Grandemange Morgane, Costet Nathalie, Doyen Matthieu, Monfort Christine, Michineau Léah, Saade Marie-Béatrice, Multigner Luc, Cordier Sylvaine, Pladys Patrick, Rouget Florence
CHU Rennes, Endocrinologie-Diabétologie Pédiatrique, Rennes, France.
Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France.
Front Pediatr. 2019 Jul 10;7:269. doi: 10.3389/fped.2019.00269. eCollection 2019.
Childhood obesity prevalence has increased over the last 30 years. The Heart Rate Variability (HRV) studies performed in adults suggest a possible relation between abnormal autonomic regulation and hypertension in the situation of overweight or obesity. The aims of this study were to explore the early relationships between adiposity and blood pressure and HRV in pre-pubertal children. Data were collected during the medical examination of the follow-up at 7 years of the TIMOUN mother-child cohort in Guadeloupe. Body Mass Index z-score (zBMI), sum of tricipital and subscapular skinfold thickness, percentage of fat mass, and Waist-to-Height Ratio were measured. A global corpulence score was computed using a Principal Component Analysis (PCA). Systolic Blood Pressure (SBP) and HRV parameters (cardiac holter monitoring) were collected under 2 conditions (calm and tachycardial period). Relations between HRV, SBP, each adiposity indicator and the corpulence score were studied with restricted cubic splines models, and linear regression models. The age at adiposity rebound (AR) was estimated from the individual growth curves. 575 children were included in the SBP study (mean age: 7.7 years, from 85 to 99 months). SBP was linearly correlated with the corpulence score and the zBMI. An increase of 1 in the zBMI was associated with an increase of 2.3 (±0.28) mmHg in SBP. The effect-size of zBMI on SBP was higher in children with early age at AR. Compared to children with normal BMI, children with a zBMI <™2SD had their RMSSD, SDNN, LF and HF indicators in tachycardial conditions significantly reduced by -30, -21, -37, and -48%, respectively. In boys with a zBMI >2SD, we observed a global increase in all HRV parameters (under tachycardial conditions), particularly the LF [β = 0.43 (±0.18)]. In pre-pubertal period a positive correlation between adiposity excess and SBP was observed with significant changes of HRV in boys, arguing for an early abnormal autonomic regulation and for early preventive intervention in the infancy period, particularly in case of overweight or obesity. Thinness was associated with a reduction in almost all the HRV parameters studied, when compared to normal corpulence, suggesting a decrease in autonomic influence.
在过去30年中，儿童肥胖患病率有所上升。针对成年人进行的心率变异性（HRV）研究表明，在超重或肥胖情况下，自主神经调节异常与高血压之间可能存在关联。本研究的目的是探讨青春期前儿童肥胖与血压及HRV之间的早期关系。数据收集于瓜德罗普岛TIMOUN母婴队列7岁随访体检期间。测量了体重指数z评分（zBMI）、肱三头肌和肩胛下皮褶厚度之和、脂肪量百分比以及腰高比。使用主成分分析（PCA）计算了总体肥胖评分。在两种情况下（平静期和心动过速期）收集收缩压（SBP）和HRV参数（心脏动态监测）。采用受限立方样条模型和线性回归模型研究了HRV、SBP、各肥胖指标与肥胖评分之间的关系。根据个体生长曲线估计肥胖反弹（AR）年龄。575名儿童纳入SBP研究（平均年龄：7.7岁，85至99个月）。SBP与肥胖评分和zBMI呈线性相关。zBMI每增加1，SBP升高2.3（±0.28）mmHg。AR年龄较小的儿童中，zBMI对SBP的效应量更高。与BMI正常的儿童相比，zBMI<−2SD的儿童在心动过速情况下的RMSSD、SDNN、LF和HF指标分别显著降低了30%、21%、37%和48%。在zBMI>2SD的男孩中，我们观察到所有HRV参数（心动过速情况下）总体升高，尤其是LF[β = 0.43（±0.18）]。在青春期前，观察到肥胖与SBP呈正相关，男孩的HRV有显著变化，这表明自主神经调节早期异常，支持在婴儿期进行早期预防性干预，尤其是在超重或肥胖的情况下。与正常肥胖相比，消瘦与几乎所有研究的HRV参数降低有关，表明自主神经影响减弱。
