本文選題：高出生體重 + 超重肥胖　； 參考：《復(fù)旦大學(xué)》2013年博士論文

【摘要】：[研究背景] 自20世紀(jì)80年代英國學(xué)者Barker提出“成人期疾病的宮內(nèi)起源(fetal origin of adult disease)"學(xué)說以來,胎兒宮內(nèi)發(fā)育情況對健康的長期影響受到越來越多的重視。出生體重是反映胎兒宮內(nèi)發(fā)育和營養(yǎng)狀況的一個(gè)重要指標(biāo),也是影響出生后的生長水平和健康狀況的因素之一。以往的很多研究關(guān)注的是低出生體重兒的生長發(fā)育和健康狀況,低出生體重已經(jīng)被證實(shí)是很多疾病的危險(xiǎn)因素。 近三十年來,無論是在發(fā)達(dá)國家還是一些發(fā)展中國家,嬰兒的出生體重和巨大兒發(fā)生率均有增加的趨勢；兒童青少年的血壓水平也呈現(xiàn)上升趨勢,高血壓的患病率有所增加。高出生體重對兒童青少年血壓的影響值得關(guān)注。同時(shí),研究兒童青少年血壓的影響因素,對有針對性地開展兒童青少年高血壓的預(yù)防也具有重要的意義。 [研究目的] 本研究的目標(biāo)為探討高出生體重和兒童期、青少年期的超重肥胖對兒童青少年血壓的影響,并分析兒童期和青少年期血壓的影響因素。 [研究方法] 本研究為高出生體重作為暴露因素的隊(duì)列研究。研究現(xiàn)場為江蘇省無錫市的一個(gè)縣級市(江陰市)和兩個(gè)行政區(qū)(惠山區(qū)和錫山區(qū))。研究對象為出生于1993-1995年的單胎活產(chǎn)嬰兒,其中出生體重≥4000克者作為暴露組,2500克≤出生體重4000克者作為非暴露組。在出生隊(duì)列建立時(shí),非暴露組對象按照性別和“出生日期±2個(gè)月”進(jìn)行配對,兩組均排除父母或(外)祖父母有高血壓或有糖尿病的對象。分別于2005年10月-2006年9月和2011年6月-2012年5月對研究對象進(jìn)行2次隨訪。 隊(duì)列建立時(shí)的數(shù)據(jù)庫資料包括母親孕期情況、圍產(chǎn)期情況；兩次隨訪的問卷調(diào)查內(nèi)容包括人口學(xué)特征和生活習(xí)慣等,并進(jìn)行身高、體重、血壓的測量。應(yīng)用Epidata3.1軟件進(jìn)行數(shù)據(jù)錄入,應(yīng)用SAS9.2、LISREL8.7軟件進(jìn)行數(shù)據(jù)分析。以血壓作為結(jié)局變量(收縮壓、舒張壓、血壓升高比例),采用方差分析、x2檢驗(yàn)、隨機(jī)截距發(fā)展模型、廣義線性混合效應(yīng)模型、線性回歸、Logistic回歸、結(jié)構(gòu)方程模型等方法,分析高出生體重對血壓的影響、超重肥胖對血壓的影響和兒童期、青少年期血壓的影響因素。 [研究結(jié)果] 1.隊(duì)列概況 本研究隊(duì)列建立時(shí),共有1595對(3190人)符合條件的對象被納入到隊(duì)列中。完成兩次隨訪的研究對象有2256人,其中暴露組1126人、非暴露組1130人。男生占66.45%(1499名),女生占33.55%(757名),兩組之間的性別分布均衡。隨訪到的對象和失訪對象在組別、出生年份和性別分布上無統(tǒng)計(jì)學(xué)差異。 2.暴露組和非暴露組基本情況的比較 暴露組和非暴露組對象出生時(shí)母親的人口學(xué)特征和孕期特征無統(tǒng)計(jì)學(xué)差異。但暴露組母親的身高、體重和孕期增重均顯著高于非暴露組。暴露組過期妊娠(≥42周)的比例較高,出生身長、頭圍均顯著高于非暴露組。 兒童期隨訪時(shí),暴露組平均每天看電視時(shí)間≥1小時(shí)的比例為36.93%,低于非暴露組(42.06%)。青少年期隨訪時(shí),暴露組經(jīng)常偏食的比例低于非暴露組,平均每天運(yùn)動(dòng)時(shí)間≥2小時(shí)的比例高于非暴露組。 3.高出生體重對血壓的影響 在兒童期,高出生體重組的SBP和DBP分別為100.40±10.5865.45±8.95mmHg,正常出生體重組分別為99.81±9.96mmHg、65.02±8.65mmHg。在青少年期,高出生體重組的SBP和DBP分別為110.90±9.49mmHg、72.16±6.34mmHg;正常出生體重組分別為109.36±9.20mmHg、71.63±6.39mmHg.高出生體重對青少年期收縮壓有統(tǒng)計(jì)學(xué)顯著性影響(P0.0001)。高出生體重組兒童期的高血壓檢出率為6.93%,青少年期為3.55%；正常出生體重組分別為6.46%、2.83%。高出生體重組兒童期和青少年期的“血壓升高比例”分別為14.30%、20.78%,顯著高于正常出生體重組(11.50%、16.64%),RR值分別為1.24(95%CI：1.00-1.54)、1.25(95%CI:1.05-1.49). 控制重復(fù)測量時(shí)間,并調(diào)整母親分娩時(shí)的年齡、母親職業(yè)、母親產(chǎn)時(shí)妊高征、研究對象的性別、胎齡、胎次、出生重量指數(shù)(PI)和兒童期年齡后,高出生體重組的收縮壓、血壓升高比例均顯著高于正常出生體重組,參數(shù)估計(jì)值分別為0.81±0.30、0.21±0.09。 高出生體重與青少年期經(jīng)常吃甜食對青少年期的收縮壓、舒張壓有顯著的相加交互作用；對血壓升高比例影響的交互作用超額相對危險(xiǎn)度(RERI)為2.71(95%CI：0.75-4.67),交互作用歸因比(AP)為66.5%(95%CI：41.2-91.8)。 4.高出生體重對超重肥胖的影響 高出生體重組對象的兒童期和青少年期BMI均高于正常出生體重組。高出生體重組兒童期“超重肥胖”(超重+肥胖)的比例為15.99%、青少年期為11.99%,均顯著高于正常出生體重組(兒童期：11.59%、青少年期：8.85%),RR值分別為1.38(95%CI：1.12-1.70)、1.35(95%CI：1.06-1.73)�？刂浦貜�(fù)測量的分析顯示高出生體重對兒童青少年的BMI、超重肥胖比例有顯著不良影響。 5.超重肥胖對血壓的影響 調(diào)整出生體重組別、母親生育年齡、母親職業(yè)、母親產(chǎn)時(shí)妊高癥、胎次、胎齡、出生身長、性別、兒童期年齡、兒童期是否經(jīng)常偏食、是否經(jīng)常吃油炸食品和運(yùn)動(dòng)時(shí)間的分析顯示,超重肥胖兒童的收縮壓(β±SE:2.49±0.61)和舒張壓(β±SE：3.20±0.51)顯著升高,血壓升高的風(fēng)險(xiǎn)增加(OR=2.16,95%CI:1.52-3.08)。 多因素分析顯示,青少年超重肥胖者的收縮壓顯著升高(β±SE:5.62±.61)、舒張壓也顯著升高(β±SE:3.35±0.42)。青少年期BMI超重肥胖和高出生體重對血壓升高比例的影響有交互作用,其RERI為2.22(95%CI：0.42-4.02),AP為49.5%(95%CI:22.1-76.8).在正常出生體重組、高出生體重組,青少年期超重肥胖導(dǎo)致血壓升高的風(fēng)險(xiǎn)分別為2.21(95%CI:1.35-3.62)、3.97(95%CI:2.65-5.94)。 6.出生體重和BMI對血壓影響的效應(yīng)分析 出生體重對兒童期收縮壓、舒張壓影響的總效應(yīng)均為0.04。出生情況(體重、身長)對兒童期血壓影響的直接效應(yīng)為0.11、間接效應(yīng)為0.04。兒童期BMI對血壓水平影響的效應(yīng)為0.25。 出生體重對青少年期收縮壓影響的總效應(yīng)0.07,對舒張壓影響的總效應(yīng)為0.06。出生情況(體重、身長)對青少年期血壓影響的間接效應(yīng)為0.11。青少年期BMI對血壓水平影響的效應(yīng)為0.51。 7.兒童期血壓的影響因素 多因素分析發(fā)現(xiàn)母親產(chǎn)時(shí)妊高征、經(jīng)常吃油炸食品是兒童血壓升高的危險(xiǎn)因素。隨著兒童期年齡和BMI的增加,收縮壓、舒張壓上升,血壓升高的風(fēng)險(xiǎn)增加。男生的兒童期收縮壓高于女生。收縮壓隨著出生身長的增加而增加。 平均每天運(yùn)動(dòng)時(shí)間≥2小時(shí)能降低兒童的收縮壓、舒張壓和血壓升高的比例。有氧運(yùn)動(dòng)能降低兒童的收縮壓和血壓升高風(fēng)險(xiǎn)。經(jīng)常偏食能導(dǎo)致兒童的舒張壓下降、血壓升高的風(fēng)險(xiǎn)降低。母親生育時(shí)職業(yè)為工人和其他(教師、干部、商業(yè)服務(wù)業(yè)等)的子女,其兒童期收縮壓低于母親生育時(shí)職業(yè)為農(nóng)民的子女。 8.青少年期血壓的影響因素 母親產(chǎn)時(shí)妊高征對青少年期的血壓有顯著不良影響。男生的青少年期收縮壓、舒張壓、血壓升高比例均高于女生。隨著青少年期BMI的增加,收縮壓和舒張壓上升、血壓升高的風(fēng)險(xiǎn)增加。隨著出生身長的增加,收縮壓上升。青少年期的收縮壓還隨著兒童期收縮壓的上升而上升。隨著年齡的增加,舒張壓和血壓升高的比例增加。經(jīng)常吃甜食是青少年期收縮壓和血壓升高比例上升的危險(xiǎn)因素。母親孕晚期有高危因素(妊娠合并癥或并發(fā)癥)是青少年期血壓升高的危險(xiǎn)因素。在青少年期隨訪時(shí)父親或母親有高血壓的對象,其“血壓升高比例”增加。 有氧或無氧運(yùn)動(dòng)都能降低青少年的收縮壓；有氧和無氧兩者都有的運(yùn)動(dòng)方式能降低青少年的舒張壓和血壓升高的比例。 [結(jié)論] 1.高出生體重是兒童青少年血壓升高的危險(xiǎn)因素；而且高出生體重對青少年期血壓的影響存在與不良飲食習(xí)慣(吃甜食)的交互作用。 2.高出生體重能導(dǎo)致兒童期和青少年的超重肥胖增加。兒童期和青少年期超重肥胖均是血壓升高的危險(xiǎn)因素；而且青少年期超重肥胖和高出生體重對青少年期血壓升高比例的影響存在交互作用。 3.出生體重可以直接對兒童青少年的血壓產(chǎn)生影響；又可以導(dǎo)致兒童期、青少年期BMI的升高而對血壓產(chǎn)生不良影響。BMI對血壓影響的效應(yīng)水平高于出生體重對血壓影響的效應(yīng)水平。 4.兒童青少年的血壓存在著性別、年齡差異。母親產(chǎn)時(shí)妊高癥、兒童期經(jīng)常吃油炸食品、青少年期經(jīng)常吃甜食與血壓升高有關(guān)。父親／母親高血壓與青少年期的血壓升高有關(guān)。有氧運(yùn)動(dòng)是兒童青少年血壓的保護(hù)因素。
[Abstract]:[research background]
Since the "fetal origin of adult disease" theory was proposed by British scholar Barker in 1980s, the long-term effects of fetal intrauterine development on health have been paid more and more attention. Birth weight is an important indicator of fetal development and nutritional status, and also after birth. A number of previous studies have focused on the growth and health of low birth weight infants, and low birth weight has been identified as a risk factor for many diseases.
In the last thirty years, both in developed and some developing countries, the birth weight and the incidence of giant infants have increased; the blood pressure level of children and adolescents is also rising, the prevalence of hypertension has increased. The effect of high birth weight on the blood pressure of young children is worth paying attention. The influencing factors of blood pressure in young adolescents are also important for the prevention of hypertension in children and adolescents.
[research purposes]
The aim of this study was to investigate the effects of overweight and obesity on blood pressure in children and adolescents, and to analyze the influence factors of blood pressure in childhood and adolescence.
[research methods]
The study was a cohort study of high birth weight as a factor of exposure. The study was a county-level city (Jiangyin city) and two administrative districts (Huishan and Xishan) in Wuxi, Jiangsu province. The study was a single born baby born in 1993-1995 years, with a birth weight of more than 4000 grams as an exposure group and 2500 grams less than 4000 grams of birth weight. When the birth cohort was established, the non exposed groups were paired according to sex and "date of birth for 2 months", and the two groups all excluded parents or grandparents with hypertension or diabetes. The subjects were followed up in September -2006, October 2005, and May June 2011, respectively, and the subjects were followed up for 2 times.
The database data at the time of the establishment of the cohort included maternal pregnancy and perinatal conditions; the two follow-up questionnaires included demographic characteristics and living habits, and measured height, weight and blood pressure. Epidata3.1 software was used for data entry, SAS9.2 and LISREL8.7 software were used for data analysis. Blood pressure was used as the outcome. Variables (systolic pressure, diastolic pressure, blood pressure increase), analysis of variance, x2 test, random intercept development model, generalized linear mixed effect model, linear regression, Logistic regression, structural equation model, and other methods to analyze the effect of high birth weight on blood pressure, the influence of overweight and obesity on blood pressure, and the influence of childhood and adolescence blood pressure Factor.
[results]
1. queue profile
When the cohort was established, 1595 pairs (3190 people) were included in the cohort. There were 2256 subjects for two follow-up studies, including 1126 exposed groups and 1130 non exposed groups. Boys accounted for 66.45% (1499), girls accounted for 33.55% (757), and the gender distribution between the two groups was balanced. The subjects followed up and the missing subjects were in the group. There was no statistical difference in the year of birth and sex distribution.
Comparison of the basic situation between 2. exposed and non exposed groups
There was no significant difference in the demographic and pregnancy characteristics between the exposed and non exposed groups at birth, but the height, weight and weight gain of the mothers in the exposed group were significantly higher than those in the non exposed groups. The proportion of the exposed group was higher than that of the exposed group (over 42 weeks), and the length of the birth and the head circumference were significantly higher than that of the non exposed group.
In the follow-up period of childhood, the average rate of watching TV time more than 1 hours per day in the exposure group was 36.93%, lower than that of the non exposed group (42.06%). The proportion of frequent partial eclipse of the exposure group was lower than that in the non exposed group. The average daily exercise time of more than 2 hours was higher than that of the non exposed group.
3. the effect of high birth weight on blood pressure
In the childhood, the SBP and DBP of the high birth weight group were 100.40 + 10.5865.45 + 8.95mmHg respectively. The normal birth weight group was 99.81 + 9.96mmHg and 65.02 + 8.65mmHg. in adolescence. The SBP and DBP of the high birth weight group were 110.90 + 9.49mmHg and 72.16 + 6.34mmHg respectively. The normal birth weight group was 109.36 + 9.20mmHg, 71.63 + 6.39mmHg.. The birth weight has a statistically significant effect on the systolic pressure in adolescence (P0.0001). The prevalence of hypertension in the high birth weight group was 6.93%, the adolescence was 3.55%, the normal birth weight group was 6.46%, and the 2.83%. high birth weight group was 14.30%, 20.78%, respectively, and was 20.78%, respectively. In the normal birth weight group (11.50%, 16.64%), the RR values were 1.24 (95%CI:1.00-1.54) and 1.25 (95%CI:1.05-1.49) respectively.
To control the time of repeated measurements, and to adjust the age of mother's childbirth, mother's occupation, mother's pregnancy induced hypertension, sex, fetal age, birth weight, birth weight index (PI) and childhood age, the systolic pressure and blood pressure in the high birth weight group were significantly higher than those of the normal birth weight group, and the estimated value of the parameters was 0.81 + 0.30,0.21, respectively. + 0.09.
High birth weight and regular eating dessert had significant interaction effect on systolic blood pressure and diastolic pressure in adolescence, and the interaction effect of excess relative risk (RERI) was 2.71 (95%CI:0.75-4.67) and AP was 66.5% (95%CI:41.2-91.8).
The effect of 4. high birth weight on overweight and obesity
The BMI of the high birth weight group was higher in childhood and adolescence than in the normal birth weight group. The proportion of overweight and obesity (overweight + obesity) in the high birth weight group was 15.99%, and the adolescence was 11.99%, which was significantly higher than that in the normal birth weight group (11.59%, 8.85%) and 1.38 (95%CI:1.12-1.7 0), 1.35 (95%CI:1.06-1.73). Analysis of repeated measures showed that high birth weight had a significant adverse effect on BMI and overweight and obesity in children and adolescents.
5. effect of overweight and obesity on blood pressure
The birth weight group, mother's birth age, mother's occupation, mother's pregnancy, pregnancy induced hypertension, fetal age, birth length, birth length, sex, childhood age, children's frequent bias, frequent fried food and exercise time showed that the systolic pressure (beta SE:2.49 + 0.61) and diastolic pressure (beta + SE:3.20 + 0.51) of overweight and obese children were (beta + 0.61) and diastolic pressure. The risk of elevated blood pressure increased significantly (OR=2.16,95%CI:1.52-3.08).
The multifactor analysis showed that the systolic pressure of overweight and obese adolescents increased significantly (beta SE:5.62 +.61), and diastolic pressure increased significantly (beta SE:3.35 + 0.42). The effect of BMI overweight and high birth weight on the proportion of blood pressure increased in adolescence, and RERI was 2.22 (95%CI:0.42-4.02) and AP was 49.5% (95%CI:22.1-76.8). The risk of elevated blood pressure was 2.21 (95%CI:1.35-3.62) and 3.97 (95%CI:2.65-5.94), respectively.
An analysis of the effect of 6. birth weight and BMI on blood pressure
The total effect of birth weight on systolic blood pressure and diastolic pressure in children was that the direct effect of 0.04. birth (weight, length) on children's blood pressure was 0.11, and the effect of indirect effect on the level of blood pressure in 0.04. childhood BMI was 0.25.
The total effect of birth weight on systolic blood pressure in adolescence was 0.07. The total effect on diastolic pressure was the indirect effect of 0.06. birth (weight, length) on adolescent blood pressure. The effect of BMI on blood pressure in 0.11. adolescence was 0.51.
7. influence factors of children's blood pressure
Multifactor analysis found that the mother's pregnancy induced hypertension and frequent fried food were the risk factors for the increase of blood pressure in children. With the age of children and the increase of BMI, the systolic pressure, diastolic pressure increased, and the risk of blood pressure increased. The boys' systolic pressure was higher than that of the girls.
The average daily exercise time of more than 2 hours reduces children's systolic pressure, diastolic pressure, and blood pressure increase. Aerobic exercise reduces the risk of systolic blood pressure and blood pressure in children. Frequent partial eclipse can lead to a decrease in diastolic blood pressure in children and a lower risk of rising blood pressure. Mother's childbearing time is a worker and other (teachers, cadres, business services). The child's systolic blood pressure is lower than that of the mother when the child is born.
8. influential factors of blood pressure in adolescence
Pregnancy induced hypertension (PIH) has a significant negative effect on the blood pressure in adolescence. The proportion of boys' systolic pressure, diastolic pressure, and blood pressure is higher than that of girls. With the increase of BMI, systolic and diastolic pressure increases, the risk of blood pressure increases. As the length of birth increases, systolic pressure rises. Systolic pressure in adolescence. With the increase of systolic blood pressure in childhood, the proportion of diastolic pressure and blood pressure increases as the age increases. Frequent dessert is a risk factor for the increase in the proportion of systolic blood pressure and blood pressure. In the late pregnancy, there are high risk factors (pregnancy complications or complications) in the late pregnancy. During the follow-up period, the proportion of blood pressure increased in both mothers and fathers with hypertension.
Both aerobic and anaerobic exercise can reduce the systolic blood pressure in adolescents; both aerobic and anaerobic exercise can reduce the proportion of diastolic pressure and blood pressure in adolescents.
[Conclusion]
1. high birth weight is a risk factor for high blood pressure in children and adolescents; and the influence of high birth weight on adolescent blood pressure is interacted with bad eating habits (eating desserts).
2. high birth weight can lead to an increase in overweight and obesity in childhood and adolescents. Overweight and obesity in childhood and adolescence are risk factors for high blood pressure, and there is an interaction between overweight and obesity and high birth weight in adolescence.
3. birth weight can directly affect the blood pressure of children and adolescents; it can also lead to childhood, adolescent BMI and adverse effects on blood pressure. The effect of.BMI on blood pressure is higher than the effect of birth weight on blood pressure.
4. children and adolescents have sex, age differences, pregnancy induced hypertension during mother birth, often eating fried foods in childhood, frequent eating sweets in adolescence and elevated blood pressure. Father / mother hypertension is associated with elevated blood pressure in adolescence. Aerobic exercise is a protective factor for children and adolescents.

【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2013
【分類號】：R723.14;R725.4

【共引文獻(xiàn)】

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7 沈s，

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