学龄儿童尿邻苯二甲酸酯代谢物与新发超重肥胖、血压偏高及其共病的纵向关联

Longitudinal associations of urinary phthalate metabolites with incident overweight/obesity, elevated blood pressure, and their comorbidity in school-aged children

摘要

目的 探讨学龄儿童尿邻苯二甲酸酯代谢物暴露与新发超重肥胖、血压偏高及二者共病的纵向关联。方法 基于厦门市青春期发育队列PAEs重复测量子队列,2018年有效分析823名儿童;816名儿童至少贡献1个相邻随访区间,共1 542个观察区间。检测7种尿PAEs代谢物并构建∑LMWP、∑DEHP和∑PAEs,暴露经预期肌酐校正、自然对数转换和IQR标准化。采用广义估计方程分析前一波暴露与后一波新发超重肥胖、血压偏高及共病的关联,调整随访区间及人口学、家庭和生活方式因素,并进行青春期发育和前一波心血管代谢状态敏感性分析。结果 共发生新发超重肥胖56人次、血压偏高238人次和共病90人次。完全调整模型中,MEHHP和∑DEHP每增加1个IQR,新发共病OR值分别为1.307(95%CI:1.018~1.679,P=0.036)和1.340(95%CI:1.013~1.772,P=0.040),q值均为0.202。未观察到PAEs与单纯新发超重肥胖或血压偏高的稳定关联,随访区间及性别交互作用均无统计学意义;敏感性分析中MEHHP和∑DEHP的效应估计仍均大于1,但均未达到统计学意义。结论 DEHP相关代谢物暴露可能与学龄儿童后续新发超重肥胖合并血压偏高共病呈正向关联,但仍需进一步验证。

Abstract

Objective To examine the longitudinal associations of urinary phthalate metabolite exposure with incident overweight/obesity, elevated blood pressure, and their comorbidity among school-aged children. Methods This study used the phthalate repeated-measurement subcohort of the Xiamen Pubertal Development Cohort. In 2018, 823 children had valid data; 816 contributed at least one adjacent follow-up interval, yielding 1 542 intervals. Seven urinary phthalate metabolites were measured, and three molar-sum indices were calculated (∑LMWP, ∑DEHP, and ∑PAEs). All exposure measures were adjusted for expected creatinine, natural-log-transformed, and standardised to the interquartile range (IQR). Generalized estimating equation logistic models assessed associations between exposure at the previous wave and subsequent incident outcomes, adjusting for follow-up interval and demographic, family, and lifestyle factors. Sensitivity analyses additionally adjusted for pubertal development and cardiometabolic status at the previous wave. Results A total of 56 incident overweight/obesity events, 238 elevated blood pressure events and 90 incident comorbidity events occurred. In fully adjusted models, each IQR increase in MEHHP and ∑DEHP was associated with incident comorbidity [OR=1.307 (95% CI: 1.018-1.679), P=0.036; OR=1.340 (95% CI: 1.013-1.772), P=0.040]; both q values were 0.202. No stable associations were observed for incident overweight/obesity or elevated blood pressure alone. No statistically significant interactions were observed between exposure and follow-up interval or sex. In sensitivity analyses,the effect estimates for MEHHP and ∑DEHP remained above 1.0 but were not statistically significant. Conclusion Exposure to DEHP-related phthalate metabolites may be positively associated with incident comorbidity of overweight/obesity and elevated blood pressure, and further confirmation is warranted.

关键词

邻苯二甲酸酯类 / 环境内分泌干扰物 / 超重肥胖 / 血压偏高 / 共病

Key words

phthalates / endocrine-disrupting chemicals / overweight and obesity / elevated blood pressure / comorbidity

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基金资助

国家自然科学基金项目(82103865)