小学生超重肥胖与心血管代谢风险的纵向关联

Longitudinal association between overweight/obesity and cardiometabolic risk in primary school students

摘要

目的 了解2020—2024年上海市浦东新区小学生超重肥胖及血压、血脂、血糖等心血管代谢风险指标的发生水平及进展,分析超重肥胖及BMI与心血管代谢风险的纵向关联,为儿童心血管疾病的早期预防提供依据。方法 采用分层整群随机抽样,于2020年在浦东新区13所小学建立前瞻性队列,基线调查对象为6~7岁入学儿童,并于2022年(8~9岁)和2024年(10~11岁)随访复测。共1 483名儿童完成3次检测。测量身高、体重并计算体质量指数(BMI);检测收缩压(SBP)、舒张压(DBP)并采集空腹静脉血检测总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C);2022年与2024年增加空腹血糖(FPG)检测。采用重复测量方差分析比较连续指标在三个时间点的变化,采用广义估计方程分析异常指标检出率的时间趋势,采用线性混合模型评估连续BMI与各代谢指标的纵向关联。结果 2020、2022、2024年超重检出率分别为18.41%、16.93%、16.79%,肥胖检出率分别为18.95%、22.25%、21.44%。SBP偏高检出率由11.94%上升至19.96%,DBP偏高检出率由18.75%下降至6.07%。高TC血症由6.61%上升至17.73%;高TG血症由9.78%下降至1.69%后回升至5.73%;2020、2022、2024年高LDL-C血症分别为4.25%、11.46%、7.35%;低HDL-C血症分别为3.57%、1.82%、4.18%。FPG异常率在2022年为0.47%,2024年上升至10.18%。与体重正常组相比,超重肥胖组SBP偏高的风险在三个时间点均更高(OR=1.621、2.564、2.693),高TG血症(OR=1.609、8.151、2.814)和低HDL-C血症(OR=3.001、8.927、3.154)亦更常见(P<0.05),而高TC血症、高LDL-C血症及FPG异常检出率差异未达统计学意义(P>0.05)。线性混合模型显示,BMI每增加1 kg/m²,SBP增加1.518 mmHg,DBP增加0.451 mmHg,TG上升0.032 mmol/L,LDL-C上升0.021 mmol/L,HDL-C降低0.035 mmol/L,FPG增加0.015 mmol/L(P<0.001),BMI与TC无显著线性关联(P=0.833)。结论 超重肥胖是儿童心血管代谢异常的重要危险因素,尤其与血压偏高、TG升高和HDL-C降低显著相关。连续监测BMI变化比单纯的超重肥胖分类更能敏感地识别早期心血管代谢风险信号。

Abstract

Objective To describe the prevalence and temporal trends of overweight/obesity and cardiometabolic risk indicators (blood pressure, lipids, and glucose, etc) among primary school students in Pudong New Area, Shanghai from 2020 to 2024, and to examine longitudinal associations of overweight/obesity and body mass index (BMI) with cardiometabolic risk, so as to provide evidence for early prevention of cardiovascular diseases in children and adolescents. Methods A prospective cohort was established in 2020 using stratified cluster random sampling from 13 primary schools in Pudong New Area.Children aged 6 - 7 years were assessed at baseline (2020) and followed up in 2022 (aged 8 - 9 years) and 2024 (aged 10 - 11 years).A total of 1 483 children completed all three assessments.Height and weight were measured to calculate BMI.Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured.Serum total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were assessed at each visit.Fasting plasma glucose (FPG) was measured in 2022 and 2024 but not at baseline.Repeated-measures analysis of variance was used to compare continuous outcomes across visits.Generalized estimating equations were used to assess temporal trends in abnormal detection rate of cardiometabolic indicators.Linear mixed-effects models were used to evaluate longitudinal associations between continuous BMI and cardiometabolic measures. Results The prevalence of overweight was 18.41%, 16.93%, and 16.79% in 2020, 2022, and 2024, respectively, whereas obesity prevalence was 18.95%, 22.25%, and 21.44%.The detection rate of elevated SBP increased from 11.94% to 19.96%, while elevated DBP decreased from 18.75% to 6.07%.Hypercholesterolemia increased from 6.61% to 17.73%.Hypertriglyceridemia decreased from 9.78% to 1.69% and then rebounded to 5.73%.Elevated LDL-C was 4.25%, 11.46%, and 7.35% in 2020, 2022, and 2024, respectively, and low HDL-C was 3.57%, 1.82%, and 4.18%, respectively.The detection rate of abnormal fasting plasma glucose was 0.47% in 2022 and increased to 10.18% in 2024.Compared with normal-weight peers, overweight/obese children had higher risk of elevated systolic blood pressure at all three visits (OR=1.621, 2.564, 2.693), as well as hypertriglyceridemia (OR=1.609, 8.151, 2.814) and low HDL-C (OR=3.001, 8.927, 3.154) (P<0.05).Differences in hypercholesterolemia, elevated LDL-C, and abnormal fasting plasma glucose were not statistically significant (P>0.05).In linear mixed-effects models, each 1 kg/m² increment in BMI was associated with higher SBP (β=1.518 mmHg) and DBP (β=0.451 mmHg), higher TG (β=0.032 mmol/L), higher LDL-C (β=0.021 mmol/L), lower HDL-C (β=-0.035 mmol/L), and higher fasting plasma glucose (β=0.015 mmol/L) (P<0.001), while the association with total cholesterol was not significant (P=0.833). Conclusions Overweight and obesity are important risk factors for cardiovascular metabolic abnormalities in children, particularly associated with elevated blood pressure, increased TG, and decreased HDL-C.Continuous monitoring of BMI changes may be more sensitive than simple overweight/obesity categorization in detecting early signs of cardiometabolic risk.

关键词

超重 / 肥胖 / 血压 / 血脂 / 血糖 / 体质量指数 / 心血管代谢风险 / 纵向研究

Key words

overweight / obesity / blood pressure / blood lipids / blood glucose / body mass index / cardiovascular metabolic risk / longitudinal study

[1] 王兵.全球及中国的肥胖症流行病学现状及趋势[J].中国普外基础与临床杂志,2025,32(6):661-668.
Wang B.Global and Chinese obesity epidemiology: Current status and trends [J].Chinese Journal of Bases and Clinics in General Surgery, 2025, 32 (6):661-668.(in Chinese)
[2] 国家卫生健康委员会.中国居民营养与慢性病状况报告(2020年)[R].北京:人民卫生出版社, 2021.
[3] GBD 2021 Adult BMI Collaborators.Global,regional,and national prevalence of adult overweight and obesity, 1990-2021, with forecasts to 2050: A forecasting study for the Global Burden of Disease Study 2021[J].Lancet, 2025, 405(10481): 813-838.
[4] 国家卫生计生委.WS/T 586—2018学龄儿童青少年超重与肥胖筛查[S].北京:中华人民共和国卫生和计划生育委员会, 2018.
[5] 国家卫生计生委.WS/T 610—2018 7岁～18岁儿童青少年血压偏高筛查界值[S].北京:中华人民共和国卫生和计划生育委员会, 2018.
[6] 任亚萍,秦存,胡卉,等.上海市浦东新区小学女生血脂水平状况及其与青春期发育关联的研究[J].现代预防医学, 2024, 51(13):2387-2392.
Ren YP, Qin C, Hu H, et al.A study on the blood lipid level of primary school girls in Pudong New Area, Shanghai and its association with puberty development [J].Modern Preventive Medicine, 2024, 51(13): 2387-2392.(in Chinese)
[7] American Diabetes Association.2.Classification and diagnosis of diabetes:Standards of medical in diabetes-2020 [J].Diabetes Care, 2020, 43(Suppl 1):14-31.
[8] 黄雪华,谢伟光,黄岸仲,等.儿童青少年超重肥胖流行特征及影响因素分析[J].华南预防医学, 2023, 49(2):198-201.
[9] 王洋,阿力木江·依米提·塔尔肯.2000—2019年中国汉族7～18岁儿童青少年超重与肥胖变化趋势[J].卫生研究,2023,52(4):519-527.
Wang Y, Alimjiang· Y·T.Secular trend in overweight and obesity among Chinese children and adolescents of 7-18 years old during 2000—2019 [J].Journal of Hygiene Research, 2023, 52 (4): 519-527.(in Chinese)
[10] 杨赜骁,冷俊宏,杨西林.天津市学龄前儿童超重和肥胖与血压、血糖、血脂异常的关系[J].中国慢性病预防与控制, 2023, 31(7):518-522.
Yang ZX,Leng JH,Yang XL. Relationship between overweight/obesity and blood pressures,fasting plasma glucose or serum lipids in preschool children of Tianjin city[J]. Chin J Prev Contr Chron Dis, 2023, 31(7): 518-522.(in Chinese)
[11] Otiashvili L. Metabolic syndromes in overweight/obese school-age children[J].Glob Pediatr Health,2022, 9:2333794 X221122716.
[12] 刘军廷,么鸿雁,于事成,等.中国六省学龄儿童体重指数、体脂百分比评价肥胖与心血管代谢危险因素的相关性[J].中国儿童保健杂志, 2022, 309(5):469-474.
Liu JT, Yao HY, Yu SC,et al.Association of obesity classified by body mass index and fat mass percentage with cardiometabolic risk factors among school-age children in 6 pro-vinces,China [J].Chin J Child Health Care, 2022, 309 (5): 469-474.(in Chinese)
[13] Stanesby O, Armstrong MK, Otahal P, et al.Tracking of serum lipid levels from childhood to adulthood: Systematic review and meta-analysis [J].Atherosclerosis, 2024, 391: 117482.
[14] van Vliet M, Heymans MW, von Rosenstiel IA,et al.Cardiometabolic risk variables in overweight and obese children: A worldwide comparison [J].Cardiovasc Diabetol, 2011, 10:106.
[15] Pinto-Silva C, Correia-Costa A, Moura C, et al.Cardiovascular rhythmicity in overweight and obese children [J].J Bras Nefrol.2023, 45(4):449-457.
[16] Andrades CDS, Poletti VV, Closs VE, et al.Prevalence of dyslipidemia, atherogenic and cardiovascular risk in overweight and obese adolescents [J].Rev Paul Pediatr,2023, 41:e2021312.
[17] Daneshzad E, Rostami S, Aghamahdi F, et al.Association of cardiometabolic risk factors with insulin resistance in overweight and obese children [J].BMC Endocr Disord, 2022, 22(1):320.
[18] 杨香春,王飞,李海波.肥胖儿童血清生化指标的代谢改变研究[J].中国现代医生,2023,61(36):63-67.
Yang XC,Wang F,Li HB.Study on metabolic changes of serum biochemical indexes in obese children [J].China Modern Doctor, 2023, 61 (36): 63-67.(in Chinese)
[19] Wang J, Zhu Y, Cai L, et al.Distinct trajectories of childhood body mass index and adult cardiometabolic risk among Chinese individuals [J].Obesity, 2020, 28(1): 213-221.
[20] American Academy of Pediatrics.Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity [J].Pediatrics, 2023, 151(2): e2022060640.

基金资助

上海市浦东新区科技发展基金事业单位民生科研专项医疗卫生项目(PKJ2025-Y87);上海市浦东新区卫生健康委员会研究者发起的临床研究项目(队列建设)(2025-PWDL-20);上海市浦东新区疾病预防控制中心(复旦大学浦东预防医学研究院)专项科技项目(YJY-2024-01)