6~17岁患者非酒精性脂肪肝与代谢健康型肥胖关系的横断面研究  

Relationship between non-alcoholic fatty liver disease and metabolically heathy obesity in patients aged 6-17 years:a cross-sectional study

作　　者：唐墨莲 张晓敏[1] 陈之琦[1] 汪佳璐[1] 万燕萍[1] 徐仁应[1] TANG Mo-lian;ZHANG Xiao-min;CHEN Zhi-qi;WANG Jia-lu;WAN Yan-ping;XU Ren-ying(Department of Clinical Nutrition,Renji Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院临床营养科,上海200127

出　　处：《复旦学报（医学版）》2022年第6期961-967,共7页Fudan University Journal of Medical Sciences

摘　　要：目的探讨6~17岁患者非酒精性脂肪肝(non-alcoholic fatty liver disease,NAFLD)与代谢健康型肥胖(metabolically healthy obesity,MHO)之间的关系。方法以2000年1月至2017年3月在仁济医院营养科就诊肥胖儿童/青少年作为研究对象。依据门诊病历获得患者社会学信息、体重指数(body mass index,BMI)、腰围(waist circumference,WC)、体脂肪含量(body fat content,BF)、血压、血生化、饮食/行为习惯及家族史。BMI、WC和BF分别进行Z值转换。依据肝脏超声结果将所有研究对象分为无脂肪肝(Non-NAFLD)组和NALFD组。运用《中国儿童代谢健康型肥胖定义与筛查专家共识》定义MHO,MHO为肥胖且不合并下列任一指标异常:收缩压/舒张压≥儿童血压的P90(同年龄同性别);空腹血糖(fasting blood glucose,FBG)≥5.6 mmol/L;三酰甘油(triacylglycerol,TG)≥1.7 mmol/L;高密度脂蛋白<1.03 mmol/L,并与以往MHO诊断标准进行结果比较。结果共纳入348名儿童/青少年,男251名,女97名,平均年龄(12.0±2.8)岁。MHO和代谢不健康型肥胖(metabolically unhealthy obesity,MUO)分别为121例(34.8%)和227例(65.2%)。除FBG、胆固醇和低密度脂蛋白水平外,两组研究对象其他临床指标存在显著差异。Logistic回归分析结果显示,在仅控制年龄和性别时,NAFLD与MUO显著相关(OR=1.83,95%CI:1.11~3.03),但进一步控制体格测量指标(BMI、WC、和BF)和生活方式等混杂因素后,NAFLD与MUO之间并无显著的相关关系(OR:1.20~1.38,P:0.24~0.52)。运用以往MHO诊断标准进行分组发现代谢异常为77例(22.1%)。多元Logistic回归分析结果显示,在控制了体格检测指标、生活方式等因素后,NAFLD与MUO依然显著相关(OR:2.9.~3.20,P:0.01~0.02)。结论6~17岁肥胖患者发生代谢异常的风险主要与体格测量指标相关,运用不同MHO诊断标准,NAFLD与MUO之间相关性不一致。Objective To investigate the relationship between non-alcoholic fatty liver disease(NAFLD)and metabolically healthy obesity(MHO)in patients aged 6-17 years.Methods Obese patients aged 6-17 years who attended department of clinical nutrition,Renji Hospital from Jan 2000 to Mar 2017 were selected in the research.Sociological information,body mass index(BMI),waist circumference(WC),body fat content(BF),blood pressure,blood biochemical index,diet/behavior habits and family history were obtained.BMI,WC and BF were converted into Z values.All subjects were further divided into Non-NAFLD group and NALFD group based on liver-ultrasound.MHO was defined as obese without any of the following metabolic abnormalities:systolic blood pressure(SBP)/diastolic blood pressure(DBP)≥P90 for children of the same age and sex;fasting blood glucose(FBG)≥5.6 mmol/L;triacylglycerol(TG)≥1.7 mmol/L and high-density lipoprotein cholesterol(HDL-C)<1.03 mmol/L according to Expert Consensus on Definition and Screening of Metabolic Healthy Obesity in Children in China,and the results were compared with those calculated by the previous definition of MHO.Results A total of 348 cases(251 males vs.97 females)aged(12.0±2.8)years were included in this study.The number of MHO and metabolic unhealthy obesity(MUO)was 121(34.8%)vs.227(65.2%).There were significant differences in other clinical indicators between the two groups except for FBG,TC and LDL-C.Multivariate logistic regression analysis showed that NAFLD was significantly associated with MUO after adjusting age and sex(OR=1.83,95%CI:1.11-3.03),but there was no significant correlation between NAFLD and MUO after adjusting anthropometric variables(BMI,WC,BF)and lifestyle(OR:1.20-1.38,P:0.24-0.52).According to the previous definition of MHO,the number of MUO was 77(22.1%).Multivariate logistic regression analysis showed that NAFLD was significantly associated with MUO after adjusting anthropometric variables(BMI,WC,BF)and lifestyle(OR:2.90-3.20,P:0.01-0.02).Conclusion The risk of metabolic abn

关 键 词：肥胖 代谢健康型肥胖(MHO) 代谢不健康型肥胖(MUO) 非酒精性脂肪肝(NAFLD) 

分 类 号：R153.2[医药卫生—营养与食品卫生学]