中国成年居民肥胖状况变化对血压水平影响的队列研究（CHNS）

发布时间：2018-04-28 21:03

本文选题：腰围 + 腰围身高比　；参考：《中国疾病预防控制中心》2017年硕士论文

【摘要】：研究背景:高血压的病因复杂,是遗传因素和环境因素共同作用的结果。除遗传因素外,目前公认的危险因素有不合理膳食、超重和肥胖、缺乏运动、吸烟、过量饮酒等。国内外流行病学研究表明,超重和肥胖是高血压的重要危险因素。目前评估肥胖的常用指标包括中心型肥胖指标腰围(Waist Circumference,WC)、腰围身高比(Waist-to-height ratio,WHtR)、腰围臀围比(Waist-to-hip ratio,WHR)和全身性肥胖指标体质指数(Body Mass Index,BMI),人群的肥胖指标常处于动态变化中,既往关于肥胖与高血压关系的研究多为横断面研究,少数相关队列研究中主要关注其基线肥胖情况以及对高血压发病风险的影响,缺少对血压值影响的研究,存在一定的局限性。研究目的:本研究旨在了解1997-2011年我国成年居民中心型肥胖指标腰围、腰围身高比、腰臀比及全身性肥胖指标体质指数的水平及其变化对血压值及高血压发病风险的影响。研究内容与方法:本研究利用中美合作课题“中国健康与营养调查”1997年和2011年两轮调查数据进行纵向分析。纳入的研究对象共2488人,将研究对象按照年龄18-39岁和40-65岁分为两组,并按性别分层分析,描述1997-2011年研究对象血压、WC、WHtR、WHR、BMI的变化情况,运用多元线性回归模型分析WC、WHtR、WHR、BMI水平及其变化对血压值的影响;排除基线高血压者后,运用Logistic回归模型分析WC、WHtR、WHR、BMI水平及其变化对高血压发病风险的影响,并分析中心型肥胖状态的变化对高血压发病风险的影响,两模型均控制研究对象受教育程度、基线血压、吸烟、饮酒、身体活动、脂肪供能比、蔬菜水果和钠的摄入。研究结果:1.研究对象随访14年间WC、WHtR、WHR、BMI及血压值均有所上升。男性WC、WHtR、WHR及BMI变化18-39年龄组大于40-65岁年龄组(18-39岁年龄组分别为8.72cm、0.05、0.05、1.94kg/m2,40-65 岁年龄组分别为 5.11cm、0.03、0.03、0.89kg/m2),女性WC、WHtR及WHR变化在两年龄组中无明显差异,而BMI变化18-39年龄组大于40-65岁年龄组(18-39岁年龄组为1.62kg/m2,40-65岁年龄组为1.10kg/m2);男性和女性收缩压(Systolic Blood Pressure,SBP)变化40-65岁年龄组大于18-39岁年龄组(18-39岁年龄组男性和女性分别为6.45mmHg、8.52mmHg,40-65岁年龄组男性和女性分别为 8.94mmHg、11.21mmHg),舒张压(Diastolic Blood Pressure,DBP)变化表现为男性18-39岁年龄组大于40-65岁年龄组(18-39岁年龄组为4.78mmHg,40-65岁年龄组为3.02mmHg),女性无明显差异;18-39岁年龄组,WC和BMI变化男性大于女性,40-65岁年龄组,WC、WHtR、WHR及SBP变化女性大于男性;男性和女性18-39年龄组和40-65岁年龄组的DBP变化无明显差异。2.WC变化与血压变化相关系数总体趋势为β 18-39年龄组β 40-65年龄组(男性中β 收缩压、β舒张压分别为0.27、0.11和0.20、0.19,女性中分别为0.28、0.09和0.18、0.14);18-39岁年龄组β收缩压β舒张压;β基线变化。WHtR变化与血压变化相关系数总体趋势为β18-39年龄组β40-65年龄组(男性中β收缩压、β舒张压分别为5.01、2.45和3.41、3.37,女性中分别为4.28、1.77和2.55、2.00);18-39岁年龄组β收缩压β舒张压,40-65岁年龄组β舒张压β收缩压;β基线β变化。WHR变化与血压变化的相关系数总体趋势为β18-39年龄组β40-65年龄组(男性中β收缩压、β舒张压分别为2.75、0.19和1.96、0.03,女性中分别为2.14、0.65和0.69、0.48);β收缩压β舒张压;β基线β变化。BMI变化与血压变化的相关系数总体趋势为β 18-39年龄组β 40-65年龄组(男性中β收缩压、β舒张压分别为0.46、1.92和0.49、1.16,女性中分别为0.55、1.41和0.37、0.79),18-39岁年龄组β基线β变化,40-65岁年龄组β基线β变化。3.Logistic回归结果显示,以WC变化的第一分位为参照,男性和女性18-39岁年龄组随着分位数的增加,OR值也增加,高血压的发病风险呈现逐渐增加的趋势(P趋势0.05),第四分位高血压的发病风险显著增加(18-39岁年龄组OR=2.56,95%CI:1.56-4.22,40-65 岁年龄组 OR=2.84,95%CI:1.77-4.57)。以WHtR变化、WHR变化、BMI变化第一分位为参照,男性和女性18-39岁年龄组和40-65岁年龄组随着分位数的增加,OR值也相应增加,高血压的发病风险呈现逐渐增加的趋势(P趋势0.05),第四分位高血压的发病风险显著增加(18-39岁年龄组其 OR 值及 95%CI 分别为:OR=2.51,95%CI:1.52-4.16;OR=3.05,95%CI:1.77-5.25;OR=3.28,95%CI:1.92-5.59;40-65 岁年龄组 OR=2.89,95%CI:1.80-4.62;OR=1.93,95%CI:1.15-3.26;OR=3.26,5%CI:1.98-5.35)。4.男性18-39岁年龄组WC由正常变为中心型肥胖者SBP和DBP的增加值大于两次WC均正常者(SBP增加值分别为10.OmmHg和4.OmmHg,DBP增加值分别为8.OmmHg和3.3mmHg),而40-65岁年龄组两者SBP和DBP的增加值无明显差异。女性18-39岁年龄组和40-65岁年龄组WC由正常变为中心型肥胖者SBP和DBP增加值大于两次WC均正常者(18-39岁年龄组SBP增加值分别为11.OmmHg和6.2mmHg,DBP增加值分别为7.OmmHg和4.OmmHg;40-65岁年龄组SBP增加值分别为12.OmmHg和8.7mmHg,DBP增加值分别为5.3mmHg和2.OmmHg)。以1997年和2011年两次测量WC均正常者为参照,男性和女性18-39岁年龄组(男性OR=2.90,95%CI:1.82-4.63;女性OR=2.69,95%CI:1.47-4.91;)和40-65岁年龄组(男性 OR=2.08,95%CI:1.13-3.80;女性 OR=2.05,95%CI:1.26-3.34;)由正常变为中心型肥胖者高血压的发病风险显著增加。结论:1997年到2011年,我国18-65岁成年居民中心型肥胖评价指标WC、WHtR、WHR的变化与SBP和DBP的变化存在正相关关系,18-39岁年龄组较40-65岁年龄组显著,基线水平对血压值的影响大于其变化;BMI的变化对血压值的影响40-65岁年龄组较18-39岁年龄组显著;WC、WHtR、WHR、BMI的基线水平及其变化与高血压发病相关,WC、WHtR、WHR、BMI的增加及中心型肥胖状态的改变可增加高血压的发病风险。本研究的结果提示,无论基线水平是否在正常范围,均应该主动采取健康的生活方式控制肥胖指标的增加,预防高血压的发生。
[Abstract]:Background: the cause of hypertension is complex, which is the result of the combination of genetic and environmental factors. In addition to hereditary factors, the current recognized risk factors are irrational diet, overweight and obesity, lack of exercise, smoking, excessive drinking and so on. The commonly used indicators for obesity include Waist Circumference (WC), waist circumference height ratio (Waist-to-height ratio, WHtR), waist circumference ratio (Waist-to-hip ratio, WHR) and body mass index (Body Mass Index). The obesity index of the crowd is often in dynamic change, with previous obesity and hypertension The study of the relationship is mostly cross-sectional study. In a few related cohort studies, the main concern about the baseline obesity and the impact on the risk of hypertension and the lack of influence on the value of blood pressure has some limitations. The purpose of this study is to understand the waist circumference and waist circumference of central obesity in adult residents in China for 1997-2011 years. The effects of high ratio, waist to hip ratio and body weight index body mass index (BMI) on blood pressure and hypertension risk. Research contents and methods: This study used the Sino American cooperative project "China Health and Nutrition Survey" in 1997 and 2011 to carry out longitudinal analysis. The subjects included in the study were 2488 people. The subjects were divided into two groups according to age 18-39 and 40-65 years old. According to the sex stratification analysis, the changes of blood pressure, WC, WHtR, WHR, BMI were described for 1997-2011 years. The multilinear regression model was used to analyze the effects of WC, WHtR, WHR, BMI level and its changes on the blood pressure. After excluding the baseline hypertension, the Logistic regression model was used to analyze WC. The effects of WHtR, WHR, BMI and their changes on the risk of hypertension and the impact of the change in central obesity on the risk of hypertension. The two model controlled the subjects' education, baseline blood pressure, smoking, drinking, physical activity, fat supply ratio, and the intake of vegetables and fruits and sodium. Research results: 1. research subjects followed The value of WC, WHtR, WHR, BMI and blood pressure increased in 14 years. The 18-39 age groups of male WC, WHtR, WHR and BMI were larger than the age group of 40-65 years (18-39 year old group were 8.72cm, 0.05,0.05,1.94kg/m2,40-65 age group was 5.11cm, 0.03,0.03,0.89kg/m2), and there was no significant difference in the two age group. The 18-39 age group was more than 40-65 years old (age group of 18-39 years of age was 1.62kg/m2,40-65 age group 1.10kg/m2); male and female systolic blood pressure (Systolic Blood Pressure, SBP) was more than 18-39 years old age group (18-39 year old men and women were 6.45mmHg, 8.52mmHg, 40-65 age group male and female respectively, respectively. For 8.94mmHg, 11.21mmHg), the diastolic pressure (Diastolic Blood Pressure, DBP) in male 18-39 years old group is larger than 40-65 years old group (18-39 year old age group 4.78mmHg, 40-65 age group 3.02mmHg), there is no significant difference in women. 18-39 year old age group, WC and BMI changes men are more than women, WC, WHtR, WHtR, and changes. Women were more than men; there was no significant difference in the DBP changes between the 18-39 age group and the 40-65 year old age group. The general trend of the correlation coefficient of.2.WC and blood pressure was in the beta 40-65 age group of the group beta 18-39 (beta systolic pressure in male, 0.27,0.11 and 0.20,0.19 for beta diastolic pressure respectively, 0.28,0.09 and 0.18,0.14 in women, respectively); 18-39 year old year. Beta systolic pressure beta diastolic pressure in the age group; the general trend of.WHtR changes in beta baseline changes and blood pressure changes in beta 18-39 age group beta 40-65 age group (male beta systolic pressure, beta diastolic pressure 5.01,2.45 and 3.41,3.37 respectively, 4.28,1.77 and 2.55,2.00 in women, respectively); beta systolic pressure beta diastolic pressure in 18-39 year old age group and 40-65 year age group beta relaxation The general trend of the correlation coefficient of beta baseline beta change.WHR changes and blood pressure changes in beta 18-39 age group beta 40-65 age group (beta systolic pressure in male, 2.75,0.19 and 1.96,0.03 of beta diastolic pressure respectively, 2.14,0.65 and 0.69,0.48 in women, respectively); beta systolic pressure beta diastolic pressure, beta baseline beta change.BMI and blood pressure changes The total number trend was beta 40-65 age group (beta 18-39 age group, beta diastolic pressure 0.46,1.92 and 0.49,1.16 respectively, 0.55,1.41 and 0.37,0.79 in women respectively), beta baseline beta change in 18-39 year old age group, and.3.Logistic regression results of beta baseline beta of 40-65 years old age group, with the first division of WC change as reference. As the 18-39 year old age group increased, the OR value increased as the number of quantiles increased, and the risk of hypertension increased gradually (P trend 0.05). The risk of hypertension in fourth division was significantly increased (OR= 2.84,95%CI:1.77-4.57 in the age group of 18-39 years of age OR=2.56,95%CI:1.56-4.22,40-65). WHtR, WHR, BMI As a reference, the 18-39 year old age group and 40-65 year old age group increased the value of OR, and the risk of hypertension increased gradually (P trend 0.05), and the risk of hypertension in fourth division increased significantly (the value of OR and 95%CI in the 18-39 year old group were OR=2.51,95%CI:1.52-4., respectively, OR=2.51,95%CI:1.52-4. 16; OR=3.05,95%CI:1.77-5.25; OR=3.28,95%CI:1.92-5.59; 40-65 year old age group OR=2.89,95%CI:1.80-4.62; OR=1.93,95%CI:1.15-3.26; OR=3.26,5%CI:1.98-5.35).4. male 18-39 year old age group WC from normal to central obesity, the increase value of SBP and DBP is greater than that of two WC (SBP increase is 10.OmmHg and increase, respectively. The values of SBP and DBP in the 40-65 year old age group were not significantly different. The values of SBP and DBP in the 18-39 year old age group and the 40-65 year old group were higher than those of the two times WC (the 18-39 year old age group, the SBP increase value was divided into 11.OmmHg and 6.2mmHg, and the DBP increase value was respectively, " MHg and 4.OmmHg; the 40-65 year old age group SBP added values were 12.OmmHg and 8.7mmHg, DBP added values were 5.3mmHg and 2.OmmHg respectively. In 1997 and 2011, the two times measured WC were normal, male and female 18-39 year old age group (male OR=2.90,95%CI:1.82-4.63; female OR= 2.69,95%CI:1.47-4.91;) and 40-65 year old age group. %CI:1.13-3.80; female OR=2.05,95%CI:1.26-3.34;) the risk of hypertension increased significantly from normal to central obesity. Conclusion: from 1997 to 2011, the central obesity evaluation index of 18-65 year old adults in China, WC, WHtR, WHR, was positively correlated with the changes of SBP and DBP, and the age group of 18-39 years was more than 40-65 years old age group. The effect of baseline level on the value of blood pressure was greater than that of the change; the effect of BMI changes on the blood pressure was significantly higher in the 40-65 year old age group than in the 18-39 year old age group; the baseline levels of WC, WHtR, WHR, BMI were associated with hypertension, and the increase in WC, WHtR, WHR, BMI and central obesity could increase the risk of hypertension. The results suggest that no matter whether the baseline level is in the normal range, a healthy lifestyle should be taken to control the increase of the obesity index and prevent the occurrence of hypertension.

【学位授予单位】：中国疾病预防控制中心
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R589.2;R181.3

【参考文献】