中国六城市学龄儿童代谢综合征流行现状研究

目的 分析中国汉族学龄儿童代谢综合征(MS)流行现状,比较两种儿童青少年MS定义(中国:简称MS-CHN2012,国际糖尿病联盟:简称MS-IDF2007)在人群中的诊断效率.方法 对我国北部地区(北京、天津)、东部(杭州、上海)、中西部(重庆和南宁)六城市2010年22 071名(男性11 638名,女性10 433名)7 ～16岁中小学生的流行病学调查资料进行分析;分别采用上述两种定义诊断MS并比较两者诊断的一致性.结果 (1)7～16岁学龄儿童中,19.9％为超重及肥胖,肥胖占8.9％,男性10.9％,女性6.6％ (P＜0.001).(2)肥胖患病率依次为:北部16.9％、中西部5.9％、东部4.9％,差异有统计学意义(x2=1.007×103,P ＜0.001).(3)两种定义界定的MS,在7～ 16岁学龄儿童中分别为2.4％和1.4％,在肥胖人群中分别为28.8％和16.8％;不同定义所得的患病率差异有统计学意义(P ＜0.001).(4)两种定义诊断一致率达98.9％(Kappa值为0.711,P＜0.001).结论 7 ～16岁学龄儿童超重及肥胖已达19.9％,需引起高度重视;MS-CHN2012和MS-IDF2007两种定义在儿童青少年MS诊断上具有较好的一致性,而MS-CHN2012定义能较早检出MS高风险儿童青少年,有利于早期实行防治措施并降低成年期MS的发生风险.     

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.     

中国六城市学龄儿童代谢综合征流行现状研究北大核心CSCD

目的分析中国汉族学龄儿童代谢综合征（MS）流行现状,比较两种儿童青少年MS定义（中国：简称MS-CHN2012,国际糖尿病联盟：简称MS．IDF2007）在人群中的诊断效率。方法对我国北部地区（北京、天津）、东部（杭州、上海）、中西部（重庆和南宁）六城市2010年22071名（男性11638名,女性10433名）7-16岁中小学生的流行病学调查资料进行分析;分别采用上述两种定义诊断MS并比较两者诊断的一致性。结果（1）7～16岁学龄儿童中,19．9％为超重及肥胖,肥胖占8．9％,男性10．9％,女性6．6％（P〈0．001）。（2）肥胖患病率依次为：北部16．9％、中西部5．9％、东部4．9％,差异有统计学意义（X。=1．007×103,P〈0．001）。（3）两种定义界定的MS,在7～16岁学龄儿童中分别为2．4％和1．4％,在肥胖人群中分别为28．8％和16．8％;不同定义所得的患病率差异有统计学意义（P〈0．001）。（4）两种定义诊断一致率达98．9％（Kappa值为0．711,P〈0．001）。结论7—16岁学龄儿童超重及肥胖已达19．9％,需引起高度重视;MS—CHN2012和MS—IDF2007两种定义在儿童青少年MS诊断上具有较好的一致性,而MS．CHN2012定义能较早检出MS高风险儿童青少年,有利于早期实行防治措施并降低成年期MS的发生风险。     

肥胖儿童非酒精性脂肪肝病及代谢综合征发病情况分析

目的 研究肥胖儿童中非酒精性脂肪肝病(NAFLD)与代谢综合征(MS)的发生情况,并探索两者之间的关系.方法 对308例在本院内分泌科住院的9～14岁肥胖儿童进行腰围、体块指数、血脂、肝功能、肝脏B超、糖耐量试验及胰岛素释放试验等各项检查,根据诊断标准分别计算发生NAFLD[包括单纯性非酒精性脂肪肝(SNAFL)、非酒精性脂肪肝炎(NASH)]和MS的患病率,并将308例肥胖患儿分为无肝脏损害的肥胖儿童组(OCWLD组),SNAFL组和NASH组,比较各组胰岛素、胰岛素抵抗(IR)指标及MS的发病率和MS组成成分的发病率.结果 (1)308例中发生NAFLD的达到203例(65.9%),其中发生SNAFL者140例(45.5%),发生NASH者63例(20.5%).(2)308例中发生MS 76例(24.7%),这76例中合并有NAFLD的64例(84.2%).NAFLD组中MS 64例(31.5%),高于OCWLD组的12例(11.4%),差异有统计学意义,但SNAFL组中MS 41例(29.3%),与NASH组的23例(36.5%)比较差异无统计学意义.(3)就单个MS的组成成分来说,OCWLD组与SNALF组比较仅在高血压的发病率上差异有统计学意义,而OCWLD组与NASH组比较在高血压、高血脂、高血糖的发病率上差异均有统计学意义;SNALF组与NASH组比较在高血脂的发病率上差异有统计学意义.随OCWLD向SNAFL和NASH发展,空腹胰岛素水平逐渐上升,IR也越加明显.但NAFLD患儿与MS患儿比较各IR指标差异无统计学意义.结论 肥胖儿童中NAFLD和MS的发生率均已相当高,MS患儿合并NAFLD的比例很高,IR是NAFLD和MS共同的发病基础,且随着NAFLD患儿病情的进展,MS成分指标越来越严重,IR也越来越严重.     

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.     

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。     

儿童和青少年代谢综合征

代谢综合征（metabolic syndrome）曾以多种名称被描述,如代谢障碍综合征X、胰岛素抵抗综合征,甚或更加奇特的名称如高甘油三酯血症-腰综合征（hypertriglyceridaemic waist syndrome）。这些名称常被交替使用,但它们所描述的临床特征并不完全相同。胰岛素抵抗综合征（insulin resistance syndrome,IRS）的概念由Reaven在其划时代的Banting医学奖演讲中统一并扩展,IRS最初的意义仅为教学用语,     

小儿肥胖症与代谢综合征关系的探讨

目的分析小儿肥胖症的临床特征,初步探讨其与代谢综合征的关系.方法对30例确诊肥胖症患儿的临床特征进行分析,并根据1999年WHO及2002年美国国家胆固醇教育计划成人治疗组第三次指南(NCEP-ATPⅢ)提出的成人代谢综合征诊断标准对本组患儿进行代谢综合征的评定.结果(1)30例(100%)患儿[BMI(31.88±5.83)kg/m2;腰围(93.31±10.08)cm]均有不良生活习惯;23例(76.67%)有阳性家族史(包括肥胖、高血压和糖尿病);18例(60%)体检发现有高血压;24例(80%)有高胰岛素血症;7例(23.33%)有糖耐量损伤;23例(76.67%)有不同程度血脂紊乱;27例(90%)有脂肪肝.(2)BMI与空腹胰岛素水平有高度正相关性.(3)据WHO标准,完全符合者16例(53.33%),符合至少2项者24例(80%);据NCEP-ATPⅢ标准,完全符合者8例(26.67%),符合至少2项者19例(63.33%).结论(1)肥胖症和代谢综合征的关系可能互为因果,两者共同构成严重危害健康的恶性循环.(2)因儿童肥胖是成人期肥胖的危险因素,且儿童期是一个不断发展变化的时期,故有待于制订更适合于小儿的代谢综合征的诊断标准.(3)小儿肥胖症是遗传因素和环境因素共同作用的结果,因此小儿肥胖重在预防;一旦肥胖发生,在减重同时应定期、长期随访.     

小儿代谢综合征

近年来,代谢综合征(metabolic syndrome,MS)已成为一个临床热点问题.MS是指多种代谢异常集聚发生在某个体的病理生理现象,主要包括糖尿病或糖调节受损、全身或中心性肥胖、高血压、脂代谢紊乱、微量白蛋白尿等,而这些组分都是心血管病的危险因素.因此如何早期识别儿童MS患者并及时采取合理的防治措施是目前亟待解决的问题.     

学龄前儿童家庭环境中超重和肥胖危险因素分析

目的对北京市1173名儿童家长进行问卷调查,探讨北京市学龄前儿童家庭中与儿童超重和肥胖有关的危险因素。方法在北京市2个城区在园儿童数200人以上的机关直属幼儿园中随机选择5所幼儿园为调查单位,5所幼儿园中的1364名儿童为调查对象,对调查儿童进行身高和体重的测量,采用国际肥胖工作组不同年龄和性别的体重指数作为儿童超重和肥胖的判定标准。对所有调查儿童家长发放问卷进行调查,共收集填写完整的问卷1173份,回收率86％。问卷内容为家庭饮食习惯和生活方式、喂养方式、家长特征等。结果调查儿童中肥胖和超重的检出率分别为4．1％和6．9％。父母均肥胖的家庭儿童肥胖和超重的总检出率为15．2％,父母非肥胖家庭肥胖和超重的总检出率为7．5％;父母和儿童在体重指数、餐馆就餐频率、运动时间和看电视时间上存在正相关;多因素分析发现,父母肥胖、母亲文化程度低、儿童看电视和玩电脑游戏时间长是儿童肥胖和超重的危险因素。结论家庭环境对儿童肥胖的发生、发展影响较大,应针对家庭危险因素对儿童超重和肥胖进行有效干预。     

北京市超重肥胖儿童青少年中黑棘皮症检出率及与胰岛素抵抗的关系

目的 分析超重、肥胖儿童青少年黑棘皮症(AN)与胰岛素抵抗的关系,为诊断胰岛素抵抗提供临床线索.方法 以2004年北京市儿童青少年代谢综合征调研中筛查出的1 877例6～18岁超重和肥胖儿童青少年作为研究对象.测量体重指数、腰围,并检测空腹血糖、胰岛素和血脂水平,采用稳态模式评估(HOMA-IR)法,评价个体胰岛素抵抗状况.结果 超重、肥胖儿童中黑棘皮症检出率分别为12.7%和26.3%;合并AN者的腰围、胰岛素、甘酰甘油(甘油三酯)、血压均分别显著高于单纯超重、肥胖者,肥胖合并AN者的高密度脂蛋白-胆固醇水平显著低于单纯肥胖者;超重、肥胖组中AN阳性者的HOMA-IR指数几何均值(P25～P75)分别为2.81(2.13～4.12)mU/L和3.69(2.53～5.34)mU/L,分别显著高于两组AN阴性者[2.03(1.45～3.01)mU/L;2.45(1.72～3.61)mU/L](P＜0.001).结论 超过1/4的肥胖儿童罹患黑棘皮症;具有黑棘皮症表型特征的超重、肥胖儿童更容易出现代谢异常指标的改变,以及胰岛素抵抗程度的加重;黑棘皮症可以作为筛查胰岛素抵抗患儿的临床表型特征.     

Metabolic syndrome and leptin concentrations in obese children

Objective Obesity and its complications including metabolic syndrome has been increased in children and adolescents recently. Leptin is known to play an important role in the pathogenesis of obesity. Methods The objective of this study was to evaluate the relationship of leptin and metabolic syndrome in obese Iranian children. A cross sectional study was carried out in 65 primary schools in Tehran. The children with waist circumferences equal or above 90^th percentile for their height and age were chosen for further evaluations. 505 children aged 7–12 years participated in the study. Anthropometric variables measurements, blood pressure, fasting plasma glucose, triglyceride, high-density lipoprotein cholesterol and serum leptin were obtained from the study sample. Results Serum leptin levels were significantly higher in girls in comparison to the boys (with median 11.0 Vs 8.25 ng/dl; P value =0.007). Serum level of leptin were higher in children with metabolic syndrome (median 11.3 Vs 8.9 ng/dl; P value=0.045). However, after adjustment for sex, this association was removed. Conclusion Leptin did not appear to have a major role in metabolic syndrome, even though it was strongly associated with obesity parameters. More studies evaluating the relationship between leptin and metabolic syndrome in various ethnic groups are recommended.     

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.     

Metabolic syndrome in obese children born large for gestational age

Objective This study was to compare the prevalence of metabolic syndrome (MS) and insulin release in Chinese obese children born large-for-gestational age (LGA) with those born appropriate-for-gestational age (AGA). Methods Obese children were divided into LGA group (n = 60) and AGA group (n = 312); clinical and metabolic characteristics were collected. An oral glucose tolerance test was performed to detect glucose and insulin concentration at 0, 30, 60, 90, and 120 min. Differences between parameters were compared in the two groups and MS was determined. Results The age of adiposity rebound (AR) was earlier and the period from AR to hospitalization was longer in LGA group than AGA group (4.58 ± 3.35 years vs 5.64 ± 3.08 yr, p=0.016 and 5.87 ± 2.85 yr, vs 4.98 ± 2.7 yr, p=0.02). There were no differences in β-cell function, insulin resistance, insulin sensitivity and Disposition index between the two groups. Fasting insulin (FINS) and area under curve of insulin (AUCI) showed differences between two groups. The prevalence of MS was 65% for LGA group, which was significantly higher than AGA group (42.3%). LGA status increased the risk of MS with hazard ratios of 2.53 [95% confidence intervals (CI): 1.42–4.51]. Timing of AR showed significant negative correlation with hypertriglyceridemia (r = −0.497, P = 0.01). Multiple logistic regression analysis identified age at AR as an independent factor associated with blood triglyceride level. The prevalence of hypertension and hypertriglyceridemia was independently associated with LGA [adjusted odds ratios (95% CI) 2.41 (1.39–4.36), P = 0.003; 2.18(1.21–3.72), P = 0.016]. Conclusions There was a younger trend in age of AR in obese children born LGA. The prevalence of MS was particularly higher in obese pediatric populations born LGA. Hypertension and hypertriglyceridemia were better components for diagnosis of MS in obese children.     

The association of elevated alanine aminotransferase and the metabolic syndrome in an overweight and obese pediatric population of multi-ethnic origin

We studied the association between alanine aminotransferase (ALT) and features of the metabolic syndrome in a cohort of overweight and obese children aged 3–18 years. An oral glucose tolerance test was performed in 443 consecutive children from an obesity out-patient clinic (median age 11.2, range 3.1–18.0 years; n = 240 boys) of multi-ethnic origin. The prevalence of the metabolic syndrome, insulin resistance, elevated ALT (>30 IU/L), and the association of ALT with (components of) the metabolic syndrome was assessed. The metabolic syndrome was present in 26.9%. Elevated ALT levels were found in 20.3%, with a higher prevalence in boys than in girls (25.8% versus 13.8%, P < 0.001). ALT was associated with the prevalence of the metabolic syndrome, insulin resistance, high triglycerides, and low HDL-cholesterol after adjustment for gender, age, and BMI. In conclusion, elevated ALT levels were highly prevalent and associated with the metabolic syndrome, insulin resistance, high triglycerides, and low HDL-cholesterol in an obese multiethnic pediatric population.     

血浆促酰化蛋白水平与儿童青少年肥胖和代谢综合征的关联性分析

目的探讨儿童青少年血浆促酰化蛋白（ASP）水平与肥胖及代谢综合征（MS）的关系。方法以2004年北京市儿童青少年代谢综合征（BCAMS）调查总样本中1 603名6~18岁儿童青少年为研究对象。采用中国肥胖问题工作组推荐的标准诊断超重和肥胖。符合下述5项指标中的3项及以上者诊断为MS：①腹型肥胖（腰围≥P90）;②高血压（≥P90）;③高密度脂蛋白胆固醇≤1.03 mmol·L-1;④三酰甘油≥1.24 mmol·L-1;⑤高空腹血糖（≥5.60 mmol·L-1)。采用ELISA法检测血浆ASP水平,免疫透射比浊法检测补体3（C3）水平。采用方差分析比较超重、肥胖及MS儿童青少年的血浆ASP水平,多因素Logistic回归分析血浆ASP水平与超重、肥胖及MS的关系。结果1 603名研究对象中男性873名（54.5%）、女性730名（45.5％）;超重和肥胖者分别为291名（18.2%）和709名（44.2%）;MS为376名（23.4%）。正常体重、超重和肥胖组MS检出率分别为2.2%(13/603名)、15.5%(45/291名)和44.9%(318/709名)。正常体重组血浆ASP水平男性低于女性,差异有统计学意义（t=2.527,P<0.05）。正常体重、超重和肥胖组血浆ASP的几何均值（P25~P75）,男性分别为37.52(22.36~64.58)、57.88(34.10~95.11)和60.63(35.30~109.72) nmol·L-1;女性分别为44.16(27.27~74.72)、60.25(35.68~113.15)和66.68(44.56~113.97) nmol·L-1,均呈逐渐升高趋势（男性：F=34.329,P<0.001;女性：F=22.246,P<0.001）。C3水平仅在肥胖女性中升高（P<0.01）。血浆ASP水平随MS组分聚集的数目增加而升高（男性：F=16.422,P<0.001;女性：F=9.661,P<0.001）,与高血压、腹型肥胖和高空腹血糖的关系尤为密切。血浆ASP水平升高与儿童青少年超重、肥胖和MS的患病风险密切相关,相对于最低5分位值,位于最高5分位值的ASP水平与超重、肥胖和MS关系的OR值(95%CI)分别为3.90(2.38~6.39)、6.05(4.06~9.01)和2.89(1.93~4.33)。结论超重、肥胖和MS儿童青少年血浆ASP水平明显升高,血浆ASP水平可能对儿童青少年超重、肥胖和MS的发生具有较好的预测价值。     

Metabolic syndrome in pediatrics: old concepts revised, new concepts discussed

The worldwide epidemic of childhood obesity in the last decades is responsible for the occurrence in pediatrics of disorders once mainly found in adults, such as the metabolic syndrome. A key factor in the pathogenesis of metabolic syndrome is insulin resistance, a phenomenon occurring mainly in obese subjects with a general resistance to the insulin effect only on carbohydrates metabolism. Given that the metabolic syndrome is driven by obesity, the prevalence of the latter will strongly influence the prevalence of metabolic syndrome. This article addresses the causes of metabolic syndrome and the relevance of obesity in the pediatric population.