Disease risks of childhood obesity in China

Objective To estimate the relative risks of dyslipidemia, hypertension, diabetes mellitus, and metabolic syndromes among overweight and obese Chinese children compared with their normal weight counterparts. Methods Overweight and obesity were defined by age- and sex-specific BMI classification reference for Chinese children and adolescents. Pediatric metabolic syndrome （MetS） and each risk factor for MetS were defined using the criteria for US adolescents. Definition of hyper-TC, LDL, and dyslipidemia for adults was applied as well. General linear model factor analysis and chi-square test were used to compare the difference in metabolic indicators among normal weight, overweight, and obese groups. Multiple logistic regression analysis was performed to estimate the odds ratio of metabolic abnormalities between obesity, overweight, and normal weight children, after adjustment for living area, family economic level, age, sex, and daily exercise time and TV watching time, as well as different dietary indices in the model. Results Significant increases in blood lipids, glucose, and blood pressure were found among overweight and obese children as compared with their counterparts with normal weight. By applying WGOC-recommended BMI classification, the risks for hypertriglyceridemia, low HDL and dyslipidemia among overweight children were 1.9, 1.4, and 1.5 times, and was 3.3, 1.5, and 1.8 times among obese groups compared to their counterparts with normal weight after adjustment for age, sex, region, socioeconomic status, physical activity, and dietary intakes. The overweight and obese children （15-17.9 years） had a high-risk of developing hypertension, which was 2.3 and 2.9 times higher than their counterparts with normal weight. Above 90% obese adolescents had abdominal obesity, while less than 1% normal weight ones had abdominal obesity. No obese adolescents were free from any risk factors for MetS, while 36.9% of normal weight adolescents were from the risk factors. 83.3% obese boys and all obese girls had metabolic syndrome, while only 15.5% normal weight boys and 18.8% normal weight girls had metabolic syndrome. Four risk factors for metabolic syndrome were found in 8.3% obese boys while none in normal weight boys and girls. The prevalence of MetS among normal weight, overweight, and obesity groups was 1.5%, 18.3%, and 38.1% respectively. Conclusion The cardiovascular disease （CVD） risk factors are clustered in obese Chinese children. Our observations strongly suggest that efforts should be made to prevent the onset of overweight and its associated diseases during early childhood.     

A Study on the Factors influencing insulin resistance in obese adolescents

Objective: To explore the factors influencing insulin resistance in obese Chinese children. Methods: We randomly selected 53 children with uncomplicated obesity between 9 to14 years of age, and 29 normal healthy children, matched for age and sex. Anthropometric and plasma biochemical variables(including lipid profiles, glucose and insulin) were measured using standard methods. We calculated insulin resistance(IR) index using homeostasis model assessment(HOMA) methods and measured plasma high-sensitivity C-reactive protein(hs-CRP) levels using nephelometric methods. All statistical analyses were conducted using the statistical package SPSS. Results: Levels of fasting serum insulin, hs-CRP, total cholesterol(TC), low density lipoproteins cholesterol(LDL-C) and IR index were higher in obese children than in controls, while high-density lipoprotein cholesterol(HDL-C) values were lower in the obese children. There was no significant difference in levels of fasting blood glucose between the two groups. HOMA-IR was used as the dependent variable in multivariate regression analysis. Significant independent predictors for insulin resistance adjusted for waist/hip ratio, diastolic pressure (DBP), BMI, triglycerides and HDL-C level were waist circumference(WC), weight and systolic pressure(SBP). Conclusion: Waist circumference, weight and SBP are predictors of insulin resistance syndrome in Chinese adolescents     

Fufang Cangzhu Tang for Treatment of Senile Obesity or Overweight Complicated with Impaired Glucose Tolerance——A Clinical Observation in 32 Cases

To observe the therapeutic effect of Fufang Cangzhu Tang （复方苍术汤 Composite Atractylodes Decoction） on senile obesity or overweight with impaired glucose tolerance （IGT）. Methods： 32 cases of senile obesity or overweight with IGT were treated with Composite Atractylodes Decoction, with another 30 cases treated with dimethyldiguanide as the controls. Changes of body weight, waist circumference, hip circumference, waist hip circumference ratio （WHR）, glucose tolerance, fast serum insulin and blood lipid before and after treatment were compared. Results： After treatment, the body weight, waist circumference, hip circumference and WHR, glucose tolerance, fast serum insulin and blood lipid in the Composite Atractylodes Decoction treatment group decreased significantly （P〈0.05 or P〈0.01）, with no significant difference as compared with the control group （P〉0.05）. Conclusion： Composite Atractylodes Decoction can obviously decrease the body weight, waist circumference, hip circumference, WHR, glucose tolerance, fast serum insulin and blood lipid in the senile patients with obesity or overweight with impaired glucose tolerance.     

Variation of serum monocyte chemoattractant protein-1 in patients with diabetes and metabolic syndrome

This study investigated the variation of serum monocyte chemoattractant protein-1(MCP-1) in patients with both diabetes mellitus(DM) and metabolic syndrome(MS).Based on the International Diabetes Federation(IDF) diagnostic criteria,93 patients enrolled in this study were divided into four groups:normal control(NC),simple DM,simple MS,and DM plus MS(DM-MS) groups.The main measures included height,weight,waist circumference(WC),hip circumference,blood pressure,fasting blood glucose,insulin resistance index(HOMA-IR),serum triglyceride(TG),HDL-ch,LDL-ch,and MCP-1.The results showed that the serum levels of MCP-1 in the DM-MS group were significantly increased as compared with those in the DM and MS groups(P<0.05),and the increase in the MCP-1 level in the DM group was much higher than in the MS group(P<0.05).The DM-MS group had the highest HOMA-IR levels,followed by MS,DM and NC groups(P<0.05).Correlation tests showed that the association of MCP-1 with age,HDL-ch,or LDL-ch was insignificant,whereas that of MCP-1 with body mass index(BMI),waist hip rate(WHR),WC,systolic blood pressure(SBP),diastolic blood pressure(DBP),TG,and HOMA-IR was significantly positive.It was concluded that circulating MCP-1 was substantially increased in patients with both DM and MS as compared with that in the patients with DM or MS alone,and the central obese state may contribute to a more vicious proinflammatory condition and insulin resistance in patients with diabetes.     

Association of the Common Genetic Variant Upstream of INSIG2 Gene with Obesity Related Phenotypes in Chinese Children and Adolescents

Objective To study the association between the rs7566605 variant of INSIG2 and obesity-related phenotypes in Chinese children and adolescents. Methods The study sample consisted of two independent cohorts of Chinese children and adolescents. Anthropometric indices, lipids, blood pressure, fasting glucose, insulin and percentage of fat mass were determined. PCR with restriction fragment length polymorphism analysis was performed for genotyping the rs7566605 variant. Results In each of the two independent cohorts, no significant association was observed between rs7566605 and obesity under additive, dominant or recessive model. We also did not detect any difference in the genotype frequency between all the obese children and controls. Furthermore, we did not find evidence of an association between body composition indices and metabolic phenotypes in all children. However, the triglyceride level of CC homozygotes was significantly higher than that of GG＋GC genotypes in obese children （P=0.022）. Additionally, we observed a non-significant trend of severe obesity in a post-hoc test. Conclusion INSIG2 rs7566605 variant is not associated Chinese childhood obesity in two independent cohorts. Further study is needed to verify the effect of rs7566605 on triglyceride in obese children.     

Reduced Arterial Compliance Associated with Metabolic Syndrome in Chinese Children and Adolescents

Objective To explore the metabolic syndrome and its association with arterial compliance in Chinese children and adolescents. Methods 337 participants aged 6 to 18 years with males accounted for 55.8% were grouped according to their traits of metablic syndrome. Anthropometry, blood pressure, fasting plasma glucose, insulin and serum lipid profile were measured. Homeostasis model was assessed and insulin resistance （HOMA-IR） index was measured and calculated for estimating individual insulin resistance. Arterial compliance was also measured using digital pulse wave analyzing method （Micro medical, London）, and stiffness index was calculated. Results The stiffness index in participants with metablic syndrome was significant higher than that in participants with no riskof metablic syndrome [（7.69±1.63） vs （6.25±0.86） m/s, P〈0.01] and stiffness index and HOMA-IR were progressively increased with the increase of traits of metablic syndrom （P for linear trend 〈0.001）. After gender, age, and pubertal development were adjusted, both traits of metablic syndrome and HOMA-IR were correlated positively with stiffness index （both P〈0.05）. Conclusion The clustering of metablic syndrome was closely associated with risk at increased arterial stiffness in Chinese children and adolescents. It was suggested that arterial compliance assessment of children and adolescents might be an important measure for prevention of cardiovascular diseases.     

Ethnic Differences in Body Mass Index and Prevalence of Obesity in School Children of Urumqi City, Xinjiang, China

Objective To investigate the prevalence of obesity and distribution of body mass index （BMI） in school children of four ethnic groups in Urumqi, Xinjiang, China. Methods A total of 55 508 school children of Han, Hui, Uygur and Kazak nationalities aged 8-18 years were selected by a cluster sampling from a districts of Urumqi City for anthropometrie measurement and demographic survey. Prevalence of obesity and overweight and distribution of body mass index （BMI） by gender, age, and nationality were analyzed and compared. Cutoff points of BMI for defining obesity and overweight were based on the proposal set by the Working Group on Obesity in China （WGOC） to assess age-, gender- and nationality-specific prevalence of obesity and overweight. Results Prevalence of obesity was 5.34%, 6.78%, 3.39 %, and 1.22% for boys and 2.61%, 1.83%, 1.78%, and 1.40% for girls of Han, Hui, Uygur and Kazak nationalities, respectively. Prevalence of obesity tended to decrease with age overall, whereas that of overweight increased with age in Han children. Conclusions Prevalence of obesity in school children in Urumqi varies with their nationalities and is lower than that of an average national level and a level of western countries. Obesity is more prevalent in boys than in girls of Urmuqi overall, which is just the opposite in Kazak children. Han boys and Hui girls have the highest prevalence of obesity and Kazak boys and girls have the lowest ones. Prevalence of obesity decreases with age, but that of overweight shows a different trend.     

Risk Factors for Cardiovascular Disease in Obese and Normal School Children：Association of Insulin with Other Cardiovascular Risk Factors

Objective To investigate the level of insulin and other known cardiovascular risk factorsinschool childreg and their association with obesity.Design Cross-sectional study.Subjects 123 normal and 16 obese school children categorized by weight-for-height, mean age :10.2and 10.5 years old respectively.Measurements Family histories of diseases by questionnaires;blood pressure(BP) and waish and hip ciecumferences by measurements;fasting blood for glucose,insulin,total cholesterol,HDL-cholesterol and triglycerides.Results The numbers of boys in the normal and obese group were 65 and 58,those of the girls ,53 and 63 respectively.The obese group was more likely to have family histories of obesity,high blood pressure and diabetes;had significantly greater waist-hip-ratio(WHR) ,higher systolic and diastolic BP,lower HDL-cholesterol,higher triglyceride and fasting insulin levels (with fasting blood sugar in the normal range) than the normal weight group.In a crude analysis,insulin levels were positively correlated with obesity,systolic BP,WHR,age and triglycerides and negatively associated with male gender and HDL-cholesterol.After aduustment using multiple regression,only obesity status ,age,gender and triglycerides still remained significantly associated with insulin level.Limitation of utilizing family remained significantly associated with insulin level.Limitation of utilizing family disease history report for identification of children at risk was discussed.Conclusion These findings suggest that risk to coronary heart disease and hyperten-sion through insulin resistance already operates in school-aged children.     

Report on Childhood Obesity in China （1） Body Mass Index Reference for Screening Overweight and Obesity in Chinese School-age Children

Purpose To establish and propose a national body mass index （BMI） reference for screening overweight and obesity in Chinese school-age children and adolescents. Methods 2000 CNSSCH （Chinese National Survey on Students Constitution and Health） data, including 216 620 primary and secondary school students aged 7 to 18 years old, were used as a reference population. Compared with those of the NCHS intematioanl reference, three temporary sets of cut-off BMI were proposed by testing different combinations of P85, P90, and P95. When physiological and biochemical measures between and among “obesity” “overweight”, and “normal weight” groups were taken into consideration, set Ⅱ was selected to be the most appropriate one. The sex-age-specific curves were then plotted and smoothed by using B-spline method. Results Based on the samples from costal developed metropolis, the BMI curves successfully overcame the shortcomings of lower and level-off tendency of the Chinese total population. Temporary set H, composed by cut-offs of P85 for overweight and P95 for obesity, was finally selected by its sensitivity and peculiarity. BMI 24 and 28 were used as cut-offs for overweight and obesity for both males and females aged 18 years old. These cut-offs, consistent with Chinese Adult＇s Reference, was proposed as the Body mass index reference for screening overweight and obesity in Chinese school-age children and adolescents. Conehlsion The new reference clearly showed its superiorty in both prospectivity and actuality. The proposed reference minimized the gaps of the BMI curve between Chinese adolescents and the international reference. Most importantly was that it was consistent with the Eastern Asia ethnic characteristics of body fatness growth. It was therefore proposed by the Working Group on Obesity in China （WGOC） to use it as an nationwide reference for screening overweight and obesity of school-age children and adolescents in China.     

多囊卵巢综合征患者血清内脂素和高敏C反应蛋白水平的测定与临床意义

Objective To explore serum levels of visfatin and high-sensitivity C-reactive protein (Hs-CRP) in patients with polycystic ovary syndrome (PCOS), as well as their clinical significance. Methods Ninety patients with PCOS and 30 ovulating healthy women with body mass index (BMI) less than 25 as controls were recruited. PCOS patients were divided to two groups, 48 in obese group with BMI≥ 25 and 42 in non-obese group with BMI<25. Serum level of visfatin was measured by enzyme-linked immunosorbent assay (ELISA) and that of Hs-CRP was assayed by immunoturbidimetry in all participants. Oral glucose tolerance test (OGTT) and insulin sensitivity were assessed in PCOS patients only. Results ①Obese and non-obese patients with PCOS beth presented markedly higher serum levels of visfatin and Hs-CRP than those in controls (t=11.35, 8.46, 10.43 and 8.25, respectively, P<0.05), and levels of visfatin and Hs-CRP were higher in obese group than those in non-obese group (t=7.74 and 6.38, respectively, P< 0.05 ). ②Univariate analysis revealed that serum levels of visfatin and Hs-CRP positively correlated with BMI and homeostasis model assessment insulin resistance, respectively (P<0.05) and serum level of visfatin positively correlated with that of Hs-CRP (P<0.05). Conclusions Chronic inflammation possibly exists in patients with PCOS, which may cause their serum visfatin and Hs-CRP levels increased.     

抗精子抗体和抗子宫内膜抗体与不孕及流产的关系

目的　探讨抗精子抗体（ＡｓＡｂ）与抗子宫内膜抗体（ＥＭＡｂ）在不孕、流产中的作用及二者关系,进一步 揭示不孕、流产的病因。方法　采用酶联免疫吸附试验（ＥＬＩＳＡ）同时检测３４５例不孕、流产妇女血清中的ＡｓＡｂ与 ＥＭＡｂ,按ＡｓＡｂ检测结果分阳性组和阴性组,比较两组ＥＭＡｂ阳性率的差异。结果　原发不孕及自然流产妇女中, ＡｓＡｂ（－）组ＥＭＡｂ阳性率高达１６．６７％和１９．５１％,而ＡｓＡｂ（＋）组ＥＭＡｂ阳性率高达４３．６４％和４２．８６％,显著高于 ＡｓＡｂ（－）组（Ｐ＜０．０１,Ｐ＜０．０５）。继发不孕妇女中ＡｓＡｂ（－）组ＥＭＡｂ阳性率为１８．１８％,ＡｓＡｂ（＋）组ＥＭＡｂ阳性率 为３２．２％,二者无显著性差异（０．０１＞Ｐ＞０．０５）。结论原发不孕及自然流产妇女中因个体免疫反应差异使某些 人易对体内、外物质发生免疫反应而产生抗体,从而导致不孕或流产。     

亚硝基脲类和亚硝基硫脲类的理化性质及致突变能力

本题选择N,N′-二甲基亚硝基脲(DMNU),N,N′-二乙基亚硝基脲(DENU),及其类似物N,N′-二甲基亚硝基硫脲(DMNTU)、N,N′-二乙基亚硝基硫脲(DENTU)为代表,测定了这些化合物的水解反应速度、脂溶性(HPLC的logk′值)、水解产物和致突变能力。证明了硫脲的脂溶性大于脲的脂溶性。DMNTU对TA100菌株的致突变能力最强,其它较弱。     

气血与足月妊娠分娩关系的探讨

论述足月妊娠分娩的发动和维持依靠气的推动、温煦、气化、固摄功能和血的营养、濡润功能。顺利分娩既要气血充足，还要气顺血和。临床研究结果表明调补气血，是促进产程，预防难产的重要手段。实验研究结果阐明调补气血中药加强产力、促进产程主要是从改善产妇全身情况，提高机体抗应激、抗疲劳、耐缺氧能力，即所谓使产妇气血充足调和，充分发挥气血在分娩过程中的生理作用。     

水疗联合抚触对新生儿的生长发育、黄疸及睡眠的影响

目的探讨新生儿游泳联合抚触对新生儿的生长发育、黄疸及睡眠的影响。方法将经阴道顺产分娩的正常新生儿100例随机分为两组，观察组（水疗联合抚触组）50例，对照组（单纯沫浴组）50例。①测定两组10日、28日的体重、身长、上臂围；②观察记录胎便转黄时间，测定皿清胆红素；③记录24h睡眠时间。结果两组新生儿10日、28日体重、身长、上臂同增长有显著差异（P〈0．05），两组新生儿5日时，胎便转黄时间及黄疸指数比较均有显著性差异（P〈0．01），两组睡眠时间比较有统计学意义（P〈0．05），两组并发症比较无统计学意义（P〉0．05）。结论新生儿水疗联合抚触可促进新生儿的生长发育，能加速胎粪的早排出，减轻生理性黄疸程度，有效地降低新生儿高胆红素血症的发病率，提高睡眠质量。