目的 了解5~14岁儿童青少年骨密度水平和体成分构成现状,分析肌肉、脂肪、脂肪分布和脂肪肌肉比与骨密度的相关性。方法 采用便利抽样选取2021—2023年在空军军医大学第二附属医院就诊的1 618名5~14岁儿童青少年进行横断面研究和体格检查,利用双能X线吸收法检测全身各部位体成分及全身骨密度(BMD),计算脂肪质量指数(FMI)、肌肉质量指数(MMI)、Android腹部脂肪百分比(AWR)、Gynoid臀部脂肪百分比(GWR)、四肢脂肪百分比(LWR)和脂肪肌肉比(F/M),按体重状态分层,采用多元线性回归分析探讨校正混杂因素后体成分与骨密度的相关性。结果 1)男女生全身骨密度随年龄的增长稳定增加(男:F=67.741,P＜0.001;女:F=112.780,P＜0.001),青春期骨密度累积出现提速,且女生青春期骨密度累积提速早于男生;超重肥胖儿童青少年骨密度高于非超重儿童青少年(男:t=9.028,P＜0.001;女:t=12.315,P＜0.001)。2)按照非超重组和超重肥胖组分层,男女生各组MMI与骨密度正相关(P＜0.05),非超重组男女生FMI与骨密度呈正相关(男:B=0.009, P＜0.001;女:B=0.014, P＜0.001),在超重肥胖组未显示出相关性。男生F/M在非超重组(B=-0.105, P＜0.001)和超重肥胖组(B=-0.188, P＜0.001)与骨密度呈负相关,AWR仅在超重肥胖组(B=-0.801, P=0.018)与骨密度呈负相关。女生在超重肥胖组F/M(B=-0.153, P＜0.001)和AWR(B=-1.030, P=0.011)与骨密度负相关。骨密度与F/M的最佳拟合模型为三次曲线模型(男:R2=0.104,P<0.001;女:R2=0.226,P<0.001),男生和女生F/M在0.8范围内,随着F/M的增加骨密度逐渐上升,但当F/M超过0.8时,骨密度缓慢下降。结论 肌肉与骨密度始终正相关,脂肪对骨密度的影响存在阈值效应,腹部脂肪与超重肥胖儿童青少年骨密度负相关。
Abstract
Objective To understand the current situation of bone mineral density and body composition of children and adolescents aged 5 - 14 years, and to analyze the correlation of muscle, fat, fat distribution, fat muscle ratio with bone mineral density. Methods A cross-sectional study was conducted on 1 618 children and adolescents aged 5 - 14 years who were treated in the Second Affiliated Hospital of Air Force Military Medical University from 2021 to 2023 by convenience sampling. Physical examination, body composition and bone mineral density (BMD) of all parts of the body were detected by dual energy X-ray absorptiometry. Fat mass index (FMI), muscle mass index (MMI), Android abdominal fat percentage (AWR), Gynoid hip fat percentage (GWR), limb fat percentage (LWR), and fat to muscle ratio (F/M) were then calculated. Multiple linear regression analysis stratified by weight status was used to explore the relationship between body composition and BMD after adjusting for confounders. Results 1) The BMD of both boys and girls increased steadily with age (boys: F=67.741, P＜0.001; girls: F=112.780, P＜0.001). The accumulation of BMD in adolescence increased, and the increase of BMD in girls was earlier than that in boys. The BMD of overweight and obese children and adolescents was higher than that of non-overweight children and adolescents (boys: t=9.028, P＜0.001; girls: t=12.315, P＜0.001). 2) Stratified by non-overweight and overweight obesity groups, MMI was positively correlated with BMD in male and female students (P<0.05), and FMI was positively correlated with BMD in male and female students (male: B=0.009, P＜0.001; female: B=0.014, P＜0.001). No correlation was observed in the overweight and obesity group. The F/M ratio of male students was negatively correlated with BMD both in non-overweight group (B=-0.105, P＜0.001) and overweight obesity group (B=-0.188, P＜0.001), while AWR was only found to be negatively correlated with BMD in the overweight and obesity group (B=-0.801, P＝0.018). F/M (B=-0.153, P＜0.001) and AWR (B=-1.030, P= 0.011) was negatively correlated with BMD in overweight and obese female students. The best fitting model between BMD and F/M was the cubic curve model (male: R2=0.104, P<0.001; female: R2=0.226, P<0.001). The F/M of boys and girlswas within 0.8, and the BMD gradually increased with the increase of F/M, but when the F/M exceeded 0.8, the BMD slowly decreased. Conclusions Muscle and bone mineral density are always positively correlated. There is a threshold effect of fat on bone mineral density. Abdominal fat is negatively correlated with bone mineral density in overweight and obese children and adolescents.
关键词
儿童青少年 /
骨密度 /
体成分 /
双能X线
Key words
children and adolescents /
bone mineral density /
body composition /
dual energy X-ray
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基金
陕西省社会发展领域(S2024-YF-YBSF-1303)
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