儿童单纯性肥胖与糖、脂代谢及脂肪肝

目的探讨儿童单纯性肥胖对血糖、血脂成分及肝脏的影响。方法应用B超、生化分析仪,对117例7～13岁儿童（其中肥胖组60例,正常对照组57例）进行肝脏B超、血糖、血脂及肝功能等指标的检查测定。结果重度肥胖组血糖为5.12mmol/L,对照组为4.16mmol/L,差异有统计学意义（P〈0.05）;肥胖组血清甘油三脂（TG）、低密度脂蛋白（LDL）、谷丙转氨酶（ALT）和谷草转氨酶（AST）浓度均高于对照组,差异均有统计学意义（P均〈0.05）;肥胖组脂肪肝检出率为23.33%,对照组检出率为5.26%,差异有高度统计学意义（P〈0.01）。结论单纯性肥胖对儿童的糖脂代谢和肝脏均造成危害,预防成人期糖尿病、心血管病和脂肪肝等疾病必须从儿童时期开始。     

重组人生长激素治疗对特发性矮小儿童的糖脂代谢及甲状腺功能的影响

目的 探讨重组人生长激素(r-hGH)对特发性矮小(ISS)儿童的糖、脂代谢及甲状腺功能的影响.方法 选取2009年1月至2013年1月应用r-hGH治疗并定期随访的ISS儿童47例,年龄为10±3岁,治疗期限为3~24个月,随访间隔为每3个月1次,检测治疗后0~1年及治疗后1~2年时的空腹血糖、胰岛素、血脂、甲状腺功能等指标的变化.结果 r-hGH治疗后,患儿空腹血糖、胰岛素水平、胰岛素敏感指数、空腹血糖/胰岛素比值(FGIR)与治疗前比较差异无统计学意义,但FGIR有下降趋势;FGIR结论 r-hGH治疗ISS儿童是安全可靠的,可改善脂代谢,对甲状腺功能、空腹血糖、胰岛素水平无明显影响,但有胰岛素敏感性降低的可能.     

肥胖儿童脂代谢及血压与ACE基因多态性的临床研究

目的 探讨血管紧张素转换酶(ACE)基因第16内含子的插入/缺失(I/D)多态性和D等位基因频率在健康及单纯型肥胖儿童中的分布及ACE基因多态性对肥胖儿童的血压、脂质代谢及体脂分布的影响.方法 常规酚一氯仿法抽提基因组DNA,用聚合酶链式反应一限制性片断长度多态性(PCR-RFLP)琼脂糖凝胶电泳法分析105例单纯性肥胖儿童及98例健康儿童ACE基因的基因型及等位基因频率并测定两组儿童血清三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDLC)、低密度脂蛋白胆固醇(LDLC)浓度,并测定两组儿童血压、身高和体质量,按公式计算其体质指数(BMI).结果 检出3种ACE基因第16内含子的基因型D/D、D/I、I/I.与健康儿童相比,单纯性肥胖儿童具有较高的D/D基因型频率(27.5%)及D等位基因频率(43.75%).D/D型儿童与D/I型和I/I型儿童相比具有较高水平血TG、TC、LDL-C及收缩压、舒张压、BMI和较低水平的血HDL-C.结论 健康及单纯性肥胖儿童ACE基因存在多态性,且ACE基因多态性对健康儿童及肥胖儿童的血脂代谢、体脂分布及血压均有影响.     

膳食钙对儿童肥胖及其代谢紊乱的影响

近年来,一些流行病学资料和实验室数据均显示,高钙膳食可能对控制体质量增长有作用;也有研究发现,钙还可以从不同环节调节血脂、血糖和血压等代谢指标.文章就这一领域研究作一阐述.作者最近对上海市在校小学生的单位体质量钙摄入量与肥胖相关指标的关系研究发现,学生的体质量、体质指数、体脂百分比、收缩压、舒张压、腰围和肥胖度均随单位体质量膳食钙摄入量的升高而减小.     

瘦素抵抗及其受体基因变异对单纯性肥胖患儿脂代谢的影响

目的探讨瘦素受体(LEPR)基因外显子突变与瘦素抵抗对单纯性肥胖患儿脂代谢的影响。方法选取6～14岁单纯性肥胖患儿102例(肥胖组)及非肥胖儿童83例(对照组)为研究对象,空腹12 h后抽取2组儿童外周静脉血,常规抽提基因DNA,用PCR限制性片断长度多态性及聚丙烯酰胺凝胶电泳法对2组儿童LEPR基因的第20外显子基因变异频率进行分析,采用放射性免疫分析法测定其血清瘦素水平及血清三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平及2组儿童身高和体质量。结果共检出3种LEPR基因第20外显子的基因型:AA型、AG型、GG型;与对照组儿童比较,单纯性肥胖患儿LEPR基因第3 057位核苷酸G→A突变率增高。AA基因型的肥胖患儿血清TC、TG、LDL-C水平均明显高于GG型者,而HDL-C水平低于后者。与对照组比较,肥胖组患儿存在血脂代谢紊乱,血清瘦素水平增高,79%存在瘦素抵抗。瘦素抵抗组患儿血清TC、TG、LDL-C显著高于瘦素敏感组,HDL-C低于瘦素敏感组。基因型为AA的瘦素抵抗者与基因型为GG的瘦素抵抗者比较,血清TG、LDL-C水平升高,HDL-C水平降低(Pa<0.05)。结论单纯性肥胖患儿存在瘦素抵抗及LEPR基因第20外显子基因突变,二者可影响儿童脂质代谢,且有一定的协同作用。临床表现为LEPR基因第20外显子AA基因型的瘦素抵抗个体更易发生血脂代谢紊乱。     

肠道微生物与儿童肥胖

肥胖是影响儿童和成人健康的一个严重的公共卫生问题,其病因复杂,是遗传、环境等多种因素共同作用的结果.越来越多的证据显示,肠道微生物参与了体重调控、能量代谢和炎症反应,在肥胖的发生中起了重要作用.自然分娩、母乳喂养和避免生命早期抗生素暴露有益于维持肠道微生物的平衡,可能降低未来发生肥胖的风险.益生元和益生菌可以改变肠道微生物构成,从而影响摄食和体重.探求肠道微生物与肥胖间的关系可为防治儿童肥胖打开新思路.     

伊朗东北部儿童代表性样本中儿童肥胖的膳食预测因素

目的：伊朗儿童的肥胖患病率不断升高。这项研究旨在评价伊朗东北部城市Neishabour的儿童代表性样本中肥胖的某些膳食决定因素。方法：在这项病例对照研究中,病例组为114名在校学生,年龄6~12岁,体重指数（BMI）≥第95个百分位（根据伊朗儿童的参考值）,而对照组为102名年龄和性别匹配的非肥胖同班同学。由受过训练的营养师在儿童在场的情况下与母亲面谈,进行两次24 h膳食回顾调查,收集了营养摄入数据;使用食物频率问卷调查了零食摄入模式;使用SPSS软件（第16版）进行了单因素和多因素logistic回归分析。结果：单因素logistic回归分析显示,总能量、蛋白质、碳水化合物、脂肪（包括饱和脂肪、单不饱和脂肪和多不饱和脂肪）和膳食纤维是学生肥胖的正向预测因素;玉米膨化食品、碳酸饮料、薯片、快餐食品和巧克力的摄入频率的粗估比值比（OR）有统计学意义。多因素logistic回归分析显示,肥胖与能量摄入量（OR = 2.489,95%CI：1.667~3.716）、玉米膨化食品摄入频率（OR=1.122,95%CI：1.007~1.250）及薯片摄入频率（OR=1.143,95%CI：1.024~1.276）显著相关;而膳食纤维摄入量（OR=0.909,95%CI：0.835~0.988）和天然果汁摄入量（OR= 0.601,95%CI：0.368~0.983）是预防肥胖的保护因素。结论：该研究结果证实了不健康饮食对儿童肥胖的作用,尤其是高热量零食。应鼓励儿童养成健康的饮食习惯,如摄入高纤维食物。     

肥胖儿童血浆增食欲素A水平与能量摄入的相关性

目的 探讨肥胖儿童血浆增食欲素A水平的改变及其与能量摄入的相关性.方法 肥胖组儿童48例,检测患儿空腹外周血中增食欲素A水平、体质量指数(BMI)、能量摄入量,并与48例性别、年龄匹配的健康儿童(健康对照组)进行比较.分析2组血浆增食欲素A水平与BMI、能量摄入的相关性.结果 1.肥胖组儿童血浆增食欲素A水平显著低于健康对照组(F=5.632 P=0.008);2.肥胖组儿童血浆增食欲素A水平与BMI呈负相关(r=-0.478 P=0.012),与总能量、脂肪、蛋白质摄入量均呈正相关(r=0.503,0.659,0.381 P=0.007,0.006,0.026),与碳水化合物摄入量呈负相关(r=-0.316 P=0.022);3.健康对照组儿童血浆增食欲素A水平与BMI呈负相关(r=-0.491 P=0.018),与总能量、脂肪、蛋白质摄入量均呈正相关(r=0.512,0.406,0.313 P=0.009,0.005,0.020),与碳水化合物摄入量呈正相关(r=0.432 P=0.025).结论 增食欲素A参与了肥胖儿童的能量代谢,增食欲素A与能量摄入存在相关性,而且在不同的营养状态下这一作用不同.     

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。     

Short-term high dietary fructose intake had no effects on insulin sensitivity and secretion or glucose and lipid metabolism in healthy, obese adolescents

There is virtually no information on the metabolic impact of dietary fructose intake in adolescents despite their high fructose consumption, particularly via sweetened beverages. AIM: To determine the short-term metabolic effects of dietary fructose intake in obese adolescents. METHODS: Six volunteers (3 M/3 F; 15.2 +/- 0.5 yr; 35 +/- 2 kg/m2; 39 +/- 2% body fat) were studied twice following 7 d of isocaloric, isonitrogenous high carbohydrate (60% CHO; 25% fat) diets with fructose accounting for 6% and 24% of total energy intake, respectively (random order). Insulin sensitivity and secretion were analyzed by the stable labeled intravenous glucose tolerance test and glucose and lipid kinetics using GCMS. RESULTS: A fourfold increase in dietary fructose intake did not affect insulin sensitivity or secretion, glucose kinetics, lipolysis or glucose, insulin, C-peptide, triglycerides, HDL- and LDL-cholesterol concentrations. CONCLUSIONS: In the short term, when energy intake is constant, dietary fructose per se is not a contributor to insulin resistance and hypersecretion in obese adolescents.     

Effects of dietary intervention and strength training on blood lipid level in obese children

Aims: To evaluate effects of a low energy diet, with or without strength training, on blood lipid profile in obese children. Methods: Eighty two obese children were enrolled into a six week dietary programme, and were randomly allocated to a training group or a non-training group. The training group underwent regular exercise sessions with emphasis on strength training. Results: Height increased significantly, with a non-significant reduction in body mass index. Fat free mass increased significantly in the training group. Serum total cholesterol was significantly reduced in both groups. The LDL:HDL ratio significantly decreased in the training group. Conclusion: Results support the potentially beneficial effects of both diet and physical training. Further and longer term evaluation of such programmes is required.     

炎症递质与肥胖儿童糖脂异常代谢指标的关系研究

目的探讨肥胖儿童血糖、血脂异常及其与炎症递质变化的关系。方法选择儿科门诊就诊的符合单纯性肥胖诊断标准的肥胖儿童,以及年龄、性别相匹配的正常体质量健康儿童为研究对象,测定两组儿童的血清超敏C反应蛋白(CRP)、血清肿瘤坏死因子-α(TNF-α)、白介素-8(IL-8),以及血糖、血脂、胰岛素水平等。结果 65例肥胖儿童与30例正常体质量儿童相比,CRP、TNF-α、IL-8水平明显增高,差异均有统计学意义(P<0.01)。肥胖儿童中,血糖、胰岛素、以及血胆固醇、三酰甘油、血高密度脂蛋白胆固醇水平异常者与正常者比较,其CRP、TNF-α、IL-8水平也均明显增高,差异有统计学意义(P<0.01)。结论肥胖儿童体内存在炎症反应状态。血糖、胰岛素、血脂升高可能肥胖与所致的炎症反应相关。[临床儿科杂志,2012,30(5):435-437]     

Mineral metabolism in obese children

Blood levels of glucose, insulin (IRI), Calcium (Ca), phosphorus (P), alkaline phosphatase (AP), osteocalcin (OC), parathyroid hormone (PTH), calcitonin (CT), 25-hydroxyvitamin D3 (25OHD3), 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) and urinary excretion of Ca (Ca/Cr), P (TmP/GFR), hydroxyproline (OH-P/Cr) and cyclic AMP (cAMP/GFR) were determined in 16 obese children, aged 8 to 11 years, on a diet rich in calories and carbohydrates and in 15 controls of the same age. Blood glucose, IRI, Ca, P, PTH and CT were also determined in both groups of subjects, during an oral glucose tolerance test (OGTT). In basal conditions glucose, IRI, AP, OC, PTH, CT and 1,25(OH)2D3 levels were significantly higher, and 25OHD3 levels lower, in obese children than in controls. Urinary Ca/Cr, TmP/GFR were lower in obese than in non obese children, while OH-P/Cr and cAMP/GFR were higher. Bone mineral content (BMC), measured by photon absorptiometry, and BMC/bone width ratio were lower in obese than in non obese children. During OGTT serum Ca and P decreased and serum PTH and CT increased less in obese than in non obese children. In obese children receiving a diet with high carbohydrate content, an alteration of mineral metabolism occurred, characterized by secondary increase of PTH and 1,25(OH)2D3. Ca decreased and PTH and CT increased less markedly during OGTT.     

Effects of dietary intervention and strength training on blood lipid level in obese children.

AIMS: To evaluate effects of a low energy diet, with or without strength training, on blood lipid profile in obese children. METHODS: Eighty two obese children were enrolled into a six week dietary programme, and were randomly allocated to a training group or a non-training group. The training group underwent regular exercise sessions with emphasis on strength training. RESULTS: Height increased significantly, with a non-significant reduction in body mass index. Fat free mass increased significantly in the training group. Serum total cholesterol was significantly reduced in both groups. The LDL:HDL ratio significantly decreased in the training group. CONCLUSION: Results support the potentially beneficial effects of both diet and physical training. Further and longer term evaluation of such programmes is required.     

Beneficial effects of dietary intervention on serum lipid and apolipoprotein levels in obese children.

Effects of weight reduction on serum levels of lipids and apolipoproteins were measured in 13 obese children (seven girls, six boys). Mean weight loss of 8.4% of the initial body weight was achieved after 4 weeks of energy intake restriction and exercise. Serum total cholesterol (5.46 +/- 1.01 mmol/L) and triglyceride (2.08 +/- 0.52 mmol/L) levels were significantly high compared with control values before treatment and were significantly reduced to 4.32 +/- 0.75 and 1.31 +/- 0.42 mmol/L, respectively, after treatment. Serum high-density lipoprotein cholesterol level (1.03 +/- 0.23 mmol/L) was significantly low and unchanged after treatment (0.94 +/- 0.25 mmol/L). Serum apolipoprotein A-I level (0.039 +/- 0.009 mmol/L or 111 +/- 0.26 g/L) was normal before treatment and significantly reduced, to 0.032 +/- 0.007 mmol/L or 0.92 +/- 0.19 g/L, after weight reduction. Serum apolipoprotein B level (0.00019 +/- 0.00007 mmol/L or 1.07 +/- 0.21 g/L) was significantly high before treatment and decreased to the normal range after treatment (0.00014 +/- 0.0009 mmol/L or 0.76 +/- 0.24 g/L). The ratio of apolipoprotein B to apolipoprotein A-I (1.09 +/- 0.29) was significantly high on admission and decreased significantly to 0.64 +/- 0.12 after treatment. Serum apolipoprotein E level (0.0014 +/- 0.0006 mmol/L or 0.05 +/- 0.02 g/L) was normal and decreased to 0.0008 +/- 0.0002 mmol/L or 0.03 +/- 0.01 g/L after treatment. In conclusion, weight reduction achieved by energy intake restriction and exercise had beneficial effects on serum lipid and apolipoprotein concentrations for the prevention of future atherosclerosis.     

Carbohydrate, lipid and glucocorticoid metabolism in children with asthma following treatment with high-dose steroid aerosol

In 16 asthmatic children 5–16 years old (mean 11.4 yr) treated with inhaled beclomethasone dipropionate or budesonide, serum lipids and serum lipoproteins, serum C-peptide and serum insulin and urinary cortisol excretion were measured. The dose of inhaled corticosteroid was unchanged for 5 to 12 months prior to investigation. The doses ranged from 800 to 4000 μg (mean 1465 μg) per day. Serum lipids and serum lipoproteins were within the normal range in all patients. One patient treated with an extremely high dose of inhaled steroid showed a high level of serum C-peptide and serum insulin and a very low level of urinary cortisol excretion. The results of the other 15 patients were within the normal range.     

Sugar metabolism in obese children.

In obese children the glucose tolerance curve results in high blood sugar values. A pathologic rise of the serum insulin level may occur even with normal blood sugar curves and the insulin levels tend to be higher in obesity of long standing. In obese children of families with diabetes, post-loading insulin levels were comparatively lower. It is suggested that this weaker insulin response is related to a prediabetic state.