基于体质量指数分层的儿童青少年血清维生素A、D与血压非线性阈值关联研究

Body mass index-stratified analysis of nonlinear thresholds and associations of serum vitamin A and D with blood pressure in children and adolescents

摘要

目的 分析儿童青少年血清维生素A(VA)、维生素D(VD)水平与血压的关联,并基于体质量指数(BMI)分层进行非线性阈值效应关联分析。方法 采用横断面研究,于2019年5月—2021年11月选取广东地区447名6~17岁中小学生,测量身高、体重、血压(测量3次取均值)及人体成分(生物电阻抗法),检测空腹血清VA、VD。利用平滑曲线及AIC准则确定阈值,构建校正年龄、性别及体脂百分比(PBF)后的BMI分层分段回归模型进行关联分析。结果 总体多元线性回归显示,校正BMI和PBF后,VA、VD与收缩压(SBP)和舒张压(DBP)的线性关联均无统计学意义(P>0.05)。分层分段回归显示:正常BMI组中,VD与SBP呈J型关联,阈值为27.60 ng/mL,阈值以上呈正相关(β=2.07, P=0.003);VA呈双向特征,<0.29 mg/L时与DBP正相关(β=1.34, P=0.012),>0.30 mg/L时与SBP正相关(β=0.21, P=0.006)。消瘦组VA>0.28 mg/L时与DBP呈显著正相关(β=0.45, P<0.001)。超重肥胖组未见显著关联。结论 儿童青少年血清VA、VD与血压的关联呈现复杂的非线性阈值特征,并且这种效应可能与个体的BMI状态有关。

Abstract

Objective To analyze the associations of serum vitamin A (VA) and vitamin D (VD) levels with blood pressure in children and adolescents, and to explore the nonlinear threshold effects based on body mass index (BMI) stratification. Methods A cross-sectional study was conducted among 447 students aged 6 -17 years in Guangdong Province from May 2019 to November 2021.Height, weight, blood pressure (mean of three measurements), and body composition (bioelectrical impedance analysis) were measured.Fasting serum VA and VD levels were determined.Optimal thresholds were identified using smoothing curves and the Akaike Information Criterion (AIC).BMI-stratified piecewise regression models were constructed to analyze the associations with adjustment for age, sex, and percent body fat (PBF). Results Overall multiple linear regression showed that the linear associations of VA and VD with systolic blood pressure (SBP) and diastolic blood pressure (DBP) were not significant after adjustment for BMI and PBF(P>0.05).In the normal-BMI group, VD exhibited a J-shaped association with SBP with an inflection point at 27.60 ng/mL; VD was positively associated with SBP above this threshold (β=2.07, P=0.003).VA was positively associated with SBP when VA>0.30 mg/L (β=0.21, P=0.006) and positively associated with DBP when VA<0.29 mg/L (β=1.34, P=0.012),exhibiting a dual pattern.In the underweight group, when VA exceeds 0.28 mg/L, it showed a significant positive correlation with DBP (β=0.45, P<0.001).No significant association was observed in the overweight/obesity group. Conclusion The associations of serum VA and VD with blood pressure in children and adolescents exhibit complex nonlinear threshold characteristics, and these effects may be dependent on individual BMI status.

关键词

血压 / 维生素A / 维生素D / 体质量指数 / 阈值效应

Key words

blood pressure / vitamin A / vitamin D / body mass index / threshold effect

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基金资助

科技部科技基础资源调查专项(No.2017FY101104)