高出生体重和超重肥胖对儿童青少年血压影响的队列研究

发布时间：2018-04-21 19:30

本文选题：高出生体重 + 超重肥胖　；参考：《复旦大学》2013年博士论文

【摘要】：[研究背景] 自20世纪80年代英国学者Barker提出“成人期疾病的宫内起源(fetal origin of adult disease)"学说以来,胎儿宫内发育情况对健康的长期影响受到越来越多的重视。出生体重是反映胎儿宫内发育和营养状况的一个重要指标,也是影响出生后的生长水平和健康状况的因素之一。以往的很多研究关注的是低出生体重儿的生长发育和健康状况,低出生体重已经被证实是很多疾病的危险因素。近三十年来,无论是在发达国家还是一些发展中国家,婴儿的出生体重和巨大儿发生率均有增加的趋势；儿童青少年的血压水平也呈现上升趋势,高血压的患病率有所增加。高出生体重对儿童青少年血压的影响值得关注。同时,研究儿童青少年血压的影响因素,对有针对性地开展儿童青少年高血压的预防也具有重要的意义。 [研究目的] 本研究的目标为探讨高出生体重和儿童期、青少年期的超重肥胖对儿童青少年血压的影响,并分析儿童期和青少年期血压的影响因素。 [研究方法] 本研究为高出生体重作为暴露因素的队列研究。研究现场为江苏省无锡市的一个县级市(江阴市)和两个行政区(惠山区和锡山区)。研究对象为出生于1993-1995年的单胎活产婴儿,其中出生体重≥4000克者作为暴露组,2500克≤出生体重4000克者作为非暴露组。在出生队列建立时,非暴露组对象按照性别和“出生日期±2个月”进行配对,两组均排除父母或(外)祖父母有高血压或有糖尿病的对象。分别于2005年10月-2006年9月和2011年6月-2012年5月对研究对象进行2次随访。队列建立时的数据库资料包括母亲孕期情况、围产期情况；两次随访的问卷调查内容包括人口学特征和生活习惯等,并进行身高、体重、血压的测量。应用Epidata3.1软件进行数据录入,应用SAS9.2、LISREL8.7软件进行数据分析。以血压作为结局变量(收缩压、舒张压、血压升高比例),采用方差分析、x2检验、随机截距发展模型、广义线性混合效应模型、线性回归、Logistic回归、结构方程模型等方法,分析高出生体重对血压的影响、超重肥胖对血压的影响和儿童期、青少年期血压的影响因素。 [研究结果] 1.队列概况本研究队列建立时,共有1595对(3190人)符合条件的对象被纳入到队列中。完成两次随访的研究对象有2256人,其中暴露组1126人、非暴露组1130人。男生占66.45%(1499名),女生占33.55%(757名),两组之间的性别分布均衡。随访到的对象和失访对象在组别、出生年份和性别分布上无统计学差异。 2.暴露组和非暴露组基本情况的比较暴露组和非暴露组对象出生时母亲的人口学特征和孕期特征无统计学差异。但暴露组母亲的身高、体重和孕期增重均显著高于非暴露组。暴露组过期妊娠(≥42周)的比例较高,出生身长、头围均显著高于非暴露组。儿童期随访时,暴露组平均每天看电视时间≥1小时的比例为36.93%,低于非暴露组(42.06%)。青少年期随访时,暴露组经常偏食的比例低于非暴露组,平均每天运动时间≥2小时的比例高于非暴露组。 3.高出生体重对血压的影响在儿童期,高出生体重组的SBP和DBP分别为100.40±10.5865.45±8.95mmHg,正常出生体重组分别为99.81±9.96mmHg、65.02±8.65mmHg。在青少年期,高出生体重组的SBP和DBP分别为110.90±9.49mmHg、72.16±6.34mmHg;正常出生体重组分别为109.36±9.20mmHg、71.63±6.39mmHg.高出生体重对青少年期收缩压有统计学显著性影响(P0.0001)。高出生体重组儿童期的高血压检出率为6.93%,青少年期为3.55%；正常出生体重组分别为6.46%、2.83%。高出生体重组儿童期和青少年期的“血压升高比例”分别为14.30%、20.78%,显著高于正常出生体重组(11.50%、16.64%),RR值分别为1.24(95%CI：1.00-1.54)、1.25(95%CI:1.05-1.49). 控制重复测量时间,并调整母亲分娩时的年龄、母亲职业、母亲产时妊高征、研究对象的性别、胎龄、胎次、出生重量指数(PI)和儿童期年龄后,高出生体重组的收缩压、血压升高比例均显著高于正常出生体重组,参数估计值分别为0.81±0.30、0.21±0.09。高出生体重与青少年期经常吃甜食对青少年期的收缩压、舒张压有显著的相加交互作用；对血压升高比例影响的交互作用超额相对危险度(RERI)为2.71(95%CI：0.75-4.67),交互作用归因比(AP)为66.5%(95%CI：41.2-91.8)。 4.高出生体重对超重肥胖的影响高出生体重组对象的儿童期和青少年期BMI均高于正常出生体重组。高出生体重组儿童期“超重肥胖”(超重+肥胖)的比例为15.99%、青少年期为11.99%,均显著高于正常出生体重组(儿童期：11.59%、青少年期：8.85%),RR值分别为1.38(95%CI：1.12-1.70)、1.35(95%CI：1.06-1.73)。控制重复测量的分析显示高出生体重对儿童青少年的BMI、超重肥胖比例有显著不良影响。 5.超重肥胖对血压的影响调整出生体重组别、母亲生育年龄、母亲职业、母亲产时妊高症、胎次、胎龄、出生身长、性别、儿童期年龄、儿童期是否经常偏食、是否经常吃油炸食品和运动时间的分析显示,超重肥胖儿童的收缩压(β±SE:2.49±0.61)和舒张压(β±SE：3.20±0.51)显著升高,血压升高的风险增加(OR=2.16,95%CI:1.52-3.08)。多因素分析显示,青少年超重肥胖者的收缩压显著升高(β±SE:5.62±.61)、舒张压也显著升高(β±SE:3.35±0.42)。青少年期BMI超重肥胖和高出生体重对血压升高比例的影响有交互作用,其RERI为2.22(95%CI：0.42-4.02),AP为49.5%(95%CI:22.1-76.8).在正常出生体重组、高出生体重组,青少年期超重肥胖导致血压升高的风险分别为2.21(95%CI:1.35-3.62)、3.97(95%CI:2.65-5.94)。 6.出生体重和BMI对血压影响的效应分析出生体重对儿童期收缩压、舒张压影响的总效应均为0.04。出生情况(体重、身长)对儿童期血压影响的直接效应为0.11、间接效应为0.04。儿童期BMI对血压水平影响的效应为0.25。出生体重对青少年期收缩压影响的总效应0.07,对舒张压影响的总效应为0.06。出生情况(体重、身长)对青少年期血压影响的间接效应为0.11。青少年期BMI对血压水平影响的效应为0.51。 7.儿童期血压的影响因素多因素分析发现母亲产时妊高征、经常吃油炸食品是儿童血压升高的危险因素。随着儿童期年龄和BMI的增加,收缩压、舒张压上升,血压升高的风险增加。男生的儿童期收缩压高于女生。收缩压随着出生身长的增加而增加。平均每天运动时间≥2小时能降低儿童的收缩压、舒张压和血压升高的比例。有氧运动能降低儿童的收缩压和血压升高风险。经常偏食能导致儿童的舒张压下降、血压升高的风险降低。母亲生育时职业为工人和其他(教师、干部、商业服务业等)的子女,其儿童期收缩压低于母亲生育时职业为农民的子女。 8.青少年期血压的影响因素母亲产时妊高征对青少年期的血压有显著不良影响。男生的青少年期收缩压、舒张压、血压升高比例均高于女生。随着青少年期BMI的增加,收缩压和舒张压上升、血压升高的风险增加。随着出生身长的增加,收缩压上升。青少年期的收缩压还随着儿童期收缩压的上升而上升。随着年龄的增加,舒张压和血压升高的比例增加。经常吃甜食是青少年期收缩压和血压升高比例上升的危险因素。母亲孕晚期有高危因素(妊娠合并症或并发症)是青少年期血压升高的危险因素。在青少年期随访时父亲或母亲有高血压的对象,其“血压升高比例”增加。有氧或无氧运动都能降低青少年的收缩压；有氧和无氧两者都有的运动方式能降低青少年的舒张压和血压升高的比例。 [结论] 1.高出生体重是儿童青少年血压升高的危险因素；而且高出生体重对青少年期血压的影响存在与不良饮食习惯(吃甜食)的交互作用。 2.高出生体重能导致儿童期和青少年的超重肥胖增加。儿童期和青少年期超重肥胖均是血压升高的危险因素；而且青少年期超重肥胖和高出生体重对青少年期血压升高比例的影响存在交互作用。 3.出生体重可以直接对儿童青少年的血压产生影响；又可以导致儿童期、青少年期BMI的升高而对血压产生不良影响。BMI对血压影响的效应水平高于出生体重对血压影响的效应水平。 4.儿童青少年的血压存在着性别、年龄差异。母亲产时妊高症、儿童期经常吃油炸食品、青少年期经常吃甜食与血压升高有关。父亲／母亲高血压与青少年期的血压升高有关。有氧运动是儿童青少年血压的保护因素。
[Abstract]:[research background]
Since the "fetal origin of adult disease" theory was proposed by British scholar Barker in 1980s, the long-term effects of fetal intrauterine development on health have been paid more and more attention. Birth weight is an important indicator of fetal development and nutritional status, and also after birth. A number of previous studies have focused on the growth and health of low birth weight infants, and low birth weight has been identified as a risk factor for many diseases.
In the last thirty years, both in developed and some developing countries, the birth weight and the incidence of giant infants have increased; the blood pressure level of children and adolescents is also rising, the prevalence of hypertension has increased. The effect of high birth weight on the blood pressure of young children is worth paying attention. The influencing factors of blood pressure in young adolescents are also important for the prevention of hypertension in children and adolescents.
[research purposes]
The aim of this study was to investigate the effects of overweight and obesity on blood pressure in children and adolescents, and to analyze the influence factors of blood pressure in childhood and adolescence.
[research methods]
The study was a cohort study of high birth weight as a factor of exposure. The study was a county-level city (Jiangyin city) and two administrative districts (Huishan and Xishan) in Wuxi, Jiangsu province. The study was a single born baby born in 1993-1995 years, with a birth weight of more than 4000 grams as an exposure group and 2500 grams less than 4000 grams of birth weight. When the birth cohort was established, the non exposed groups were paired according to sex and "date of birth for 2 months", and the two groups all excluded parents or grandparents with hypertension or diabetes. The subjects were followed up in September -2006, October 2005, and May June 2011, respectively, and the subjects were followed up for 2 times.
The database data at the time of the establishment of the cohort included maternal pregnancy and perinatal conditions; the two follow-up questionnaires included demographic characteristics and living habits, and measured height, weight and blood pressure. Epidata3.1 software was used for data entry, SAS9.2 and LISREL8.7 software were used for data analysis. Blood pressure was used as the outcome. Variables (systolic pressure, diastolic pressure, blood pressure increase), analysis of variance, x2 test, random intercept development model, generalized linear mixed effect model, linear regression, Logistic regression, structural equation model, and other methods to analyze the effect of high birth weight on blood pressure, the influence of overweight and obesity on blood pressure, and the influence of childhood and adolescence blood pressure Factor.
[results]
1. queue profile
When the cohort was established, 1595 pairs (3190 people) were included in the cohort. There were 2256 subjects for two follow-up studies, including 1126 exposed groups and 1130 non exposed groups. Boys accounted for 66.45% (1499), girls accounted for 33.55% (757), and the gender distribution between the two groups was balanced. The subjects followed up and the missing subjects were in the group. There was no statistical difference in the year of birth and sex distribution.
Comparison of the basic situation between 2. exposed and non exposed groups
There was no significant difference in the demographic and pregnancy characteristics between the exposed and non exposed groups at birth, but the height, weight and weight gain of the mothers in the exposed group were significantly higher than those in the non exposed groups. The proportion of the exposed group was higher than that of the exposed group (over 42 weeks), and the length of the birth and the head circumference were significantly higher than that of the non exposed group.
In the follow-up period of childhood, the average rate of watching TV time more than 1 hours per day in the exposure group was 36.93%, lower than that of the non exposed group (42.06%). The proportion of frequent partial eclipse of the exposure group was lower than that in the non exposed group. The average daily exercise time of more than 2 hours was higher than that of the non exposed group.
3. the effect of high birth weight on blood pressure
In the childhood, the SBP and DBP of the high birth weight group were 100.40 + 10.5865.45 + 8.95mmHg respectively. The normal birth weight group was 99.81 + 9.96mmHg and 65.02 + 8.65mmHg. in adolescence. The SBP and DBP of the high birth weight group were 110.90 + 9.49mmHg and 72.16 + 6.34mmHg respectively. The normal birth weight group was 109.36 + 9.20mmHg, 71.63 + 6.39mmHg.. The birth weight has a statistically significant effect on the systolic pressure in adolescence (P0.0001). The prevalence of hypertension in the high birth weight group was 6.93%, the adolescence was 3.55%, the normal birth weight group was 6.46%, and the 2.83%. high birth weight group was 14.30%, 20.78%, respectively, and was 20.78%, respectively. In the normal birth weight group (11.50%, 16.64%), the RR values were 1.24 (95%CI:1.00-1.54) and 1.25 (95%CI:1.05-1.49) respectively.
To control the time of repeated measurements, and to adjust the age of mother's childbirth, mother's occupation, mother's pregnancy induced hypertension, sex, fetal age, birth weight, birth weight index (PI) and childhood age, the systolic pressure and blood pressure in the high birth weight group were significantly higher than those of the normal birth weight group, and the estimated value of the parameters was 0.81 + 0.30,0.21, respectively. + 0.09.
High birth weight and regular eating dessert had significant interaction effect on systolic blood pressure and diastolic pressure in adolescence, and the interaction effect of excess relative risk (RERI) was 2.71 (95%CI:0.75-4.67) and AP was 66.5% (95%CI:41.2-91.8).
The effect of 4. high birth weight on overweight and obesity
The BMI of the high birth weight group was higher in childhood and adolescence than in the normal birth weight group. The proportion of overweight and obesity (overweight + obesity) in the high birth weight group was 15.99%, and the adolescence was 11.99%, which was significantly higher than that in the normal birth weight group (11.59%, 8.85%) and 1.38 (95%CI:1.12-1.7 0), 1.35 (95%CI:1.06-1.73). Analysis of repeated measures showed that high birth weight had a significant adverse effect on BMI and overweight and obesity in children and adolescents.
5. effect of overweight and obesity on blood pressure
The birth weight group, mother's birth age, mother's occupation, mother's pregnancy, pregnancy induced hypertension, fetal age, birth length, birth length, sex, childhood age, children's frequent bias, frequent fried food and exercise time showed that the systolic pressure (beta SE:2.49 + 0.61) and diastolic pressure (beta + SE:3.20 + 0.51) of overweight and obese children were (beta + 0.61) and diastolic pressure. The risk of elevated blood pressure increased significantly (OR=2.16,95%CI:1.52-3.08).
The multifactor analysis showed that the systolic pressure of overweight and obese adolescents increased significantly (beta SE:5.62 +.61), and diastolic pressure increased significantly (beta SE:3.35 + 0.42). The effect of BMI overweight and high birth weight on the proportion of blood pressure increased in adolescence, and RERI was 2.22 (95%CI:0.42-4.02) and AP was 49.5% (95%CI:22.1-76.8). The risk of elevated blood pressure was 2.21 (95%CI:1.35-3.62) and 3.97 (95%CI:2.65-5.94), respectively.
An analysis of the effect of 6. birth weight and BMI on blood pressure
The total effect of birth weight on systolic blood pressure and diastolic pressure in children was that the direct effect of 0.04. birth (weight, length) on children's blood pressure was 0.11, and the effect of indirect effect on the level of blood pressure in 0.04. childhood BMI was 0.25.
The total effect of birth weight on systolic blood pressure in adolescence was 0.07. The total effect on diastolic pressure was the indirect effect of 0.06. birth (weight, length) on adolescent blood pressure. The effect of BMI on blood pressure in 0.11. adolescence was 0.51.
7. influence factors of children's blood pressure
Multifactor analysis found that the mother's pregnancy induced hypertension and frequent fried food were the risk factors for the increase of blood pressure in children. With the age of children and the increase of BMI, the systolic pressure, diastolic pressure increased, and the risk of blood pressure increased. The boys' systolic pressure was higher than that of the girls.
The average daily exercise time of more than 2 hours reduces children's systolic pressure, diastolic pressure, and blood pressure increase. Aerobic exercise reduces the risk of systolic blood pressure and blood pressure in children. Frequent partial eclipse can lead to a decrease in diastolic blood pressure in children and a lower risk of rising blood pressure. Mother's childbearing time is a worker and other (teachers, cadres, business services). The child's systolic blood pressure is lower than that of the mother when the child is born.
8. influential factors of blood pressure in adolescence
Pregnancy induced hypertension (PIH) has a significant negative effect on the blood pressure in adolescence. The proportion of boys' systolic pressure, diastolic pressure, and blood pressure is higher than that of girls. With the increase of BMI, systolic and diastolic pressure increases, the risk of blood pressure increases. As the length of birth increases, systolic pressure rises. Systolic pressure in adolescence. With the increase of systolic blood pressure in childhood, the proportion of diastolic pressure and blood pressure increases as the age increases. Frequent dessert is a risk factor for the increase in the proportion of systolic blood pressure and blood pressure. In the late pregnancy, there are high risk factors (pregnancy complications or complications) in the late pregnancy. During the follow-up period, the proportion of blood pressure increased in both mothers and fathers with hypertension.
Both aerobic and anaerobic exercise can reduce the systolic blood pressure in adolescents; both aerobic and anaerobic exercise can reduce the proportion of diastolic pressure and blood pressure in adolescents.
[Conclusion]
1. high birth weight is a risk factor for high blood pressure in children and adolescents; and the influence of high birth weight on adolescent blood pressure is interacted with bad eating habits (eating desserts).
2. high birth weight can lead to an increase in overweight and obesity in childhood and adolescents. Overweight and obesity in childhood and adolescence are risk factors for high blood pressure, and there is an interaction between overweight and obesity and high birth weight in adolescence.
3. birth weight can directly affect the blood pressure of children and adolescents; it can also lead to childhood, adolescent BMI and adverse effects on blood pressure. The effect of.BMI on blood pressure is higher than the effect of birth weight on blood pressure.
4. children and adolescents have sex, age differences, pregnancy induced hypertension during mother birth, often eating fried foods in childhood, frequent eating sweets in adolescence and elevated blood pressure. Father / mother hypertension is associated with elevated blood pressure in adolescence. Aerobic exercise is a protective factor for children and adolescents.

【学位授予单位】：复旦大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R723.14;R725.4

【共引文献】