膳食、运动、PPAR γC161→T基因多态对儿童肥胖易感性和血脂血糖的影响

发布时间：2018-04-30 14:38

本文选题：膳食 + 体力活动　；参考：《复旦大学》2012年博士论文

【摘要】：学龄儿童超重和肥胖在全世界范围内呈现上升趋势,而在我国,学龄儿童超重肥胖的发展同样呈现全面流行趋势。学龄儿童超重肥胖会给儿童带来代谢性紊乱、心肺功能紊乱、发育障碍等生理方面的损害,也会带来社会接受性低、自我意识受损等心理方面的影响,并且更可增加成年期肥胖的风险,从而增加心血管疾病、糖尿病等一系列慢性病的发病风险。目前普遍认为肥胖是由基因、膳食、运动等遗传和环境因素相互作用引起的。研究目的了解学龄儿童超重肥胖的流行病学特点,探讨膳食因素(特别是膳食模式)、体力活动(包括静态运动情况)、PPARγC161→T基因多态对儿童超重肥胖的易感性和血脂血糖的影响,并初步研究PPARγC161→T基因多态与膳食、体力活动交互作用对儿童超重肥胖易感性和血脂血糖的影响,为今后确定学龄儿童超重肥胖重点监测人群和个性化防制措施提供合理的理论依据。方法采用整群随机抽样法,从上海市某区整群分层随机抽取的6所学校抽取三、四、五年级的学龄儿童,每所学校每个年级随机抽取2个班作为研究对象。采用3d24h小时膳食记录法进行膳食调查,通过发放自制的《7天回顾性身体活动调查问卷》,回顾过去7天包括各项运动、出行方式和时间、各项静态运动时间等身体活动情况,由经过培训的工作人员进行身高、体重、腰围体格检查。抽取调查对象清晨空腹静脉血5m1,检测血清中血脂(包括总胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白)、血糖、胰岛素的含量。采用酚-氯仿的方法提取血凝块中的基因组DNA,然后通过PCR-RFLP方法进行PPARγC161→T基因型分析。结果 1、上海某区儿童超重肥胖流行现状上海某区学龄儿童超重率为10.4%,肥胖率为8.9%,超重肥胖率为19.3%,其中男性学龄儿童超重肥胖率为24.9%,女性为13.5%,男性高于女性(X2=25.506,P=-0.000)。 2、学龄儿童超重肥胖情况及影响因素分析 (1)膳食因素与学龄儿童超重肥胖超重肥胖者大豆类和奶类的摄入低于正常组,粮谷类300g/d摄入者比≤300g/d者超重肥胖患病风险降低；膳食总抗氧化能力正常组7.92±3.36mmol,超重肥胖组7.38±3.18mmol,正常组高于超重肥胖组(P0.05),第1四分位数(Q1)的儿童超重肥胖风险最高,并且膳食总抗氧化能力与学龄儿童体重和腰围成负相关；因子分析后富含优质蛋白和蔬菜水果的膳食模式因素1代表的健康饮食模式,是超重肥胖的保护性因素,其第4四分位数(Q4)超重肥胖风险低于第1四分位数(Q1),OR(95%CI)为0.615(0.387～0.978)。 (2)体力活动与学龄儿童超重肥胖总静态活动时间≥28h/w者超重肥胖风险高于28h/w者,OR(95%CI)为1.425(1.020～1.991),睡眠时间每天≥9h者超重肥胖风险低于9h儿童,其OR(95%CI)为0.516(0.337～0.790),静态运动时间和腰围、BMI和体重呈正相关,睡眠时间和这些体检指标负相关。 (3)综合生活模式与学龄儿童超重肥胖静态运动时间长、西方膳食模式为主、睡眠时间短的西方生活模式Q4组超重肥胖风险高于Q1组,OR(95%CI)为1.834(1.172～2.871),体力活动时间长、健康膳食模式为主、静态运动时间较少的健康生活模式的Q2组超重肥胖风险低于于Q1组,OR(95%CI)为0.560(0.351～0.894)。 (4) PPAR γC161→T基因多态性与学龄儿童超重肥胖 PPAR γC161→T基因多态性与性别、粮谷类的摄入、生活模式对学龄儿童超重肥胖存在交互作用；T突变基因是女性学龄儿童超重肥胖的危险因素,OR(95%CI)为1.833(1.041-3.277),对男性儿童的影响没有统计学意义；在粮谷类摄入300g/d水平的儿童中,T突变基因携带者超重肥胖风险降低,OR(95%CI)为0.275(0.083-0.914)；在西方生活模式因子得分的Q1组,T突变基因携带者超重肥胖风险增加,OR (95%CI)为2.248(1.022-4.948)。 (5)学龄儿童超重肥胖多影响因素分析 Logistic多因素回归模型显示,儿童超重肥胖的危险因素有年龄的增加、男性、膳食总抗氧化能力低、静态运动时间长等,保护性因素有膳食模式1(健康饮食模式)、睡眠时间大于9h/d、粮谷类摄入300g/d；各体检指标影响因素采用多元线性回归显示,BMI的主要影响因素有年龄、性别、步行时间、睡眠时间,主要影响体重和腰围的变量有年龄、性别、步行时间、静态运动时间和睡眠时间。 3、学龄儿童血糖血脂影响因素 (1)一般情况与学龄儿童血脂血糖血脂血糖基本随着年龄的增加而增加；超重肥胖者TG、LDL、LDL/HDL、 TCH/HDL、胰岛素、HOMA指数都高于体重正常者,而HDL低于正常者。 (2)膳食营养素摄入与学龄儿童血脂血糖碳水化合物、膳食纤维、植物蛋白、粮谷类、水果类、蛋类的摄入、碳水化合物供能比与学龄儿童血糖血脂呈负相关,饱和脂肪酸、单不饱和脂肪酸、晚餐供能比、鱼肉类摄入与血脂血糖呈正相关：总学龄儿童中,膳食模式1(健康饮食模式)与葡萄糖呈现负相关,在超重肥胖学龄儿童中,膳食模式2(西方饮食模式)与葡萄糖成正相关。 (3)体力活动情况与学龄儿童血脂血糖 TG和血糖与步行时间负相关,步行次数与血糖负相关；写作业时间和静态运动总时间与血糖正相关；运动时间与血糖负相关。 (4)综合生活模式与学龄儿童血脂血糖西方生活模式因子得分与胰岛素、HOMA指数呈现正相关,健康生活模式与血糖负相关。 (5) PPAR γC161→T基因多态与学龄儿童血脂血糖总学龄儿童和体重正常儿童中,T突变基因携带儿童TCH高于野生基因型儿童,但在超重肥胖儿童中,T等位基因携带者TG高于野生基因型；基因型和性别之间对TG存在交互作用,女性学龄儿童中,T突变基因携带者TCH和TG浓度高于野生基因型；西方生活模式和健康生活模式Q1组中,T突变基因携带者TCH浓度高于野生型。 (6)学龄儿童血脂血糖影响因素多元线性回归 TCH, TG,血糖,HDL, TCH/HDL,胰岛素的影响变量分别为基因携带者,写作业时间,年龄、性别和膳食模式1健康饮食模式,年龄,做作业时间,年龄。结论 1、上海某区儿童超重肥胖率的流行现状严峻,且男生的超重和肥胖率均大于女生。 2、男性、膳食粮谷类摄入少、膳食总抗氧化能力低、健康饮食模式评分低、静态活动时间长、睡眠时间短、PPAR γC161→T基因突变是学龄儿童超重肥胖风险因素。 3、不同性别、膳食、运动等生活方式的学龄儿童,PPAR γC161→T基因多态性对超重肥胖所起的作用不同。T突变基因是女性学龄儿童、西方生活模式者超重肥胖的危险因素,是粮谷类摄入300g/d儿童的保护性因素,可以为肥胖超重监控的重点人群和个性化预防措施提供初步线索。 4、健康饮食模式评分低、静态运动时间长、运动时间短、PPAR γC161→T基因突变与高血脂高血糖相关。 5、PPAR γC161→T基因多态性对学龄儿童血脂的影响受到性别和膳食、运动生活方式等环境的影响。女性学龄儿童中、西方生活模式和健康生活模式因子Q1组中,T等位基因携带者TCH和(或)TG浓度高于野生型,可为学龄儿童血脂血糖监测重点人群提供理论依据。
[Abstract]:Overweight and obesity in school-age children are on the rise in the world, but in China, the development of overweight and obesity in school age children also presents a comprehensive trend. Overweight and obesity in school-age children will bring about metabolic disorders, cardiopulmonary dysfunction, developmental disorders and other physiological aspects, and also bring low social acceptability and self meaning. It can increase the risk of obesity and increase the risk of obesity in adulthood, which increases the risk of a series of chronic diseases such as cardiovascular disease and diabetes. It is generally believed that obesity is caused by genetic and environmental factors such as gene, diet, exercise and so on.
research objective
To understand the epidemiological characteristics of overweight and obesity in school-age children, to explore the dietary factors (especially dietary patterns), physical activity (including static exercise), the effect of PPAR gamma C161 to T gene polymorphism on the susceptibility to overweight and obesity in children and the effect of blood lipid and blood glucose, and to study the interaction of PPAR gamma C161 to T gene polymorphism with dietary and physical activity. The susceptibility of overweight and obesity and the influence of blood lipid and blood sugar in children provide a reasonable theoretical basis for determining the key monitoring population and individual prevention measures for overweight and obesity in school-age children.
Method
A cluster random sampling method was used to extract three, four and five grade school aged children from 6 schools with stratified and random sampling in a district of Shanghai. 2 classes were randomly selected from each grade of each school. The dietary survey was carried out by the 3d24h hour diet recording method, and the self-made questionnaire on the retrospective physical activity of <7 days was carried out. In the past 7 days, the past 7 days include physical activity, travel mode and time, and static exercise time, and the body height, weight, and waist circumference of the trained staff were examined. The early morning venous blood was extracted from the subjects. The serum lipids (including total cholesterol, triglycerides, LDL, HDL, HDL) were detected. Protein), blood sugar, insulin content. Genomic DNA in blood clot was extracted by phenol chloroform method, and then PPAR gamma C161 to T genotypes were analyzed by PCR-RFLP method.
Result
1, the prevalence of overweight and obesity in children in a district of Shanghai
The overweight rate of school-age children in Shanghai was 10.4%, the obesity rate was 8.9%, the overweight and obesity rate was 19.3%, of which the rate of overweight and obesity in male school-age children was 24.9%, the female was 13.5%, and the male was higher than that of the female (X2=25.506, P=-0.000).
2, overweight and obesity in school age children and its influencing factors
(1) dietary factors and overweight and obesity in school-age children
The intake of soybean and milk in overweight and obese people was lower than that of the normal group, and the 300g/d intake of cereals was lower than that of those with less than 300g/d; the total dietary antioxidant capacity was 7.92 + 3.36mmol, the overweight and obesity group was 7.38 + 3.18mmol, the normal group was higher than the overweight group (P0.05), and the children with first four quantiles (Q1) were at the highest risk of overweight and obesity. The total antioxidant capacity of the diet was negatively correlated with the weight and waist circumference of school-age children; the healthy diet model, which was rich in quality protein and vegetables and fruits 1, was a protective factor for overweight and obesity, the fourth four quantile (Q4) was lower than first and four quantiles (Q1), and OR (95%CI) was 0.615 (0.387). To 0.978).
(2) physical activity and overweight and obesity in school-age children
The risk of overweight and obesity with total static time > 28h/w was higher than that of 28h/w, OR (95%CI) was 1.425 (1.020 ~ 1.991), the risk of overweight and obesity was lower than 9h children, and OR (95%CI) was 0.516 (0.337 ~ 0.790). The static exercise time and waist circumference were positively correlated with the weight of BMI and weight, and the sleep time was negatively correlated with these physical indexes.
(3) comprehensive life model and overweight and obesity of school-age children
The risk of overweight and obesity in the western life model Q4 group with long static exercise time, Western diet mode and short sleep time was higher than that of Q1 group, OR (95%CI) was 1.834 (1.172 ~ 2.871), physical activity time was long, the healthy diet mode was mainly, the Q2 group with less static exercise time was lower than the Q1 group, and OR (95%CI) was 0.5. 60 (0.351 to 0.894).
(4) PPAR gamma C161 to T polymorphism and overweight and obesity in school-age children.
PPAR gamma C161 / T gene polymorphism and sex, grain intake and life pattern have interaction effect on overweight and obesity in school-age children; T mutation gene is a risk factor for overweight and obesity in female school-age children, OR (95%CI) is 1.833 (1.041-3.277), and the effect on male children is not statistically significant; children in grain cereals intake 300g/d level are not statistically significant. In the T mutation carrier, the risk of overweight and obesity was reduced, and OR (95%CI) was 0.275 (0.083-0.914); the risk of overweight and obesity in the T mutant gene carriers was increased in the Q1 group with the Western lifestyle factor, and the OR (95%CI) was 2.248 (1.022-4.948).
(5) analysis of the factors affecting overweight and obesity in school-age children
Logistic multi factor regression model showed that the risk factors of overweight and obesity in children were increasing age, male, low dietary total antioxidant capacity, long static time, dietary pattern 1 (healthy diet mode), sleep time greater than 9h/d, cereals were taken into 300g/d, and the factors affecting the physical examination indexes were linear regression. The main influencing factors of BMI were age, sex, walking time, sleep time, and age, sex, walking time, statically exercise time and sleep time, which mainly influenced the weight and waist circumference.
3, the influencing factors of blood glucose and blood lipid in school-age children
(1) general situation and blood lipid and blood sugar of school-age children
Blood lipid and blood glucose increased with age; the TG, LDL, LDL/HDL, TCH/HDL, insulin, and HOMA index of overweight and obese people were higher than those of normal weight, and HDL was lower than those of normal ones.
(2) dietary intake of nutrients and blood lipids in school-age children
Carbohydrates, dietary fiber, plant protein, Cereals, fruits, eggs, and carbohydrates are negatively correlated with blood glucose and blood lipids in school-age children, saturated fatty acids, monounsaturated fatty acids, dinner energy ratios, fish intake and blood lipid and blood glucose Cheng Zhengxiang: total school age children, diet model 1 (healthy eating mode) and Portuguese. There was a negative correlation between sugar and glucose. In overweight and obese school-age children, dietary pattern 2 (Western diet pattern) was positively correlated with glucose.
(3) physical activity and blood lipid and blood sugar in school-age children
TG and blood glucose were negatively correlated with walking time, and the number of walking times was negatively correlated with blood sugar, and the writing time and the total static exercise time were positively related to blood glucose, and the exercise time was negatively correlated with blood glucose.
(4) comprehensive life pattern and blood lipid and blood sugar in school-age children
Western lifestyle factor score was positively correlated with insulin and HOMA index, and healthy lifestyle was negatively correlated with blood glucose.
(5) polymorphism of PPAR gamma C161 to T gene and blood glucose and blood glucose in school-age children.
Among school-age children and normal weight children, the T mutant gene carried children TCH higher than the wild genotypic children, but in overweight and obese children, the T allele carrier TG was higher than the wild genotype, and the genotype and sex had interaction with TG, and the TCH and TG concentration of T mutant gene carriers was higher than that of the wild genotypes in female school-age children. In the Western lifestyle and healthy lifestyle group Q1, the T mutation gene carrier TCH concentration was higher than that of the wild type.
(6) multiple linear regression of factors affecting blood glucose and blood glucose in school-age children
TCH, TG, blood sugar, HDL, TCH/HDL, and insulin were the gene carriers, respectively, to write job time, age, sex and dietary pattern 1 healthy eating patterns, age, work time, age.
conclusion
1, the prevalence of overweight and obesity among children in a certain district of Shanghai is serious, and the overweight and obesity rates of boys are greater than that of girls.
2, male, dietary grain intake is less, dietary total antioxidant capacity is low, healthy diet model score is low, static activity time is long, sleep time is short, PPAR gamma C161 T gene mutation is the risk factor of overweight and obesity in school-age children.
3, school-age children with different sex, diet, sports and other lifestyle, PPAR gamma C161 T gene polymorphism plays the role of overweight and obesity, different.T mutation genes are female school age children, the risk factors of overweight and obesity in Western life models are the protective factors for grain cereals intake of 300g/d children, which can be the key people for overweight and overweight monitoring. Group and individualized precautions provide preliminary clues.
4, low score of healthy diet pattern, long static exercise time, short exercise time, and PPAR gamma C161 to T gene mutation were associated with hyperlipidemia and hyperglycemia.
5, the influence of PPAR gamma C161 to T gene polymorphism on the blood lipid of school-age children is influenced by sex and diet, sports life style and other environment. In the female school age children, the TCH and (or) TG concentration of T allele carriers in the western life model and healthy lifestyle factor Q1 group are higher than those of the wild type, which can be used to monitor the blood lipid and blood glucose in school children. The group provides a theoretical basis.

【学位授予单位】：复旦大学
【学位级别】：博士
【学位授予年份】：2012
【分类号】：R725.8

【参考文献】