目的 探究肥胖青少年减重率与静息代谢率变化量间的剂量-效应关系,为肥胖青少年预防体重反弹提供科学精准的理论支撑。方法 2023年7—8月,招募10~17岁肥胖青少年60名,进行4周减重干预。减重率=(干预后体重-干预前体重)×(-1)/干预前体重×100%;采用气体代谢分析仪收集氧气吸入量和二氧化碳呼出量,代入Weir公式求得静息代谢率,计算调整体重的Δ相对静息代谢率=干预后-干预前。采用配对样本t检验比较减重干预前后体重和相对静息代谢率差异,线性回归方法分析减重率与Δ相对静息代谢率的剂量-效应关系,限制性立方样条(RCS)分析减重率与Δ相对静息代谢率的阈值效应。结果 最终纳入49名肥胖青少年进行统计分析,男性26例,平均年龄(13.15±1.80)岁,体质量指数(BMI)为(31.20±3.91)kg/m2。4周减重后体重明显下降(t=20.486,P＜0.05),干预前后相对静息代谢率差异无统计学意义(t=0.222,P＞0.05)。线性回归分析显示,减重率每增加1%,Δ相对静息代谢率增加0.874kCal/(d·kg)(95%CI:0.185~1.563,P＜0.05)。RCS结果表明调整年龄、性别、基线体重后,减重率与肥胖青少年Δ相对静息代谢率存在非线性的剂量-效应关系(P<0.05);当减重率≤7.90%,每增加1%的减重率,Δ相对静息代谢率增加2.245kCal/(d·kg)(95%CI:1.032~3.467,P＜0.05)。当减重率＞7.90%,减重率的增加并不能显著增加Δ相对静息代谢率(P＞0.05)。结论 肥胖青少年4周减重率与静息代谢率变化量存在非线性的剂量-效应关系和阈值效应。当减重率不超过7.90%,其与静息代谢率变化量间存在量化关系,增加减重率可逐渐提升静息代谢率变化量;一旦超过7.90%,两者间关系并不显著。
Abstract
Objective To investigate the dose-response relationship between weight loss rate and changes in resting metabolic rate(RMR) in adolescents with obesity, so as to provide scientific and accurate theoretical support for the prevention of weight rebound in adolescents with obesity. Methods From July to August 2023,sixty obese adolescents aged 10 - 17 were recruited and underwent a 4-week weight loss intervention.The weight loss rate was calculated as [(post-intervention weight after intervention －pre-intervention weight) ×(－1) /weight before intervention] ×100%. A gas metabolism analyzer was used to collect oxygen intake and carbon dioxide exhalation, which were then substituted into the Weir formula to determine RMR. The adjusted Δ relative resting metabolic rate(ΔRMR) per kilogram of body weight change was calculated as the difference between post-intervention and pre-intervention values. Paired-sample t-test was used to compare differences in weight and relative RMR before and after the weight loss intervention. Linear regression analysis was conducted to assess the dose-effect relationship between weight loss rate and ΔRMR, while restricted cubic spline(RCS) analysis was employed to examine threshold effects. Results Forty-nine obese adolescents were included in the statistical analysis,(including 26 males) with a mean age of(13.15±1.80) years and a mean body mass index(BMI) of(31.20±3.91) kg/m2. Significant weight loss was observed after the 4-week intervention(t=20.486, P<0.05), while there was no significant change in relative RMR before and after the intervention(t=0.222, P>0.05). Linear regression analysis showed that for every 1% increase in weight loss rate, ΔRMR increased by 0.874kCal/(d·kg)(95%CI: 0.185 to 1.563, P<0.05). RCS results indicated a nonlinear dose-effect relationship between weight loss rate and ΔRMR among obese adolescents after adjusting for age, sex, and baseline weight(P-Nonlinear<0.05). Specifically, when the weight loss rate was ≤7.90%, each additional 1% of weight loss was associated with an increase in ΔRMR by 2.245kCal/(d·kg)(95%CI: 1.032 to 3.467, P<0.05). However, when the weight loss rate exceeded 7.90%, further increases in the weight loss rate did not significantly elevate ΔRMR(P>0.05). Conclusions There is a nonlinear dose-response relationship and threshold effect between 4-week weight loss and changes in RMR among obese adolescents. When the weight loss rate does not exceed 7.90%, there is a quantitative relationship with changes in RMR, such that increasing the weight loss rate gradually enhances changes in RMR. Once the weight loss rate exceeds 7.90%, the relationship between them is not significant.
关键词
减重率 /
静息代谢率 /
剂量-效应关系 /
肥胖 /
青少年
Key words
weight loss rate /
resting metabolic rate /
dose-response relationship /
obesity /
adolescents
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