本文選題：腰圍 + 腰圍身高比��； 參考：《中國(guó)疾病預(yù)防控制中心》2017年碩士論文

【摘要】：研究背景:高血壓的病因復(fù)雜,是遺傳因素和環(huán)境因素共同作用的結(jié)果。除遺傳因素外,目前公認(rèn)的危險(xiǎn)因素有不合理膳食、超重和肥胖、缺乏運(yùn)動(dòng)、吸煙、過(guò)量飲酒等。國(guó)內(nèi)外流行病學(xué)研究表明,超重和肥胖是高血壓的重要危險(xiǎn)因素。目前評(píng)估肥胖的常用指標(biāo)包括中心型肥胖指標(biāo)腰圍(Waist Circumference,WC)、腰圍身高比(Waist-to-height ratio,WHtR)、腰圍臀圍比(Waist-to-hip ratio,WHR)和全身性肥胖指標(biāo)體質(zhì)指數(shù)(Body Mass Index,BMI),人群的肥胖指標(biāo)常處于動(dòng)態(tài)變化中,既往關(guān)于肥胖與高血壓關(guān)系的研究多為橫斷面研究,少數(shù)相關(guān)隊(duì)列研究中主要關(guān)注其基線肥胖情況以及對(duì)高血壓發(fā)病風(fēng)險(xiǎn)的影響,缺少對(duì)血壓值影響的研究,存在一定的局限性。研究目的:本研究旨在了解1997-2011年我國(guó)成年居民中心型肥胖指標(biāo)腰圍、腰圍身高比、腰臀比及全身性肥胖指標(biāo)體質(zhì)指數(shù)的水平及其變化對(duì)血壓值及高血壓發(fā)病風(fēng)險(xiǎn)的影響。研究?jī)?nèi)容與方法:本研究利用中美合作課題“中國(guó)健康與營(yíng)養(yǎng)調(diào)查”1997年和2011年兩輪調(diào)查數(shù)據(jù)進(jìn)行縱向分析。納入的研究對(duì)象共2488人,將研究對(duì)象按照年齡18-39歲和40-65歲分為兩組,并按性別分層分析,描述1997-2011年研究對(duì)象血壓、WC、WHtR、WHR、BMI的變化情況,運(yùn)用多元線性回歸模型分析WC、WHtR、WHR、BMI水平及其變化對(duì)血壓值的影響;排除基線高血壓者后,運(yùn)用Logistic回歸模型分析WC、WHtR、WHR、BMI水平及其變化對(duì)高血壓發(fā)病風(fēng)險(xiǎn)的影響,并分析中心型肥胖狀態(tài)的變化對(duì)高血壓發(fā)病風(fēng)險(xiǎn)的影響,兩模型均控制研究對(duì)象受教育程度、基線血壓、吸煙、飲酒、身體活動(dòng)、脂肪供能比、蔬菜水果和鈉的攝入。研究結(jié)果:1.研究對(duì)象隨訪14年間WC、WHtR、WHR、BMI及血壓值均有所上升。男性WC、WHtR、WHR及BMI變化18-39年齡組大于40-65歲年齡組(18-39歲年齡組分別為8.72cm、0.05、0.05、1.94kg/m2,40-65 歲年齡組分別為 5.11cm、0.03、0.03、0.89kg/m2),女性WC、WHtR及WHR變化在兩年齡組中無(wú)明顯差異,而B(niǎo)MI變化18-39年齡組大于40-65歲年齡組(18-39歲年齡組為1.62kg/m2,40-65歲年齡組為1.10kg/m2);男性和女性收縮壓(Systolic Blood Pressure,SBP)變化40-65歲年齡組大于18-39歲年齡組(18-39歲年齡組男性和女性分別為6.45mmHg、8.52mmHg,40-65歲年齡組男性和女性分別為 8.94mmHg、11.21mmHg),舒張壓(Diastolic Blood Pressure,DBP)變化表現(xiàn)為男性18-39歲年齡組大于40-65歲年齡組(18-39歲年齡組為4.78mmHg,40-65歲年齡組為3.02mmHg),女性無(wú)明顯差異;18-39歲年齡組,WC和BMI變化男性大于女性,40-65歲年齡組,WC、WHtR、WHR及SBP變化女性大于男性;男性和女性18-39年齡組和40-65歲年齡組的DBP變化無(wú)明顯差異。2.WC變化與血壓變化相關(guān)系數(shù)總體趨勢(shì)為β 18-39年齡組β 40-65年齡組(男性中β 收縮壓、β舒張壓分別為0.27、0.11和0.20、0.19,女性中分別為0.28、0.09和0.18、0.14);18-39歲年齡組β收縮壓β舒張壓;β基線變化。WHtR變化與血壓變化相關(guān)系數(shù)總體趨勢(shì)為β18-39年齡組β40-65年齡組(男性中β收縮壓、β舒張壓分別為5.01、2.45和3.41、3.37,女性中分別為4.28、1.77和2.55、2.00);18-39歲年齡組β收縮壓β舒張壓,40-65歲年齡組β舒張壓β收縮壓;β基線β變化。WHR變化與血壓變化的相關(guān)系數(shù)總體趨勢(shì)為β18-39年齡組β40-65年齡組(男性中β收縮壓、β舒張壓分別為2.75、0.19和1.96、0.03,女性中分別為2.14、0.65和0.69、0.48);β收縮壓β舒張壓;β基線β變化。BMI變化與血壓變化的相關(guān)系數(shù)總體趨勢(shì)為β 18-39年齡組β 40-65年齡組(男性中β收縮壓、β舒張壓分別為0.46、1.92和0.49、1.16,女性中分別為0.55、1.41和0.37、0.79),18-39歲年齡組β基線β變化,40-65歲年齡組β基線β變化。3.Logistic回歸結(jié)果顯示,以WC變化的第一分位為參照,男性和女性18-39歲年齡組隨著分位數(shù)的增加,OR值也增加,高血壓的發(fā)病風(fēng)險(xiǎn)呈現(xiàn)逐漸增加的趨勢(shì)(P趨勢(shì)0.05),第四分位高血壓的發(fā)病風(fēng)險(xiǎn)顯著增加(18-39歲年齡組OR=2.56,95%CI:1.56-4.22,40-65 歲年齡組 OR=2.84,95%CI:1.77-4.57)。以WHtR變化、WHR變化、BMI變化第一分位為參照,男性和女性18-39歲年齡組和40-65歲年齡組隨著分位數(shù)的增加,OR值也相應(yīng)增加,高血壓的發(fā)病風(fēng)險(xiǎn)呈現(xiàn)逐漸增加的趨勢(shì)(P趨勢(shì)0.05),第四分位高血壓的發(fā)病風(fēng)險(xiǎn)顯著增加(18-39歲年齡組其 OR 值及 95%CI 分別為:OR=2.51,95%CI:1.52-4.16;OR=3.05,95%CI:1.77-5.25;OR=3.28,95%CI:1.92-5.59;40-65 歲年齡組 OR=2.89,95%CI:1.80-4.62;OR=1.93,95%CI:1.15-3.26;OR=3.26,5%CI:1.98-5.35)。4.男性18-39歲年齡組WC由正常變?yōu)橹行男头逝终逽BP和DBP的增加值大于兩次WC均正常者(SBP增加值分別為10.OmmHg和4.OmmHg,DBP增加值分別為8.OmmHg和3.3mmHg),而40-65歲年齡組兩者SBP和DBP的增加值無(wú)明顯差異。女性18-39歲年齡組和40-65歲年齡組WC由正常變?yōu)橹行男头逝终逽BP和DBP增加值大于兩次WC均正常者(18-39歲年齡組SBP增加值分別為11.OmmHg和6.2mmHg,DBP增加值分別為7.OmmHg和4.OmmHg;40-65歲年齡組SBP增加值分別為12.OmmHg和8.7mmHg,DBP增加值分別為5.3mmHg和2.OmmHg)。以1997年和2011年兩次測(cè)量WC均正常者為參照,男性和女性18-39歲年齡組(男性O(shè)R=2.90,95%CI:1.82-4.63;女性O(shè)R=2.69,95%CI:1.47-4.91;)和40-65歲年齡組(男性 OR=2.08,95%CI:1.13-3.80;女性 OR=2.05,95%CI:1.26-3.34;)由正常變?yōu)橹行男头逝终吒哐獕旱陌l(fā)病風(fēng)險(xiǎn)顯著增加。結(jié)論:1997年到2011年,我國(guó)18-65歲成年居民中心型肥胖評(píng)價(jià)指標(biāo)WC、WHtR、WHR的變化與SBP和DBP的變化存在正相關(guān)關(guān)系,18-39歲年齡組較40-65歲年齡組顯著,基線水平對(duì)血壓值的影響大于其變化;BMI的變化對(duì)血壓值的影響40-65歲年齡組較18-39歲年齡組顯著;WC、WHtR、WHR、BMI的基線水平及其變化與高血壓發(fā)病相關(guān),WC、WHtR、WHR、BMI的增加及中心型肥胖狀態(tài)的改變可增加高血壓的發(fā)病風(fēng)險(xiǎn)。本研究的結(jié)果提示,無(wú)論基線水平是否在正常范圍,均應(yīng)該主動(dòng)采取健康的生活方式控制肥胖指標(biāo)的增加,預(yù)防高血壓的發(fā)生。
[Abstract]:Background: the cause of hypertension is complex, which is the result of the combination of genetic and environmental factors. In addition to hereditary factors, the current recognized risk factors are irrational diet, overweight and obesity, lack of exercise, smoking, excessive drinking and so on. The commonly used indicators for obesity include Waist Circumference (WC), waist circumference height ratio (Waist-to-height ratio, WHtR), waist circumference ratio (Waist-to-hip ratio, WHR) and body mass index (Body Mass Index). The obesity index of the crowd is often in dynamic change, with previous obesity and hypertension The study of the relationship is mostly cross-sectional study. In a few related cohort studies, the main concern about the baseline obesity and the impact on the risk of hypertension and the lack of influence on the value of blood pressure has some limitations. The purpose of this study is to understand the waist circumference and waist circumference of central obesity in adult residents in China for 1997-2011 years. The effects of high ratio, waist to hip ratio and body weight index body mass index (BMI) on blood pressure and hypertension risk. Research contents and methods: This study used the Sino American cooperative project "China Health and Nutrition Survey" in 1997 and 2011 to carry out longitudinal analysis. The subjects included in the study were 2488 people. The subjects were divided into two groups according to age 18-39 and 40-65 years old. According to the sex stratification analysis, the changes of blood pressure, WC, WHtR, WHR, BMI were described for 1997-2011 years. The multilinear regression model was used to analyze the effects of WC, WHtR, WHR, BMI level and its changes on the blood pressure. After excluding the baseline hypertension, the Logistic regression model was used to analyze WC. The effects of WHtR, WHR, BMI and their changes on the risk of hypertension and the impact of the change in central obesity on the risk of hypertension. The two model controlled the subjects' education, baseline blood pressure, smoking, drinking, physical activity, fat supply ratio, and the intake of vegetables and fruits and sodium. Research results: 1. research subjects followed The value of WC, WHtR, WHR, BMI and blood pressure increased in 14 years. The 18-39 age groups of male WC, WHtR, WHR and BMI were larger than the age group of 40-65 years (18-39 year old group were 8.72cm, 0.05,0.05,1.94kg/m2,40-65 age group was 5.11cm, 0.03,0.03,0.89kg/m2), and there was no significant difference in the two age group. The 18-39 age group was more than 40-65 years old (age group of 18-39 years of age was 1.62kg/m2,40-65 age group 1.10kg/m2); male and female systolic blood pressure (Systolic Blood Pressure, SBP) was more than 18-39 years old age group (18-39 year old men and women were 6.45mmHg, 8.52mmHg, 40-65 age group male and female respectively, respectively. For 8.94mmHg, 11.21mmHg), the diastolic pressure (Diastolic Blood Pressure, DBP) in male 18-39 years old group is larger than 40-65 years old group (18-39 year old age group 4.78mmHg, 40-65 age group 3.02mmHg), there is no significant difference in women. 18-39 year old age group, WC and BMI changes men are more than women, WC, WHtR, WHtR, and changes. Women were more than men; there was no significant difference in the DBP changes between the 18-39 age group and the 40-65 year old age group. The general trend of the correlation coefficient of.2.WC and blood pressure was in the beta 40-65 age group of the group beta 18-39 (beta systolic pressure in male, 0.27,0.11 and 0.20,0.19 for beta diastolic pressure respectively, 0.28,0.09 and 0.18,0.14 in women, respectively); 18-39 year old year. Beta systolic pressure beta diastolic pressure in the age group; the general trend of.WHtR changes in beta baseline changes and blood pressure changes in beta 18-39 age group beta 40-65 age group (male beta systolic pressure, beta diastolic pressure 5.01,2.45 and 3.41,3.37 respectively, 4.28,1.77 and 2.55,2.00 in women, respectively); beta systolic pressure beta diastolic pressure in 18-39 year old age group and 40-65 year age group beta relaxation The general trend of the correlation coefficient of beta baseline beta change.WHR changes and blood pressure changes in beta 18-39 age group beta 40-65 age group (beta systolic pressure in male, 2.75,0.19 and 1.96,0.03 of beta diastolic pressure respectively, 2.14,0.65 and 0.69,0.48 in women, respectively); beta systolic pressure beta diastolic pressure, beta baseline beta change.BMI and blood pressure changes The total number trend was beta 40-65 age group (beta 18-39 age group, beta diastolic pressure 0.46,1.92 and 0.49,1.16 respectively, 0.55,1.41 and 0.37,0.79 in women respectively), beta baseline beta change in 18-39 year old age group, and.3.Logistic regression results of beta baseline beta of 40-65 years old age group, with the first division of WC change as reference. As the 18-39 year old age group increased, the OR value increased as the number of quantiles increased, and the risk of hypertension increased gradually (P trend 0.05). The risk of hypertension in fourth division was significantly increased (OR= 2.84,95%CI:1.77-4.57 in the age group of 18-39 years of age OR=2.56,95%CI:1.56-4.22,40-65). WHtR, WHR, BMI As a reference, the 18-39 year old age group and 40-65 year old age group increased the value of OR, and the risk of hypertension increased gradually (P trend 0.05), and the risk of hypertension in fourth division increased significantly (the value of OR and 95%CI in the 18-39 year old group were OR=2.51,95%CI:1.52-4., respectively, OR=2.51,95%CI:1.52-4. 16; OR=3.05,95%CI:1.77-5.25; OR=3.28,95%CI:1.92-5.59; 40-65 year old age group OR=2.89,95%CI:1.80-4.62; OR=1.93,95%CI:1.15-3.26; OR=3.26,5%CI:1.98-5.35).4. male 18-39 year old age group WC from normal to central obesity, the increase value of SBP and DBP is greater than that of two WC (SBP increase is 10.OmmHg and increase, respectively. The values of SBP and DBP in the 40-65 year old age group were not significantly different. The values of SBP and DBP in the 18-39 year old age group and the 40-65 year old group were higher than those of the two times WC (the 18-39 year old age group, the SBP increase value was divided into 11.OmmHg and 6.2mmHg, and the DBP increase value was respectively, " MHg and 4.OmmHg; the 40-65 year old age group SBP added values were 12.OmmHg and 8.7mmHg, DBP added values were 5.3mmHg and 2.OmmHg respectively. In 1997 and 2011, the two times measured WC were normal, male and female 18-39 year old age group (male OR=2.90,95%CI:1.82-4.63; female OR= 2.69,95%CI:1.47-4.91;) and 40-65 year old age group. %CI:1.13-3.80; female OR=2.05,95%CI:1.26-3.34;) the risk of hypertension increased significantly from normal to central obesity. Conclusion: from 1997 to 2011, the central obesity evaluation index of 18-65 year old adults in China, WC, WHtR, WHR, was positively correlated with the changes of SBP and DBP, and the age group of 18-39 years was more than 40-65 years old age group. The effect of baseline level on the value of blood pressure was greater than that of the change; the effect of BMI changes on the blood pressure was significantly higher in the 40-65 year old age group than in the 18-39 year old age group; the baseline levels of WC, WHtR, WHR, BMI were associated with hypertension, and the increase in WC, WHtR, WHR, BMI and central obesity could increase the risk of hypertension. The results suggest that no matter whether the baseline level is in the normal range, a healthy lifestyle should be taken to control the increase of the obesity index and prevent the occurrence of hypertension.

【學(xué)位授予單位】：中國(guó)疾病預(yù)防控制中心
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R589.2;R181.3

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