Lane Jennifer Ce, Butler Katherine L, Poveda-Marina Jose Luis, Martinez-Laguna Daniel, Reyes Carlen, de Bont Jeroen, Javaid Muhammad Kassim, Logue Jennifer, Compston Juliet E, Cooper Cyrus, Duarte-Salles Talita, Furniss Dominic, Prieto-Alhambra Daniel
NIHR BRC, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.
Department of Trauma and Orthopaedic Surgery, Stoke Mandeville Hospital, Aylesbury, UK.
J Bone Miner Res. 2020 Jun;35(6):1022-1030. doi: 10.1002/jbmr.3984. Epub 2020 Apr 7.
This study aimed to determine if having an overweight or obese range body mass index (BMI) at time of beginning school is associated with increased fracture incidence in childhood. A dynamic cohort was created from children presenting for routine preschool primary care screening, collected in the Information System for Research in Primary Care (SIDIAP) platform in Catalonia, Spain. Data were collected from 296 primary care centers representing 74% of the regional pediatric population. A total of 466,997 children (48.6% female) with a validated weight and height measurement within routine health care screening at age 4 years (±6 months) between 2006 and 2013 were included, and followed up to the age of 15, migration out of region, death, or until December 31, 2016. BMI was calculated at age 4 years and classified using WHO growth tables, and fractures were identified using previously validated ICD10 codes in electronic primary care records, divided by anatomical location. Actuarial lifetables were used to calculate cumulative incidence. Cox regression was used to investigate the association of BMI category and fracture risk with adjustment for socioeconomic status, age, sex, and nationality. Median follow-up was 4.90 years (interquartile range [IQR] 2.50 to 7.61). Cumulative incidence of any fracture during childhood was 9.20% (95% confidence interval [CI] 3.79% to 14.61%) for underweight, 10.06% (9.82% to 10.29%) for normal weight, 11.28% (10.22% to 12.35%) for overweight children, and 13.05% (10.69% to 15.41%) for children with obesity. Compared with children of normal range weight, having an overweight and obese range BMI was associated with an excess risk of lower limb fracture (adjusted hazard ratio [HR] = 1.42 [1.26 to 1.59]; 1.74 [1.46 to 2.06], respectively) and upper limb fracture (adjusted HR = 1.10 [1.03 to 1.17]; 1.19 [1.07 to 1.31]). Overall, preschool children with an overweight or obese range BMI had increased incidence of upper and lower limb fractures in childhood compared with contemporaries of normal weight. © 2020 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.
本研究旨在确定入学时体重指数（BMI）处于超重或肥胖范围是否与儿童骨折发生率增加相关。我们从西班牙加泰罗尼亚地区初级医疗保健研究信息系统（SIDIAP）平台收集的、前来进行常规学龄前初级保健筛查的儿童中创建了一个动态队列。数据来自代表该地区74%儿科人口的296个初级保健中心。纳入了2006年至2013年间在4岁（±6个月）常规医疗保健筛查中有有效体重和身高测量值的466,997名儿童（48.6%为女性），并随访至15岁、迁出该地区、死亡或至2016年12月31日。4岁时计算BMI，并使用世界卫生组织生长图表进行分类，骨折通过电子初级保健记录中先前验证的ICD10编码进行识别，并按解剖部位划分。使用精算生命表计算累积发病率。采用Cox回归分析BMI类别与骨折风险的关联，并对社会经济状况、年龄、性别和国籍进行调整。中位随访时间为4.90年（四分位间距[IQR]为2.50至7.61年）。体重过轻儿童童年期任何骨折的累积发病率为9.20%（95%置信区间[CI]为3.79%至14.61%），正常体重儿童为10.06%（9.82%至10.29%），超重儿童为11.28%（10.22%至12.35%），肥胖儿童为13.05%（10.69%至15.41%）。与正常体重范围的儿童相比，BMI处于超重和肥胖范围与下肢骨折（调整后风险比[HR]=1.42[1.26至1.59]；1.74[1.46至2.06]）和上肢骨折（调整后HR=1.10[1.03至1.17]；1.19[1.07至1.31]）的额外风险相关。总体而言，与正常体重的同龄人相比，BMI处于超重或肥胖范围的学龄前儿童童年期上肢和下肢骨折的发生率增加。©2020作者。《骨与矿物质研究杂志》由美国骨与矿物质研究学会出版。
