儿童体力活动状况与鸢尾素及心血管代谢危险因素的关系

近年来,心血管疾病(cardiovascular disease,CVD)已成为我国居民死亡的首位原因,占疾病死亡构成的40 %以上[1].儿童期心血管疾病的代谢危险因素(如超重肥胖、血压偏高、糖脂代谢异常)可预测成年早期亚临床动脉粥样硬化[2-4],提示成人期CVD的防控应从儿童期开始.     

1117名7～11岁城市儿童心血管危险因素水平现状调查

对北京市城区1117名7～11岁儿童进行了心血管危险因素水平现况调查.结果显示:358%的儿童心血管病家族史阳性;20.8%的儿童每周锻炼次数不超过3天;129%的男童和7.4%的女童血压偏高(收缩压≥16.0kPa或舒张压≥106kPa);男、女童肥胖率分别为16.9%和10.5%(身高标准体重法);33.3%的儿童血脂水平达到膳食干预界限(TC≥4.4mmol/L或LDL-C≥2.9mmol/L);膳食调查结果显示儿童平均脂肪供能比为34.3%,794%的儿童胆固醇摄入量大于或等于300mg/天.此结果表明,目前我国城市儿童有较高的心血管病危险因素暴露水平.     

儿童心血管疾病预防知识干预实验研究

目的：探讨对儿童心血管疾病预防知识进行干预的方法、途径和内容。方法：通过对山西省太原市桃园小学3－5年级儿童的心血管疾病预防知识状况进行测查，发现儿童在心血管疾病预防知识掌握方面存在一定问题。在基线测查的基础上，根据研究目的将被试儿童分为干预组和对照组，经统计学检验两组被试的均衡性较好。对干预组儿童进行了1个学期的干预实验。干预后复制。结果：干预组儿童心血管疾病预防知识得分显著高于对照组（P＜0．01）。结论：本次干预实验方法可行，内容适当。     

广州市儿童静态生活与心血管代谢危险因素的关系

目的  了解广州市儿童课外静态生活方式情况,探究课外静态生活方式与心血管代谢危险因素的关系。 方法  本研究采用分层整群随机抽样的方法,于2017年抽取广州市7~12岁儿童4 294名,采用体格检查、问卷调查等方法,收集儿童课外静态生活方式及心血管代谢危险因素状况,分析比较不同课外静态生活时间对心血管代谢危险因素的影响。 结果  被调查儿童每天课外静态生活时间平均为194.3 min（男生200.3 min,女生187.3 min）,四分位数分组分别为≤ 130.0、131.0~、181.0~、≥ 241.0 min。在控制混杂因素后,与每天课外静态生活时间最低组相比,每天课外静态生活时间最高组发生中央型肥胖、超重肥胖、总胆固醇异常、甘油三酯异常以及低密度脂蛋白胆固醇异常的OR值及其95% CI分别为1.39（1.08~1.80）,1.44（1.16~1.80）,1.26（1.05~1.51）,1.63（1.34~1.98）和1.28（1.06~1.55）。 结论  过长的课外静态生活时间会增加儿童中央型肥胖、超重肥胖的风险,并且与儿童的血脂紊乱有关,应加强对我国儿童青少年生活方式的干预,减少儿童青少年静态生活时间。     

儿童中心性体脂分布与心血管危险因素的关联

肥胖与儿童青少年心血管疾病的危险因素相关联 ,这些危险因素可持续至成年期 ,导致日后心血管疾病患病风险增加。很多研究显示 ,相对于体脂含量、儿童体脂分布与心血管疾病之间的相关性更为密切。该文对肥胖儿童体脂分布与心血管疾病关系的流行病学及其关联机制作一综述。     

儿童中心性体脂分布与心血管危险因素的关联

肥胖与儿童青少年心血管疾病的危险因素相关联，这些危险因素可持续至成年期，导致日后心血管疾病患病风险增加。很多研究显示，相对于体脂含量、儿童体脂分布与心血管疾病之间的相关性更为密切。该文对肥胖儿童体脂分布与心血管疾病关系的流行病学及其关联机制作一综述。     

基于发展生态理论的儿童虐待风险因素及其累积效应

儿童虐待(child abuse)是一种广泛存在的社会问题[1],指对儿童有抚养义务、看管和操纵权利的人做出足以对儿童心理健康、成长发育造成潜移默化影响的伤害行为,分性虐待、躯体虐待、情感虐待、躯体忽视和情感忽视5种类型[2].据报道,美国儿童虐待的发生率高达53%[3];我国大学生儿童期虐待比例为47.1%,其中情感虐待、情感忽视和躯体忽视所占比例较高[4].在中学生样本中虐待比例高达78%[5].可见,父母对孩子的虐待在我国的发生率非常高,可能与我国对儿童虐待的预防措施还处于初步发展阶段有关.因此,需明确影响儿童虐待的风险因素,并使用更好的预测方式即累积风险视角来识别和预测儿童虐待的发生风险.     

特殊人群心血管和代谢性疾病与血尿酸关系的分析

目的：调查特殊人群心血管及代谢性疾病的检出率，并探讨血尿酸（SUA）在各种疾病中的分布及与之关系。方法：收集华西医科大学附三院2000－2001年474例高收入、脑力劳动者有关心血管及代谢性疾病的病史以及相关家族史资料，分析有无上述疾病者SUA分布，并分别进行比较，结果：该人群中所调查疾病检出率由高到低依次为高脂血症（44．3％）、肥胖症（36．9％），高尿酸血症（29．1％）、高血压（15．6％）、脂肪肝（11．2％），胆囊结石（7．4％）、痛风（7．2％）、糖尿病（6．3％）、肾结石（4．3％）、冠心病（3．1％）；痛风、肥胖、高脂血症、脂肪肝、高血压患者及有痛风和高血压家族史者SUA水平明显高于非疾患者和无家族史者（P均＜0．01）。结论：该组人群上述疾病检出率高于一般人群，SUA升高可能是某些心血管疾病及代谢性疾病的重要标志。     

青少年血尿酸水平与心血管代谢危险因子的相关性分析

了解青少年血尿酸水平与心血管代谢危险因子的相关性,为预防儿童高尿酸血症,降低心血管疾病的风险提供参考依据.方法 以哈尔滨市城区1 640名10 ~ 18岁中小学生为研究对象,对其进行体格检查,并测定血尿酸(SUA)、三酰甘油(TG)、胆固醇(TC)、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(FPG)等.结果 高尿酸血症的检出率为23.0% (377/1 640),男生为29.7% (242/816),女生为16.4% (135/824),男生检出率高于女生(x2=40.80,P<0.05).不同性别中小学生心血管代谢危险因子的患病率差异均有统计学意义,高血糖、低HDL-C以及超重或肥胖的患病率均为男生高于女生(x2值分别为10.101,2.829,24.602,P值均<0.05).FPG,TG,HDL-C,超重或肥胖以及血压异常组的血尿酸水平均高于其正常组(t值分别为4.003,7.422,5.369,13.340,5.753,P值均<0.05).血尿酸水平与心血管代谢危险因子收缩压(SBP)、舒张压(DBP)、FPG、TG、体质量指数(BMI)均呈正相关(r值分别为0.352,0.127,0.176,0.232,0.441,P值均<0.05),而与HDL-C呈负相关(r=-0.238,P<0.05).将研究对象按SUA水平四分位间距分成4组,随着血尿酸水平的增高,SBP,DBP,FPG,TG,BMI水平随之升高,而HDL-C水平随之降低(P值均<0.05).结论 10 ~18岁青少年血尿酸水平与心血管代谢危险因子存在密切相关性,防治高尿酸血症应从儿童青少年开始.     

儿童青少年膳食及血清锌状况与心血管疾病代谢危险因素的关系

目的 了解2016-2017年江苏省儿童青少年膳食及血清锌状况,探索其与营养相关心血管疾病代谢危险因素之间可能存在的关系。 方法 采用多阶段分层随机抽样的方法,2016-2017年从江苏省12个监测点抽取1 251名6~17岁儿童青少年进行体格测量(身高、体重、腰围)、血液生化检验(血清锌、空腹血糖、血脂),并采用连续3 d 24 h膳食回顾法对其进行膳食调查。统计学方法采用Pearson χ²检验、Kruskal-Wallis检验及线性回归分析。 结果 最终有1 122名6～17岁儿童青少年纳入本研究。其膳食锌摄入低于平均需要量(EAR)比例为39.39%,其中13~17岁年龄组、一般农村的被调查对象比例较高,分别为56.7%和54.8%;血清锌水平低于参考值的比例较低,为0.5%,但在不同性别、地区间存在差异,其中男性、大城市儿童青少年血清锌水平较高。线性回归分析结果表明,膳食锌与血清锌无线性关系;膳食锌与高密度脂蛋白呈正相关(β=0.072,95%CI: 0.034~0.111,P<0.001);血清锌与空腹血糖呈负相关(β=-0.506,95%CI:-0.575~-0.437,P<0.001)。 结论 江苏省儿童青少年存在膳食锌摄入不足风险的比例依然较高,充足的膳食锌摄入及较高的血清锌水平与儿童青少年良好的代谢状况有关。     

Identifying CHD risk factors in children: Intrafamilial lipoprotein correlations

Intrafamilial associations of high- and low-density lipoprotein cholesterol (C-HDL, C-LDL) were examined in 116 parent-child and 70 sibling combinations in subjects randomly recalled in the Lipid Research Clinic's Princeton School Study. The nature and extent of parent-child lipoprotein correlations were assessed, and the hypothesis was examined that knowledge of parental C-LDL and C-HDL can improve case-finding efficiency for identification of children at coronary heart disease (CHD) risk by virtue of their lipoprotein levels. For C-HDL there was a consistent, positive, and significant relationship between parents and children; nearly 25% of the variation of the children's C-HDL could be explained by knowledge of the parents' C-HDL. For C-LDL, there were significant positive correlations between parents and children, and between parents and daughters, and mothers and daughters. However, there were no significant C-LDL relationships between parents and sons, fathers and sons, or mothers and sons. For C-HDL, mother-offspring correlations were higher than those for father-offspring. Less consistently, mother-offspring C-LDL correlations were also higher than those for father-offspring. The sibling-sibling lipoprotein correlations were similar to those in parents-offspring; however, their C-LDL:C-LDL correlations were somewhat stronger than for C-HDL:C-HDL. After categorizing the data into parental and pediatric lipoprotein quartiles, 46% of the children whose parents had highest quartile C-LDL themselves had highest quartile C-LDL, 1.8 times (46% ÷ 25%) more than would be expected in the top quartile of a pediatric population, P < 0.01. Moreover, 47% of children whose parents had lowest quartile C-HDL, themselves had lowest quartile C-HDL, 1.9 times (47% ÷ 25%) more than would be expected in the lowest quartile of a pediatric population, P < 0.01. The appreciable nature of parent-child lipoprotein concordance was further highlighted by the finding of progressive increases in the mean levels of pediatric C-HDL and C-LDL with parental classification from the lowest to the highest parental C-HDL and C-LDL quartiles. Since CHD risk in adults appears to be continuous throughout the range of C-HDL and C-LDL levels, knowledge of parental C-LDL and C-HDL should be useful in identifying pediatric cohorts at varying degrees of risk for CHD, by virtue of high or low C-HDL and C-LDL.     

Healthy lifestyle factors associated with reduced cardiometabolic risk

Minimal data are available regarding the cumulative effects of healthy lifestyle behaviours on cardiometabolic risk. The objective of the present study was to examine a combination of healthy lifestyle behaviours associated with cardiometabolic risk reduction. The analysis was based on a cross-sectional study of 1454 participants from the population-based Lipid Research Clinic's Princeton Follow-up Study. The healthy lifestyle factors included fruit and vegetable intake?≥?5?servings/d, meat intake?≤?2?servings/d, never smoking, consuming 2-6 alcoholic drinks/week, television (TV) viewing time?≤?2?h/d and moderate to vigorous physical activity?≥?4?h/week. The combination of healthy lifestyle behaviours was strongly and negatively associated with the presence of cardiometabolic risk, as well as with a composite cardiometabolic risk score after adjustment for race, age, generation and sex. With each additional healthy lifestyle factor, cardiometabolic risk decreased by 31?% (OR 0·69; 95?% CI 0·61, 0·78). A higher healthy lifestyle score was associated with a lower prevalence of cardiometabolic risk (P for trend?相似文献   

Maternal childhood cardiometabolic risk factors and pregnancy complications

PurposeThe influence of childhood health on later-life health outcomes is increasingly hypothesized but rarely tested. We examined the relationship between cardiometabolic indicators in childhood and risk of pregnancy-induced hypertension, preeclampsia, and gestational diabetes.MethodsChildhood measurements from 755 women in the Bogalusa Heart Study included body mass index, systolic and diastolic blood pressure (SBP and DBP), low- and high-density lipoprotein cholesterol, total cholesterol, triglycerides, insulin, and glucose. Average childhood values were estimated by area under the curve computed from longitudinal quadratic random-effects growth models to account for the unequally spaced repeated measures. Women reported pregnancy complications, and medical records were linked to interview data where possible. Log-Poisson models predicted adjusted risk associated with an interquartile range increase in cardiometabolic indicators.ResultsElevated childhood insulin was associated with 10%–15% increased risk across the three outcomes. Elevated childhood SBP was associated with preeclampsia (SBP RR = 1.50, 95% CI: 1.13, 2.01) and SBP, DBP, and body mass index predicted pregnancy-induced hypertension (SBP RR = 2.15, 95% CI: 1.65, 2.82; DBP RR = 1.83, 95% CI: 1.38, 2.43; BMI RR = 1.67, 95% CI: 1.41, 1.98). Blood pressure mediated the association between childhood body mass index and pregnancy-induced hypertension.ConclusionsResults suggest the potential long-term impact of early-life cardiometabolic profiles on complications of pregnancy.     

文献快报(1):夜猫子时型和周末迟睡增加青春期女童肥胖风险

该研究来源于美国Viva项目(Project Viva),是自1999年起由凯撒医疗集团研究部对波士顿地区的2128名儿童及其母亲开展的纵向出生队列研究。马萨诸塞州儿童总医院、哈佛医学院的研究人员在2012—2016年期间,对804名12~17岁青少年开展了腕式体力活动加速度计监测、问卷调查和人体测量。青少年自评时型(chronotype)包括晚睡型和早起型节律模式;周末与上学日之间的睡眠时间中点差值来衡量“社会时差”;采用双能X线吸收仪评价体脂指数,并对479名具有血液样本的青少年计算心血管代谢风险评分,包括腰围、收缩压、高密度脂蛋白胆固醇、三酰甘油以及胰岛素等指标。     

Association of exposure to Bisphenol A with obesity and cardiometabolic risk factors in children and adolescents

In this study, the association of exposure to Bisphenol A (BPA) with obesity and cardiometabolic risk factors was investigated on 132 children and adolescents aged 6–18 years living in Isfahan, Iran. Potential contributors to BPA exposure were assessed by a questionnaire. Total BPA was detected in urine samples of all participants without significant difference in boys and girls.

The mean body mass index (BMI) and waist circumference (WC) increased significantly across the BPA tertiles (p for trend = < 0.001). Similar trend was documented for systolic blood pressure (SBP) and diastolic blood pressure (DBP) as well as fasting blood sugar. The risk of obesity was 12.48 times higher in participants in the third tertile of BPA than in others (95% CI: 3.36–46.39, p < 0.001). The current study showed significant association between BPA exposure with obesity and some cardiometabolic risk factors in children and adolescents, however, further longitudinal studies are necessary to evaluate the clinical effects of this finding.

Abbreviations: BMI: Body Mass Index; BPA: Bisphenol A; BSTFA: N, O-Bistrifluoroacetamide; CDC: Centers for Disease Control and Prevention; CI: Circumference Interval; DBP: Diastolic Blood Pressure; DLLME: Dispersive liquid-liquid microextraction method; FBS: Fasting Blood Glucose; HDL: high-density lipoprotein cholesterol were; LDL: low-density lipoprotein cholesterol; OR: Odd Ratio; PA: Physical Activity; SBP: Systolic Blood Pressure; TC: total cholesterol; TG: triglycerides; WC: Waist Circumference.     

Identifying children with high mortality risk

This issue reports selected results from a comprehensive study of infant and child mortality based on the National Family Health Survey data. The analysis distinguishes between neonatal, postneonatal, infant and child mortality since mortality and its causes vary considerably among children of different ages. Hazard regression analysis was used to estimate the effects of each individual variable as the factors that affect infant and child mortality tend to be correlated with each other. The study involves adjusted effects of selected socioeconomic and demographic characteristics on neonatal, postneonatal, infant, and child mortality for children born during the survey. Short birth intervals have a great effect on infant and child mortality. A previous birth interval of less than 24 months increases child mortality by about 67%. Neonatal mortality is highest among children of very young mothers. Child mortality is higher for girls in all states except Tamil Nadu, Kerala, and Goa. Seven groups of children who are especially vulnerable to infant and child mortality were identified. Thus, intervention programs, such as efforts to provide supplemental nutrition and basic immunization to pregnant mothers, infants and young children need to focus on these high-risk groups. Results for many states show elevated mortality rates for girls after the neonatal period. Family health programs aimed at overall improvement in mortality levels should pay attention to providing basic health care and supplemental nutrition to girls.     

广州市小学生静态回合与心血管代谢危险因素的关系

  目的  了解广州市7~12岁儿童不同时长静态回合与心血管代谢危险因素的关系，为儿童心血管疾病的防控提供科学依据。  方法  采用整群随机抽样的方法，于2017年抽取广州市5所小学共356名学生作为研究对象。要求受试者连续7 d佩戴加速度计对静态行为和体力活动进行客观测量。对每名受试者的静态回合进行长度划分。通过体格检查、实验室检测收集受试者的心血管代谢危险因素指标。采用多重线性回归分析静态回合与心血管代谢危险因素的关系。  结果  广州市7~12岁儿童的静态行为时间主要由 < 10 min的短时静态回合累积而成。5~ < 10，10~ < 15，15~ < 20 min静态回合的累积时间与心血管代谢危险因素得分呈正相关(B值分别为1.24，2.01，2.40)，与高密度脂蛋白胆固醇(B值分别为-0.13，-0.21，-0.27)呈负相关; 1~ < 5，5~ < 10，10~ < 15，15~ < 20 min静态回合的累积时间与体质量指数(BMI)(B值分别为1.07，1.89，2.86，3.65)和腰围(B值分别为2.79，4.81，8.04，10.14)呈正相关(P值均 < 0.05)。  结论  5~ < 20 min的持续性静态行为增加儿童心血管健康风险，儿童应减少20 min以内的持续性静态行为。