Botton Jérémie, Heude Barbara, Kettaneh Adrien, Borys Jean-Michel, Lommez Agnès, Bresson Jean-Louis, Ducimetiere Pierre, Charles Marie-Aline
INSERM, Unit 780, IFR69, F-94807 Villejuif Cedex, France.
Metabolism. 2007 May;56(5):614-22. doi: 10.1016/j.metabol.2006.12.006.
This study aimed to document for the first time in a general population of French children the prevalence and levels of cardiovascular risk factors and to assess separately in boys and girls whether these risk factors were associated with fat mass distribution independently of subcutaneous overall adiposity. A cross-sectional analysis of baseline data from 452 children (235 boys and 217 girls) aged 8 to 17 years included in a 1999 population-based epidemiologic study (the Fleurbaix Laventie Ville Santé II study) was made. Overweight was defined according to the International Obesity Task Force references and the 90th percentiles of the French body mass index curves. The thresholds of parameters defining cardiovascular and metabolic risks were the 95th percentile of the Task Force Report on High Blood Pressure in Children and Adolescents for blood pressure and those of the American Academy of Pediatrics for lipids. Anthropometric and biological parameters were described by sex and according to overweight status. Partial correlations between cardiovascular risk factors and anthropometric measures of adiposity (body mass index, sum of 4 skinfold thicknesses, waist circumference, waist-to-height ratio) were calculated. Then, these correlations were additionally adjusted for the sum of 4 skinfold thicknesses. High plasma triglycerides, high insulin concentration, and low plasma high-density lipoprotein cholesterol (HDL-C) concentration were associated with all measures of adiposity (|r| > or = 0.20, P < .002). When obese children were excluded, overweight children already had high triglycerides and low HDL-C levels, respectively, 2 and 20 times more frequently than normal-weight children did. Among overweight children, 7.7% had at least 2 risk factors among high blood pressure, high plasma triglycerides or glucose, and low HDL-C concentration vs 0.25% among normal-weight children (P = .002). After adjusting for the sum of skinfolds, an independent association between the risk factors and waist circumference was found in girls. In conclusion, (a) modest excess weight is associated with increased levels of cardiovascular risk factors. (b) In girls, abdominal fat distribution is associated with cardiovascular risk factors, independently of overall adiposity. (c) International definition of abdominal obesity in children is required to standardize studies and to progress in the evaluation of childhood obesity and its consequences.
本研究旨在首次记录法国儿童普通人群中心血管危险因素的患病率和水平，并分别评估男孩和女孩这些危险因素是否独立于皮下总体肥胖与脂肪量分布相关。对纳入1999年基于人群的流行病学研究（弗勒尔拜-拉旺蒂健康城市II研究）的452名8至17岁儿童（235名男孩和217名女孩）的基线数据进行了横断面分析。超重根据国际肥胖特别工作组的参考标准和法国体重指数曲线的第90百分位数来定义。定义心血管和代谢风险的参数阈值为儿童和青少年高血压问题特别工作组报告中血压的第95百分位数以及美国儿科学会对血脂的定义。人体测量和生物学参数按性别以及超重状况进行描述。计算了心血管危险因素与肥胖的人体测量指标（体重指数、4处皮褶厚度之和、腰围、腰高比）之间的偏相关性。然后，这些相关性再根据4处皮褶厚度之和进行调整。高血浆甘油三酯、高胰岛素浓度和低血浆高密度脂蛋白胆固醇（HDL-C）浓度与所有肥胖指标相关（|r|≥0.20，P<0.002）。排除肥胖儿童后，超重儿童高甘油三酯和低HDL-C水平的发生率分别是正常体重儿童的2倍和20倍。在超重儿童中，7.7%在高血压、高血浆甘油三酯或血糖以及低HDL-C浓度方面至少有2种危险因素，而正常体重儿童中这一比例为0.25%（P = 0.002）。在根据皮褶厚度之和进行调整后，发现女孩中危险因素与腰围之间存在独立关联。总之，（a）适度超重与心血管危险因素水平升高相关。（b）在女孩中，腹部脂肪分布与心血管危险因素相关，独立于总体肥胖情况。（c）需要国际上对儿童腹部肥胖进行定义，以便规范研究并在儿童肥胖及其后果的评估方面取得进展。
