代谢综合征患儿肝前脂肪厚度和腰围变化

目的 研究代谢综合征(MS)儿童肝前脂肪厚度和腰围的变化及其临床意义。方法 2017年2月～2019年2月在我院健康体检儿童445例,发现非酒精性脂肪性肝病(NAFLD)54例,MS 18例,对患儿和从373例健康儿童中配比选择54例,分别行超声检查,检测肝前脂肪厚度、腹内脂肪厚度、腰围和颈动脉内中膜层厚度(IMT),并行血清检测。结果 MS患儿肝前脂肪厚度、腹内脂肪厚度和腰围分别为(1.6±0.2)cm、(4.4±1.5)cm 和(83.4±4.8)cm,显著大于健康儿童【分别为(1.3±0.4)cm、(3.4±1.5)cm和(76.8±5.3)cm,P < 0.05】或NAFLD儿童【分别为(1.4±0.3)cm、(3.5±1.6)cm和(80.3±5.0)cm,P < 0.05】;MS患儿胰岛素抵抗指数、高敏C反应蛋白、收缩压和低密度脂蛋白胆固醇水平分别为(5.9±1.6)、(1.8±0.2)mg/L、(136.5±14.0)mmHg和(2.6±0.8)mmol/L,显著大于健康儿童【分别为(3.5±1.7)、(1.4±0.2) mg/L、(110.8±12.7)mmHg和(1.7±0.5)mmol/L,P < 0.05】或NAFLD儿童【分别为(4.2±1.5)、(1.5±0.3)mg/L、(128.9±13.8)mmHg和(2.4±0.7)mmol/L,P < 0.05】,而MS患儿血清高密度脂蛋白胆固醇水平为(1.3±0.5) mmol/L,显著低于健康儿童【(1.8±0.7)mmol/L,P < 0.05】或NAFLD儿童【1.4±0.5)mmol/L,P < 0.05】;Logistic多因素回归分析结果显示肝前脂肪厚度(95% CI =1.098-4.198,OR=2.147,P=0.026)、腰围(95% CI =1.395-4.523,OR =2.512,P=0.002)和腹内脂肪厚度(95% CI =1.332-5.958,OR =2.817,P=0.007)是MS发生的独立危险因素。结论 使用超声检测肝前脂肪厚度简单易行,有助于诊断MS儿童,临床应用价值较高。     

人体测量学指标和三酰甘油葡萄糖乘积指数对代谢综合征的诊断价值比较

背景　代谢综合征（MS）与冠心病、糖尿病等慢性病密切相关,其患病率逐年升高,但目前诊断标准不统一,诊断条件复杂,基层医务人员操作困难。目的　比较中国人群中人体测量学指标〔腰高比（WHtR）、腰臀比（WHR）、腰围（WC）、体质指数（BMI）〕及三酰甘油葡萄糖乘积（TyG）指数、TyG指数与BMI的乘积（TyG-BMI）、TyG指数与WC的乘积（TyG-WC）与MS相关性的差异及其对MS的诊断价值,确定MS的简易筛查指标。方法　选取北京市通州区觅子店社区2 972例参加健康体检人员,分别进行问卷调查、体格检查及实验室检查,计算WHtR、WHR、BMI及TyG指数、TyG-BMI、TyG-WC。依据中华医学会糖尿病学分会（CDS）诊断标准确定MS患者。采用SPSS 18.0统计软件绘制上述各项指标诊断MS的受试者工作特征（ROC）曲线,计算曲线下面积（AUC）,并采用MedCalc 16.8软件进行AUC比较。结果　男性和女性的MS患病率无统计学差异〔206/1 044比368/1 928,P>0.05〕。同性别MS患者的WHtR、WHR、WC、BMI、TyG指数、TyG-BMI、TyG-WC均高于非MS者（P<0.05）。BMI、WHtR、WHR、WC诊断男性MS的AUC分别为0.81、0.77、0.68、0.77,诊断女性MS的AUC分别为0.78、0.76、0.66、0.76,BMI诊断男性MS和女性MS的AUC均高于其他3项指标（P<0.05）。BMI诊断男性和女性MS的切点分别为25.00、25.30 kg/m2。TyG指数、TyG-BMI、TyG-WC诊断男性MS的AUC分别为0.88、0.89、0.88,诊断女性MS的AUC分别为0.88、0.88、0.87,TyG指数诊断男性MS和女性MS的AUC与其他2项指标比较无统计学差异（P>0.05）。TyG指数诊断男性和女性MS的切点分别为8.87、8.80。TyG指数诊断男性MS和女性MS的AUC高于BMI（P<0.05）。结论　人体测量学指标、TyG指数及其相关指数与MS均明显相关。BMI同MS的相关性优于其他人体测量学指标,可用于MS的大规模人群初步筛查;TyG指数的诊断价值优于BMI,可作为基层医务人员判断MS风险的简易指标。     

从腰夹脊穴论治中风后平衡功能障碍针刺思路探析

平衡功能障碍是中风后常见后遗症,增加了患者跌倒的风险及患者的病痛和负担,延缓了康复的进程,影响功能的恢复。针刺治疗是治疗中风后平衡功能障碍的重要方法,临床多以脏腑辨证和经络辨证为基础,多采用头皮针、体针、芒针等方法,虽取得一定疗效,但仍存在相应的局限性,缺乏现代学理论依据;本文从经络辨证和现代医学核心肌群理论出发,选取处于腰部核心肌群的夹脊穴,既可以通督脉、调摄膀胱经之背俞穴,入络脑室,从而达到整体治疗、调整阴阳的目的,又可以松解神经,进而缓解肌痉挛,降低肌张力,提高平衡功能。最后提出以针刺腰部夹脊穴治疗中风后平衡功能障碍,期待在临床治疗中取得更好的效果。     

Determination of most suitable cut off point of waist circumference for diagnosis of metabolic syndrome in Kerman

ObjectivesMetabolic syndrome is a determining indicator of cardiovascular diseases and diabetes. Abdominal obesity, determined by measuring waist circumference, is one of the most important criteria for diagnosing this syndrome. This criterion varies between men and women and among different races. The present study aims at the assessment of the sensitivity and specificity of the commonly used cut off point of waist circumference, and the estimation of the most suitable cut off point of waist circumference for the diagnosis of metabolic syndrome in the urban society of Kerman.Methods5332 subjects consisting of 2966 women and 2366 men, 20 years old and above were studied in a population based, cross sectional study. Waist circumference, blood pressure, blood sugar, and blood lipids were measured. People with at least two of the NCEP ATP III criteria – high blood pressure (BP > 130/80), high triglycerides (TG > 150), high glucose (FBG > 100) and low HDL (HDL < 40 in men and <50 in women) – were taken as population at risk. ROC analysis was used for determining the most suitable cut off point of waist circumference. The prevalence of metabolic syndrome was then assessed based on IDF, NCEP criteria and the proposed criterion, and agreement among the three methods in diagnosing people suffering from metabolic syndrome was examined.ResultsThe average ± standard deviation of waist circumference in women and in men was 83.90 ± 12.55 and 87.99 ± 11.94 cm respectively. The most suitable cut off point of waist circumference for metabolic syndrome diagnosis was 86 in women and 89 in men. These circumferences had the highest specificity and sensitivity. The prevalence of metabolic syndrome in IDF, NCPE, and the proposed criterion was 30.4%, 27.7%, and 35.2% respectively. The new criterion and the NCEP criterion achieved the highest agreement (kappa factor = 83%).ConclusionThe cuts off point of waist circumference in men and women are close. It is possible, then, to determine a common cut off point of waist circumference for both in Iran. Therefore, the cut point of 90-cm of waist circumference proposed by the National Obesity Committee seems to be appropriate for the Iranian society. These clinical findings should nevertheless be verified by simulation.     

Association between alcohol consumption patterns and metabolic syndrome

AimsExamine associations between self-reported alcohol consumption patterns and metabolic syndrome.Materials and methodsSample (N = 7432) included adult (≥20 years) participants in the 1999–2006 National Health and Nutrition Examination Survey.ResultsAbove moderate alcohol consumption (AMAC) was negatively associated with waist circumference among those in the 20–29, 40–49, and 70–79 age groups (β = −6.21, β = −8.34, and β = −6.60, respectively) and moderate alcohol consumption (MAC) was negatively associated with waist circumference among those in the 30–39, 40–49, and 70–79 age groups (β = −4.60, β = −5.69, and β = −2.88, respectively). AMAC was negatively associated with triglycerides among those in the 70–79 and 80+ age groups (β = −23.62 and β = −34.18, respectively) and positively associated with HDL-C levels in all groups (β range 8.96–18.25). MAC was positively associated with HDL-C in the age groups spanning 20–69 years (β range 3.05–5.34) and those over 80 (β = 5.26). AMAC and MAC were negatively associated with fasting glucose levels in the 20–29 and 70–79 age groups (β = −3.38 and −15.61, respectively). MAC was negatively associated with fasting glucose levels among those 70–79 and those over 80 years of age (β = −7.06 and β = −5.00, respectively).ConclusionMAC and AMAC may favorably impact metabolic health.     

经脐水平测定腹围与腹内脂肪体积关系的研究

目的 比较临床常用的3种腹围测量方法与CT测定的腹内脂肪体积的关系,探讨最能反映腹内脂肪堆积程度的腹围测量方法和临床应用价值.方法 对147例18岁以上经年龄和性别匹配的成年人进行身高、体重和臀围测量,分别采用髂嵴上缘水平(WC1)、肋骨下缘和髂嵴上缘连线中点水平(WC2)和脐水平( WC3)测量腹围,与CT测量的腹内脂肪体积进行比较.结果 男性腹内脂肪体积高于女性[(1 236.0±608.4对931.0±665.0)cm3,P＜0.01].相关性分析显示WC1 (r=0.634),WC2(r =0.677)和WC3(r=0.712)均与腹内脂肪体积呈正相关(均P＜0.01),经性别、体重或体重指数校正后,WC3(r分别为0.488和0.432)与腹内脂肪体积的相关性优于WC1(r分别为0.347和0.293)和WC2(r分别为0.424和0.365).多元逐步线性回归分析显示WC2和WC3均与腹内脂肪体积独立相关,其中以WC3相关性最强(β=0.270,R2C=0.504,P＜0.01).结论 经髂嵴上缘水平、肋骨下缘与髂嵴上缘连线中点水平以及经脐水平腹围均能反映腹内脂肪含量,其中经脐水平测量腹围是简便易行、更好地反映腹内脂肪体积的方法.     

Waist Circumference of the Elderly over 65 Years Old in China Increased Gradually from 1993 to 2015: A Cohort Study

ObjectiveThis study aimed to analyze the temporal trends and characteristics associated with waist circumference (WC) among elderly Chinese people.MethodsWe used data from 3,096 adults ≥ 65 years who participated in the China Health and Nutrition Survey (CHNS), an ongoing cohort study, between 1993 and 2015. We used longitudinal quantile regression models to explore the temporal trends and characteristics associated with WC.ResultsWC increased gradually among the elderly Chinese population during the survey. The WC curves shifted to the right with wider distributions and lower peaks in men and women. All WC percentile curves shifted upward with similar growth rates in the 25th, 50th, and 75th percentiles. The WC means increased from 78 cm to 86 cm during the 22 years of our study. WC significantly increased with age and body mass index and decreased with physical activity (PA). These associations were stronger in the higher percentiles than in the lower percentiles.ConclusionsWC is rising among Chinese adults ≥ 65 years. Factors affecting WC in elderly people may have different effects on different percentiles of the WC distribution, and PA was the most important protective factor in the higher percentiles of the WC distribution. Thus, different interventional strategies are needed.     

Measures of Abdominal Adiposity and Risk of Stroke：A Dose-Response Meta-analysis of Prospective Studies

ObjectiveWaist circumference, waist-to-hip ratio and waist-to-height ratio, which are the indicators or measures of abdominal adiposity, have long been hypothesized to increase therisk of stroke; yet evidence accumulated till date is not conclusive. Here, we conducted a dose-response meta-analysis to summarize evidences of the association between these measures of abdominal adiposity and the risk of stroke. MethodsPubMed and Web of Science databases were searched from inception to May 2015. Two investigators independently conducted the study selection and data extraction. Dose-response relationships were assessed by the generalized least squares trend estimation, while the summaryeffect estimates were evaluated by the use of fixed- or random-effect models. Subgroup and sensitivity analyses were performed to assess the potential sources of heterogeneity and the robustness of the pooled estimation. Publication biasof the literaturewas evaluated usingBegg’s and Egger’s test. ResultsAltogether 15 prospective cohort studies were identified in this study. The summary of relative risks (95% confidence intervals) of stroke for the highest versus the lowest categories was 1.28 (1.18-1.40) for waist circumference, 1.32 (1.21-1.44) for waist-to-hip ratio, and 1.49 (1.24-1.78) for waist-to-height ratio. For a 10-cm increase in waist circumference, the relative risk of stroke increased by 10%; for a 0.1-unit increase in waist-to-hip ratio, the relative risk increased by 16%; and for a 0.05-unit increase in waist-to-height ratio, the relative risk increased by 13%. There was evidence of a nonlinear association between waist-to-hip ratio and stroke risk,Pnonlinearity=0.028. ConclusionFindings from our meta-analysis indicated that waist circumference, waist-to-hip ratio, and waist-to-height ratio were positively associated with the risk of stroke, particularly ischemic stroke.     

Associations of Alcoholic Beverage Consumption with Dietary Intake,Waist Circumference,and Body Mass Index in US Adults: National Health and Nutrition Examination Survey 2003-2012

Background

Findings from studies of alcohol and obesity measures (eg, waist circumference [WC] and body mass index [BMI; calculated as kg/m²]) are conflicting. Residual confounding by dietary intake, inconsistent definitions of alcohol consumption across studies, and the inclusion of former drinkers in the nondrinking comparison group can contribute to the mixed literature.

Obesity and symptoms and quality of life indicators of individuals with disabilities

BackgroundHealth risks of obesity are well known, but effects of obesity on health-related quality of life (HRQOL) have not been well-studied in people with physical disabilities.Objective/hypothesisWe examined the association between obesity and HRQOL in people with disabilities relative to the general US population. We hypothesized (a) overall, individuals with disabilities will report worse HRQOL than the general US population and (b) obese individuals with disabilities will report worse HRQOL than non-obese individuals.MethodsIndividuals with muscular dystrophy, multiple sclerosis, post-polio syndrome, and spinal cord injury (N = 1849) completed Patient Reported Outcomes Measurement Information System (PROMIS) measures of fatigue, pain interference, physical and social function, depression, sleep disturbance, and sleep-related impairment. Participants were classified as obese or non-obese based on self-reported weight and height (BMI) and/or waist circumference (WC). PROMIS T-scores were compared to norms and between obesity groups.ResultsMean BMI was 26.4 kg/m² with 23.4% classified as obese. Mean WC was 37.5 inches (males) and 34.0 inches (females); 26.4% reported abdominal obesity. Based on BMI and/or WC, 33.3% (n = 616) were classified obese. Compared to PROMIS norms, obese individuals reported worse HRQOL on all domains (p < 0.0001). Compared to non-obese individuals, obese individuals reported worse functioning on all domains except depression (p < 0.01). Obese individuals with MS and MD reported worse outcomes than non-obese counterparts.ConclusionsObesity in people with physical disabilities is associated with poorer HRQOL. More research is needed to inform clinicians in identifying obese patients and helping them achieve healthy weight, reduce symptom burden, and improve QOL.