腰围与肥胖儿童血脂水平的关系

目的 研究腰围与肥胖儿童血脂代谢的关系.方法 回顾性分析2002年1月至2006年9月仁济医院肥胖专科门诊206例6～14岁单纯性肥胖患儿的临床资料,男134例,女72例.测量肥胖儿童体重、身高、腰围、臀围并测定空腹血脂水平.2006年9～12月对上海市浦东新区1 180名6～14岁学生测量体重、身高、腰围、臀围,以此为依据建立同龄同性别腰围百分位值.结果 1 180名在校儿童腰围超过同龄同性别85 th和95th百分位分别为170名(14.4%)和65名(5.5%);206名肥胖儿童腰围均趟过85 th百分位值,腰围在85 th和95 th百分位值之间的儿童16名(7.8%),超过95 th百分位190名(92.2%).肥胖儿童出现血脂代谢紊乱109名(52.9%),其中1项指标异常者76名(36.9%),2项指标异常者23名(11.2%),3项指标异常者10名(4.9%),血总甘油三酯ゥ(TG)升高100名(48.5%),总胆固醇(TC)升高31名(15.0%),低密度脂蛋白(LDL)升高14名(6.8%),高密度脂蛋白(HDL)降低8名(3.9%).腰围在85 th和95 th百分位值之间的16名肥胖儿童有8名(50%)血脂异常,其中1项指标异常6名,2项指标异常2名.190名腰围超过95 th百分位肥胖儿童中101名(53.2%)血脂异常,其中1项血脂指标异常70名(36.8%),2项血脂指标异常21名(11.1%),3项血脂指标异常为10名(5.3%).校正年龄和性别因素后,腰围不仅与血清TG水平呈明显正相关(r=0.17,P＜0.05),还与血脂紊乱程度明显相关(r=0.15,P＜0.05).结论 以同龄同性别95 th百分位为标准,1 180名6～14岁在校学生中心性肥胖发生率为5.5%.中心性肥胖儿童更易发生血脂代谢紊乱,以血清TG和TC升高最常见.

Relationship between age and gender specific waist circumference and serum lipid profiles in obese children

Objectives To evaluate the relationship between age and gender specific waist circumference and serum lipid profiles in obese children in Shanghai. Methods A total of 206 obese children(obese group)aged 6 to 14 years old were recruited from obesity outpatient service from January 2002 to December 2006. Of them,134 were boysand 72 were girls. Another 1 180 students(control group)aged 6 to 14 years from two elementary schools in Pudong New Area,Shanghai were also enrolled in the study to establish standard of age and gender specific waist circumference. Height,body weight,waist circumference,hip circumference and fasting serum TG,TC,HDL-C and LDL-C were measured for each obese child. Results Among children in the control group whose waist circumference exceeded the 85 th and 95 th of age and gender specific waist circumference were 14.4% and 5.5%,respectively. All children in the obese group exceeded the 85th percentile of the waist circumference,and those with waist circumference between 85th and 95th percentile were 16 (7.8%),those with waist circumference exceeded 95th percentile were 190(92.2%). 52.9%(109/206)of obese children were diagnosed with dyslipidemia,76(36.9%)with one,23(11.2%)with two and 10(4.9%)with three abnormal lipid indices. Elevation of TG was observed in 100(48.5%)obese children and elevation of TC was appeared in 31(15.0%). Increase of LDL-C was found in 14(6.8%)children, while decrease of HDL-C was found in 8(3.9%). Serum lipid profiles were abnormal in 8 children whose waist circumference were between 85th and 95th percentile,in which 6 children with one abnormal lipid index and 2 children with two abnormal lipid indexes. 53.2% of children were diagnosed with dyslipidemia in children whose waist circumference exceeded 95th percentile,in which 70(36.8%)children with one abnormal lipid index and 21(11.1%)children with two abnormal lipid indexes and 10(5.3%)with three abnormal lipid indexes. Waist circumference showed a positive relationship not only with serum TG(r = 0.17,P = 0.02),but also with the degree of dsylipidemia(r = 0.15,P = 0.04)adjusted for age and gender. Conclusions The prevalence of central obesity is 5.5% in 1 180 school students aged 6 -14 years in Shanghai when 95th percentile of waist circumference was applied as a diagnostic criterion. Central obesity predisposes obese children to get dyslipidemia. Elevation of serum TG and TC are popular in obese children.