超重肥胖儿童青少年代谢综合征流行现状调查

目的 了解上海市浦东新区川沙地区超重肥胖儿童青少年中代谢综合征(MS)的流行现状和临床特点.方法 对432例7～15岁超重肥胖儿童青少年进行体格测量和血液生化检测.应用Cook定义诊断MS,具有下列5项中至少3项者诊断为MS:腹型肥胖、高血压、高血糖、高甘油三脂(TG)血症和低高密度脂蛋白胆固醇(HDL-C)血症.结果 腹型肥胖、高血压、高血糖、高TG血症和低HDL-C血症的总检出率分别为85.9%、44.4%、13.4%、48.6%和9.0%.具有0、1、2和3项及3项以上MS组分者分别占4.4%、28.3%、36.3%和31.0%.约95%的个体至少有1项MS组分异常,约60%～70%的个体至少有2项异常.共检出MS134例,检出率为31.0%.结论 川沙地区超重肥胖儿童青少年多存在明显的代谢紊乱,MS的流行已相当严重,接近发达国家水平.     

儿童肥胖相关肾病

随着儿童超重/肥胖在世界范围内发病率逐渐增高,肥胖相关肾病（ORG）越来越受到儿童肾脏专科医师的关注。ORG早期表现为蛋白尿、 肾小球肥大, 后期可出现局灶节段性肾小球硬化和肾功能下降, 如不及时干预, 可呈慢性进行性进展, 最终部分将发展至终末期肾病。文章从ORG发病机制（包括肾脏血流动力学、 神经体液、 脂代谢紊乱及其介导代谢性炎症等方面）、 临床与病理特征、 诊断与鉴别诊断、 治疗策略等方面的最新进展做系统总结。     

单纯性肥胖患儿心血管系统的改变

儿童单纯性肥胖患病率越来越高,对儿童健康构成严重威胁,其关注焦点是心血管疾病.现阐述单纯性肥胖患儿心血管结构和心功能改变及血压、血脂和心律失常等,重点介绍儿童单纯性肥胖与成人心血管疾病的关系,单纯性肥胖对冠状动脉粥样硬化性心脏病的促发性以及单纯性肥胖在代谢综合征中的作用.     

北京地区肥胖儿童青少年血脂状况调查

目的 通过大样本流行病学调查,了解北京地区肥胖儿童青少年血脂状况,为早期预防心血管疾病的发生提供科学依据.方法 对北京市4个市区包括东城、西城、海淀、朝阳,3个郊区包括大兴、平谷、延庆共7个城郊区县的6～19岁儿童青少年进行横断面的流行病学调查,共19 450例.男9 727例,女9 723例;年龄(12.59±3.25)岁.城区儿童青少年10 292例,郊区儿童青少年9 158例.测量所有对象的体质量、身高,计算体质量指数(BMI),参照<中国学生超重、肥胖BMI筛查标准>,根据BMI将被调查人群分为肥胖组(n=2 220)、超重组(n=1 690)和正常组(n=15 540),应用Accutrend GCT诊断仪检测各组周围血总胆固醇(TC)和三酰甘油(TG).应用SPSS 13.0软件进行统计学分析.结果 肥胖组TC、TG水平均显著高于超重组及正常组(Pa<0.01).在正常组中,女生TC、TG显著高于男生,城区人群TC水平显著高于郊区,而郊区人群TG水平显著高于城区(Pa<0.01).在超重组中,男生和女生TC水平无显著性差异,TG水平女生显著高于男生(P<0.01),城区人群TC水平显著高于郊区(P<0.05),而城区、郊区人群TG水平无显著性差异.在肥胖组中,男生和女生TC水平及TG水平均无显著性差异,城区、郊区人群间比较TC、TG水平均无显著性差异.结论 肥胖儿童青少年血TC、TG水平显著升高,血脂水平存在城郊区间及性别间的分布特征.     

肥胖儿童青少年血清脂肪因子与其代谢特征的相关性研究

目的 探讨肥胖儿童青少年血清脂肪因子瘦素、脂联素、神经调节蛋白4(Nrg4)及锌α-2糖蛋白(ZAG)与肥胖及代谢的关系。方法 选取在南京医科大学附属儿童医院儿童保健科就诊的5~14岁肥胖儿童。测量身高、体重、腰围、体脂百分比(FM%)、血压、腰围身高比(WHtR)和体重指数标准差(BMISDS);测定ALT、AST及糖脂代谢指标;根据血压及糖脂代谢,将肥胖儿童分为代谢不健康型肥胖(MUO)和代谢健康型肥胖(MHO)。酶联免疫吸附法测定血清脂肪因子水平。结果 192例肥胖儿童(男138名)纳入分析,平均年龄(10.59±1.93)岁,平均BMISDS 2.86(2.38,3.26)。肥胖儿童中检出MUO 164例(85.4%),MHO 28例。校正年龄后,MUO组血清脂联素、Nrg4水平低于MHO组(P<0.05),两组瘦素、ZAG差异无统计学意义。相关性分析显示,MUO组血清瘦素水平与 BMISDS、FM%、WHtR呈正相关(P<0.05);脂联素与年龄、ALT、AST及胰岛素抵抗指数(HOMA-IR)呈负相关(P<0.05);Nrg4与BMISDS、WHtR、ALT、AST呈负相关(P<0.05);ZAG与FM%呈负相关(P<0.05)。logistic回归分析显示,脂联素和Nrg4是肥胖儿童代谢保护因子;ROC曲线显示,脂联素与Nrg4评估肥胖儿童代谢风险的界值点分别为5.56 μg·mL^-1和5.5 ng·mL^-1。结论 肥胖合并代谢紊乱的儿童青少年血清瘦素、ZAG 水平与体脂含量密切相关,而脂联素、Nrg4水平与代谢紊乱程度相关。这些脂肪因子对于识别和干预肥胖儿童青少年代谢紊乱的发生发展具有重要意义。     

肥胖儿童青少年血清脂肪因子与其代谢特征的相关性研究

目的 探讨肥胖儿童青少年血清脂肪因子瘦素、脂联素、神经调节蛋白4(Nrg4)及锌α-2糖蛋白(ZAG)与肥胖及代谢的关系。方法 选取在南京医科大学附属儿童医院儿童保健科就诊的5~14岁肥胖儿童。测量身高、体重、腰围、体脂百分比(FM%)、血压、腰围身高比(WHtR)和体重指数标准差(BMISDS);测定ALT、AST及糖脂代谢指标;根据血压及糖脂代谢,将肥胖儿童分为代谢不健康型肥胖(MUO)和代谢健康型肥胖(MHO)。酶联免疫吸附法测定血清脂肪因子水平。结果 192例肥胖儿童(男138名)纳入分析,平均年龄(10.59±1.93)岁,平均BMISDS 2.86(2.38,3.26)。肥胖儿童中检出MUO 164例(85.4%),MHO 28例。校正年龄后,MUO组血清脂联素、Nrg4水平低于MHO组(P<0.05),两组瘦素、ZAG差异无统计学意义。相关性分析显示,MUO组血清瘦素水平与 BMISDS、FM%、WHtR呈正相关(P<0.05);脂联素与年龄、ALT、AST及胰岛素抵抗指数(HOMA-IR)呈负相关(P<0.05);Nrg4与BMISDS、WHtR、ALT、AST呈负相关(P<0.05);ZAG与FM%呈负相关(P<0.05)。logistic回归分析显示,脂联素和Nrg4是肥胖儿童代谢保护因子;ROC曲线显示,脂联素与Nrg4评估肥胖儿童代谢风险的界值点分别为5.56 μg·mL^-1和5.5 ng·mL^-1。结论 肥胖合并代谢紊乱的儿童青少年血清瘦素、ZAG 水平与体脂含量密切相关,而脂联素、Nrg4水平与代谢紊乱程度相关。这些脂肪因子对于识别和干预肥胖儿童青少年代谢紊乱的发生发展具有重要意义。     

儿童肥胖与代谢综合征的相关性

目的 探讨儿童肥胖与代谢综合征(MS)各指标的关系.方法 选择60例肥胖患儿作为肥胖组,60例正常体质量儿童作为健康对照组,比较2组体质量指数(BMI)、腰围与身高比(WHtR)、平均动脉压(MAP)、三酰甘油(TG)、空腹胰岛素(FIS)、血尿酸(UA)、脂蛋白(LP)及胰岛素敏感指数(ISI)和抵抗指数(IRI)等MS指标,并进行统计学处理.结果 肥胖组BMI、WHtR、MAP、TG、FIS、UA、LP及ISI、IRI均显著高于健康对照组,差异均有统计学意义(Pa<0.05).结论 肥胖儿童存在胰岛素抵抗及脂血谢紊乱,并有血压、血UA升高.对处于生长发育期的儿童,应控制和预防肥胖发展,以降低MS及成年时糖尿病、冠心病的发生.     

儿童代谢综合征尿酸变化及其与心血管危险因素的关系

目的 探讨肥胖代谢综合征儿童血清尿酸(SUA)水平与心血管疾病危险因素之间的相关性.方法 肥胖儿童157例,代谢综合征(MS)77例,非代谢综合征(非MS)80例.分析两组患儿人体测量参数、血尿酸、血脂、血糖及胰岛素等指标间差异,观察SUA与人体测量参数、血压、糖脂代谢紊乱的相关性,并对影响SUA水平的指标进行多元逐步回归分析.结果 MS组血尿酸、腰围、血压、三酰甘油(TG)均高于非MS组,高密度脂蛋白胆固醇(HDL-C)低于非MS组(P<0.05).Spearman相关分析提示SUA水平与体质指数、腰围、腰围身高比、舒张压、收缩压、空腹胰岛素水平、胰岛素抵抗指数(HOMA-IR)、TG及患儿已表现出的MS组分个数呈正相关(P<0.05);与HOMA-IS及HDL-C呈负相关(P<0.05).结论 MS儿童除血压、血脂、血糖异常,也伴有嘌呤代谢紊乱.腰围、TC、舒张压、HDL-C为SUA水平的重要影响指标.高尿酸血症与中心性肥胖、高血压、高血脂关系密切.SUA水平增高可能成为心血管疾病的一个重要的危险因素,参与心血管相关疾病的发生、发展过程.     

宁夏银川市城区儿童青少年不同肥胖表型与血压异常的关系

目的:了解银川市城区儿童青少年不同肥胖表型与血压异常的关系,为肥胖儿童青少年提供适宜的治疗及干预措施。方法:采用现况研究设计,以方便整群抽样的方法于2017年9月至2018年9月共抽取银川市1 047名12～18岁儿童青少年为研究对象,其中男530名、女517名,年龄(13.93±1.24)岁,并对其进行问卷调查、体格...     

血尿酸水平与维吾尔族超重/肥胖儿童青少年代谢综合征的关系

目的 探讨维吾尔族超重/肥胖儿童青少年的血尿酸（SUA）水平与代谢综合征（MS）之间的关系。方法 研究对象为维吾尔族儿童青少年超重/肥胖患者（n=173）和体重正常者（n=200）。测量其身高、体重、腰围及总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-c）、低密度脂蛋白胆固醇（LDL-c）、空腹血糖及 SUA。结果 超重组和肥胖组的 SUA 水平分别为 235±42、285±42 μmol/L,均明显高于对照组（199±32 μmol/L）,差异有统计学意义（PPP2,SUA 水平增加 5.74 μmol/L。结论 维吾尔族超重/肥胖儿童青少年的 SUA 水平明显升高;SUA水平升高,MS 及其组分发生率增加;SUA 与体重指数呈正相关。     

Dietary and lifestyle counselling reduces the clustering of overweight‐related cardiometabolic risk factors in adolescents

Aim: The aim of this study was to evaluate the impact of individualised dietary and lifestyle counselling, primarily aimed to decrease serum low‐density lipoprotein cholesterol, on the clustering of overweight‐related cardiometabolic risk factors in children. Design and participants: The 7‐month‐old study children were randomized either to counselling (n = 540) or control group (n = 522). Main outcome measures: The 5‐ to 15‐year‐old participants who fulfilled the international criteria were classified as overweight. Being in the highest [lowest for high‐density lipoprotein (HDL) cholesterol] age‐ and gender‐specific quintile of body mass index (BMI), blood pressure, serum triglycerides, HDL cholesterol or glucose was considered a risk factor. A cluster was defined as having high BMI and ≥2 other risk factors. Results: The counselling did not reduce the prevalence of overweight in 5‐ to 15‐year‐old participants. From age 7 onwards, the proportion of children with ≥2 risk factors was lower in the intervention than in the control group (p = 0.005). At the age of 15 years, 13.0% of girls and 10.8% of boys in the intervention group and 17.5% of girls and 18.8% of boys in the control group had the risk factor cluster (p = 0.046 for main effect of the study group). Having even one risk factor at the age of 5 years predicted the clustering of risk factors at the age of 15 years (OR: 3.8, p < 0.001). Conclusion: Repeated, individualized dietary and lifestyle counselling may reduce the clustering of overweight‐related cardiometabolic risk factors in adolescents even though the counselling is not intense enough to prevent overweight.     

Self-esteem in a clinical sample of morbidly obese children and adolescents

Aim: To study self-esteem in clinical sample of obese children and adolescents.
Methods: Obese children and adolescents aged 8–19 years (n = 107, mean age 13.2 years, mean BMI 32.5 [range 22.3–50.6], mean BMI z-score 3.22 [range 2.19–4.79]; 50 boys and 57 girls) were referred for treatment of primary obesity. Self-esteem was measured with a validated psychological test with five subscales: physical characteristics, talents and skills, psychological well-being, relations with the family and relations with others. A linear mixed effect model used the factors gender and adolescence group, and the continuous covariates: BMI z-scores, and BMI for the parents as fixed effects and subjects as random effects.
Results: Age and gender, but neither the child's BMI z-score nor the BMI of the parents were significant covariates. Self-esteem decreased (p < 0.01) with age on the global scale as well as on the subscales, and was below the normal level in higher ages in both genders. Girls had significantly lower self-esteem on the global scale (p = 0.04) and on the two subscales physical characteristics (p < 0.01) and psychological well-being (p < 0.01).
Conclusion: Self-esteem is lower in girls and decreases with age. In treatment settings special attention should be paid to adolescent girls.     

Metabolic disturbances and cardiovascular risk factors in obese children with vitamin D deficiency

ObjectivesThe prevalence of obesity among children and adolescents has been rapidly increasing in recent years. Obese individuals are at risk of vitamin D deficiency. The aim of this study was to investigate the relationship between vitamin D deficiency and anthropometric measurements, cardiovascular risk factors, and glucose homeostasis in obese children.MethodsBetween June 2011 and January 2012, 40 obese and 30 non-obese children (between 7 and 14 years of age) were evaluated at Tepecik Training and Research Hospital. The following characteristics were recorded: height; weight; body mass index (BMI); total body fat content; fasting glucose, insulin, and lipid levels; basic biochemical parameters; complete blood count; bilateral carotid intima media thickness; liver ultrasound results; and left ventricular wall thickness were recorded. 25-hydroxy (OH) vitamin D levels were measured from serum.ResultsThe serum 25(OH) vitamin D level was low in 45 children (64.3%). The 24-h ambulatory blood pressure measurements, carotid intima-media thickness, and the prevalence of 25(OH) vitamin D deficiency were different between obese and non-obese children (P < 0.05). The incidence of dyslipidemia was not statistically different between obese and non-obese children (P > 0.05). Plasma 25(OH) vitamin D concentrations were negatively correlated with age, BMI, total body fat content, 24-h ambulatory blood pressure, and carotid intima-media thickness (P < 0.05). Plasma 25(OH) vitamin D levels were not correlated with fasting plasma glucose, HOMA-IR, triglycerides, total cholesterol, low-density cholesterol, and high-density cholesterol (P > 0.05).ConclusionVitamin D deficiency is more prevalent in obese children. Serum 25(OH)vitamin D was significantly associated with several cardiometabolic risk factors. There was no relationship between abnormal glucose homeostasis and dyslipidemia with vitamin D deficiency in obese children.     

Metabolically obese normal-weight children

Non-obese children with elevated serum insulin levels and metabolic disorders such as, hyperglycemia, hypertension, and/or hypertriglyceridemia are a subset of children in high risk of developing cardiovascular disease later in life. Since usually the health policies for the prevention of the obesity associated disorders in children are based on the screening focused on the obese, frequently the metabolically obese normal-weight (MONW) children are not identified in primary care setting. Given that characterization of the MONW children is an important public health issue, and that a large amount of resources might be unnecessarily used in the screening of metabolic risk of nonobese children; we review data regarding criteria for the early recognition of this subset of children in high risk of developing cardiovascular disease. Results of our review suggests that the presence of family history of type 2 diabetes and/or hypertension, the elevated percentage of body fat, and the high birth-weight should be taken into account as criteria of high cardiovascular risk, irrespective of obesity.     

Medical care of obese children and adolescents

So far in Europe, no studies have been published on the structuring of medical care for obese children and adolescents. Besides anthropometric parameters, evaluations of the cardiovascular risk factors hypertension, dyslipidaemia, impaired glucose metabolism and treatment modalities were documented in a standardised multicentre evaluation survey (APV) of 18 primarily outpatient and nine rehabilitation institutions. In total, 3837 children (aged 2–20 years) took part in the years 2000 up to March 2003, of whom 1985 were treated in outpatient institutions and 1852 in rehabilitation institutions. Of these children, 10% were overweight, 37% obese, 49% extremely obese and 4% of normal weight at initial presentation. The frequencies of diagnostic procedures performed and documented were low (measurement of blood pressure 43%, lipids 40%, glucose metabolism 21%). In the subgroup of obese children who were screened for cardiovascular risk factors, 23% suffered from hypertension, 11% displayed increased cholesterol, 9% increased low-density lipoprotein-cholesterol, 29% increased triglycerides, 11% decreased high-density lipoprotein-cholesterol and 6% had impaired glucose metabolism. Conclusion: despite the high prevalence of cardiovascular risk factors in obese children and adolescents confirmed in this report, diagnostic procedures failed in a considerable percentage even in specialised treatment centres for obese children and adolescents. In future, the feedback based on standardised evaluation of diagnostic and treatment procedures should aim to improve the quality of medical care.Abbreviations BMI body mass index - HDL high-density lipoprotein - LDL low-density lipoprotein - SDS standard deviation scoreOn behalf of the APV Study Group, Department of Paediatrics, University of Ulm, Germany     

Ethnic differences in metabolic syndrome among overweight and obese children and adolescents: the Oslo Adiposity Intervention Study

Aim: Are there differences in the prevalence of metabolic syndrome between obese and overweight Norwegian and immigrant children and adolescents? Methods: Two hundred and three overweight and obese Norwegian, Pakistani, Tamil and Turkish patients aged 6–17 years living in Norway were included. Metabolic syndrome was defined as the presence of at least three abnormal values of waist circumference, blood pressure, fasting triglycerides, fasting glucose and HDL cholesterol. Results: The prevalence of metabolic syndrome was significantly higher among the immigrant compared to Norwegian subjects when adjusted for age, gender and BMI‐Z‐score (20.8 vs. 30.6%; OR = 2.2, 95% CI = 1.05–4.77). The prevalence of metabolic syndrome increased with increasing severity of obesity and reached 50% in severely obese immigrants and 30% in severely obese Norwegians. Among the overweight subjects metabolic syndrome prevalence was 23.5% among immigrants and 19.4% among Norwegians. Conclusion: Metabolic syndrome was found more frequently among children and adolescents with Middle Eastern and South Asian origins than Norwegians. Differences were found even after adjustment for age, sex and degree of obesity. This suggests that ethnic minorities may have an increased sensitivity to adiposity and need more aggressive prevention and treatment than their Norwegian counterparts.     

The relationship between sleep duration and obesity in Turkish children and adolescents

Aim: To determine the relationship between sleep duration and obesity in Turkish children and adolescents.
Methods: This study was conducted in Turkey with 5358 children aged 6 to 17 years. Height, weight, waist circumference (WC), mid-upper arm circumference (MUAC), triceps skinfold thickness were measured. Body mass index (BMI), arm fat area were calculated. Self-reported sleep duration by parents were obtained.
Results: As sleep duration increased, BMI, which was significantly higher in girls sleeping ≤8 h, decreased (p < 0.05). WC, MUAC, BMI were significantly higher in boys sleeping ≤8 h versus males sleeping ≥10 h. Boys sleeping ≤10 h in 6.0–17.0-years had significantly higher risk of overweight/obesity. In 6.0 to 17.0 years, the risk of overweight/obesity in boys sleeping 9–10 h, 8–9 h and ≤8 h were 1.86-, 1.74- and 2.06-times higher respectively, versus children sleeping ≥10 h (p < 0.05).
Conclusion: Sleep duration may be an important factor for obesity and providing ≥10 h of sleep is recommended as a prevention strategy for obesity.