A comparative study on diagnostic cut points of dyslipidemia in children and adolescents in China / 中华流行病学杂志

To compare the power of dyslipidemia diagnosis by different sets of cut points in the prediction of cardiovascular metabolic risk factors and identify the appropriate cut points for the diagnosis of dyslipidemia in children and adolescents in China. Data were obtained from the baseline survey of 'School-based Cardiovascular and Bone Health Promotion Program' in Beijing in 2017. Dyslipidemia was diagnosed by using two set of cut points. Receiver operating characteristic curve analysis was conducted to assess the power of dyslipidemia diagnosis by the two set of cut points to predict the prevalence of hypertension, obesity, high fat mass percentage and impaired fasting glucose. A total of 14 390 children and adolescents were in included in the study. The prevalence rates of high TC, high LDL-C, low HDL-C, and high TG in the participants were 2.7, 2.7, 14.4, and 3.7 according to 'Chinese Reference Standard', and 5.0, 3.7, 13.3, and 3.5 according to 'China Expert Consensus'. Low HDL-C and high TG defined by the 'Chinese Reference Standard' had better performance for the prediction of high fat mass percentage and obesity in boys, but worse performance in girls (<0.001). Using 'China Reference Standard' can increase the true positive rate in the prediction of obesity or high fat mass percentage in boys, and reduce the false positive rate in girls. The cut points for the diagnosis of dyslipidemia in Chinese children and adolescents need to be further validated by using national representative sample and in longitudinal study.

Value of body fat mass measured by bioelectrical impedance analysis in predicting abnormal blood pressure and abnormal glucose metabolism in children / 中国当代儿科杂志

OBJECTIVE@#To study the value of body fat mass measured by bioelectrical impedance analysis (BIA) in predicting abnormal blood pressure and abnormal glucose metabolism in children.@*METHODS@#Stratified cluster sampling was used to select the students aged 6-16 years, and a questionnaire survey and physical examination were performed. The BIA apparatus was used to measure body fat mass. Body mass index (BMI), body fat mass index (FMI), and fat mass percentage (FMP) were calculated. Fasting blood glucose level were measured.@*RESULTS@#A total of 14 293 children were enrolled, among whom boys accounted for 49.89%. In boys and girls, the percentile values (P, P, P, P, P, P, P, P) of FMI and FMP fitted by the LMS method were taken as the cut-off values. Based on the receiver operating characteristic curve analysis, the P values with a better value in predicting abnormal blood pressure and blood glucose metabolism were selected as the cut-off values for excessive body fat. When FMI or FMP was controlled below P, the incidence of abnormal blood pressure or abnormal glucose metabolism may be decreased in 8.25%-43.24% of the children.@*CONCLUSIONS@#The evaluation of obesity based on FMI and FMP has a certain value in screening for hypertension and hyperglycemia in children, which can be further verified in the future prevention and treatment of obesity and related chronic diseases in children.

Prevalence of nonalcoholic fatty liver disease and metabolic abnormalities in 387 obese children and adolescents in Beijing, China / 中华流行病学杂志

<p><b>OBJECTIVE</b>To determine the prevalence of nonalcoholic fatty liver disease (NAFLD) and metabolic abnormalities in obese children and adolescents in Beijing.</p><p><b>METHODS</b>This study involved 387 obese children and adolescents, aged 12 to 17 years in Beijing. Data on anthropometric measurements was collected, including weight, height and age. All subjects underwent a clinic examination containing fasting blood and liver ultrasonography. Nonalcoholic fatty liver disease was diagnosed using diagnostic criteria for nonalcoholic fatty liver disease which was recommended by the Fatty liver and Alcoholic Liver Disease Study Group of Liver Disease Association in China.</p><p><b>RESULTS</b>174 out of the 387 children were diagnosed as having NAFLD. The overall prevalence of NAFLD was 45.0% in this study population. The prevalence rates of NAFLD did not show significant difference between girls and boys. The prevalence rates of diabetes mellitus and IFG were 0.8% and 49.1% respectively. The prevalence rates of HTG, HTC, HLDL-C, LHDL-C, IFG, elevated ALT (or AST) and acanthosis nigricans were 6.3%, 4.0%, 37.9%, 22.8%, 46.0%, 17.8% and 28.5% in students combined with obesity and NAFLD, respectively. In the NAFLD subgroup, higher prevalence of high TG, acanthosis nigricans, abnormal ALT or AST were seen. With the increasing of obesity, the level of LDL-C, TG, liver function disturbance and prevalence of NAFLD and acanthosis nigricans were aggravated. Under binary logistic regression analysis, results showed that high BMI, acanthosis nigricans and TG were significantly correlated with NAFLD in obese children and adolescent population.</p><p><b>CONCLUSION</b>NAFLD was common in obese children, and the prevalence of NAFLD in obese children was 45.0%. Higher BMI, acanthosis nigricans and abnormal TG were independent risk factors for NAFLD in obese children. Obese children who had been exposed to high risk factors should take the ultrasonography.</p>

Waist circumference reference values in Beijing versus the national values in detecting cardiovascular risk factors in 7-18 years old children / 中华预防医学杂志

<p><b>OBJECTIVE</b>To compare the optimal references of waist circumference (WC) between Beijing and China in detecting cardiovascular risk factors in school-age children.</p><p><b>METHODS</b>Percentile curves for WC were drawn by sex using LMS method based on 21 787 children and adolescents aged 7 - 18 from Beijing Child and Adolescent Metabolic Syndrome Study. The 75(th) and the 90(th) percentiles by age and by gender of WC percentile curves were chosen as the optimal WC reference for 3 - 18 years old children and adolescents in Beijing. The sensitivities (Se) and specificities (Sp) were compared between Beijing and China WC references based on the evaluation of cardiovascular risk factors including hypertension, dyslipidemia, impaired fasting glucose and non-alcoholic fatty liver disease (NAFLD) in the test population being composed of 4927 school children aged 7 - 18 years. The predictive values for those cardiovascular risk factors were compared between the two optimal thresholds through comparison of the odds ratio (OR) in regression analysis.</p><p><b>RESULTS</b>The optimal reference for Beijing children and adolescents aged 3 - 18 years ranged from 51.8 to 78.2 cm for the 75(th) percentile in boys and 50.8 to 72.1 cm in girls, and the 90(th) percentile increased from 54.0 to 86.0 cm in boys and 53.3 to 77.3 cm in girls. The Ses of Beijing and China WC references in detecting hypertension were 0.74 and 0.82 in boys and 0.68 and 0.73 in girls; the Ses were 0.69 and 0.80 in detecting low-high density lipoprotein in boys and 0.64 and 0.71 in girls; and they were 0.98 and 1.00 in boys and both were 0.93 in girls for NAFLD. The Sps of Beijing and China WC references in screening hypertension were 0.62 and 0.53 in boys and 0.68 and 0.63 in girls, respectively. In predicting low-high density lipoprotein, the Sps were 0.59 and 0.50 in boys and 0.66 and 0.61 in girls, the Sps were 0.60 and 0.50 in boys and 0.56 and 0.51 in girls for predicting NAFLD. After adjustment for age and gender, ORs and their 95% credibility intervals (CI) of the 90(th) WC percentiles of Beijing and China school children were 6.3 (5.2 - 7.7) and 6.0 (4.9 - 7.4) in predicting hypertension. Both predictive ORs and their 95%CIs were 1.3 (1.1 - 1.5) in predicting impaired fasting glucose and the both were 2.9 (2.5 - 3.4) for dyslipidemia. In predicting NAFLD the ORs and their 95%CIs were 49.1 (12.0 - 201.6) and 69.8 (9.7 - 504.2) for Beijing and China WC optimal references, separately.</p><p><b>CONCLUSION</b>Compared with Chinese WC reference, WC reference of Beijing had high Sps in screening cardiovascular risk factors in 7 - 18 years old children. The predictive values were not significant different between Beijing and China WC references for almost all cardiovascular risk factors except NAFLD. The WC reference in Beijing was more practical and handy for reference in Beijing and other north developed metropolises.</p>

Familial clustering of obesity and the role of lifestyle factors among children in Beijing / 中华预防医学杂志

<p><b>OBJECTIVE</b>To investigate the correlation between lifestyle factors, parental obesity and adiposity in children, in order to provide theoretical evidence for public health policy establishment.</p><p><b>METHODS</b>A cross-sectional observation study was conducted among approximately 20 thousand children aged 2 - 18 years old in urban and rural regions of Beijing, by using stratified randomization clustering sampling methods. Familial environmental risk factors of children adiposity and parental obesity were assessed with standardized questionnaire. Anthropometric measurements, including height and weight, were conducted. SPSS 13.0 software was applied to analyze the data, including general description, chi(2) trend test and non-condition logistic analyse.</p><p><b>RESULTS</b>With IOTF obesity references, the prevalence of obesity in 21,198 children aged 2 - 18 years old was 5.6%. The behavioral characters (for example, smoking and drinking) and children obesity showed significant familial aggregation. In groups including "both parents not smoke", "only one parent smoke" and "both parents smoke", the smoking rates of offsprings were 1.50%, 2.93% and 6.01%, respectively (chi(trend)(2) = 107.009, P < 0.01). A similar pattern was found for offsprings' alcohol consumption rates (5.85%, 9.12% and 13.96%; chi(trend)(2) = 107.009, P < 0.01). Based on parents' BMI status, in groups including "both parents had normal weight", "father was obese", "mother was obese" and "both parents were obese", the prevalence of obesity in children were 3.29%, 11.48%, 9.12% and 27.01%, respectively (chi(trend)(2) = 293.404, P < 0.01). After controlling for sex and ages, factors such as physical exercises, sleeping times per day, fat intakes, watching TV, drinking alcohol were impact factors of children obesity. After controlling of confounding factors, such as children gender, age, birth weight, puberty, smoking history, drinking history, fat intakes, soft drink, physical exercises, education experiences of parents, smoking history, drinking history, family income and so on, maternal obesity had a greater influence on daughters than on sons (OR = 5.93, 95% CI: 3.57 - 9.84), and paternal obesity showed similar influence on sons (OR = 4.29, 95% CI: 3.21 - 5.72). Comparing to parents with normal weight, obese parents had more powerful impact on daughters (OR = 28.51, 95% CI: 15.13 - 53.72) than on sons (OR = 7.21, 95% CI: 4.07 - 12.75), regarding to 2 - 5 years group and 10 - 12 years group versus other age group (OR = 18.67, 95% CI: 1.49 - 234.46; OR = 22.25, 95% CI: 10.62 - 46.59).</p><p><b>CONCLUSION</b>Parental obesity is an independent risk factor of adiposity in children; gender and age affect this association. The lifestyle patterns of parents should have great impact on children. When prevention or intervention with children obesity, familial environmental factors should be emphasized.</p>

Effect of blood pressure status changes from childhood to adulthood on hypertension related cardiac-renal function in adulthood / 中华儿科杂志

<p><b>OBJECTIVE</b>To assess the effect of blood pressure (BP) changes from childhood to adulthood on hypertension related cardiac and renal function in adulthood.</p><p><b>METHODS</b>The "Beijing children and adolescents BP study cohort" consists of 2505 subjects 6-18 years of age who were enrolled in the baseline BP investigation in 1987. Among them, 412 individuals aged 23-37 years were successfully followed up in 2005. In this study, clinical examinations and questionnaire survey about risk factors of cardiovascular disease (CVD) were carried out.</p><p><b>RESULTS</b>Among 412 adults, the prevalence rate of hypertension was 14.8% (61/412); 83.6% of persons with hypertension were overweight or had obesity. Hypertension related cardiac and renal functional abnormalities were relatively common (72.1%) clinical signs among this adult population. With BP level elevation, cardiac and renal functions damage became more severe. The morbidity of cardiac and renal functional abnormalities in those who were hypertensive in childhood and were not hypertensive in adulthood was similar to those who were not hypertensive at both times. The morbidity of microalbuminuria and abnormalities in electrocardiogram (ECG) were higher in those who were hypertensive at both times than those who had appropriate BP levels in childhood and became hypertensive in adulthood. Adjusted for age, gender, BMI and body surface area (BSA) during adulthood, the left ventricular end-diastolic dimension (LVd), the left ventricular mass (LVM), the intraventricular septal thickness (IVST), the left ventricular posterior wall thickness (LVPWT) in the group of hypertension were higher than that in the group which was not hypertensive, and the ejection fraction (EF) was lower in the group of hypertension in adulthood. The LVd, LVM, IVST, LVPWT and EF in those who were hypertensive in childhood and were not hypertensive in adulthood were similar to those who were not hypertensive at both times. Logistic regression analysis showed that persons who were hypertensive in childhood and remained so during adulthood were at an increased risk of cardiac and renal functional damage (OR = 4.072, 95% CI = 1.472 - 11.266). Those who were hypertensive in childhood and became normotensive in adulthood did not have significant abnormalities in cardiac and renal functions (OR = 1.086, 95% CI = 0.514 - 2.298, chi2 = 0.047, P = 0.828).</p><p><b>CONCLUSION</b>Persons who were hypertensive at both times were at an increased risk of cardiac and renal function damage. Those who were hypertensive in childhood and became normotensive in adulthood did not have significant abnormalities in cardiac and renal functions. Thus prevention and control of hypertension in children and adolescents may have important beneficial effects on prevention of CVD in adulthood.</p>

Family aggregation of primary hypertension among children and adolescents in Beijing / 中华流行病学杂志

Objective To explore the association between histories of hypertension in parents and level of blood pressure in their children so as to provide strategy for early intervention. Methods 19 088 children aged 6-17 years were selected in Beijing with stratified random cluster sampling method,and data on influencing factors including parental history of hypertension and other related environmental factors were collected.Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were examined.SPSS 13.0 was used for data analyses.Results The average prevalence of high blood pressure in children and adolescents was 9.13%based on the blood pressure criteria Beijing Children and Adolescents Metabolic Syndrome (BCAMS) set in 2004.Familial aggregation of hypertension in children and adolescents was observed (P＜0.001).There were positive associations between the numbers of parents with history of hypertension and both SBP and DBP of their offspring.Partial regression coefficients appeared to be 0.980 (95%CI:0.524-1.437) and 0.832 (95%CI:0.463-1.201) respectively,after controlling for con founding variables including gender,age,residential regions,body mass index (BMI),pubertal development,histories of smoking and drinking alcohol,fat intakes,physical exercises,parents' education level etc.Results from multiple factor logistic regression analysis showed that when compared with children whose parents did not have hypertension,the odds ratios of children having high blood pressure with only paternal history,only maternal history or with both parental histories were 1.688 (1.385-2.059),1.559 (1.164-2.087) and 1.273 (0.673-2.406),respectively,after adjustment for confounding factors.Conclusion Parental history of hypertension seemed to be an important independent risk factor for high blood pressure to their offspring.Heredity factors should be emphasized in the development of prevention and intervention on hypertension in children and adolescents.

Blood pressure of children and adolescents in Beijing / 中华儿科杂志

<p><b>OBJECTIVE</b>Hypertension is one of the most common disorders in adults. Although it may be already present in children and adolescents, it does not often have clinical pictures. There is a lack of data on the blood pressure in children in Beijing area. This study was conducted to investigate the present situation of blood pressure of children and adolescents in Beijing area.</p><p><b>METHODS</b>Children and adolescents aged 3 to 18 years in 4 urban and 3 rural areas of Beijing were involved in the study at random. Blood pressure (BP) was measured three times with the use of mercury sphygmomanometery, and the means of the last two BP value were recorded. Systolic BP (SBP) was determined by the first Korotkoff sound, and diastolic BP (DBP) by the fourth Korotkoff sound.</p><p><b>RESULTS</b>Altogether, 20 780 (99.6%) individuals with complete records were studied, including 10 582 from urban and 10 198 from rural areas; 10 398 were males and 10 382 were females. BP of boys was higher than that of girls [SBP: (106 +/- 12) mm Hg vs. (101 +/- 11) mm Hg, u = 27.14, P < 0.01; DBP: (67 +/- 9) mm Hg vs. (65 +/- 8) mm Hg, u = 14.14, P < 0.01]. BP of both boys and girls increased with age. However, SBP had a larger magnitude of increase than that of DBP. Both SBP and DBP of urban children were lower than those of rural children [SBP: (103 +/- 12) mm Hg vs. (104 +/- 12) mm Hg, u = 2.55, P < 0.05; DBP: (66 +/- 8) mm Hg vs. (67 +/- 9) mm Hg, u = 6.73, P < 0.01]. There was a positive correlation between BP and age, height, weight and BMI. SBP had a stronger relationship with each variable than DBP did. Among children aged 6 - 18 years, about 8.1% were found to have hypertension according to the criteria of blood pressure of children and adolescents by age and by gender of 1987 in Beijing.</p><p><b>CONCLUSIONS</b>The present study provided with the current information and characteristics of blood pressure of children and adolescents in Beijing area. The blood pressure was correlated with sex, age, body height, body weight and BMI of children and adolescents.</p>

Metabolic syndrome in overweight and obese schoolchildren in Beijing / 中华儿科杂志

<p><b>OBJECTIVE</b>To determine the prevalence and clinical phenotype of metabolic syndrome among overweight and obese schoolchildren in Beijing, and to compare the rates of diagnosis made according to the criteria of the National Cholesterol Education Program (NCEP) of the United States and International Diabetes Federation (IDF).</p><p><b>METHODS</b>Based on Beijing Child and Adolescent Metabolic Syndrome (BCAMS) study with body mass index (BMI), waist circumference (WC) and blood pressure measured, the overweight and obese children were screened among nearly 20 000 children 6-18 years of age in Beijing by Chinese BMI cutoffs for schoolchildren (7-18 years) and the US 2000 CDC Growth Charts--the 85th and 95th percentile (6 years) and were enrolled as the study population. Simultaneously a group of children with normal BMI were selected as the control group and based on the international method of age grouping, each of the above groups was divided further into 4 sub-groups in terms of age: 6-9, 10-12, 13-15 and 16-18 years old, respectively. Fasting plasma glucose (FPG) and insulin (FINS), serum high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG) were examined. HOMA-IR index was calculated for estimating individual insulin resistance. A child who met any three or more of the following five criteria, according to NCEP definition, was diagnosed as MS. A diagnosis of MS using IDF definition required abdominal obesity plus any two or more of the other four criteria: (1) abnormal obesity: WC > or = P(90); (2) elevated BPs: SBP/DBP > or = P(90); (3) low HDL-C: HDL-C < 1.03 mmol/L (40 mg/dl); (4) high TG: TG > or = 1.24 mmol/L (110 mg/dl); (5) impaired fasting glucose (IFG): FPG > or = 5.6 mmol/L (100 mg/dl).</p><p><b>RESULTS</b>The prevalence rates of MS by NCEP definition were: 0.9%, 7.6% and 29.8% in the normal weight (control group), overweight and obese children, respectively, which were higher than the rates diagnosed by IDF definition with 0.1%, 5.2% and 28.6% in the three groups. The prevalence rates of individual MS component among obese children were: 81.6% for abnormal obesity, 47.7% for elevated BPs, 35.6% for high TG, 16.9% for low HDL-C, and 13.4% for IFG. Elevated BPs (29.8%), abnormal obesity (27.4%) and high TG (26.0%) were the leading three abnormalities among overweight children. With the increase of BMI, the clustering of MS components and insulin resistance (HOMA-IR) were remarkably increased. HOMA-IR significantly increased as the number of MS component increased.</p><p><b>CONCLUSIONS</b>MS has been in an epidemic status among the obese schoolchildren in Beijing. Abnormal obesity, elevated BPs and high TG were the three most common metabolic abnormalities for overweight and obese children. The prevalence rates of MS by NCEP definition in the present study was higher than those diagnosed by using IDF definition.</p>

The relationship between serum leptin level and metabolic syndrome among a middle-aged Chinese population / 中华预防医学杂志

<p><b>OBJECTIVE</b>To explore the relationship between serum level of leptin and the components of metabolic syndrome in a group of mid-aged Chinese population.</p><p><b>METHODS</b>345 adults (184 men and 161 women) aged 46 - 53 were enrolled from Fetal Origin of Adult Disease (FOAD) cohort to participate the clinic examination including anthropometry, measurements of blood pressure, fasting and 2 hr plasma levels of glucose and insulin, serum levels of lipid and leptin. HOMA-IR index was calculated to estimate individual insulin resistance. Metabolic syndrome (MS) was diagnosed according to the definition criteria issued by the International Diabetes Federation (IDF) in 2005.</p><p><b>RESULTS</b>The prevalences of central obesity, higher serum level of triglyceride (TG), lower serum level of high-density lipoprotein (HDL-C), IFG, higher blood pressure and MS were 53.0%, 47.5%, 34.2%, 26.7%, 33.9%, 31.9% in this mid-aged population, respectively. Serum geometric mean level of leptin was higher in females than in males. Serum level of leptin increased with the prevalence of MS and components of abnormal metabolism. The serum level of leptin compared with central obesity, higher blood pressure, higher serum level of triglyceride (TG), lower serum level of high-density lipoprotein cholesterol (HDL-C), IFG and MS was significantly higher respectively (P < 0.05) without HDL-C in males. The serum level of leptin increased with the number of components of abnormal metabolism subjects had (P < 0.001).</p><p><b>CONCLUSION</b>The serum level of leptin in this population is significantly associated with MS and components of MS. Hyperleptinemia could be a new component of metabolic syndrome. It might be a target in selection of MS and relative diseases.</p>

The prevalence of diabetes in children and adolescents of Beijing / 中华流行病学杂志

<p><b>OBJECTIVE</b>To study the prevalence of Diabetes mellitus (DM) in children and adolescents and to describe the characteristics on age, gender and district distribution of schoolchildren, in Beijing.</p><p><b>METHODS</b>A cross-sectional screening program the fasting capillary blood glucose (FCBG) was carried out in 19,593 schoolchildren in 7 areas of Beijing from March to October, 2004. According to the WHO diagnostic criteria: DM was set as FCBG < or = 6.1 mmol/L, impaired fasting glucose (IFG) was set as 5.6 mmol/L < or = FCBG < 6.1 mmol/L.</p><p><b>RESULTS</b>The total aggregate age-adjusted prevalence rates of DM and IFG were 5.7 per thousand and 13.5 per thousand, respectively. The prevalence rates of DM and IFG in males were significantly higher than that in females (7.7 per thousand vs. 3.6 per thousand and 26.8 per thousand vs. 11.3 per thousand. DM X2 = 12.27, P = 0.0005; IFG X2 =47.29, P = 0.0000). Among seven districts, East District had the highest prevalence rates of DM and IFG, 8.9 per thousand and 27.4 per thousand (companied high obesity 28.68%) while Ping-Gu District having the lowest ones as 2.0 per thousand and 7.5 per thousand (obese 12.75%) respectively (X2 = 13.75, and X2 = 32.65, P = 0.0002 and P < 0.0001). The DM prevalence rates between districts ranged from 2.0 per thousand to 8.9 per thousand, X2 = 18.94, P = 0.004 and the IFG prevalence of districts ranged from 7.5 per thousand to 27.4 per thousand (X2 = 52.05, P < 0.0001). The prevalence rates of DM among different age groups increased with age, with the highest prevalence of IFG on the 10-14 age group. Among boys, the highest prevalence rates of DM and IFG fell in the 15-18 and 10-14 age groups respectively while the highest prevalence rates on both DM and IFG among girls were in the same age group 10-14.</p><p><b>CONCLUSION</b>The high prevalence rates on DM and IFG were seen in Beijing and showed significant discrimination on age, gender and district distribution. More developed urban district and males had a higher prevalence, companied by higher obesity prevalence. Age seemed to be a high risk factor on DM for boys while the puberty development seemed a high risk factor for girls.</p>

Impact of early menarche on adiposity during late puberty and mid-life / 中华流行病学杂志

<p><b>OBJECTIVE</b>To evaluate the impact of menarche age (MA) on obese status in late puberty (LP) and mid-life (ML) females.</p><p><b>METHODS</b>2035 girls aged 16 to 18 years were selected from a Beijing Child and Adolescent Metabolic Syndrome (BCAMS) study, which was performed from April to October in 2004, as the LP study population. 479 women aged 41 to 52 years were from the Fetal Origin of Adult Disease (FOAD) cohort, which established in 1995 to 2001, as the ML study population. Based on the 25 and 75 percentile of MA of each population, all subjects of LP and ML were divided into early, middle, and late matured groups, respectively. Overweight and obesity were defined by Chinese age-, gender-specific BMI criteria for LP girls, and Chinese BMI criteria for ML women while central obesity was defined by the waist-to-height ratio (WHtR) cutoff of 0.5. Multiple linear regression was used to explore the associations between MA and BMI, waist circumference (WC) and WHtR. The impact of early menarche on obese status in late life was estimated by odds ratio (OR) using logistic regression analyses.</p><p><b>RESULTS</b>The prevalence of overweight and obesity increased with the decrease of MA in both LP and ML population. When MA had a one-year advance, a 0.58 kg/m2 increase in BMI and a 1.1 cm increase in WC during LP, and a 0.35 kg/m2 increase in BMI and a 0.6 cm increase in WC during ML were observed. After adjustment for age, residence area and life style related variables, those who experienced earlier menarche were at higher risk of suffering from obesity in LP (OR :8.740, 95% CI: 3.653-20.911) and during ML (2.498, 1.145-5.453) when compared to those with later menarche. We also noticed that the risk increased for central obesity [LP: 14.280 (3.223-63. 267), ML: 15.604 (1.821-133.679)].</p><p><b>CONCLUSION</b>Menarche age appeared to be an independent predictor for obese status in LP and ML among women.</p>

Prevalence of overweight and obesity among children and adolescents in Beijing in 2004 / 中华流行病学杂志

<p><b>OBJECTIVE</b>To determine the current prevalence of overweight and obesity among children and adolescents (2-18 years) in Beijing and its distribution by age, gender and urban-rural residence.</p><p><b>METHODS</b>As part of the Beijing Child and Adolescent Metabolic Syndrome Study, a stratified cluster representative sample of 23,422 children aged 0-18 years was selected. Anthropometric measures including weight and height were collected from 21,198 subjects aged 2-18 years from April to October in 2004. Overweight and obesity were defined according to body mass index [BMI, weight(kg)/height(m2)] cutpoints. For national and international comparisons, three sex-age-specific BMI criteria were used:1) The BMI cutoffs recommended by the Chinese Working Group on Obesity for Children (WGOC) aged 7-18 years; 2) The US 2000 CDC Growth Charts (CDC 2000) frac 34, the 85th and 95th percentiles; 3) The International Obesity Task Force (IOTF) reference.</p><p><b>RESULTS</b>The overall combined prevalence of overweight and obesity was 18.6% with obesity as 8.1% based on the CDC 2000 criteria, The figures were 17.4% and 5.1% based on the IOTF criteria. According to the WGOC criteria, the combined prevalence of obesity was 20.9% and 8.9% in children aged 7-18 years. The combined prevalence was higher in school-age children (6-18 years) than in preschool-age children (19.8% vs. 14.8%, based on the CDC 2000 criteria). Among school-age children, the prevalence was higher in boys than in girls (26.7% vs. 16.5%), in urban than in rural areas (27.0% vs. 15.9%). However, these differences were not observed in preschool-age children. It was estimated that approximately 450 000 children from 2 through 18 years of age,were overweight or obesity in Beijing.</p><p><b>CONCLUSION</b>Data from our study indicated that one fifth of the children and adolescents in Beijing were under overweight or obesity situation which was the highest in the nation. Obesity among children and adolescents in Beijing had already become a serious public health problem which deserved greater attention.</p>

Polymorphisms of exon 17 of insulin-receptor gene in pathogenesis of human disorders with insulin resistance / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To investigate the relationship between polymorphisms of insulin-receptor (INSR) gene and insulin resistance in a population-based study in China.</p><p><b>METHODS</b>Polymerase Chain Reaction (PCR) was used to the amplify Exon 17 of INSR gene and all amplified products were analyzed by direct sequencing.</p><p><b>RESULTS</b>Six single-nucleotide polymorphisms (SNPs) were found at the following loci: T to TC at the locus of 10699 (Tyr(984)), G to GC at the locus of 10731 (Glu(994)), Deletion G at the locus of 10798 (Asp(1017)), C to T/TC at the locus of 10923 (His(1058)), C to CA at the locus of 10954 (Leu(1069)), and T to TA at the locus of 10961 (Phe(1071)), which might not change the amino acid sequence. The data were in agreement with the test of Hardy-Weinberg balance (P > 0.05). Among the 345 cases, all clinical indices were higher in males than in females except for HDL cholesterol (P < 0.05). The proportion of insulin resistance in males (64.4%) was higher than that in females (35.6%, OR = 1.83). It implied that the relative risk of developing insulin resistance in males was 1.83 times as high as that in females. The biochemical indices in different loci on Exon 17 showed that the individuals with deletion G on the locus of 10798 had lower TG (P = 0.052) and higher HDL (P = 0.027) than those without deletion G on the same site. Homa-Index was lower in those with deletion G than in those without deletion G (P > 0.05). After sex stratification in analysis, all allele frequencies on the six loci of SNPs of Exon 17 had different distributions between the insulin resistant group and the control group, but P > 0.05.</p><p><b>CONCLUSION</b>SNPs of Exon 17 of INSR gene are unlikely to play a direct role in the pathogenesis of human disorders with insulin resistance.</p>

Ponderal index at birth predicts metabolic syndrome in mid-aged Chinese / 中华预防医学杂志

<p><b>OBJECTIVE</b>To examine the association between Ponderal index (PI) at birth and metabolic syndrome during middle age.</p><p><b>METHODS</b>Totally, 975 adults (494 men and 481 women) aged 41-52 from the study cohort of Fetal Origin of Adult Disease were recruited in the study for clinic examinations, involving anthropometry and measurements of blood pressure, fasting and 2 hr plasma levels of glucose and insulin, serum lipid profile. Their HOMA-insulin resistance (IR) index was estimated. Metabolic syndrome (MS) was diagnosed according to 1999 WHO definition. Multivariate logistic regression analysis was used to estimate the effect of PI on MS and the interaction between PI at birth and body mass index (BMI) in adulthood.</p><p><b>RESULTS</b>Prevalence of MS was 18.7% in this mid-aged population, 24.8%, 19.4%, 16.3% and 14.0% in those with less than the 25th percentile, the 25th to less than the 50th percentile, the 50th to less than the 75th percentile and more than 75th percentile of PI at birth, respectively, in a decreasing trend (chi2 M-H for trend=9.938 adjusted for gender, P=0.002). Logistic regression analysis showed that both PI at birth and BMI during adulthood could influence their occurrence of MS (beta=-0.125, P=0.002, for PI; and beta=0.430, P=0.000, for BMI). A synergistic effect between PI at birth and BMI in adulthood was observed in this population. Persons who were thin at birth with PI less than the 25th percentile, and became overweight with BMI greater than or equal to 24 kg/m2 later in their life, were at higher risk of suffering from metabolic syndrome (OR=29.1, 95% CI=13.6-62.1), in comparison with those who became overweight during adulthood from a higher PI at birth (OR=16.0, 95% CI=7.9-32.3) and those who were thin at birth and remained a appropriate BMI during their adulthood (OR=2.0, 95% CI=0.7-5.7). Attributable fraction of the interaction to MS was 34.6%.</p><p><b>CONCLUSIONS</b>Thin at birth was a predictor for later occurrence of metabolic syndrome, as well as an effect modifier for the association between of later BMI and metabolic syndrome, i.e., overweight later in his life was most deleterious for a person with growth retardation at birth.</p>

Relationship between Obesity Phenotypes and Adipocytokines in Children / 实用儿科临床杂志

Objective To explore the relationship between obesity phenotypes and adipocytokines in children.Methods Based on the Beijing child and adolescent metabolic syndrome (BCAMS) study,3 508 children (1 788 boys and 1 720 girls) aged 6-18 were recruited.In this study,participants were categorized into four groups:226 cases in general obese group,192 cases in abdominal obese group,1 004 cases in combined obese group and 2 086 cases in non-obese group,according to the sex,age,specific body mass index(BMI),and waist circumference (WC) equal to or greater than the 90th percentile for age and gender of school children in Beijing in 2004.The levels of plasma insulin,serum leptin,resistin and adiponectin were measured by sensitive,specific double-antibody sandwich enzyme-linked immunosorbent assays (ELISA).Analysis of covariance,multivariate linear regression and binary logistic regression analysis were performed.Results There were highest plasma insulin and serum leptin,and lowest adiponectin levels in combined obese group than those in other obese groups and non-obese group and resistin level in abdominal obese group was highest than those in other obese groups or non-obese group.Among subjects with general obesity and conbined obesity,WC was more important factor than BMI for plasma insulin[?(WC)=0.158 P0.05].With covariates adjusted,the odds ratios(OR)and 95% confidence intervals of general obesity,abdominal obesity and combined obesity were 3.46(2.44-4.91),5.41(3.87-7.57) and 10.10(8.26-12.35) for predicting hyperinsulinemia,respectively,5.83(4.02-8.45),7.07(4.97-10.05)and 20.82(16.49-26.28) for hyperleptinaemia,respectively,1.47(1.05-2.07),2.0(1.42-2.80) and 2.66(2.23-3.18) for hypoadiponectinaemia,respectively.Serum resistin was highest in abdominal obesity.Conclusion The levels of adipocytokines in children were correlated with the phenotypes of obesity,especially for abdominal obesity.

Study on the relationship between polymorphism of insulin-receptor gene EXON2-2257 and insulin resistance in Chinese people / 中华流行病学杂志

<p><b>OBJECTIVE</b>To understand the role of insulin-receptor gene in the development of insulin resistance on a population-based study in China.</p><p><b>METHODS</b>Polymerase chain reaction (PCR) was used to amplify the EXON2 of the insulin-receptor gene and all amplified products were analyzed by direct sequencing.</p><p><b>RESULTS</b>Three genotypes of single nucleotide at the site of 2257 in EXON2 of the insulin-receptor gene were identified. In 237 of the 345 cases (68.7%), homozygote genotype of CC phenotype was found with a gene frequency of 0.825; 13 cases (3.77%) showed homozygote genotype of TT phenotype with a gene frequency of 0.175 and the rest 95 cases (27.54%) showed heterozygote genotype of CT phenotype. Data were in agreement with the test of Hardy-Weinberg balance (chi(2) = 0.2898, upsilon = 3 - 2 = 1, 0.5 < P < 0.75). The serum level of triglyceride and the HOMA-IR index, the status of insulin resistance assessed by homeostasis model assessment (HOMA), were lower in the TT or CT genotype group than that in the CC genotype group (P < 0.05). Comparing with CC genotype, the proportion of CT genotype (18.4%) in the insulin resistance group (large than 75th percentile of HOMA-IR) was significantly lower than that in the control group (30.6%) (P = 0.022, OR = 0.493). The proportion of TT genotype (2.3%) in insulin resistance group was lower than that in the control group (4.3%, P = 0.297). logistic analysis revealed that after adjusting possible confounding factors such as taking anti-hypertensive and anti-diabetic medications, serum triglyceride and high density lipoprotein cholesterol (HDL-C), hypertension, BMI, smoking history, the OR value of people in the insulin resistance group with CT genotype was 0.448 (95% CI: 0.214 to 0.940) compared to the group with CC genotype.</p><p><b>CONCLUSION</b>The hybridization CT genotype at the site of 2257 in EXON2 of insulin-receptor gene might have a candidate gene to serve as a protective factor for insulin resistance.</p>

Prevalence of vitamin A deficiency in children under six years of age in Tibet, China / 中华预防医学杂志

<p><b>OBJECTIVE</b>To understand the prevalence of vitamin A deficiency (VAD) among children under six years of age in Tibet, China.</p><p><b>METHODS</b>Totally, 1 257 children under six years of age were selected from two cities, two farming counties, two semi-farming counties and two livestock farming counties with stratified cluster sampling to asses VAD status in Tibet. Family information, children's feeding and disease history in the previous two weeks were collected by questionnaire. Blood specimen was collected from each child and serum was separated for detection of vitamin A concentration with microfluorescent spectrophotometry.</p><p><b>RESULTS</b>Totally, 1 257 children under six years of age were surveyed, with 635 boys, 622 girls, 862 aged over two years, and 98.5% of Tibet nationality. Six cases of night blindness and two cases of xerophthalmia were detected from them, with prevalence of clinical VAD of 0.96%. Eighteen of 1071 mothers with children under six years of age were found suffering from night blindness, accounting for 1.7%. Clinical cases of VAD both in children and mothers came from all four sampling strata. Average serum concentration of vitamin A and prevalence of subclinical VAD (serum vitamin A lower than or equal to 0.70 micromol/L) was 1.15 micromol/L and 5.4% and 1.12 micromol/L and 4.7% in cities and livestock farming counties, respectively, significantly higher than those in farming (1.04 micromol/L and 11.0%) and semi-farming counties (1.05 micromol/L and 12.3%), respectively, as compared to average levels of 1.09 micromol/L and 8.4% in the autonomous region as a whole. Prevalence of subclinical VAD in children under six months and those aged six to eleven months were 22.2% and 13.3%, respectively, significantly higher than those in children aged one year (8.5%), two to three years (5.4%) and four to five years (7.9%), respectively. There was also significant difference in serum level of vitamin A between children at varied ages, but no significant difference both in serum level of vitamin A and prevalence of subclinical VAD between gender was found.</p><p><b>CONCLUSIONS</b>In general, status of VAD in children of Tibet was milder than that at national level. But, moderate subclinical VAD in some areas, such as farming and semi-farming counties, did exist, so vitamin A supplementation aiming to children, especially those under one year of age, in those areas should be urged.</p>