学龄期肥胖儿童骨密度水平及影响因素研究

目的 了解学龄期肥胖儿童骨密度水平,探究影响骨密度变化的因素。方法 于2018年10月-2019年10月招募北京积水潭医院小儿内科96例6~12岁肥胖儿童为研究对象进行问卷调查,空腹胰岛素、血清钙、血维生素D、血脂检测和体成分、双前臂尺桡骨远端骨密度测量、腹部超声检查。采用SPSS 25.0软件进行统计学分析。结果 96名学龄期肥胖儿童平均年龄(9.10±1.88)岁,左、右前臂尺、桡骨远端骨密度比较,差异无统计学意义(P>0.05),男、女童骨密度比较,差异无统计学意义(P>0.05)。10~12岁组肥胖儿童骨密度明显高于6~7岁组和8~9岁组,差异有统计学意义(H＝13.917,P<0.05)。学龄期肥胖儿童骨密度与年龄、肌肉量均呈正相关关系(r=0.359、0.315,P<0.05),与总胆固醇、甘油三酯、低密度脂蛋白、钙均呈负相关关系(r=-0.311、-0.203、-0.246、-0.207,P<0.05)。奶及奶制品、含糖碳酸饮料、中等强度运动、阳光直射时间会影响肥胖学龄期儿童骨密度,差异有统计学意义(P<0.05)。多元线性回归分析显示,阳光直射时间为骨密度的独立影响因素(β=0.036,t=2.836,P<0.05)。结论 学龄期肥胖儿童骨密度随年龄增长而增加,膳食、环境因素对骨密度水平有重要影响。

Study on bone mineral density level and its influencing factors in obese school-age children

Objective To investigate changes and influencing factors of bone mineral density (BMD) in school-aged children with obesity. Methods A total of 96 school-age children (aged 6 to12 years) who visited the pediatric department of Beijing Jishuitan Hospital from October 2018 to October 2019, were enrolled in this study to complete a questionnaire survey.A series of physical examination were performed for these participants, including body composition, BMD of both distal ulnar and radius, abdominal ultrasound, blood level of lipids, calcium, vitamin D and fasting insulin.SPSS 25.0 software was used for statistical analysis. Results The average age of 96 children was (9.10±1.88) years old.There was no significant difference on BMD between left and right distal ulnar and radius, or between boys and girls (P>0.05).BMD of 10- to 12-year-old children was significantly higher than that in children aged 6-7 years and 8-9 years(H=13.917,P＜0.05).Age and muscle mass were both positively correlated with BMD of obese school-age children (r=0.359, 0.315, P<0.05), while the levels of total cholesterol, triglyceride, low density lipoprotein-cholesterol and calcium were negatively related to BMD (r=-0.311, -0.203, -0.246, -0.207, P<0.05).Milk and dairy products, carbonated beverage, moderate exercise, sunlight exposure and sedentary time were found to be influencing factors of BMD (P<0.05).Multiple linear regression analysis showed that sunlight exposure time was an independent factor affecting BMD(β=0.036, t=2.836, P< 0.05). Conclusion BMD increases with age for obese school-aged children.Dietary and environmental factors are important contributors to ensure the healthy growth of BMD.