Department of Health & Exercise Science, Colorado State University, Fort Collins, CO, USA.
Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA.
J Pediatr Endocrinol Metab. 2021 Apr 7;34(6):763-770. doi: 10.1515/jpem-2020-0600. Print 2021 Jun 25.
We validated a continuous cardiometabolic risk (CMR) measure among adolescents.
Five metabolic syndrome (MetS) components including waist circumference, triglycerides, high-density lipoprotein cholesterol, fasting blood glucose, and mean arterial pressure were assessed in a national cohort of U.S. adolescents (n=560; 16.5 ± 0.5 y/o at baseline) in 10th grade (2010, Wave 1 (W1)), and follow-up assessments four (W4) and seven (W7) years later. Separately by wave, linear regressions were fitted to each MetS component controlling for age, sex, and race/ethnicity, and yielded standardized residuals (Z-scores). Wave-specific component Z-scores were summed to obtain composite CMR Z-scores. Four- and seven-year CMR change (CMR-diff W1-W4 and W1-W7). and average CMR risk (CMR-avg; (W1 + W4)/2 and (W1 + W7)/2) were calculated using the CMR Z-scores. W7 MetS was determined using adult criteria. Student's t-test and receiver operating characteristic (ROC) curve were conducted.
Participants meeting the adult criteria for MetS at W7 (74 of 416, 17.8%) had statistically significant (p<0.01) higher values for W1 CMR Z-scores (0.92 vs. -0.21), W4 CMR Z-scores (1.69 vs. -0.28), W7 CMR Z-scores (2.21 vs. -0.55), W1-W4 CMR-avg (1.53 vs. -0.27), W1-W7 CMR-diff (1.29 vs. -0.21), and W1-W7 CMR-avg (1.46 vs. -0.48) than those not meeting MetS criteria. Most results were similar for males and females in the sex-stratified analyses. The areas under the ROC curve were 0.61, 0.71, and 0.75 for W1, W4 and W7 Z-scores.
Findings support the validity of the continuous CMR Z-scores calculated using linear regression in evaluating and monitoring CMR profiles from adolescence to early adulthood.
我们验证了一种青少年连续心血管代谢风险（CMR）的衡量方法。
在一项美国青少年的全国队列研究中（n=560；基线时 10 年级（2010 年，第 1 波（W1））为 16.5±0.5 岁）评估了 5 个代谢综合征（MetS）的组成部分，包括腰围、甘油三酯、高密度脂蛋白胆固醇、空腹血糖和平均动脉压。按波分别对每个 MetS 组成部分进行线性回归，控制年龄、性别和种族/民族，得出标准化残差（Z 分数）。将特定波的成分 Z 分数相加，得到复合 CMR Z 分数。计算第 1 波至第 4 波（W1-W4）和第 1 波至第 7 波（W1-W7）的 4 年和 7 年 CMR 差异（CMR-diff W1-W4 和 W1-W7）以及平均 CMR 风险（CMR-avg；（W1+W4）/2 和（W1+W7）/2），使用 CMR Z 分数计算。使用成人标准确定第 7 波的 MetS。进行了学生 t 检验和接受者操作特征（ROC）曲线分析。
在第 7 波符合成人 MetS 标准的 74 名参与者（416 名中的 17.8%）的 W1 CMR Z 分数（0.92 比-0.21）、W4 CMR Z 分数（1.69 比-0.28）、W7 CMR Z 分数（2.21 比-0.55）、W1-W4 CMR-avg（1.53 比-0.27）、W1-W7 CMR-diff（1.29 比-0.21）和 W1-W7 CMR-avg（1.46 比-0.48）均显著更高（p<0.01）。在性别分层分析中，大多数结果在男性和女性中相似。W1、W4 和 W7 Z 分数的 ROC 曲线下面积分别为 0.61、0.71 和 0.75。
研究结果支持使用线性回归计算连续 CMR Z 分数在评估和监测从青春期到成年早期的 CMR 特征方面的有效性。
