2014年中国7~18岁学生血压状况与营养状况的关联分析——基于中国儿童青少年血压评价标准

目的：分析2014年中国7~18岁儿童青少年学生血压状况的流行病学现状及其与营养状况之间的关联性，为制定儿童血压防控措施提供依据。方法：利用2014年“中国学生体质与健康调研”结果中7~18岁的儿童青少年数据，依据我国儿童青少年分年龄、性别、身高百分位血压标准来评价血压状况，包括儿童血压偏高前期、血压偏高、单纯性收缩压偏高、单纯性舒张压偏高和混合性血压偏高。按照国际儿童青少年体质量指数（body mass index，BMI）标准评价儿童青少年营养状况，包括消瘦（重度消瘦和轻度消瘦）、正常BMI、超重和肥胖（重度肥胖和轻度肥胖）。利用多因素Logistics回归模型分析血压偏高与营养状况之间的关联性，并计算人群归因危险度评估超重肥胖控制对于预防儿童血压偏高的公共卫生学意义。结果：2014年中国7~18岁儿童青少年血压偏高和血压偏高前期的检出率分别为14.9%和 9.2%，儿童青少年血压偏高者中收缩压偏高、舒张压偏高和混合性血压偏高检出率分别为3.1%、8.8%和3.0%。血压偏高状况整体呈现为男生高于女生，乡村高于城市，随年龄逐渐增高，随地区（东部、中部和西部）逐渐降低，随BMI 的增加而增加的趋势。重度肥胖组的血压偏高检出率最高，男女生分别为 44.2%和38.8%，分别是正常组（15.8%和10.6%）的2.8倍和3.7倍。血压偏高与消瘦（重度消瘦和轻度消瘦）呈负相关，与超重肥胖呈正相关。血压偏高归因于超重肥胖的危险度为16.2%，控制超重肥胖后，血压偏高的期望检出率为12.5%，且对单纯性收缩压偏高和混合性血压偏高影响较大，归因危险度分别为28.7%和35.1%。结论：我国儿童青少年血压偏高检出率较高，且以单纯性舒张压偏高为主。超重肥胖可显著增加血压偏高的风险，尤其是对单纯性收缩压偏高和混合性血压偏高影响较大，通过控制超重肥胖可显著降低全国儿童高血压的发生风险，从而对预防成年期慢性病的发生具有重要意义。

Association between the blood pressure status and nutritional status among Chinese students aged 7-18 years in 2014: based on the national blood pressure reference for Chinese children and adolescents

Objective： To analyze the epidemic situation of blood pressure (BP) status and its association with nutritional status among Chinese children and adolescents aged 7－18 years old in 2014, and to provide important scientific basis for the control of students’ hypertension. Methods: All the subjects aged 7 to 18 years in both genders were sampled from 2014 Chinese national surveys on students’ constitution and health. BP status was evaluated according to Chinese national gender-, age-and height-specific references, including hypertension (HTN), elevated hypertension (elevated HTN), isolated systolic HTN (SHTN), isolated diastolic HTN (DHTN) and mix HTN. Their nutritional status was evaluated using the international obesity task force (IOTF) definition, including thinness (severe thinness and moderate thinness), normal, overweight and obesity (severe obesity and moderate obesity). The Logistics method was used to analyze the association between BP status and nutritional status. The population attributable risk (PAR%) of overweight and obesity for BP status was calculated. Results: The prevalence of HTN and elevated HTN among the Chinese children and adolescents aged 7－18 years in 2014 was 14.9% and 9.2%, respectively. And the prevalence of isolated SHTN, isolated DHTN and mix HTN was 3.1%, 8.8% and 3.0%, respectively. The prevalence estimates for HTN differed the greatest for the boys, those in rural, those with high age, those in the East, and those with high BMI. The highest prevalence of HTN was detected in those with severe obesity with 44.2% and 38.8% in the boys and girls respectively, which was 2.8-fold and 3.7-fold than those with normal groups. The negative association was detected between HTN and thinness, but the positive association with overweight and obesity. The PAR% of HTN due to overweight and obesity was 16.2%, and the expected prevalence of HTN was 12.5% if controlling for overweight and obesity. Higher PAR% of isolated SHTN and mix HTN due to overweight and obesity was detected in the Chinese children and adolescents with proportions of 28.7% and 35.1%. Conclusion: The prevalence of HTN among the Chinese children and adolescents aged 7－18 years was still high, whose components mainly focused on isolated DHTN. Overweight and obesity can increase the risk of HTN in children and adolescents significantly, especially for isolated SHTN and mix HTN. Controlling for overweight and obesity can decrease the risk of HTN among Chinese national children and adolescents largely, which can play an important role in preventing the occurrence of chronic disease in adults.