Ryder Justin R, Dengel Donald R, Jacobs David R, Sinaiko Alan R, Kelly Aaron S, Steinberger Julia
Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN; Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN.
Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN; School of Kinesiology, University of Minnesota, Minneapolis, MN.
J Pediatr. 2016 Jan;168:205-211. doi: 10.1016/j.jpeds.2015.08.034. Epub 2015 Oct 1.
To determine the associations of adiposity and insulin resistance with measures of vascular structure and function in children.
A cross-sectional study included 252 children (age 15.1 ± 2.4 years; body mass index percentile 68.2 ± 26.5%; Tanner 2-5). Measurements of body fat percentage were obtained with dual-energy X-ray absorptiometry and visceral adipose tissue (VAT) with computed tomography. Insulin resistance was measured with hyperinsulinemic euglycemic clamp. Vascular measurements for endothelial function (brachial artery flow-mediated dilation [FMD]), vascular structure (carotid intima-media thickness [cIMT]), vascular stiffness (carotid incremental elastic modulus), and pulse wave velocity were analyzed by tertiles of adiposity and insulin resistance. Additional analyses with ANCOVA and linear regression were adjusted for Tanner, sex, race, and family relationship; FMD was also adjusted for baseline artery diameter.
FMD was positively associated with high adiposity (body mass index, body fat percentage, and VAT) (P < .01 all). Insulin resistance was not associated with FMD. cIMT was significantly, positively related to obesity, VAT, and insulin resistance (P < .05 all). No differences in carotid incremental elastic modulus and pulse wave velocity were observed in relation to adiposity or insulin resistance.
The findings suggest that adiposity is associated with higher FMD, and insulin resistance and VAT are associated with higher cIMT in children. Further research is needed to clarify the progression of these relations.
确定儿童肥胖和胰岛素抵抗与血管结构及功能指标之间的关联。
一项横断面研究纳入了252名儿童（年龄15.1±2.4岁；体重指数百分位数68.2±26.5%；坦纳分期2 - 5期）。采用双能X线吸收法测量体脂百分比，用计算机断层扫描测量内脏脂肪组织（VAT）。通过高胰岛素正常血糖钳夹法测量胰岛素抵抗。根据肥胖和胰岛素抵抗的三分位数分析血管内皮功能（肱动脉血流介导的扩张[FMD]）、血管结构（颈动脉内膜中层厚度[cIMT]）、血管僵硬度（颈动脉增量弹性模量）和脉搏波速度的测量值。采用协方差分析和线性回归进行的其他分析对坦纳分期、性别、种族和家族关系进行了校正；FMD还对基线动脉直径进行了校正。
FMD与高度肥胖（体重指数、体脂百分比和VAT）呈正相关（均P < .01）。胰岛素抵抗与FMD无关。cIMT与肥胖、VAT和胰岛素抵抗显著正相关（均P < .05）。未观察到颈动脉增量弹性模量和脉搏波速度在肥胖或胰岛素抵抗方面的差异。
研究结果表明，肥胖与较高的FMD相关，而胰岛素抵抗和VAT与儿童较高的cIMT相关。需要进一步研究以阐明这些关系的进展情况。
