儿童青少年肌肉质量与心血管疾病危险因素的关系

doi:10.11852/zgetbjzz2021-1483

摘要/Abstract

摘要： 目的探讨儿童青少年肌肉质量与心血管疾病危险因素的关系,为心血管疾病的早期预防提供理论依据。方法采用现况研究设计,以整群抽样的方法于2017—2020年抽取宁夏银川市12~17岁儿童青少年共1 622名为研究对象。对所有参与测试者进行问卷调查、体格测量、实验室检查、体成分检查。结果总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)与肌肉质量指数(SMMI)呈负相关(r＝-0.105,-0.094,P<0.001);甘油三酯(TG)与全身肌肉质量(SMM)呈负相关(r＝-0.067,P<0.01)。高SMMI者患高血压、高TC、高TG分别是低SMMI者的0.60(95%CI: 0.37~0.97)、0.54(95%CI: 0.33~0.89)倍和0.53(95%CI: 0.32~0.87)倍(P<0.05);SMMI良好、充足患高脂血症的风险分别是SMMI严重不足的0.32(95%CI:0.15~0.70)、0.23(95%CI: 0.08~0.65)倍(P<0.05)。SMMI良好患血脂异常的风险是SMMI严重不足的0.44(95%CI:0.22~0.89)倍(P<0.05)。结论儿童青少年肌肉质量与心血管疾病危险因素关系密切,低肌肉质量为高血压、高脂血症的危险因素。

关键词: 肌肉质量, 心血管疾病, 危险因素, 儿童青少年

Abstract: Objective To explore the relationship between muscle mass and risk factors of cardiovascular disease in children and adolescents, so as to provide theoretical basis for early prevention of cardiovascular disease. Methods A current situation study design was adopted. A total of 1 622 children and adolescents aged 12 to 17 years in Yinchuan, Ningxia were selected into this study by cluster sampling from 2017 to 2020. All participants were investigated by questionnaire, and took physical measurements, laboratory examination and body composition examination. Results Total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) were negatively correlated with skeletal muscle mass index (SMMI) (r＝-0.105,-0.094,P<0.001). Triglyceride(TG) was negatively correlated with skeletal muscle mass (SMM) (r＝-0.067,P<0.01). The risks of hypertension, high TC and high TG in adolescents with high SMMI were 0.60 (95%CI: 0.37 - 0.97), 0.54 (95%CI: 0.33 - 0.89) and 0.53 (95%CI: 0.32 - 0.87) times higher than those in adolescents with low SMMI (P<0.05). The risk of hyperlipidemia in adolescents with good and sufficient SMMI was 0.32 (95%CI: 0.15 - 0.70) and 0.23 (95%CI: 0.08 - 0.65) times higher than that in adolescents severe deficiency of SMMI (P<0.05).The risk of dyslipidemia in adolescents with good SMMI was 0.44 (95%CI: 0.22 - 0.89) times higher than that in adolescents with severe SMMI deficiency (P<0.05). Conclusions There is a close correlation between muscle mass and risk factors of cardiovascular disease in children and adolescents. Low muscle mass is a risk factor for hypertension and hyperlipidemia.

Key words: muscle mass, cardiovascular disease, risk factors, children and adolescents

中图分类号:

R725.4

陶佳慧, 陈琳琳, 马钰, 丁琴琴, 王秋晶, 丁文清. 儿童青少年肌肉质量与心血管疾病危险因素的关系[J]. 中国儿童保健杂志, 2022, 30(7): 706-710.

TAO Jia-hui, CHEN Lin-lin, MA Yu, DING Qin-qin, WANG Qiu-jing, DING Wen-qing. Relationship between muscle mass and cardiovascular disease risk factors in children and adolescents[J]. Chinese Journal of Child Health Care, 2022, 30(7): 706-710.

参考文献

[1] 席波,宋逸,马军.预防成年人心血管疾病应重视儿童期危险因素防控[J].中华流行病学杂志,2020,41(9):1428-1432.
[2] Chung ST,Onuzuruike AU, Magge SN. Cardiometabolic risk in obese children[J]. Ann N Y Acad Sci,2018,1411(1):166-183.
[3] 席波.预防成年期心血管疾病应始于儿童期[J].中华预防医学杂志,2019,53(7):657-660.
[4] 朱谦让,戴月,张坚,等.儿童青少年膳食及血清锌状况与心血管疾病代谢危险因素的关系[J].中国儿童保健杂志,2021,29(12):1304-1308.
[5] 赵明利,李宁.人体成分分析及其应用[J].肠外与肠内营养,2016,23(1):50-54.
[6] Lee MM, Jebb SA, Oke J,et al. Reference values for skeletal muscle mass and fat mass measured by bioelectrical impedance in 390 565 UK adults[J]. J Cachexia Sarcopenia Muscle,2020,11(2): 487-496.
[7] 李鹏,王睿.心血管疾病中的“肥胖悖论”研究进展[J].中西医结合心脑血管病杂志,2020,18(19):3220-3223.
[8] 王清霞,张光明.肥胖与心血管疾病研究进展[J].现代中西医结合杂志,2020,29(20):2277-2280.
[9] 董虹孛. 儿童肥胖和心血管病代谢异常与骨密度关系的研究[D].北京:协和医学院,2018.
[10] 全国学生体质与健康调研组. 2014 年全国学生体质与健康调研手册[M].北京: 高等教育出版社,2014.
[11] Falkner B, Daniels SR. Summaryof the fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents[J]. Hypertension,2004,44(4): 387-388.
[12] 范晖,闫银坤,米杰.中国3～17岁儿童性别、年龄别和身高别血压参照标准[J].中华高血压杂志,2017,25(5):428-435.
[13] Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report[J].Pediatrics, 2011, 128 (Suppl 5): 213-256.
[14] Liu J, Yan Y, Xi B, et al. Skeletal muscle reference for Chinese children and adolescents[J]. J Cachexia Sarcopenia Muscle,2019,10(1): 155-164. [15] 国家卫生和计划生育委员会通告国卫通[2018]2号[J].中华人民共和国国家卫生和计划生育委员会公报,2018(Z1):7.
[16] 李会祎,仰曙芬.儿童青少年体成分影响因素的临床研究进展[J].中国儿童保健杂志,2019,27(11):1208-1210,1254.
[17] 杨园园,张欣,钟斌,等.应用生物电阻抗法分析广西百色市壮族儿童青少年肌肉发育特点[J].科技视界,2020,20:129-131.
[18] 杨乐,张宝,管石侠,等.不同性别不同年龄成年人体成分测量指标的检测分析[J].安徽医学,2019,40(11):1276-1279.
[19] 杨丽君,吴永华,张俐.肌少症、骨质疏松症的关系及研究进展[J].中国骨质疏松杂志,2017,23(8):1112-1116.
[20] Duran I,Martakis K, Schafmeyer L,et al. Inverse association of high-density lipoprotein cholesterol concentration with muscle mass in children[J]. Child Obes,2019,15(7): 476-484.
[21] Castro-Piñero J, Perez-Bey A, Cuenca-Garcia M,et al. Muscle fitness cut points for early assessment of cardiovascular risk in children and adolescents[J]. J Pediatr,2019,206: 134-141.e3.
[22] Zaniqueli D, Alvim RO, Baldo MP,et al. Muscle mass is the main somatic growth indicator associated with increasing blood pressure with age in children and adolescents[J]. J Clin Hypertens,2020,22(10): 1908-1914.
[23] Kim S, Valdez R. Metabolic risk factors in U.S. youth with low relative musclemass[J]. Obes Res Clin Pract,2015,9(2): 125-132.
[24] 首健,陈佩杰,肖卫华.运动对老年骨骼肌的改善效应及其机制[J].中国康复医学杂志,2020,35(9):1140-1145.
[25] Li G, Zhang H, RyanAS.Skeletal muscle angiopoietin-like protein 4 and glucose metabolism in older adults after exercise and weight loss[J]. Metabolites,2020,10(9):354.
[26] Vella CA, Nelson MC, Unkart JT,et al. Skeletal muscle area and density are associated with lipid and lipoprotein cholesterol levels: The Multi-Ethnic Study of Atherosclerosis[J]. J Clin Lipidol, 2020, 14(1): 143-153.
[27] Kim G, Lee SE, Jun JE,et al. Increase in relative skeletal muscle mass over time and its inverse association with metabolic syndrome development: A 7-year retrospective cohort study[J]. Cardiovasc Diabetol, 2018, 17(1): 23.
[28] Li D,Guo G, Xia L,et al. Relative handgrip strength is inversely associated with metabolic profile and metabolic disease in the general population in China[J]. Front Physiol. 2018,9:59.
[29] Han JM, Lee MY, Lee KB,et al. Low relative skeletal muscle mass predicts incident hypertension in Korean men: A prospective cohort study[J]. J Hypertens,2020,38(11): 2223-2229.
[30] Butcher JT, Mintz JD, Larion S,et al.Increased muscle mass protects against hypertension and renal injury in obesity[J]. J Am Heart Assoc,2018,7(16): e009358.
[31] 周梦洁,张洁,李娜等.人体成分与代谢综合征的相关性研究[J].西北国防医学杂志,2021,42(5):336-340.
[32] Scott D, Park MS, Kim TN,et al. Associations of low muscle mass and the metabolic syndrome in Caucasian and Asian middle-aged and older adults[J]. J Nutr Health Aging,2016,20(3): 248-255.
[33] Koter S, Cohnert TU, Hindermayr KB,et al. Increased hospital costs are associated with low skeletal muscle mass in patients undergoing elective open aortic surgery[J]. J Vasc Surg,2019,69(4): 1227-1232.
[34] Kim JH, Park YS. Low muscle mass is associated with metabolic syndrome in Korean adolescents: The Korea National Health and Nutrition Examination Survey 2009-2011[J]. Nutr Res,2016,36(12): 1423-1428.
[35] 董洋洋,蔡蓉蓉,白玲等.儿童青少年体脂肪和瘦体重对心血管危险因素聚集的交互作用[J].中国学校卫生,2021,42(10):1555-1559.
[36] Gracia-Marco L, Moreno LA, Ruiz JR,et al. Body composition indices and single and clustered cardiovascular disease risk factors in adolescents: Providing clinical-based cut-points[J].Prog Cardiovasc Dis,2016,58(5):555-564.
[37] Ito T, Sugiura H, Ito Y,et al. Relationship between the skeletal muscle mass index and physical activity of Japanese children: A cross-sectional, observational study[J]. PLoS One,2021,16(5): e0251025-e0251025.