| 方启宇,万燕萍,汪佳璐,沈婉蓉,陈之琦,赵敏.不同代谢综合征定义在肥胖儿童中应用比较[J].Chinese journal of Epidemiology,2009,30(12):1297-1301 |
| 不同代谢综合征定义在肥胖儿童中应用比较 |
| Comparison of different definitions on metabolic syndrome in obese children |
| Received:June 03, 2009 |
| DOI： |
| KeyWord: 肥胖 代谢综合征 胰岛素抵抗 儿童 |
| English Key Word: Obesity Metabolic syndrome Insulin resistance Children |
| FundProject:上海市科学技术委员会计划项目(064119518) |
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| Abstract: |
| 目的 比较2007年国际糖尿病联盟(IDF)、Cook等和Silva等提出的代谢综合征(MS)定义在肥胖儿童中的应用情况,及中国、美国切点对其影响,以提出适应中国肥胖儿童特点的MS定义.方法 采用回顾性方法,收集2004年1月至2008年12月在仁济医院临床营养科肥胖病专科门诊就诊7～18岁肥胖儿童,排除患有遗传性代谢性疾病、严重肝脏及肾脏疾病、药物等因素导致的继发性肥胖、服用影响内分泌代谢药物的儿童和资料不全者.采集人体测量指标(身高、体重、腰围)、血压、血脂、空腹血糖以及空腹血胰岛素.胰岛素抵抗采用HOMA指数进行评估.在判断MS组分(中心性肥胖和高血压)时,分别采用中国切点和美国切点.采用Kappa一致性检验分析不同定义的吻合情况.结果 纳入研究136名儿童,男生103名,女生33名.采用美国切点的三种定义MS患病率依次为19.2%、34.6%、52.9%;采用中国切点的相对应定义MS患病率为19.2%、43.4%、58.1%,差异无统计学意义,两两之间Kappa值分别为1、0.79、0.90.Cook等、da Silva等定义两者Kappa值为0.52(D2/D3)/0.51(DS/D6),IDF定义与其他定义Kappa值为0.24～0.4.仅Cook等、da Silva等定义所诊断MS儿童的HOMA指数高于非MS儿童.结论 门诊肥胖儿童MS的患病率较高,且很大程度上取决于定义.在考虑胰岛素抵抗方面,Cook等、daSilva等提出的MS定义对门诊肥胖儿童可能更为适合.中国和美国切点对MS诊断无影响,均适合中国肥胖儿童. |
| English Abstract: |
| Objective To compare the prevalence rates of metabolic syndrome(MS)in obese children,according to three commonly used 'Pediatric MS definitions':(1)the International Diabetes Federation(IDF),(2)Cook,et al,and(3)da Silva,et al,in order to choose an appropriate one for the Chinese obese children.It was also intended to assess the variances of American or Chinese cutoff values on MS prevalence.Methods A retrospective study was performed in obese children from Obesity Outpatient Service Program from January 2004 to December 2008.Subjects were eligible if they met the following criteria:(1)aged 7 to 18 years,(2)with no following conditions as hereditary endocrine or metabolic diseases,secondary obesity,hepatic or renal disease,using medication that alters blood pressure or glucose or lipid metabolism etc.,(3)data were complete on the variables of interest.Height,weight and waist circumference,systolic and diastolic blood pressure,fasting lipid profiles,blood sugar and insulin were measured.Insulin resistance was evaluated by homeostasis model assessment(HOMA).American or Chinese cutoff values were used to identify central obesity and hypertension.The prevalence rates of MS under three definitions were calculated and compared by Kappa test to determine the degree of agreement.Results 136 patients with 103 males and 33 females were enrolled in the study.According to the American cutoff value,19.2%,34.6%,52.9% of the subjects were classified as MS under definitions of IDF,Cook,et al,da Silva,et al respectively,matching well with 19.2%,43.4%,58.1% when the Chinese cutoff value was used(Kappa=1,0.79,0.90).The degrees of agreement according to the Kappa statistics between Cook,et al and da Silva,et al(0.52,American cutoff value/0.51,Chinese cutoff value)were better than the others(0.24-0.4).Children who were diagnosed as MS under the definitions of Cook,et al.or da Silva,et al.appeared to have had serious insulin resistance when compared to those without MS.Conclusion Prevalence of the metabolic syndrome appeared to be high among the obese pediatric outpatients,which was probably due to the definition being chosen.The use of definitions provided by Cook,et al and da Silva,et al might be more suitable for MS diagnosis in obese children in the outpatient department,if insulin resistance was under consideration.Both American and Chinese cutoff value could be used for MS diagnosis in the Chinese obese children. |
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