儿童和青少年的膳食高血压防治法 (DASH) 评分与肥胖表型。
Dietary approaches to stop hypertension (DASH) score and obesity phenotypes in children and adolescents.
机构信息
Nutrition and Endocrine Research Centre, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-4763, Tehran, 1985717413, Iran.
Department of Nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran.
出版信息
Nutr J. 2020 Oct 4;19(1):112. doi: 10.1186/s12937-020-00631-y.
BACKGROUND
The prevalence of obesity and its two important phenotypes, the metabolically healthy obese (MHO) and the metabolically unhealthy obese (MUO) are 10.9, 9.1, and 1.8%, respectively, among children and adolescents in Iran. Data on the link between diet quality indices and obesity phenotypes in children and adolescents is scarce. The present study aimed to assess the association of the Dietary Approaches to Stop Hypertension (DASH) score with MHO and MUO, as well as with cardiometabolic risk factors (RFs) in children and adolescents with excess weight.
METHODS
This cross-sectional study was conducted on 341 children and adolescents with excess weight aged 6-13 years, selected from primary schools of Tehran. The DASH score was determined based on eight components using a valid and reliable food frequency questionnaire. Anthropometric measures, insulin, fasting plasma glucose, lipid profile, and physical activity levels were collected. MUO was classified based on two definitions: having 2 or more cardiometabolic RFs, or being insulin resistant determined by a homeostatic model assessment of insulin resistance (HOMA-IR) ≥ 3.16. Multivariable logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for MUO phenotypes and cardiometabolic RFs in each tertile of the DASH score after adjustment for confounders.
RESULTS
The mean ± SD for age and DASH score was 9.3 ± 1.7 years and 24.0 ± 4.9, respectively. The prevalence of MUO was 62.2% based on RFs, and 43.4% based on HOMA-IR. Participants in the highest tertile of the DASH score had significantly decreased odds for MUO based on HOMA-IR (OR = 0.49; 95% CI: 0.28-0.87) compared with those in the lowest tertile, after adjustment for confounders. However, there were no associations between the DASH score and any of cardiometabolic RFs, or MUO based on RFs (OR = 0.68; 95% CI: 0.38-1.20).
CONCLUSION
The DASH score was inversely associated with MUO based on HOMA-IR, but not associated with MUO based on cardiometabolic RFs in this sample of children and adolescents. A DASH-style diet may have favourable effects on insulin sensitivity among children and adolescents with excess weight. Universal definitions for MHO/MUO are required, and longitudinal studies recommended to shed light upon this subject.
背景
在伊朗儿童和青少年中，肥胖及其两种重要表型（代谢健康型肥胖 [MHO] 和代谢不健康型肥胖 [MUO]）的患病率分别为 10.9%、9.1%和 1.8%。关于饮食质量指数与儿童和青少年肥胖表型之间联系的数据很少。本研究旨在评估饮食方法预防高血压（DASH）评分与 MHO 和 MUO 以及与超重儿童和青少年中心血管代谢危险因素（RFs）之间的相关性。
方法
这是一项横断面研究，共纳入 341 名年龄在 6-13 岁的超重儿童和青少年，他们来自德黑兰的小学。根据使用有效且可靠的食物频率问卷确定的 8 个成分来计算 DASH 评分。收集了人体测量学指标、胰岛素、空腹血糖、血脂谱和身体活动水平。根据存在 2 种或更多心血管代谢 RFs 或通过稳态模型评估的胰岛素抵抗（HOMA-IR）≥3.16 来确定 MUO 定义。采用多变量逻辑回归模型，在校正混杂因素后，根据 DASH 评分的每个三分位值，估计 MUO 表型和心血管代谢 RFs 的比值比（OR）和 95%置信区间（CI）。
结果
年龄和 DASH 评分的平均值±标准差分别为 9.3±1.7 岁和 24.0±4.9。根据 RFs，MUO 的患病率为 62.2%，根据 HOMA-IR 为 43.4%。与最低三分位相比，DASH 评分最高三分位的参与者 MUO 的发生几率显著降低（OR=0.49；95%CI：0.28-0.87），调整混杂因素后。然而，DASH 评分与心血管代谢 RFs 或基于 RFs 的 MUO 之间没有关联（OR=0.68；95%CI：0.38-1.20）。
结论
在本超重儿童和青少年样本中，DASH 评分与基于 HOMA-IR 的 MUO 呈负相关，但与基于心血管代谢 RFs 的 MUO 无关。DASH 饮食方式可能对超重儿童和青少年的胰岛素敏感性有有益影响。需要通用的 MHO/MUO 定义，并建议进行纵向研究以阐明这一主题。
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