基于学校的干预措施对儿童心血管代谢风险影响的研究进展

以学校为基础的生活方式干预可有效降低儿童超重肥胖的患病率，提高儿童及其家庭对超重肥胖知识以及与能量平衡相关行为的认知，并能改善血压、血脂及血糖等心血管代谢风险(cardiometabolic risk, CMR)水平。文章通过检索PubMed、中国知网和万方数据库，综述了基于学校的体育活动、饮食干预措施对儿童血压、血脂、血糖及其他CMR指标的影响，并分析了不同性别、年龄、种族等人群间的差异，以期为今后开展以学校为基础的儿童超重肥胖防治研究提供依据。     

识别儿童心血管代谢风险?依托政策开展分层干预

心血管代谢危险因素存在低龄化趋势,亟需早期识别并开展分层干预,从而减轻成年期心血管病负担,减少健康支出并增加社会资本。根据现有政策要求和中国儿童生长发育特点,借鉴国内外儿童随访队列的优势,建立儿童健康相关精细指标数据库,为识别儿童心血管代谢危险因素,进行早期预警及制定有效分层干预策略提供细致参考,从而降低中国儿童和成年人心血管疾病负担,提高其生命质量。     

肥胖相关性高血压的机制与防治研究进展

<正>肥胖可以引起一系列生理功能紊乱,如高血压、动脉粥样硬化、胰岛素抵抗、高脂血症和肾功能障碍等。原发性高血压的发生60%~70%可归因于肥胖。早在20世纪60年代,Framingham心脏研究就发现,体重每增加4.5 kg,收缩压就会上升4 mm Hg,肥胖可以增加高血压的患病风险。肥胖与高血压并存,可以增加血压控制的难度,促进多重心血管代谢危险因素聚集,增加心脑血管疾病风险[1]。近年来,高血压与肥胖的患病率     

健康体检人群中肥胖与部分新型心血管标志物的相关性分析

目的研究一般人群中部分新型心血管标志物与肥胖的相关性。方法检测9 361例健康体检人群高敏肌钙蛋白T(hs-cTnT)、氨基末端脑钠肽原(NT-proBNP)、脉压、脉搏波传导速度(PWV)和中心动脉收缩压(cSBP)水平。采用多种统计方法分析上述指标与体质量指数(BMI)的相关性,以及这些指标在不同BMI/代谢综合征(MetS)组合中的差异。结果肥胖与hs-cTnT、baPWV、脉压和cSBP水平正相关,当研究对象按MetS分类后,这些相关性在非MetS组中仍存在(P<0.05);与体重正常者相比,肥胖者hs-cTnT、baPWV、脉压和cSBP增高的风险分别增加1.87(95%CI为1.48~2.36)、1.27(1.02~1.57)、1.89(1.39~2.57)和2.71(2.11~3.47)倍,并且肥胖者存在1到4个心血管标志物增高的风险分别为1.61(1.26~2.05)、1.75(1.27~2.42、2.45(1.46~4.11)和3.14(2.13~4.62)。然而,在MetS组中肥胖与心血管标志物的相关性不再存在。当分别采用腰臀围比、体脂肪率和内脏脂肪指数代替BMI衡量肥胖时,上述结果未改变。结论在非MetS者中肥胖与部分新型心血管标志物(NTproBNP除外)正相关,但在MetS者中未见这种相关性。此外,肥胖但无MetS者多个心血管标志物同时增高的风险更高。结果提示在一般人群中对肥胖的管理更应该做到一级预防和早期干预,特别是在未出现代谢异常时的肥胖管理可能更有效。     

北京市学龄儿童肥胖类型与心血管危险因素的关联性研究

目的分析学龄儿童肥胖类型与心血管危险因素间的关联。方法选择“北京市儿童青少年代谢综合征研究(BCAMS)”中3508名(2 054名非肥胖、1 454名肥胖)6～18岁儿童青少年作为研究对象。采用问卷调查收集人口学资料,并测量身高、体重、腰嗣和血压,检测空腹血糖和血脂。研究对象划分为非肥胖、一般性肥胖、中心性肥胖和复合型肥胖4种类型,并根据血脂异常、空腹血糖受损(IFG)和高血压进行心血管危险因素聚集分析。采用多元线性回归以及多因素logistic回归,分析儿童肥胖类型与心血管危险因素之间的关联。结果血压、血糖和血脂(TC除外)水平及血脂异常与高血压患病率均随非肥胖、一般性肥胖、中心性肥胖至复合型肥胖逐渐升高(P<0.001);各不同类型肥胖组间IFG率的差异无统计学意义。控制年龄、性别、青春发育期后,中心性肥胖和复合型肥胖组发生一种心血管危险因素的风险分别为非肥胖组的1.54倍和2.51倍;而一般性肥胖组与非肥胖组相比,发生一种心血管危险因素风险的差异无统计学意义;一般性肥胖、中心性肥胖和复合型肥胖组发生两种及以上心血管危险因素的风险分别是非肥胖组的3.32、2.2l和7.42倍,发生3种及以上心血管危险因素的风险分别是非肥胖组的3.10、3.67和10.75倍。随着肥胖类型的变化,心血管危险因素的聚集性有逐渐升高趋势(|P结论北京市儿童青少年心血管危险因素水平及聚集风险随肥胖类型的变化而升高,其中复合型肥胖最高,其他依次为中心性肥胖和一般性肥胖。     

哈尔滨某中学隐性肥胖青少年心血管代谢危险性调查

了解体重正常而体脂肪含量超标的“隐性肥胖”青少年与正常组心血管代谢指标的差异,为评估青少年肥胖及心血管代谢风险提供依据.方法 选取哈尔滨市体质监测点校某中学的623名初中生进行体格检查、体成分测定及相关代谢生化指标检测.将BMI正常的369名初中生作为研究对象,将体脂率男生>20%,女生>25%定义为隐性肥胖,其中隐性肥胖组134名,正常组235名.结果 学生隐性肥胖检出率为36.3%,其中男生为18.9%,女生为48.6%(x2=34.06,P<0.05).隐性肥胖组总胆固醇(TC)和低密度脂蛋白胆固醇(LDL-C)水平均高于正常组,男生隐性肥胖组三酰甘油(TG)水平高于正常组,女生隐性肥胖组高密度脂蛋白胆固醇(HDL-C)水平低于正常组(P值均<0.05);隐性肥胖组血压、血糖水平与正常组之间的差异均无统计学意义(P值均>0.05).男生隐性肥胖组高TG血症检出率高于正常组,女生隐性肥胖组高TC、高LDL-C检出率均高于正常组(P值均<0.05),但男女生隐性肥胖组与正常组的血压偏高和高血糖的检出率差异均无统计学意义(P值均>0.05).结论 哈尔滨市某中学隐性肥胖检出率较高,隐性肥胖的青少年存在一定比例血脂代谢异常.及早识别青少年隐性肥胖,对控制心血管代谢性疾病具有积极意义.     

超重肥胖中学生代谢性疾病风险分析

目的初步分析超重肥胖学生高血脂、糖尿病等相关代谢性疾病的患病风险,为进一步开展肥胖综合干预提供依据。方法在知情同意的前提下,2012年4—5月于北京市海淀区、西城区8所完全中学初一、高一年级399名初筛肥胖的学生,进行身高、体重、血脂、空腹血糖、转氨酶、B超脂肪肝和黑棘皮症的检查,并对结果进行统计学分析。结果 399名学生中,空腹血糖、血脂、肝功能和黑棘皮症等代谢性相关疾病检出1项以上异常的270人,占67.7%;其中血糖偏高58人(14.5%),血脂偏高149人(37.3%),肝功能受损34人(8.5%),黑棘皮症检出66人(16.5%)。超重与肥胖学生空腹血糖、TC、TG、ALT、AST、脂肪肝、肝功损伤、黑棘皮病的异常检出率差异均有统计学意义(P值均0.05),HDL-C、LDL-C异常检出率差异均无统计学意义(P值均0.05)。结论肥胖在青少年期就已经开始造成心血管、肝脏等多系统的病变,应以肥胖学生代谢性疾病的相关指标监测与风险评估为切入点,做到早期发现、早期治疗,避免肥胖对健康造成更大的损害。     

银川中小学生不同肥胖评价指标与心血管危险因素的关系

分析银川市学龄儿童青少年不同肥胖定义指标与心血管危险因素的关系,为儿童青少年肥胖及相关心血管疾病的防治提供科学依据.方法 采用横断面研究设计,以分层方便整群抽样的方法于2015年抽取银川市6~18岁中小学生1 939名,进行问卷调查、体格检查、体成分检测及实验室检测.结果 不同指标体质量指数(BMI)、体脂百分比(FMP)、腰围身高比(WHtR)、腰围(WC)肥胖组的心血管危险因素检出率均高于正常组,差异均有统计学意义(P值均<0.01).BMI,FMP,WHtR,WC均可预测心血管危险因素的风险(OR值均>1,P值均<0.01),其中BMI和WC预测心血管危险因素的风险分别是正常组的1.46~1.86,1.51~1.91倍,预测效果优于FMP和WHtR.随着心血管危险因素聚集数的增加,BMI与WC肥胖组心血管危险因素≥1项或≥2项的检出风险预测分别是正常组的3.12(2.2~4.3)倍和5.36(3.8~7.5)倍,优于其他不同定义肥胖指标分组组合对心血管危险因素的风险预测.结论 不同指标定义肥胖对心血管危险因素的影响存在差异,BMI和WC定义肥胖的心血管危险因素检出高于FMP和WHtR,BIM与WC定义肥胖相结合对心血管危险因素的预测风险较高.     

学龄儿童肥胖持续状态与心血管代谢异常发病风险

目的分析学龄儿童肥胖持续状态与心血管代谢异常罹患风险的关系。方法研究对象为儿童青少年,根据基线和随访时状态将研究对象分为持续非肥胖、肥胖恢复、新发肥胖和持续肥胖组,并按照基线与随访时点是否为肥胖分析比较不同肥胖持续状态儿童的血压、血糖和血脂水平的变化。采用多元logistic回归方程,分析不同肥胖持续状态与心血管代谢异常发生风险的关系。结果本研究最终纳入分析11379人(男童占49.6%)。随访2年间,人群新发肥胖率为3.2%(95%CI:2.9%~3.5%),肥胖恢复率为4.4%(95%CI:4.0%~4.8%)。新发肥胖组和持续肥胖组的SBP、DBP、TG、LDL-C和非HDL-C的增加值高于持续非肥胖组,而肥胖恢复组的SBP、LDL-C和非HDL-C的增加值较低(均P<0.05)。此外,以持续非肥胖组为对照,持续肥胖组和新发肥胖组的高血压、高血糖、血脂各项异常及心血管危险因素聚集(异常个数≥2)的发生风险均显著增加,而肥胖恢复组在大部分心血管代谢异常发生风险与持续非肥胖组无统计学差异。结论新发肥胖和持续肥胖均可增加心血管代谢异常的发生风险,而肥胖儿童恢复为非肥胖后上述风险则可有效降低。     

高龄妇女再生育的产时及产后风险

生育年龄推迟是全球性问题。高龄孕妇可以导致孕期超重/肥胖、妊娠期糖尿病、妊娠高血压/子痫前期、产前出血、胎盘植入、胎膜早破、早产、死胎、胎先露异常、头盆不称、产力异常、剖宫产、产后出血、胎儿宫内窘迫、死产、低出生体重、小于胎龄儿、大于胎龄儿、出生窒息、围产儿死亡、孕产妇围产期发病/围产期死亡等多重不良妊娠结局。同时,高龄孕妇的不良妊娠结局与母亲和子代远期的高血压、2型糖尿病、代谢综合征、动脉粥样硬化、青少年肥胖等心血管代谢风险密切相关。因此,有必要加强高龄孕妇的围产期保健和产后远期的心血管代谢风险防范。     

Basic principles of cardiovascular magnetic resonance (CMR): sequences, acquisition planes and study protocol

Evaluation of the cardiovascular system with magnetic resonance (CMR) has become one of the most relevant and up-to-the-minute clinical applications of this diagnostic technique, as CMR makes possible an exact and reproducible study of the anatomy and function of the heart and great vessels. The complexity of this technique is mainly due to the anatomical location and orientation of the cardiovascular structures, the specific CMR sequences that have to be used and a lack of familiarity amongst radiologists regarding cardiovascular pathology. In this report the most basic principles of CMR are described. The clinical usefulness of anatomical, functional, and flow quantification sequences are discussed, conventional CMR acquisition planes are described, and an easy CMR study protocol is proposed.     

Is walkability associated with a lower cardiometabolic risk?

Walkability of residential environments has been associated with more walking. Given the health benefits of walking, it is expected that people living in locations with higher measured walkability should have a lower risk of cardiometabolic diseases. This study tested the hypothesis that higher walkability was associated with a lower cardiometabolic risk (CMR) for two administrative spatial units and three road buffers. Data were from the North West Adelaide Health Study first wave of data collected between 2000 and 2003. CMR was expressed as a cumulative sum of six clinical risk markers, selected to reflect components of the metabolic syndrome. Walkability was based on an established methodology and operationalised as dwelling density, intersection density, land-use mix and retail footprint. Walkability was associated with lower CMR for the three road buffer representations of the built environment but not for the two administrative spatial units. This may indicate a limitation in the use of administrative spatial units for analyses of walkability and health outcomes.     

Social patterning of cardiovascular and metabolic risk in Colombian adults

Objectives: To test for differences in cardiovascular and metabolic risk (CMR) by educational attainment and physical capital. To compare CMR among black, indigenous, and mixed populations, accounting for socioeconomic status (SES).

Design: We conducted multivariate analyses using cross-sectional data from a national survey of Colombian adults (n?=?10,814) to examine the social patterning of CMR. In sex/gender-stratified models, a CMR index was regressed on educational attainment, physical capital, ethnicity/race, and age.

Results: Women with a primary education (OR?=?1.64, 95% CI: 1.25, 2.15) had higher age- and ethnicity/race-adjusted odds of CMR than women with more than secondary education. Men with a primary education (OR?=?0.67, 95% CI: 0.48, 0.92) had significantly lower adjusted odds of CMR than men with more than secondary education; these associations did not remain significant after adjustments for physical capital. Men in the first (OR?=?0.45, 95% CI: 0.36, 0.57) and second (OR?=?0.72, 95% CI: 0.57, 0.91) physical capital tertiles had significantly lower adjusted odds of CMR than those in the highest tertile. There was not a significant patterning of CMR by ethnicity/race for women or men, or by physical capital for women.

Conclusions: Findings suggest that for Colombian adults CMR is patterned by SES; these associations differ by sex/gender.     

New mechanisms and the anti-inflammatory role of curcumin in obesity and obesity-related metabolic diseases

Purpose  

A metabolic abnormality such as obesity is a major obstacle in the maintenance of the human health system and causes various chronic diseases including type 2 diabetes, hypertension, cardiovascular diseases, as well as various cancers. This study was designed to summarize the recent scientific knowledge regarding the anti-obesity role of curcumin (diferuloylmethane), which is isolated from the herb curcuma longa, known to possess anti-inflammatory activities. However, little is known about its exact underlying molecular mechanisms in the treatment of obesity and metabolic diseases. Furthermore, cell cultures, animal models of obesity, and few human clinical and epidemiological studies have added the promise for future therapeutic interventions of this dietary compound.     

体检人群随访两年心血管及代谢指标异常检出率变化分析

目的探讨体检人群心血管及代谢指标的异常检出率变化,为心血管及代谢性疾病的早期筛查及健康干预提供依据。方法采用回顾性队列研究,收集北京某体检机构2008年度与2010年度5578名人群的体检数据（男性3404名,占61．0％,女性2174名,占39．0％）,从中选取2008年、2010年均在该机构体检的人群作为本研究的研究对象,分析该人群随访两年后的血压、血脂、空腹血糖指标异常检出率变化情况。描述采用配对t检验和配对秩和检验等统计学方法。结果随访两年后血压异常检出率的比例下降,而血糖、总胆固醇、低密度脂蛋白胆固醇升高,差异均有统计学意义（t=5．378、13．885、3．210、10．401、4．355,P〈0．05）;高密度脂蛋白胆固醇和三酰甘油的异常检出率差异无统计学意义（t=1．204、-0．012,P〉0．05）。结论心血管及代谢指标异常检出率随时间呈动态变化特点,掌握动态变化的规律,并采取有效干预措施,能够降低心血管等疾病的发生风险。     

微量元素与心血管疾病

心血管疾病的发生和发展与微量元素不平衡或代谢紊乱密切相关,简述了微量元素在高血压病、冠心病、心律失常、心力衰竭和心肌病等心血管疾病中的作用及其作用机制,从而为临床心血管疾病的预防和治疗提供新的思路。     

特殊人群心血管和代谢性疾病与血尿酸关系的分析

目的：调查特殊人群心血管及代谢性疾病的检出率，并探讨血尿酸（SUA）在各种疾病中的分布及与之关系。方法：收集华西医科大学附三院2000－2001年474例高收入、脑力劳动者有关心血管及代谢性疾病的病史以及相关家族史资料，分析有无上述疾病者SUA分布，并分别进行比较，结果：该人群中所调查疾病检出率由高到低依次为高脂血症（44．3％）、肥胖症（36．9％），高尿酸血症（29．1％）、高血压（15．6％）、脂肪肝（11．2％），胆囊结石（7．4％）、痛风（7．2％）、糖尿病（6．3％）、肾结石（4．3％）、冠心病（3．1％）；痛风、肥胖、高脂血症、脂肪肝、高血压患者及有痛风和高血压家族史者SUA水平明显高于非疾患者和无家族史者（P均＜0．01）。结论：该组人群上述疾病检出率高于一般人群，SUA升高可能是某些心血管疾病及代谢性疾病的重要标志。     

Beneficial Effects of Early Time-Restricted Feeding on Metabolic Diseases: Importance of Aligning Food Habits with the Circadian Clock

The importance of metabolic health is a major societal concern due to the increasing prevalence of metabolic diseases such as obesity, diabetes, and various cardiovascular diseases. The circadian clock is clearly implicated in the development of these metabolic diseases. Indeed, it regulates physiological processes by hormone modulation, thus helping the body to perform them at the ideal time of day. Since the industrial revolution, the actions and rhythms of everyday life have been modified and are characterized by changes in sleep pattern, work schedules, and eating habits. These modifications have in turn lead to night shift, social jetlag, late-night eating, and meal skipping, a group of customs that causes circadian rhythm disruption and leads to an increase in metabolic risks. Intermittent fasting, especially the time-restricted eating, proposes a solution: restraining the feeding window from 6 to 10 h per day to match it with the circadian clock. This approach seems to improve metabolic health markers and could be a therapeutic solution to fight against metabolic diseases. This review summarizes the importance of matching life habits with circadian rhythms for metabolic health and assesses the advantages and limits of the application of time-restricted fasting with the objective of treating and preventing metabolic diseases.     

某校大学生不同肥胖类型与心血管疾病代谢指标的关系

  目的  获得大学生不同肥胖类型与心血管疾病代谢指标之间的关联性,为有效控制青少年肥胖、预防心血管疾病提供科学依据。  方法  本次研究以芜湖市某高校2018级3 450名新生为研究对象,采用整群抽样的方法对其进行问卷调查和体格检测。使用BMI及腰围身高比(waist height ratio, WHtR)作为判断肥胖的指标。  结果  符合条件的3 349名调查对象中复合型肥胖、中心型肥胖和外周型肥胖的患病率分别为6.51%、4.93%、0.53%。除了载脂蛋白A(apolipoprotein A, APOA)外,各心血管疾病代谢异常检出率在不同肥胖类型之间差异均有统计学意义(均有P＜0.05)。除APOA外,复合型肥胖发生心血管疾病代谢异常的风险较非肥胖人群均有增加(均有P＜0.05)。与非肥胖人群相比,复合型肥胖的青少年出现指标异常数≥2的可能性是6.86倍(OR=6.86, 95% CI: 4.54~10.39)。  结论  复合型肥胖青少年发生心血管疾病代谢异常的风险较高,联合使用BMI和WHtR可提高对青少年心血管疾病的预测效应。     

Cytochrome P4502E1 phenotyping by the measurement of the chlorzoxazone metabolic ratio: assessment of its usefulness in workers exposed to styrene

OBJECTIVES: To analyse the relationship between cytochrome P4502E1 (CYP2E1) activity as assessed by the chlorzoxazone metabolic ratio (CMR) and frequent CYP2E1 genotypes ( CYP2E1*5B, *6, *1B and *1D) and to assess the value of CMR in refining the biomonitoring of exposure to styrene. METHODS: Thirty-one workers from a fibreglass-reinforced plastics factory took part in the study. Ambient styrene concentration was determined during the whole workshift by passive sampling. Each worker received a 500-mg chlorzoxazone (CZX) tablet at the beginning of the workday, and blood was taken after 2 h for CMR and CYP2E1 genotypes determination. Urine was collected at the end of the shift for the determination of styrene-specific metabolites. RESULTS: While the only worker heterozygous for CYP2E1*1D allele presented the highest value of CMR, a trend to lower CMR value for individuals possessing at least one mutant CYP2E1*6 allele compared with homozygous wild type was observed. The integration of CMR value as an independent variable to explain inter-individual variability in urinary metabolite excretion was not conclusive. CONCLUSION: Although, in the present population of workers, the CMR test was able to detect a slight influence of some genotypes on the activity of the CYP2E1 enzyme, it must be recognised that this method is not appropriate for refining the biological monitoring of industrial compounds that are metabolised by CYP2E1.