目的 探讨骨骼肌指数(SMI)对学龄期儿童矮小风险的独立影响,并分析年龄与性别的调节作用。方法 基于苏州市儿童医院2016—2022年健康体检数据,纳入6~12岁儿童1 324例(矮小331例,对照组993例)。采用生物电阻抗分析(BIA)测定体成分,计算SMI(骨骼肌质量/身高2)。通过多因素logistic回归分析SMI与矮小风险的关联,并调整年龄、性别、体脂百分比(PBF)及年龄别BMI的Z分数(BAZ)。敏感性分析采用四分位数分组及限制性立方样条(RCS)验证剂量反应关系,通过亚组分析检验年龄与性别的交互效应。结果 SMI每增加1单位,矮小风险降低78%(OR=0.22,95%CI:0.14~0.35);完全调整后最高四分位组(Q4)的矮小风险较最低四分位组(Q1)降低87%(OR=0.13, 95%CI:0.08~0.21),且剂量反应趋势显著(P趋势<0.001)。RCS显示SMI与矮小风险呈线性负相关(非线性P值=0.307)。亚组分析显示,SMI的保护作用男性中显著强于女性(P交互<0.01),而年龄无显著调节效应(P交互>0.05)。结论 SMI是儿童矮小风险的独立保护因子,其效应具有性别异质性,提示男性儿童骨骼肌质量对身高生长的关键作用。本研究支持将SMI纳入儿童生长评估体系,为早期识别矮小高危人群及实施性别差异化干预提供依据。
Abstract
Objective To investigate the independent effect of skeletal muscle index (SMI) on the risk of short stature in school-age children, and to analyze the moderating effects of age and sex. Methods Based on health check-up data from the Children's Hospital of Soochow University (2016—2022), 1 324 children aged 6 - 12 years were included (331 with short stature and 993 controls).Body composition was measured using bioelectrical impedance analysis (BIA), and SMI was calculated as skeletal muscle mass/height2.Multivariable logistic regression analysis was performed to assess the association between SMI and short stature risk, adjusting for age, sex, percentage of body fat (PBF), and BMI-for-age Z-score (BAZ).Sensitivity analysis was conducted using quartile grouping and restricted cubic splines (RCS) to examine the dose-response relationship.Subgroup analysis was performed to test the interaction effects of age and sex. Results For every 1-unit increase in SMI, the risk of short stature decreased by 78% (OR=0.22, 95%CI: 0.14 - 0.35).After full adjustment, the risk in the highest quartile (Q4) was 87% lower than that in the lowest quartile (Q1) (OR=0.13, 95%CI: 0.08 - 0.21), with a significant dose-response trend (Pfor trend<0.001).RCS analysis revealed a linear negative correlation between SMI and short stature risk (Pnonlinear=0.307).Subgroup analysis indicated that the protective effect of SMI was significantly stronger in boys than in girls (Pfor interaction<0.01), while no significant moderating effect of age was observed (Pfor interaction＞0.05). Conclusions SMI is an independent protective factor against the risk of short stature in children, with its effect showing sex heterogeneity, suggesting the critical role of skeletal muscle mass in height growth, particularly in boys.This study supports the inclusion of SMI in the child growth assessment system, providing a basis for the early identification of high-risk populations and the implementation of sex-specific interventions.
关键词
矮小症 /
骨骼肌指数 /
体成分分析 /
儿童健康
Key words
short stature /
skeletal muscle index /
body composition analysis /
child health
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基金
苏州市科技发展计划项目(SKY2023188)
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