中国儿童和青少年肥胖症外科治疗指南（2019版）

近年来,中国儿童和青少年的肥胖症患病率迅猛增加。肥胖症可以引发2型糖尿病、高血压病、高脂血症、高尿酸血症等一系列代谢紊乱性疾病。饮食控制、体育锻炼及现有的药物等对儿童和青少年肥胖症的治疗效果并不确切,越来越多的循证医学证据表明减肥手术能显著减轻肥胖症儿童青少年的体重,并缓解肥胖相关的代谢病。随着减重代谢外科在我国的快速普及,中国肥胖儿童和青少年选择减肥手术治疗肥胖症的例数逐渐增多,但仍缺少相应的基于临床研究证据的诊疗规范。因此,中国医师协会外科医师分会肥胖和糖尿病外科医师委员会于2018年6月发起编写首版《中国儿童和青少年肥胖症外科治疗指南》,旨在为该领域临床医生的临床决策提供参考依据,同时鼓励针对此临床问题进行深入的研究,以期积累国人特征的循证医学证据,为中国儿童和青少年肥胖症外科治疗的临床决策提供更高级别的证据。     

恩平市城区学龄前儿童血脂状况分析

目的探讨恩平市城区超重、肥胖学龄前儿童血脂浓度的变化特点,为儿童肥胖的预防、治疗提供依据。方法选择恩平市城区6。7岁学龄前儿童1021名,测量其身高、体质量,并根据测量结果划分为正常体质量组,超重组和肥胖组。对自愿参加血脂浓度检测的494名儿童（正常体质量组127名,超重组219名和肥胖组148名）．采集空腹肘静脉血测定血清总胆固醇（total cholesterol,TG）、三酰甘油（triaeylglyeerol,TG）、高密度脂蛋白胆固醇（high density lipoprotein cholesferol,HDL-C）、低密度脂蛋白胆固醇（low density lipoprotein cholestorol,LDL—C）浓度。结果肥胖组血清HDL．C浓度低于超重组[（1．37±0．27）mmol／Lvs（1．46±0．31）mmol／L,P〈0．05]和体质量正常组[（1．37±0．27）mmol／Lvs（1．69±0．35）mmol／L,P〈0．05];超重组血清HDL-C浓度低于体质量正常组,差异均有统计学意义（P〈0．05）。肥胖组血清TG及LDL—C浓度高于超重组[（1．11±0．52）mmol／Lvs（0．87＋0．37）mmol／L,P〈0．05;（2．44±0．54）mmol／LVS．（2．17±0．51）mmol／L,P〈0．05]及正常体质量组[（1．11±0．52）mmol／Lvs（0．71±0．25）mmol／L,P〈0．05;（2．44±0．54）mmol／L％（2．00±0．47）mmol／L,P〈0．05];超重组血清TG及LDL．C浓度高于正常体质量组,差异有统计学意义（P〈0．05）。3组血清TC浓度比较,差异无统计学意义（P〉0．05）。结论恩平市城区学龄前儿童存在明显的血脂异常;应加强超重和肥胖儿童血脂检测,并进行综合干预。     

儿童及青少年肥胖的干预

近20年来,儿童及青少年肥胖的发生率在世界范围内均明显升高,肥胖相关的危害更为引人瞩目.目前公认的儿童及青少年肥胖干预方法主要通过调整生活方式,包括饮食控制、增加运动、心理认知行为干预等.大量的证据表明,上述措施有确切的短期减重效果,然而长期效果尚未明确.即使彻底调整生活方式,仍有一部分人群减重效果不理想,因此,学者们致力于开辟有效安全的新途径,包括药物、手术,以及肥胖疫苗,以期控制儿童、青少年肥胖及其相关疾病的发生.     

儿童肥胖症的干预治疗

儿童肥胖症患病率逐渐升高 ,它严重影响了儿童的健康成长。目前对儿童肥胖的治疗方法主要是以家庭疗法为基础 ,加以饮食控制、运动训练以及认知行为治疗在内的综合治疗 ,而不主张采用药物或手术干预。     

儿童,青少年单纯性肥胖症患者血脂及载脂蛋白的含量观察

我们对乐陵市53例儿童、青少年单纯性肥胖症患者进行血脂、载脂蛋白(Apo)检测,以探讨血脂和Apo的流行病学意义,为有效防治儿童、青少年肥胖症提供参考依据。一、对象和方法(一) 检测对象:自1988年9月～1990年6月,我们采用整群抽样法在9825例7～18岁中小学生中检出单纯性肥胖症53例,检     

老年肥胖症与血脂、血尿酸的关系

肥胖引起的代谢紊乱已越来越受到人们的重视。本对311例60岁以上老年人的体重指数、血脂、血尿酸进行分析，探讨老年肥胖症对血脂、血尿酸代谢的影响以及三的关系。     

青少年肥胖症代谢手术后3年效应观察与分析

目的探究青少年肥胖症病人接受减重代谢手术后中期效益及影响。 方法回顾性分析2014年11月至2015年10月于长春嘉和外科医院接受减重代谢手术的16例青少年肥胖症患者（13~21岁）的临床资料,对他们术前及术后3年间的体重、体质量指数（BMI）、甘油三酯（TC）、高密度脂蛋白（HDL）及低密度脂蛋白（LDL）进行统计分析。 结果16名入组患者的平均体重、BMI、空腹TC、LDL在术后3年均有不同幅度下降,平均空腹HDL有所升高,数据分析均有统计学意义（P<0.05）。 结论减重代谢手术可以明确并且持续性地减轻青少年肥胖症病人的体重,同时改善血脂异常问题。青少年一旦达到肥胖II级应当尽早手术。     

提示肥胖症儿童/青少年存在非酒精性脂肪性肝炎的指标分析

目的 分析提示肥胖症儿童/青少年存在非酒精性脂肪肝炎(NASH)的指标,为临床诊断NASH提供简易解决方案。方法 2015年7月～2021年1月我院诊治的肥胖症儿童/青少年117例,采用ELISA法检测血清IL-2、IL-4、IL-6、IL-10、TNF-α和INF-γ水平,计算稳态模型胰岛素抵抗指数(HOMA-IR),使用FibroScan 502型肝脏弹性检测仪行肝脏硬度测定(LSM)和受控衰减参数(CAP),应用单因素和多因素Logistic回归分析提示NASH存在的指标。结果 在117例儿童/青少年人群中,发现单纯性脂肪肝90例,NASH者27例;NASH患者血清空腹胰岛素、HOMA-IR、ALT、AST、LSM和CAP分别为(20.2±3.2)pmol/L、(5.2±0.4)、(70.8±12.8)U/L、(57.3±12.0)U/L、(9.2±2.7)kPa和(255.6±33.7)dB/m,显著高于单纯性脂肪肝组【分别为(17.8±3.0)pmol/L、(4.0±0.3)、(33.8±7.5)U/L、(25.2±8.0)U/L、(7.8±2.4)kPa和(290.8±28...     

出生体重与青少年期单纯性肥胖及血脂、血糖、血压相关关系的队列研究

目的 探讨出生体重与青少年期单纯性肥胖及血脂、血糖、血压的相关关系。方法 采用整群抽样横断面调查与追踪调查的流行病学方法,对北京市193名健康学龄儿童（7～11岁）与9年后同一观察对象（16～20岁）进行出生情况调查、体格检查及实验室检测。结果 出生体重与儿童、青少年期体质指数呈U型相关,低出生体重组（5．6％）及高出生体重组（6．1％）青少年期超重-肥胖发生率较正常出生体重组（2．8％）有增高趋势,但差异无统计学意义（P〉0．05）。高出生及低出生体重组体质指数均显著大于正常出生体重组（P值分别为0．002和0．009）,高出生体重组（33．3％）及低出生体重组（38．9％）青少年期超重-肥胖发生率均显著高于正常出生体重组（16．2％,P值分别为0．025和0．020）。不同出生体重婴儿至儿童及青少年期血糖、血脂及血压水平未发现显著差异。结论 胎儿宫内生长与青少年期体格生长密切相关,加强孕期营养指导有利于预防青少年期单纯性肥胖的发生。     

Relationship among obesity,blood lipids and insulin resistance in Bangladeshi adults

IntroductionInsulin resistance (IR) and abnormal lipid profiles are the risk factors for cardiovascular diseases in obesity. To clarify the relationship of the changes in insulin resistance, body weight and lipid profile, the present study was performed on Bangladeshi adults, total of 1500 individuals at the time of their general health examination in the hospital.MethodsAfter exclusion of other endocrine diseases, the remaining 772 patients were classified as IR ≥ 2 and IR < 2 based on the homeostatic model assessment-estimated insulin resistance (HOMA-IR) index. The endocrine disease free subjects were further clustered based on age, gender and obesity. The anthropometric and biochemical profiles were statistically analyzed and correlated with IR ≥ 2 and IR<2 groups as well as other clusters of the subjects. Apart from some disparities, notable differences were observed in all anthropometric data.ResultsTotal cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL) and serum insulin levels were significantly higher in IR ≥ 2 group in comparison with IR<2 group. Obesity and dyslipidemia were associated as prevalent components of IR. Generalized linear model revealed that TC: LDL and TG: HDL had significant effect on IR. Age group II (41–60 years old) subjects had significantly higher lipid profile compared to age group I (20–40 years old) and age group III (61–80 years old).ConclusionsResults reported herein support the notion that lipoprotein ratios might be the reliable biomarkers to evaluate IR.     

High blood Pressure in children and its correlation with three definitions of obesity in childhood

Background

Several authors have correlated the increase of cardiovascular risk with the nutritional status, however there are different criteria for the classification of overweight and obesity in children.

Objectives

To evaluate the performance of three nutritional classification criteria in children, as definers of the presence of obesity and predictors of high blood pressure in schoolchildren.

Methods

Eight hundred and seventeen children ranging 6 to 13 years old, enrolled in public schools in the municipality of Vila Velha (ES) were submitted to anthropometric evaluation and blood pressure measurement. The classification of the nutritional status was established by two international criteria (CDC/NCHS 2000 and IOTF 2000) and one Brazilian criterion (Conde e Monteiro 2006).

Results

The prevalence of overweight was higher when the criterion of Conde e Monteiro (27%) was used, and inferior by the IOTF (15%) criteria. High blood pressure was observed in 7.3% of children. It was identified a strong association between the presence of overweight and the occurrence of high blood pressure, regardless of the test used (p < 0.001). The test showing the highest sensitivity in predicting elevated BP was the Conde e Monteiro (44%), while the highest specificity (94%) and greater overall accuracy (63%), was the CDC criterion.

Conclusions

The prevalence of overweight in Brazilian children is higher when using the classification criterion of Conde e Monteiro, and lower when the criterion used is IOTF. The Brazilian classification criterion proved to be the most sensitive predictor of high BP risk in this sample.     

Effect of childhood obesity prevention programmes on blood lipids: a systematic review and meta‐analysis

We aimed to assess the effects of childhood obesity prevention programmes on blood lipids in high‐income countries. We searched MEDLINE®, Embase, PsychInfo, CINAHL®, clinicaltrials.gov , and the Cochrane Library up to 22 April 2013 for relevant randomized controlled trials, quasi‐experimental studies and natural experiments published in English. Studies were included if they implemented diet and/or physical activity intervention(s) with ≥1 year follow‐up (or ≥6 months for school‐based intervention studies) in 2–18‐year‐olds, and were excluded if they targeted only overweight/obese children, or those with a pre‐existing medical condition. Seventeen studies were finally included. For total cholesterol, the pooled intervention effect was ?0.97 mg dL^?1 [95% confidence interval (CI): ?3.26, 1.32; P = 0.408]; for low‐density lipoprotein cholesterol (LDL‐C), ?6.06 mg dL^?1 (95% CI: ?11.09, ?1.02; P = 0.018); for high‐density lipoprotein cholesterol (HDL‐C), 1.87 mg dL^?1 (95% CI: 0.39, 3.34; P = 0.013); and for triglycerides, ?1.95 mg dL^?1 (95% CI: ?4.94, 1.04; P = 0.202). Most interventions (70%) showed similar significant or no effects on adiposity‐ and lipids outcomes: 15% interventions improved both adiposity‐ and lipids outcomes; 55% had no significant effects on either. Childhood obesity prevention programmes had a significant desirable effect on LDL‐C and HDL‐C. Two‐thirds of interventions showed similar significant or no effects in adiposity‐ and lipids outcomes. Assessing lipids outcomes provide additional useful information on obesity prevention programme benefits.     

单纯性肥胖儿童脂肪细胞载脂蛋白E基因的表达

以RT PCR法分析脂肪细胞载脂蛋白E(apoE)基因的表达,发现肥胖儿童脂肪细胞apoE基因表达水平显著下调,重度及中心性肥胖尤甚,提示apoE基因可能与肥胖密切相关。     

The influence of gender and atopy in the relationship between obesity and asthma in childhood

BackgroundThe objective of the study was to examine the relationship between asthma and overweight–obesity in Spanish children and adolescents and to determine whether this relationship was affected by gender and atopy.MethodsThe study involves 8607 Spanish children and adolescents from the International Study of Asthma and Allergies in Childhood phase III. Unconditional logistic regression was used to obtain adjusted odds ratios (OR) and 95% confidence intervals (95% CI) for the association between asthma symptoms and overweight–obesity in the two groups. Afterwards, it was stratified by sex and rhinoconjunctivitis.ResultsThe prevalence of overweight and obesity in 6–7-year-old children was 18.6% and 5.2% respectively and in 13–14 year-old teenagers was 11.4% and 1.1% respectively. Only the obese children, not the overweight children, of the 6–7 year old group had a higher risk of any asthma symptoms (wheezing ever: OR 1.68 [1.15–2.47], asthma ever: OR 2.29 [1.43–3.68], current asthma 2.56 [1.54–4.28], severe asthma 3.18 [1.50–6.73], exercise-induced asthma 2.71 [1.45–5.05]). The obese girls had an increased risk of suffering any asthma symptoms (wheezing ever: OR 1.73 [1.05–2.91], asthma ever: OR 3.12 [1.67–5.82], current asthma 3.20 [1.65–6.19], severe asthma 4.83[1.94–12.04], exercise-induced asthma 3.68 [1.67–8.08]). The obese children without rhinoconjunctivitis had a higher risk of asthma symptoms.ConclusionsObesity and asthma symptoms were associated in 6–7 year-old children but not in 13–14 year-old teenagers. The association was stronger in non-atopic children and obese girls.     

老年男性患者血清抵抗素与血脂水平的相关性研究

目的观察老年男性患者血清抵抗素与血脂水平的关系。方法选择老年(≥80岁)男性患者220例,根据血脂水平分为血脂异常组(80例)和血脂正常组(140例),使用酶联免疫法测定空腹血清抵抗素浓度,并分析两者关联。结果血脂异常组患者空腹血清抵抗素浓度较血脂正常组高[(7.16±0.77)ng/ml比(6.21±0.63)ng/ml,P<0.05],血清抵抗素浓度与总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇水平呈负相关(γ=-0.231,-0.254,-0.243,均为P<0.01),与三酰甘油水平呈正相关(γ=0.127,P<0.01),在控制了年龄、病史和相关用药后,高密度脂蛋白胆固醇与抵抗素水平独立相关(P=0.017)。结论老年男性血脂异常患者空腹血清抵抗素浓度升高,可能与脂代谢紊乱有关。     

Clinical aspects of obesity in childhood and adolescence

The level of fatness of a child at which morbidity acutely and/or later in life increases is determined on an acturial basis. Direct measurements of body fat content, e.g. hydrodensitometry, bioimpedance, or DEXA, are useful tools in scientific studies. However, body mass index (BMI) is easy to calculate and is generally accepted now to be used to define obesity in children and adolescents clinically. An increased risk of death from cardiovascular disease in adults has been found in subjects whose BMI had been greater than the 75th percentile as adolescents. Childhood obesity seems to substantially increase the risk of subsequent morbidity whether or not obesity persists into adulthood. The genetic basis of childhood obesity has been elucidated to some extent through the discovery of leptin, the ob gene product, and the increasing knowledge on the role of neuropeptides such as POMC, neuropeptide Y (NPY) and the melanocyte concentrating hormone receptors (for example, MC4R). Environmental/exogenous factors largely contribute to the development of a high degree of body fatness early in life. Twin studies suggest that approximately 50% of the tendency toward obesity is inherited. There are numerous disorders including a number of endocrine disorders (Cushing's syndrome, hypothyroidism, etc.) and genetic syndromes (Prader‐Labhard–Willi syndrome, Bardet Biedl syndrome, etc.) that can present with obesity. A simple diagnostic algorithm allows for the differentiation between primary or secondary obesity. Among the most common sequelae of primary childhood obesity are hypertension, dyslipidemia, back pain and psychosocial problems. Therapeutic strategies include psychological and family therapy, lifestyle/behaviour modification and nutrition education. The role of regular exercise and exercise programmes is emphasized. Surgical procedures and drugs used in adult obesity are still not generally recommended in children and adolescents with obesity. As obesity is the most common chronic disorder in industrialized societies, its impact on individual lives as well as on health economics has to be recognized more widely. This review is aimed towards defining the clinical problem of childhood obesity on the basis of current knowledge and towards outlining future research areas in the field of energy homoeostasis and food intake in relation to child health. Finally, one should aim to increase public awareness of the ever increasing health burden and economic dimension of the childhood obesity epidemic that is present around the globe.     

解偶联蛋白2基因多态性与儿童青少年肥胖的相关性研究

本研究应用PCR技术检测201例单纯性肥胖儿童青少年和230例正常体重儿童青少年解偶联蛋白2基因第8号外显子的插入/缺失多态性,结果显示该多态性类型为45bp串联重复序列之一的插入或缺失,此多态性与儿童青少年单纯性肥胖无显著关联。