Department of Pediatrics, Oslo University Hospital, Ullevål, PB 4956 Nydalen, 0424 Oslo, Norway.
BMC Pediatr. 2011 May 27;11:47. doi: 10.1186/1471-2431-11-47.
Weight loss and increased physical fitness are established approaches to reduce cardiovascular risk factors. We studied the reduction in BMI z-score associated with improvement in cardiometabolic risk factors in overweight and obese children and adolescents treated with a combined hospital/public health nurse model. We also examined how aerobic fitness influenced the results.
From 2004-2007, 307 overweight and obese children and adolescents aged 7-17 years were referred to an outpatient hospital pediatrics clinic and evaluated by a multidisciplinary team. Together with family members, they were counseled regarding diet and physical activity at biannual clinic visits. Visits with the public health nurse at local schools or at maternal and child health centres were scheduled between the hospital consultations. Fasting blood samples were taken at baseline and after one year, and aerobic fitness (VO2peak) was measured. In the analyses, 230 subjects completing one year of follow-up by December 2008 were divided into four groups according to changes in BMI z-score: Group 1: decrease in BMI z-score≥0.23, Group 2: decrease in BMI z-score≥0.1-< 0.23, Group 3: decrease in/stable BMI z-score≥0.0-< 0.1, Group 4: increase in BMI z-score (>0.00-0.55).
230 participants were included in the analyses (75%). Mean (SD) BMI z-score was reduced from 2.18 (0.30) to 2.05 (0.39) (p < 0.001) in the group as a whole. After adjustment for BMI z-score, waist circumference and gender, the three groups with reduced BMI z-score had a significantly greater reduction in HOMA-IR, insulin, total cholesterol, LDL cholesterol and total/HDL cholesterol ratio than the group with increased BMI z-score. Adding change in aerobic fitness to the model had little influence on the results. Even a very small reduction in BMI z-score (group 3) was associated with significantly lower insulin, total cholesterol, LDL and total/HDL cholesterol ratio. The group with the largest reduction in BMI z-score had improvements in HOMA-IR and aerobic fitness as well. An increase in BMI z-score was associated with worsening of C-peptide and total/HDL cholesterol ratio.
Even a modest reduction in BMI z-score after one year of combined hospital/and public health nurse intervention was associated with improvement in several cardiovascular risk factors.
减轻体重和提高身体适应性是降低心血管危险因素的既定方法。我们研究了超重和肥胖的儿童和青少年在接受医院/公共卫生护士联合模式治疗后，身体质量指数 z 分数的降低与心脏代谢危险因素改善之间的关系。我们还检查了有氧健身对结果的影响。
2004 年至 2007 年，307 名年龄在 7 至 17 岁的超重和肥胖儿童和青少年被转介到门诊儿科诊所，并由一个多学科团队进行评估。他们与家庭成员一起在每半年一次的诊所就诊时接受关于饮食和身体活动的咨询。在医院就诊之间，安排公共卫生护士在当地学校或母婴健康中心进行就诊。在 2008 年 12 月之前完成一年随访的 230 名受试者在以下四个组中根据 BMI z 分数的变化进行划分：组 1：BMI z 分数降低≥0.23；组 2：BMI z 分数降低≥0.1-<0.23；组 3：BMI z 分数降低/稳定≥0.0-<0.1；组 4：BMI z 分数增加（>0.00-0.55）。
230 名参与者被纳入分析（75%）。BMI z 分数的平均值（标准差）从 2.18（0.30）降至 2.05（0.39）（p<0.001）。在对 BMI z 分数、腰围和性别进行调整后，BMI z 分数降低的三组与 BMI z 分数增加的组相比，HOMA-IR、胰岛素、总胆固醇、LDL 胆固醇和总/HDL 胆固醇比值的降低幅度显著更大。将有氧健身的变化纳入模型对结果的影响很小。即使 BMI z 分数有非常小的降低（组 3），也与胰岛素、总胆固醇、LDL 和总/HDL 胆固醇比值显著降低相关。BMI z 分数降低最大的组，HOMA-IR 和有氧健身也有所改善。BMI z 分数增加与 C 肽和总/HDL 胆固醇比值恶化相关。
即使在经过一年的医院/公共卫生护士联合干预后，BMI z 分数的适度降低也与多个心血管危险因素的改善相关。
