Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada.
Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
Int J Obes (Lond). 2019 Jul;43(7):1354-1362. doi: 10.1038/s41366-019-0345-9. Epub 2019 Apr 2.
BACKGROUND/OBJECTIVES: We examined the association for rates of age- and sex-standardized body mass index (zBMI) gain between 0-3, 3-18, and 18-36 months with BP in children at 36-72 months of age.
We collected repeated measures of zBMI and BP in 2502 children. zBMI was calculated using the World Health Organization standards. Each child's zBMI at birth and rates of zBMI gain in each period from birth to 36 months were estimated using linear spline multilevel models. Generalized estimating equations were used to determine whether zBMI at birth and zBMI gain between 0-3, 3-18, and 18-36 months were each associated with repeated measures of BP at 36-72 months of age. We sequentially conditioned on zBMI at birth and zBMI gain in each period prior to each period tested, as covariates, and adjusted for important socio-demographic, familial, and study design covariates. We examined whether these associations were modified by birthweight or maternal obesity, by including interaction terms.
After adjusting for all covariates and conditioning on prior zBMI gains, a 1 standard deviation unit faster rate of zBMI gain during 0-3 months, (β = 0.59 mmHg; 95% CI 0.31, 0.86) and 3-18 months (β = 0.74 mmHg; 95% CI 0.46, 1.03) were each associated with higher systolic BP at 36-72 months. No significant associations were observed, however, for zBMI at birth or zBMI gain in the 18-36 month growth period. zBMI gains from 0-3 and 3-18 months were also associated with diastolic BP. Birthweight significantly modified the relationship during the 3-18 month period (p = 0.02), with the low birthweight group exhibiting the strongest association for faster rate of zBMI gain with higher systolic BP (β = 1.31 mmHg; 95% CI 0.14, 2.48).
Given that long-term exposure to small elevations in BP are associated with subclinical cardiovascular disease, promoting interventions targeting healthy growth in infancy may be important.
背景/目的：我们研究了 0-3 个月、3-18 个月和 18-36 个月期间年龄和性别标准化体重指数（zBMI）增长速度与 36-72 个月儿童血压之间的关系。
我们收集了 2502 名儿童的 zBMI 和血压重复测量数据。zBMI 采用世界卫生组织标准计算。使用线性样条多水平模型估计每个儿童出生时的 zBMI 和出生至 36 个月期间每个时期的 zBMI 增长率。使用广义估计方程来确定出生时的 zBMI 和 0-3 个月、3-18 个月和 18-36 个月期间的 zBMI 增长率是否与 36-72 个月时的血压重复测量值相关。我们将出生时的 zBMI 和每个测试时期之前每个时期的 zBMI 增长率作为协变量进行逐步条件分析，并调整了重要的社会人口学、家族和研究设计协变量。我们通过包括交互项来检查这些关联是否受到出生体重或母亲肥胖的影响。
在调整了所有协变量并对先前的 zBMI 增长进行条件分析后，0-3 个月期间 zBMI 增长率每增加 1 个标准差（β=0.59mmHg；95%CI 0.31，0.86）和 3-18 个月期间（β=0.74mmHg；95%CI 0.46，1.03）与 36-72 个月时的收缩压升高相关。然而，出生时的 zBMI 或 18-36 个月生长期间的 zBMI 增长率与出生体重无显著相关性。0-3 个月和 3-18 个月的 zBMI 增长也与舒张压有关。出生体重显著改变了 3-18 个月期间的关系（p=0.02），低出生体重组的 zBMI 增长率与收缩压升高的相关性最强（β=1.31mmHg；95%CI 0.14，2.48）。
鉴于长期暴露于血压轻度升高与亚临床心血管疾病有关，促进针对婴儿期健康成长的干预措施可能很重要。
