHEN F, LIU J, YAN Y, et al. Abnormal metabolic phenotypes among urban Chinese children: epidemiology and the impact of DXA-measured body composition[J]. Obesity (Silver Spring), 2019, 27(5): 837-844. doi: 10.1002/oby.22426
[20]	肖培. 中国七城市儿童青少年血脂异常的流行特征与适宜诊断切点研究[D]. 北京: 北京协和医学院, 2020. XIAO P. The epidemiological characteristies and appropriate diagnostic cutpoints of dyslipidemia among children and adolescents from seven cities in China[D]. Beijing: Peking Union Medical College Hospital, 2020. (in Chinese)
[21]	SINAIKO A R, STEINBERGER J, MORAN A, et al. Relation of body mass index and insulin resistance to cardiovascular risk factors, inflammatory factors, and oxidative stress during adolescence[J]. Circulation, 2005, 111(15): 1985-1991. doi: 10.1161/01.CIR.0000161837.23846.57
[22]	VEKIC J, ZELJKOVIC A, STEFANOVIC A, et al. Obesity and dyslipidemia[J]. Metabolism, 2019, 92: 71-81. doi: 10.1016/j.metabol.2018.11.005
[23]	FRANSSEN R, MONAJEMI H, STROES E S G, et al. Obesity and dyslipidemia[J]. Med Clin North Am, 2011, 95(5): 893-902. doi: 10.1016/j.mcna.2011.06.003
[24]	PRATT R E, KAVEY R E, QUINZI D. Combined dyslipidemia in obese children: response to a focused lifestyle approach[J]. J Clin Lipidol, 2014, 8(2): 181-186. doi: 10.1016/j.jacl.2014.01.003
[25]	ZHANG F, BASINSKI M B, BEALS J M, et al. Crystal structure of the obese protein leptin-E100[J]. Nature, 1997, 387(6629): 206-209. doi: 10.1038/387206a0