代谢正常肥胖诊断标准及其对患病率的影响

肥胖问题日趋严重,然而近来研究发现并非所有肥胖均对健康有害,并提出代谢正常肥胖亚型的概念。目前代谢正常肥胖尚无统一定义及诊断标准。通过梳理国内外代谢正常肥胖相关文献,对其不同诊断标准进行综述,归纳其差异所在并分析不同诊断标准对其患病率差异造成的影响,旨在为我国肥胖防治的精准预防提供参考依据。     

Prevalence of obesity and its comorbidities among schoolchildren in Taiwan

To evaluate the prevalence of obesity and its comorbidities among a representative sample of elementary schoolchildren in Taiwan, the Nutrition and Health Survey in Taiwan Elementary School Children used a stratified, multi-staged complex sampling scheme. In total 2,405 children (1,290 boys and 1,115 girls) were included. The prevalence of overweight and obesity was 15.5 and 14.7% in boys and 14.4 and 9.1% in girls. With respect to geographic differences, the prevalence of obesity for boys was highest in the southern area (23.3% for the 3rd stratum) and lowest in the mountain area (4.3%). For girls, the prevalence of overweight and obesity was highest in the central area (13.0% for the 3rd stratum) and lowest in the southern area (2.6% for the 3rd stratum). The obese children had higher mean levels of blood pressure, triglyceride, low density lipoprotein-cholesterol, uric acid and serum glutamic pyruvic transaminase, but lower level of high density lipoprotein-cholesterol when compared with the normal weight children. For obese and normal weight boys, the prevalence was 12.9 % vs. 0.3 % for high blood pressure, 31.4 % vs. 19.6 % for dyslipidemia, and 6.4 % vs. 0.8 % for abnormal serum glutamic pyruvic transaminase level. In conclusion, we found that about one third of the boys and one quarter of the girls were overweight and/or obesity in Taiwan. Furthermore, the prevalence of obesity-related comorbidities was significantly increased for obese and/or overweight elementary schoolchildren in the Taiwan area.     

代谢正常型肥胖的流行病学研究进展

代谢正常型肥胖是肥胖的一种特殊表型,其定义、诊断尚无统一标准,而在国内外研究中的检出率也有较大差异。同时该表型的发生机制及其与常见健康结局之间的关系还有待进一步阐明。本文对代谢正常型肥胖的流行情况、发生机制及预后等进行综述,以便后续研究者更加深入了解。     

代谢正常型肥胖的新认识及其研究机遇

肥胖悖论和代谢正常型肥胖正在受到挑战,越来越多的研究就代谢正常型肥胖的潜在机制及其预后价值产生争议。研究代谢正常型肥胖有利于阐明肥胖悖论及不同程度肥胖对人群危害的潜在机制。本研究从循证医学的角度,结合国内外相关文献,就代谢正常型肥胖的新认识、生活方式因素以及脂肪因子对代谢正常型肥胖的影响、代谢正常型肥胖研究的新机遇进行综述,以期探究代谢健康型肥胖可否长期保持并逐步降低体重,用以改善人群心血管病疾病的发病和死亡情况,从而达到相关疾病一级预防的目的。     

代谢正常型肥胖的新认识及其研究机遇

肥胖悖论和代谢正常型肥胖正在受到挑战,越来越多的研究就代谢正常型肥胖的潜在机制及其预后价值产生争议。研究代谢正常型肥胖有利于阐明肥胖悖论及不同程度肥胖对人群危害的潜在机制。本研究从循证医学的角度,结合国内外相关文献,就代谢正常型肥胖的新认识、生活方式因素以及脂肪因子对代谢正常型肥胖的影响、代谢正常型肥胖研究的新机遇进行综述,以期探究代谢健康型肥胖可否长期保持并逐步降低体重,用以改善人群心血管病疾病的发病和死亡情况,从而达到相关疾病一级预防的目的。     

代谢性肥胖与高血压发病的队列研究

目的  探讨代谢性肥胖与高血压发病的关系,为人群高血压防制提供理论依据。方法  采用前瞻性队列研究设计,于2009年在江苏省宜兴市官林、徐舍2个乡镇采用整群抽样方法纳入4 128名成人进行流行病学基线调查。排除基线2 012名高血压病例,截至2020年7月对2 116名非高血压对象进行高血压发病随访。根据体重和代谢状态将研究对象分为4组：代谢正常体重正常(metabolically healthy and normal weight, MHNW)、代谢正常超重/肥胖(metabolically healthy overweight/obesity, MHO)、代谢异常体重正常(metabolically unhealthy and normal weight, MUNW)、代谢异常超重/肥胖(metabolically unhealthy overweight/obesity, MUO)。采用Cox比例风险回归模型对代谢性肥胖与高血压发病关联进行分析,进一步做分层分析、异质性检验及相加与相乘交互作用分析;排除随访第一年发病的高血压对象、排除偏瘦人群进行敏感性分析。结果  共随访到新发高血压637例,超重肥胖及代谢异常联合相较于体重正常代谢正常的人群归因危险度(population attributable risk, PAR)及PAR%分别为17.4%、57.93%。Cox回归分析结果显示：与MHNW相比,MHO、MUNW、MUO三组的高血压发病风险增加均有统计学意义,调整后的HR(95% CI)值分别为1.29(1.08~1.56)、1.48(1.09~2.01)、1.70(1.37~2.11),并呈风险递增的趋势(均有P < 0.001)。分层分析和异质性检验结果显示：女性MUO的高血压发病风险(调整HR：2.14)高于男性MUO(调整HR：1.22),P_{异质性检验}= 0.017。相乘交互作用分析结果显示：性别与代谢状态之间存在相乘交互作用,调整后的HR(95% CI)值为1.53(1.06~2.22),P=0.024。排除随访第一年高血压发病的对象或排除偏瘦人群进行敏感性分析,关联强度无明显变化。结论  代谢性肥胖增加人群高血压发病风险,尤其在女性人群中风险更高。因此,对超重肥胖及代谢异常相关人群进行主动健康干预预防高血压具有十分重要意义。     

Adiponectin SNP276 is associated with obesity, the metabolic syndrome, and diabetes in the elderly

BACKGROUND: Genetic variations of the human adiponectin gene are associated with metabolic phenotypes, including obesity, insulin sensitivity, and diabetes. However, these associations have not been examined in an elderly population. OBJECTIVE: The objective of the study was to investigate whether the genetic variants of adiponectin are associated with any metabolic phenotype in the elderly. DESIGN: In a population-based, case-control genetic association study, a total of 1438 subjects >65 y old were recruited from the community. The phenotypes of the metabolic syndrome (MetS) were measured. Four single-nucleotide polymorphisms (SNP) were genotyped by mass spectrometry. RESULTS: The G allele of SNP276 in intron 2 was associated with a reduced risk of obesity, MetS, and diabetes mellitus. The GT genotype relative to the GG genotype had an age- and sex-adjusted odds ratio of 1.32 for obesity [body mass index (BMI; in kg/m(2)) >or= 25; P = 0.014] and of 1.33 (P = 0.011) and 1.47 (P = 0.001) for MetS according to modified National Cholesterol Education Program and International Diabetes Federation criteria, respectively. The age-, sex-, and BMI-adjusted odds ratio of diabetes mellitus for the GT and TT genotypes relative to the GG genotype were 1.28 (P = 0.042) and 1.72 (P = 0.013), respectively, and there was an obvious dosage effect (P for trend = 0.004). In linear regression after adjustment for age, sex, and BMI, the GT and TT genotypes were associated with fasting plasma glucose concentrations 5.2 and 11.1 mg/dL higher, respectively, than those of the GG genotype. CONCLUSIONS: Genetic variation of the adiponectin gene is associated with obesity, MetS, and diabetes mellitus in the elderly. The genetic effect on diabetes mellitus is partially independent of BMI.     

Potential role of sugar (fructose) in the epidemic of hypertension, obesity and the metabolic syndrome, diabetes, kidney disease, and cardiovascular disease

Currently, we are experiencing an epidemic of cardiorenal disease characterized by increasing rates of obesity, hypertension, the metabolic syndrome, type 2 diabetes, and kidney disease. Whereas excessive caloric intake and physical inactivity are likely important factors driving the obesity epidemic, it is important to consider additional mechanisms. We revisit an old hypothesis that sugar, particularly excessive fructose intake, has a critical role in the epidemic of cardiorenal disease. We also present evidence that the unique ability of fructose to induce an increase in uric acid may be a major mechanism by which fructose can cause cardiorenal disease. Finally, we suggest that high intakes of fructose in African Americans may explain their greater predisposition to develop cardiorenal disease, and we provide a list of testable predictions to evaluate this hypothesis.     

Metabolic syndrome and metabolically healthy status in adults with overweight or obesity,expressing no desire to lose weight

AimTo examine the prevalence of metabolic syndrome (MetS) and metabolically healthy status (MHS) in adults with excess weight, who express no desire to lose weight (DLW).MethodsWe used the National Health and Nutrition Examination Survey (2011–2016) to conduct a cross-sectional analysis of 4509 adults with excess weight. The prevalence of MetS and MHS was estimated by a DLW status. The prevalence ratios (PRs) were estimated, adjusting for demographic characteristics, to compare the prevalence of MetS and MHS between those with and without a DLW.ResultsAmong adults who were overweight, the crude prevalence of MetS was 28.9% (95% CI 23.7, 34.1) in the no-DLW group and 36.0% (95% CI 31.9, 40.0) in the DLW group (adjusted PR 0.88; 95% CI 0.70, 1.11). Among adults with obesity, the crude prevalence of MetS was 60.0% (95% CI 52.3, 67.6) in the no-DLW group and 63.2% (95% CI 60.0, 66.4) in the DLW group (adjusted PR 1.00; 95% CI 0.88, 1.14). Among adults who were overweight, the prevalence of MHS was 17.5% (95% CI 13.4, 22.2) in the no-DLW group, and 9.5% (95% CI 7.6, 11.6) in the DLW group (adjusted PR 1.27; 95% CI 0.96, 1.69). Nearly all adults with obesity had at least one component of MetS regardless of DSW status.ConclusionsOne in four overweight adults and three in five obese adults without a DLW had MetS in the U.S. A majority of adults who were overweight or obese without a DSW had at least one component of MetS.     

Prevalence trends of overweight,obesity, diabetes and hypertension among Brazilian women of reproductive age based on sociodemographic characteristics

The authors estimated the prevalence and trends of overweight, obesity, diabetes and hypertension among Brazilian women of reproductive age. A time series was constructed with Vigitel data from 2008 to 2015 and we analyzed trends of the prevalence of these conditions, considering sociodemographic characteristics. We observed an increasing trend in prevalence of overweight, obesity, and diabetes (for some sociodemographic characteristics), and stationary trends for hypertension. Our results highlight the need for early interventions in lifestyle of this population to reduce the NCDs risk factors burden and potentially contribute to improve maternal and neonatal outcomes and reduce the NCDs load.     

福建地区65岁以上老年肥胖流行现状及与高血压关系

目的 调查福建地区65岁以上老年肥胖流行现状及与高血压的关系.方法 2018年2月至2020年3月采用整群抽样方法对福建地区户籍中各检测区选择人口集中,医疗卫生条件及经济发展水平较有代表性的居民区、村落等11 203名65岁以上老年自然人群进行问卷调查和测量其身高、体重、腰围、臀围、血压水平.结果 9市11 203名6...     

肥胖与糖尿病,高血压关系的流行病学研究

目的：了解肥胖在自然人群中的流行特点及其与糖尿病和高血压发生的关系。方法：对江苏常州市城乡社区３２２２名对象进行流行病学研究。结果：该市２０岁以上居民超重和肥胖的患病率分别为２７．９３％、３．４０％,标化率为２４．２６％、２．７２％。肥胖和超重的患病率与年龄呈正相关。女性肥胖有患病率显著高于男性;城镇人群的患病率高于乡村。女性肥胖与糖尿病发病的关系较男性更为密切,无论男性和女性,高血压的患病率均随ＢＭＩ的升高而显著增高。结论：肥胖已成为常州城乡人群的一个重要公共卫生问题,预防肥胖的发生应成为糖尿病和心血管疾病综合防治的重要措施。     

The impact of obesity on diabetes,hyperlipidemia and hypertension in the United States

OBJECTIVE: The prevalence of obesity and associated cardiometabolic risk factors such as diabetes, hyperlipidemia and hypertension is increasing significantly for all demographic groups. RESEARCH DESIGN AND METHODS: The 2000 and 2002 Medical Expenditure Panel Survey (MEPS), a nationally representative survey of the U.S. population, was used to estimate the marginal impact of obesity on health function, perception, and preferences for individuals with diabetes, hyperlipidemia, and hypertension using multivariate regression methods controlling for age, sex, race, ethnicity, education, income, insurance, smoking status, comorbidity, and proxy response. Three different instruments were used: SF-12 physical component scale (PCS-12) and mental component scale (MCS-12); EQ-5D index and visual analogue scale (VAS). Censored least absolute deviation was used for the EQ-5D and VAS (due to censoring) and ordinary least squares (OLS) was used for the PCS-12 and MCS-12. RESULTS: After controlling for sociodemographic characteristics, diabetes, hyperlipidemia, and hypertension were associated with significantly lower scores compared to normal weight individuals without the condition for all four instruments. Obesity significantly exacerbated this association. Controlling for comorbidity attenuated the negative association of obesity and cardiometabolic risk factors on instrument scores. In addition, scores decreased for increasing weight and number of risk factors. CONCLUSIONS: Obesity significantly exacerbates the deleterious association between diabetes, hyperlipidemia, and hypertension, and health function, health perception, and preference-based scores in the United States.     

糖调节受损者睡眠质量与糖尿病发病关系的研究

  目的  了解山东省成年居民业余锻炼及静态行为和睡眠时间现状及其与高血压和糖尿病患病的关系,为采取相应的干预措施提供参考依据。  方法  于2013年9月采用多阶段分层整群随机抽样方法在山东省19个慢性病及其危险因素监测点抽取11 214名成年居民进行问卷调查、体格检查和实验室检测。  结果  山东省成年居民业余锻炼率为19.8 %,平均静态行为时间为（4.59 ± 2.41）h/d,平均睡眠时间为（7.63 ± 1.32）h/d;业余锻炼、非业余锻炼成年居民高血压和糖尿病患病率分别为29.0 %和9.6 %、30.3 %和9.0 %,是否业余锻炼成年居民高血压和糖尿病患病率差异均无统计学意义（均P > 0.05）;静态行为时间 < 2 h/d、2 h/d～、3 h/d～、≥4 h/d成年居民高血压和糖尿病患病率分别为32.3 %和8.5 %、32.6 %和8.3 %、31.9 %和9.1 %、28.7 %和9.4 %,不同静态行为时间成年居民高血压患病率差异有统计学意义（χ² = 15.528,P = 0.001）,糖尿病患病率差异无统计学意义（P > 0.05）;睡眠行为时间 < 7 h/d、7～8 h/d、> 8 h/d成年居民高血压和糖尿病患病率分别为37.7 %和11.3 %、28.0 %和8.4 %、31.0 %和9.9 %,不同睡眠行为时间成年居民高血压和糖尿病患病率差异均有统计学意义（均P < 0.001）。  结论  山东省成年居民业余锻炼率较低,静态行为时间较长,睡眠行为有待改善;静态行为和睡眠行为时间与高血压患病有关,睡眠行为时间与糖尿病患病有关。     

Prevalence and correlates of diabetes and metabolic syndrome in a rural indigenous community in Baja California,Mexico

Background

Diabetes is a leading cause of morbidity and mortality in Mexico and understudied among indigenous populations. This study aimed to determine the prevalence and identify correlates of Type 2 diabetes mellitus (Type 2 DM) and metabolic syndrome (MetS) in a rural, indigenous community in Northwestern Mexico.

Methods

A cross-sectional study was conducted in the community of San Quintin, Baja California, Mexico, among a sample of households. A total of 275 participants (≥18?years old) underwent a questionnaire, physical examination, and serologic test. Prevalence and adjusted odds ratio (AOR), using logistic regression modeling, were estimated with 95% confidence intervals (95% CI).

Results

The prevalence of Type 2 DM and MetS was 21.8 and 53.1%, respectively. Mean?±?standard deviation (SD) age and body mass index of study participants was 35.8?±?13.0?years and 28.7?±?5.6?kg/m², respectively. Participants were 75% female and 60.7% self-identified as indigenous. Thirty-seven percent of adults had high blood pressure. After controlling for age, higher educational attainment had a protective effect on Type 2 DM (AOR?=?0.39; 95% CI 0.20, 0.77). Additionally, the presence of MetS was associated with being female (AOR?=?2.27; 95% CI 1.23, 4.14) and having lower educational attainment (AOR?=?0.62; 95% CI 0.37, 0.94).

Conclusions

The prevalence of Type 2 DM and MetS was high in this rural and indigenous population, and education was shown to play a critical role. These findings support the need for community-inclusive health-promoting interventions in rural communities.

     

妊娠期铁缺乏和缺铁性贫血诊治指南

探讨总铁、补充剂铁、膳食总铁、血红素铁等不同来源铁摄入水平与妊娠期糖尿病（GDM）的关联,进一步为指导孕期合理膳食及含铁补充剂选用提供科学依据。

采用回顾性队列研究,选取2020年1月—2021年7月上海某医院分娩的668例孕中期女性为研究对象,采用自行设计的调查表,通过电子病历系统收集研究对象基本信息及孕中期含铁补充剂使用情况,应用简化的膳食频率问卷量化研究对象孕中期膳食摄入情况。确定总铁及不同来源铁摄入量,并根据摄入量五分位数和中位数进行分组,采用logistic回归分析孕中期总铁及不同来源铁摄入量对GDM发生风险的影响。

校正高龄、糖尿病家族史、孕前超重/肥胖、孕早期血红蛋白（Hb）、能量、碳水化合物供能比、蛋白质、游离糖后发现总铁摄入量与GDM风险无关（P>0.05）。与低剂量补充剂铁摄入组相比,高剂量补充剂铁摄入组GDM发生风险上升（OR=1.65,95%CI：1.14~2.39）。与低剂量膳食总铁摄入组相比,高剂量膳食总铁摄入组GDM发生风险降低（OR=0.53,95%CI：0.35~0.81）,膳食血红素铁的摄入与GDM风险无关（P>0.05）。

高膳食总铁摄入水平可能是GDM的保护因素,而高补充剂铁摄入水平则可能是GDM的危险因素,提示在无妊娠期铁缺乏的情况下,妊娠期女性宜谨慎选用高剂量含铁补充剂,建议优先保证膳食铁摄入。