超重/肥胖与高同型半胱氨酸血症的交互作用对高血压发病的影响

目的  探讨超重/肥胖与高同型半胱氨酸血症(hyperhomosycteinemia, HHcy)之间的交互作用对高血压发病的影响。方法  采用分层整群抽样方法,于2013年5月―2014年6月在湖南省抽取长沙、株洲、岳阳、衡阳、永州、湘西6个样本地区,再将每个样本地区随机抽取城市和农村各2个社区,共24个社区中所有30岁及以上且常住5年及以上共5 258名居民作为调查对象进行体格检查、问卷调查和实验室检测。应用Logistic回归分析模型分析超重/肥胖和HHcy与高血压发病风险的关联强度,并分析相加模型和相乘模型交互作用。结果  具有完整数据的4 012名对象中,患高血压者1 538例,高血压患病率为38.3%;有39.3%的居民超重/肥胖,有35.1%的居民患HHcy。在调整了性别、年龄、婚姻状况、教育程度、吸烟、饮酒、饮食和体力活动等混杂因素后,多因素非条件Logistic回归分析模型分析结果显示,超重/肥胖者患高血压的风险为非超重/肥胖者的2.801倍(OR=2.801, 95% CI: 2.407~3.261),HHcy患者高血压的患病风险为Hcy正常者的3.488倍(OR=3.488, 95% CI: 3.000~4.055),超重/肥胖且HHcy患者高血压患病风险为非超重/肥胖且Hcy正常者的10.205倍(OR=10.205, 95% CI: 8.120~12.826)。交互作用分析结果显示,超重/肥胖及HHcy的交互作用超额相对危险度、交互作用归因比和交互作用指数分别为5.218(95% CI: 3.213~7.222)、0.527(95% CI: 0.420~0.634)和2.415(95% CI: 1.848~3.156),即超重/肥胖和HHcy对高血压患病具有相加交互作用。本研究未发现超重/肥胖和HHcy之间对高血压患病的相乘交互作用有统计学意义(OR=1.246, 95% CI: 0.920~1.688)。结论  超重/肥胖和HHcy均可增加高血压的患病风险,且两者的相加交互作用增加了患高血压的风险。     

Maternal pre-pregnancy overweight and obesity and the risk of cesarean delivery in nulliparous women

PURPOSE: To examine the effect of maternal pre-pregnancy overweight and obesity on the risk of term cesarean delivery in nulliparous women. METHODS: The authors examined data from 641 nulliparous women with a term pregnancy that participated in the Pregnancy, Infection, and Nutrition Study from 1995 to 2002. Unadjusted and adjusted risk ratios and 95% confidence intervals (CI) were computed for normal weight (BMI 19.8-26.0 kg/m(2)), overweight (BMI 26.1-29.0 kg/m(2)), and obese (BMI>29.0 kg/m(2)) women. Normal weight women served as the referent population. RESULTS: The unadjusted risk ratio for cesarean delivery for overweight women compared with normal weight women was 1.4 (95% CI, 0.97, 2.1) and for obese women compared with normal weight women was 1.4 (95% CI, 1.03, 2.0). After controlling for maternal height, education, weight gain during pregnancy, and labor induction, the adjusted risk ratio for cesarean delivery among overweight women was 1.2 (95% CI, 0.8, 1.8). The adjusted risk ratio for obese women was 1.5 (95% CI, 1.05, 2.0). CONCLUSION: Our analysis confirms that there is a moderate association between maternal pre-pregnancy obesity and an unplanned term cesarean delivery. However, the risk is not as large as previously reported.     

母乳喂养与成人肥胖及超重关系

目的探讨早期母乳喂养与成年后肥胖和超重的关系,为有效预防成人肥胖和超重提供科学依据。方法随机抽取黑龙江省哈尔滨市35~45岁居民800人,采用问卷调查和体格检查方法搜集资料,以体质指数(BMI)作为肥胖和超重的判定标准。结果非母乳、混合母乳和母乳喂养人群肥胖发生率分别为21.21%,12.08%,11.31%,各组肥胖发生率差异无统计学意义(χ²=5.287,P=0.071);各组超重发生率分别为45.45%,37.68%,28.89%,差异有统计学意义(χ²=10.482,P=0.005);非母乳组超重率高于纯母乳喂养组(χ²=7.493,P<0.05)。非母乳喂养和母乳喂养人群(混合和纯母乳)肥胖和超重发生率差异均有统计学意义(P<0.05)。但肥胖和超重发生率未随纯母乳喂养时间延长而减少。在影响成人肥胖的各种因素中,母乳喂养为保护因素,可使肥胖的危险性减少到0.816倍,出生体重、母亲BMI和能量摄入为危险因素,可使肥胖的危险性分别增加1.516,1.922和1.738倍。结论母乳喂养对于成人肥胖和超重的发生具有一定预防作用,应大力提倡合理母乳喂养。     

Diet composition and risk of overweight and obesity in women living in the southwestern United States

OBJECTIVE: It is unknown whether dietary patterns or macronutrient composition contribute to the observed differences in rates of overweight and obesity among Hispanic and non-Hispanic white women in the United States. We assessed the association of dietary patterns and macronutrient composition with overweight and obesity in Hispanic and non-Hispanic white women. DESIGN: Cross-sectional analysis of dietary data from a case-control study of breast cancer. PARTICIPANTS: Population-based control participants (871 Hispanic and 1,599 non-Hispanic white women) from the southwestern United States who completed the diet and other components of the interview and whose anthropometric measurements were available. MAIN OUTCOME MEASURES: Body mass index (BMI; calculated as kg/m(2)), weight status (overweight, BMI 25 to 29.9; obese, BMI>30). STATISTICAL ANALYSES PERFORMED: Dietary patterns were defined using factor analysis. Associations of dietary patterns and macronutrient composition with overweight and obesity as compared with normal weight were assessed with logistic regression. RESULTS: Hispanic women reported consuming more energy, a greater proportion of energy from fat and vegetable protein, less alcohol, and less energy from animal protein compared with non-Hispanic white women. Western and dieter patterns were associated with higher prevalence of overweight and obesity; the Prudent dietary pattern was associated with a 29% lower prevalence of overweight and a halving of the prevalence of obesity similarly in Hispanic and non-Hispanic white women. Higher proportions of energy from protein (odds ratio [OR] 1.81, 95% confidence interval [CI] 1.28 to 2.56) and animal protein (OR 2.10 95% CI 1.47 to 2.98) were associated with a greater risk of overweight; greater proportions of energy from fat (OR 2.28, 95% CI 1.27 to 4.08), protein (3.55 95% CI 2.38 to 5.29), or animal protein (3.44 95% CI 2.31 to 5.14) were associated with higher risk of obesity among non-Hispanic white women only. CONCLUSIONS: A Western dietary pattern was associated with greater risk and a Prudent diet with reduced risk of overweight and obesity. To reduce risk of overweight and obesity, Hispanic women should maintain healthful aspects of a native Hispanic diet, and non-Hispanic white women should replace animal protein with vegetable protein.     

Eating styles, overweight and obesity in young adult twins

OBJECTIVE: To explore the association of eating styles with overweight and obesity in young adults, controlling for identical genetic background in monozygotic twins. DESIGN: Prospective twin cohort study. SETTING: Finland, 1991-2002. SUBJECTS: Two-hundred and thirty-three women and 2060 men from the FinnTwin16 study, aged 16 years at baseline (T1), and ranging from 22 to 27 years at the time of the nutritional assessment (T4). METHODS: Eating styles (Restrictive/overeating, health-conscious, snacking, emotional and externally induced), self-reported at T4, were contrasted with body mass indices (BMIs) at T1 and T4. RESULTS: At T4, obesity (BMI>or=30Kg/m(2)) was significantly cross-sectionally associated with restrictive eating, frequent snacks, eating in the evening, avoiding fatty foods and failure to maintain healthy eating patterns. These associations were independent of BMI at T1. Obese women self-reported more vulnerability to external eating cues and comfort eating than normal-weight women. However, in a multivariable model, only restrictive/overeating and health-conscious eating styles were significant correlates of obesity at T4, independent of gender and BMI at T1. When we controlled for genetic background restricting the analysis to the 39 female and 45 male monozygotic twin pairs discordant for obesity or overweight (BMI>or=25Kg/m(2)), restrictive/overeating eating style was still statistically significantly associated with excess weight. CONCLUSIONS: The eating styles of obese young adults differ from their normal-weight counterparts: restrictive eating, overeating and fewer healthy food choices are associated with obesity. Different eating styles may partially explain weight differences in individuals with identical genetic background.     

超重和肥胖与高血压、糖尿病的关系

目的　探索城市居民体重指数 (BMI)与高血压和糖尿病的关系。方法　 2 0 0 0年在广西南宁市区 ,随机抽取 1个城区中的 1个社区 ,在所抽取的社区 ,整群随机抽取的年龄在 35～ 74岁居民 810人 (男女分别为 4 0 3人和4 0 7人 )进行调查。结果　城市居民中BMI<2 4 0组中 ,高血压标化现患率为 18 1% ;BMI≥ 2 4 0但 <2 8 0组中 ,高血压标化现患率为 35 1% ;BMI≥ 2 8 0组中 ,高血压标化现患率为 31 4 %。城市居民高血压标化现患率为 2 3 8%。男性、女性高血压组中 ,腰围 (WC)值与正常血压组比较均有显著性差异 (P <0 0 1)。女性高血压组TG、血清总胆固醇 (cho)与正常血压组比较有极显著性差异 (P值均 <0 0 1) ,男性高血压组HDL -c、TG与正常血压组比较有显著性差异 (P均 <0 0 5 )。男性被调查者中 ,超重和肥胖率达 38 5 % ;女性被调查者中 ,超重和肥胖率达 34 4 %。随着BMI、WC水平的上升 ,患高血压和糖尿病的危险度升高。结论　BMI升高和WC升高是高血压病和糖尿病的主要危险因素之一 ,控制BMI和WC对于高血压和糖尿病的发生有重要意义     

基于三种统计学方法构建的超重及肥胖人群高血压发病预测模型的分析比较

目的 利用CRT分类树、logistic回归、BP神经网络构建超重及肥胖人群高血压发病预测模型。方法 抽取出3150名超重及肥胖人群（体质指数≥24kg/m²）。分别应用CRT分类树、logistic回归、BP神经网络构建超重及肥胖人群高血压发病预测模型,筛选出高危因素,采用受试者工作特征曲线（ROC）对三种统计学方法构建的预测模型进行特异性、敏感性及准确性评估。结果 三种方法构建的预测模型筛选出的高危因素包括非酒精性脂肪性肝病(NAFLD)、空腹血糖(FPG)、年龄、甘油三酯(TG)、尿酸(UA)、低密度脂蛋白胆固醇(LDL-c)。CRT分类树模型、logistic回归模型、BP神经网络模型ROC曲线下面积(AUC)值分别为0.721、0.734、0.733,敏感性分别为61.63%、76.59%、82.85%,特异性分别为77.58%、60.44%、52.00%,Youden指数分别为39.20%、37.02%、34.85%。结论 本研究筛选的危险因素包括NAFLD、FPG、年龄、TG、UA、LDL-c,基于危险因素应用三种统计学方法构建的预测模型具有中等预测价值,对超重及肥胖人群高血压发病具有较好的预测能力。     

Correlates of overweight and obesity among lesbian and bisexual women

BACKGROUND: Recent studies find lesbians at greater risk for overweight and obesity than heterosexual women. While this may reflect differences in attitudes concerning weight and body shape, little is actually known about risk factors within this group. This study examines correlates of obesity and exercise frequency among lesbians and bisexual women. METHODS: Data from a snowball sample (n = 1209) of lesbians/bisexual women living in Los Angeles Country were utilized. Overweight was defined as BMI >/= 25 kg/m(2); obesity as BMI >/= 30. Associations between sociodemographic characteristics, exercise frequency, health indicators, and weight-related measures were evaluated to identify independent predictors of BMI and exercise frequency. RESULTS: Prevalence of overweight and obesity among lesbians varied by racial/ethnic background. Higher BMI was associated with older age, poorer health status, lower educational attainment, relationship cohabitation, and lower exercise frequency. Higher BMI, perceptions of being overweight, and reporting a limiting health condition were identified as independent predictors of infrequent exercise. Women were generally quite accurate in self-perceptions of weight status. CONCLUSIONS: Correlates of overweight and obesity among lesbians and bisexual women are generally comparable to those observed in studies of heterosexual women. Evidence that lesbians' higher BMI is associated with higher levels of fitness is not supported.     

农村女性超重肥胖体质指数与体脂率法评价比较

目的 采用WHO体脂率标准评价中国现行体质指数诊断超重和肥胖标准的准确性。方法 于2013年5-7月横断面调查河北省玉田县648名18~59岁中青年农村女性,采用标准方法测量人体学指标,生物电阻抗法测量体脂率(BF%);体质指数(BMI)参照《中国成人超重和肥胖预防控制指南》,体脂率参照WHO标准。结果 调查对象平均BMI为(24.74±3.97) kg/m²,平均体脂率为(28.54±7.04)%;依据体脂率(>35%)和BMI(≥28.0 kg/m²)标准,调查对象肥胖检出率分别为18.98%和20.06%,差异无统计学意义(P>0.05)。以体脂率30%为超重标准,BMI 24 kg/m²的灵敏度和特异度分别为87.38和79.06%,诊断一致性(Kappa值)为0.66;以体脂率35%为肥胖标准,BMI 28 kg/m²的灵敏度和特异度分别为71.54和92.00%,Kappa值为0.62。BMI与体脂率呈二次曲线关系(R²=0.614,P<0.001)。结论 《中国成人超重和肥胖预防控制指南》推荐的超重和肥胖标准与WHO体脂率超重和肥胖标准的准确度和诊断一致性均较好。     

山东省五莲县居民高血压、超重及肥胖状况调查

目的了解五莲县居民高血压及超重、肥胖患病状况,有针对性地开展慢性病综合防治工作。方法在山东省五莲县3个乡镇（街道）抽取2127名20岁以上居民进行调查。结果调查20岁以上居民2127名,高血压患病率为38．98％,超重、肥胖率为36．34％。高血压患病率,体重正常组为32．05％,超重组为48．91％,肥胖组为62．02％（P〈0．01）。非条件Logistic回归分析结果,影响高血压患病的因素有性别、年龄、总胆固醇、体重指数、血糖（高血压的危险因素）、强体力活动（高血压的保护因素）。结论调查人群中高血压患病率与超重、肥胖率相关,控制体重有利于降低高血压的患病率。     

High prevalence of overweight and obesity in women of Islamshahr, Iran

This study determined the prevalence of overweight, overall and central obesity in female adolescents and women and their possible association with marital status, occupation, literacy, parity, daily meal and snack consumption. The study was a cross-sectional, random survey of households. Rural and urban areas of Islamshahr district in Iran were selected and 1003 female adolescents and women aged 10-65 years were studied. The frequency of overweight and obesity were similar in rural and urban areas. On the basis of body mass index (BMI), more than 19% of adolescents were overweight or at risk of it and 66.8% of adult females were overweight or obese. Frequency of central obesity [waist to hip ratio (WHR) > or = 0.85]was 35.7% in all females. The mean BMI was significantly higher in married women and in women with less than 8 years of formal education. The mean WHR was significantly higher in women with less than 8 years of education or with more than 6 parity female adults. In addition, the mean BMIs and WHRs were significantly higher in women without any daily snack consumption. Overweight and obesity was very common in adult females of Islam shahr thus prevention of overweight and obesity through a healthy diet and increased physical activity should now be an important priority area.     

Prevalence of overweight and obesity among adult Malaysians: an update

A total of 4428 adults (>18 years old) from 5 different selected regions in Peninsular and East Malaysia participated in this health survey. Using World Health Organization recommendations for body mass index (BMI), the prevalence of overweight and obesity were found to be 33.6% (95% CI= 32.2, 35.0) and 19.5% (95% CI= 18.3, 20.7) respectively. There were more females who were obese (22.5%, 95% CI=20.9, 24.0) compared to males (14.1%, 95% CI=12.3, 15.9). Highest prevalence of obesity were among the Indians (24.6%, 95% CI=20.3, 29.3), followed closely by the Malays (23.2%, 95% CI=21.6, 24.8%) and lowest prevalence was among the Chinese subjects (8.2%, 95% CI=6.2, 10.6). More than 43% of the 531 younger subjects (<30 years old) were either overweight (20%, 95% CI=16.6, 23.6) or obese (13.9%, 95% CI=11.1, 17.2%). All subjects who claimed to be non-diabetes were required to undergo 75 g glucose tolerance test. Compared to subjects with normal BMI (18.5-24.9 kg/m2), there was a 3- and 2-folds increase in the prevalence of newly diagnosed diabetes and impaired glucose tolerance respectively, among obese subjects (BMI>30 kg/m2) who initially claimed to have no diabetes. This study highlights a need for more active, inter-sectoral participation advocating a health-promoting environment in order to combat obesity in this country.     

辛辣食物摄入增加超重和肥胖的风险

目的探究人群中辛辣食物摄入与超重和肥胖的关系,为肥胖膳食预防提供理论依据。方法本研究数据来自中国慢性病前瞻性研究(China Kadoorie Biobank,CKB)哈尔滨市2004—2008年的横断面人群,采用整群随机抽样方法纳入57 555名30～79岁(男性23 254人,女性34 301人)研究对象。通过面对面问卷调查获得人口学信息及吸烟、饮酒等生活习惯信息,采用食物频率问卷获取各类食物包括辛辣食物摄入信息,体格检查获得身高、体重等指标,并应用Logistic回归方法分析辛辣食物摄入及其与偏爱肉食/素食膳食习惯的交互作用对超重与肥胖风险的影响。结果与摄入辛辣食物频率低的人群相比,摄入辛辣食物频率高的人群超重和肥胖的风险在男性中增加了29%(OR=1.285,95%CI 1.251～1.319,P<0.001),在女性中增加了33%(OR=1.329,95%CI 1.294～1.364,P<0.001)。与摄入微辣食物的人群相比,摄入极辣食物人群男女超重和肥胖的风险分别增加了20%(OR=1.198, 95%CI 1.137～1.259,P=0.011)和19%(OR=1.194, 95%CI 1.141～1.247,P=0.003)。在男性人群中,偏好肉食,且辛辣食物摄入频率及程度高的人群,超重和肥胖的风险最高,偏好肉食/素食的膳食习惯与辛辣食物摄入两因素间存在交互作用(P<0.001)。结论辛辣食物的摄入可能增加超重和肥胖的风险,同时减少辛辣食物和肉食的摄入可能能够更有效地预防超重和肥胖。     

父母超重肥胖对儿童青少年超重肥胖的影响

探讨父母超重肥胖对儿童青少年超重肥胖的影响,为从父母因素方面入手预防儿童超重肥胖提供参考.方法 方便抽取北京市昌平区小学二~五年级和初一、初二年级的749名7~ 15岁学生.测量学生的身高、体重,并通过调查问卷获得父母的身高与体重.分别按照中国学龄儿童青少年体质量指数(BMI)超重、肥胖筛查标准和我国成人超重和肥胖界限,将学生和父母划分为非超重、超重/肥胖.采用x2检验和Logistic回归分析父母超重肥胖对儿童青少年超重肥胖的影响.结果 749名儿童青少年中,超重肥胖者占36.7%(275/749).父亲的超重肥胖率为65.6% (491/749),母亲为33.6% (252/749).父母均超重肥胖、仅父亲超重肥胖、仅母亲超重肥胖的儿童青少年发生超重肥胖的危险性分别是父母均非超重者的3.95倍(95% CI=2.41 ~6.48)、3.11倍(95% CI=1.97 ~4.93)和2.74倍(95% CI=1.45~5.18).男生发生超重肥胖的风险最高的为双亲均超重肥胖者,其次为仅父亲超重肥胖者;女生父母均超重肥胖者、仅父亲超重肥胖者和仅母亲超重肥胖者发生超重肥胖的风险差异无统计学意义(P值均>0.05).结论 父母超重肥胖是儿童超重肥胖的重要危险因素,且存在子女性别差异;仅父亲超重肥胖对于男生的影响大于母亲,应作为今后儿童肥胖防控的重点方面.     

Breastfeeding and risk of overweight and obesity at nine-years of age

Whether breastfeeding is protective against the development of childhood overweight and obesity remains the subject of considerable debate. Although a number of meta-analyses and syntheses of the literature have concluded that the greater preponderance of evidence indicates that breastfeeding reduces the risk of obesity, these findings are by no means conclusive. The present study used data from the Growing Up in Ireland study to examine the relationship between retrospectively recalled breastfeeding data and contemporaneously measured weight status for 7798 children at nine-years of age controlling for a wide range of variables including; socio-demographic factors, the child's own lifestyle-related behaviours, and parental BMI. The results of the multivariable analysis indicated that being breastfed for between 13 and 25 weeks was associated with a 38 percent (p < 0.05) reduction in the risk of obesity at nine-years of age, while being breastfed for 26 weeks or more was associated with a 51 percent (p < 0.01) reduction in the risk of obesity at nine-years of age. Moreover, results pointed towards a dose-response patterning in the data for those breastfed in excess of 4 weeks. Possible mechanisms conveying this health benefit include slower patterns of growth among breastfed children, which it is believed, are largely attributable to differences in the composition of human breast milk compared with synthesised formula. The suggestion that the choice of infant feeding method has important implications for health and development is tantalising as it identifies a modifiable health behaviour that is amenable to intervention in primary health care settings and has the potential to improve the health of the population.     

重庆市小学生超重肥胖及高血压流行现状

了解重庆市小学生超重、肥胖及高血压流行现状,为制定相关干预措施提供科学依据.方法 采取分层整群抽样方法,按经济水平好、中、差抽取重庆市渝中区、荣昌县和开县3 225名一~六年级在校小学生于2013年10-12月对其进行身高、体重、腰围、血压等体格检查.结果 受检学生超重率为11.8%,肥胖率为8.4%;高血压初筛检出率为6.1%,确诊率为2.1%.人均GDP水平高的渝中区小学生超重(19.2%)、肥胖率(15.3%)、高血压(3.5%)确诊率均高于人均GDP水平低的荣昌县和开县(7.4%,3.9%,1.5%),城区小学生超重(14.3%)、肥胖率(10.5%)均高于农村小学生(9.3%,6.2%),男生超重(13.6%)、肥胖率(10.8%)均高于女生(10.0%,5.9%),差异均有统计学意义(P值均<0.05);高血压确诊率的城乡(2.1%,2.0%)、性别(2.2%,2.0%)差异均无统计学意义(P值均>0.05);体重超重者(3.4%)、肥胖者(11.8%)高血压确诊率均高于体重正常者(0.9%),差异均有统计学意义(P值均<0.05).结论 重庆市小学生超重、肥胖及高血压检出率较高.应培养和引导儿童形成受益终生的健康生活方式、行为和技能,从儿童期着手预防或延迟慢性病发生,实现慢性病防控关口前移.