儿童期肥胖与睡眠时间及胰岛素抵抗的关系

目的探讨儿童期肥胖与睡眠时间及胰岛素抵抗的关系。方法269名体重指数（BMI）≥23kg／m^2的7～15岁单纯性肥胖儿童按BMI不同分为三组：A组（23≤BMI〈25）57名，B组（25≤BMI〈30）164名，C组（BMI≥30）72名。对肥胖儿童及120名正常健康儿童分别记录睡眠时间。所有肥胖儿童均行口服葡萄糖耐量试验和胰岛素释放试验；对照组中70名儿童测定空腹血糖（FBG）及空腹胰岛素（FINS），均分别计算稳态模型胰岛素抵抗指数（HOMA-IR），稳态模型胰岛β细胞功能（HOMA-IS）。结果3组肥胖儿童的睡眠时间均短于对照组，FBG、FINS和HOMA-IR均高于对照组（均P〈0．05），肥胖B组和C组HOMA-IS均高于对照组（均P〈0．05），而3组肥胖儿童之间、A组与对照组之间差异均无统计学意义（均P〉0．05）。对儿童期肥胖影响因素做多因素logistic回归分析显示，睡眠时间对肥胖有影响（P〈0．05），对胰岛素抵抗影响因素做多重线性回归分析显示BMI值对HOMA-IR和HOMA-IS均有影响（P〈0．05），且BMI增加一个单位，HOMA-IR和HOMA-IS则分别随之增加0．261个单位和11．054个单位。结论睡眠时间减少者更易发生肥胖；BMI与胰岛素抵抗存在明显的相关性，随着BMI的增加发生胰岛素抵抗的风险亦随之增加。

Study on the relationships of childhood obesity and the duration of sleep as well as insulin resistance

OBJECTIVE: To investigate the relationships of childhood obesity and the duration of sleep as well as insulin resistance. METHODS: Two hundred and sixty-nine simple obese children aged from 7 to 15 years with body mass index(BMI) over 23 and 120 normal healthy children were recruited in this study. Obese children were divided into three groups: Group A: 23 < or = BMI < 25; Group B: 25 < or = BMI < 30; Group C: BMI > or = 30. Duration of sleep was calculated according to the reported sleeping hours during working days and weekends. Oral glucose tolerance test and insulin releasing test were performed in all obese children. Seventy of the 120 healthy children received fasting plasma glucose (FBG) and fasting insulin (FINS) detection. Homeostasis model assessment-insulin resistance (HOMA-IR) and islet beta cell secreting index (HOMA-IS) were calculated. RESULTS: The duration of sleep was shorter in all 3 obese groups than that in the control group and the levels of FBG, FINS and HOMA-IR were higher (P < 0.05). The levels of HOMA-IS in Group B and C were higher than that in the control group (P < 0.05), while HOMA-IS did not show much difference among the 3 obese groups and between Group A and the control group (P > 0.05). Logistic analysis showed that the duration of sleep was related to childhood obese (P < 0.05). Results from multiple linear regression model analysis showed that BMI bore a relation to HOMA-IR and HOMA-IS (P < 0.05), as well as one unit increase in BMI accompanied with 0.261 and 11.054 increase in HOMA-IR and HOMA-IS, respectively. CONCLUSION: Children with shorter duration of sleep were susceptible to become obese. A significant correlation did exist between BMI and insulin resistance.