Cardiovascular disease risk in healthy children and its association with body mass index: systematic review and meta-analysis.
Cardiovascular disease risk in healthy children and its association with body mass index: systematic review and meta-analysis.
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DOI：
10.1136/bmj.e4759
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发表时间：
2012-09-25
期刊：
影响因子：
--
通讯作者：
Ward AM
中科院分区：
文献类型：
--
作者：
Friedemann C;Heneghan C;Mahtani K;Thompson M;Perera R;Ward AM
目的 描述高度发达国家学龄儿童体重指数类别、性别和心血管疾病风险参数之间的关联及其大小。 设计系统回顾和荟萃分析。纳入研究的质量通过 Cochrane 协作组织偏倚风险评估工具的改编版本进行评估。荟萃分析中纳入的研究结果由 Review Manager 5.1 版汇总和分析。 数据来源 Embase、PubMed、EBSCOHost 的护理和联合健康文献累积索引以及 2000 年 1 月至 2011 年 12 月期间发表的论文的 Web of Science 数据库。 综述方法 高度发达国家 5 至 15 岁的健康儿童参加 1990 年之后进行的研究，并在学校、门诊或社区环境中使用前瞻性或回顾性队列、横断面、病例对照或随机临床试验设计。纳入的研究必须报告体重的客观测量值和至少一个预先设定的心血管疾病风险参数。结果 我们纳入了 49-220 名儿童的 63 项研究。研究报告称，超重和肥胖参与者的心血管疾病风险参数恶化。与正常体重儿童相比，超重儿童的收缩压高出 4.54 mm Hg（99% 置信区间 2.44 至 6.64；n=12 169，8 项研究）；肥胖儿童的收缩压高 7.49 mm Hg（3.36 至 11.62；n=8074，15 项研究）。我们发现各组之间的舒张压和 24 小时动态收缩压之间存在类似的相关性。肥胖会对所有血脂浓度产生不利影响；肥胖儿童的总胆固醇和甘油三酯分别高出0.15 mmol/L（0.04至0.25，n=5072）和0.26 mmol/L（0.13至0.39，n=5138）。肥胖参与者的空腹胰岛素和胰岛素抵抗显着较高，但超重参与者则没有。与正常体重儿童相比，肥胖儿童左心室质量显着增加19.12 g（12.66至25.59，n=223）。 结论 体重指数超出正常范围会显着恶化学龄儿童心血管疾病的风险参数。这种效应在超重儿童中已经很明显，会增加肥胖率，而且可能比之前想象的还要大。有必要确定不考虑体重的可接受参数截止水平是否是现代儿童风险的有效衡量标准，以及研究和报告中使用的方法是否应该标准化。
Objectives To describe the association and its magnitude between body mass index category, sex, and cardiovascular disease risk parameters in school aged children in highly developed countries. Design Systematic review and meta-analysis. Quality of included studies assessed by an adapted version of the Cochrane Collaboration’s risk of bias assessment tool. Results of included studies in meta-analysis were pooled and analysed by Review Manager version 5.1. Data sources Embase, PubMed, EBSCOHost’s cumulative index to nursing and allied health literature, and the Web of Science databases for papers published between January 2000 and December 2011. Review methods Healthy children aged 5 to 15 in highly developed countries enrolled in studies done after 1990 and using prospective or retrospective cohort, cross sectional, case-control, or randomised clinical trial designs in school, outpatient, or community settings. Included studies had to report an objective measure of weight and at least one prespecified risk parameter for cardiovascular disease. Results We included 63 studies of 49 220 children. Studies reported a worsening of risk parameters for cardiovascular disease in overweight and obese participants. Compared with normal weight children, systolic blood pressure was higher by 4.54 mm Hg (99% confidence interval 2.44 to 6.64; n=12 169, eight studies) in overweight children, and by 7.49 mm Hg (3.36 to 11.62; n=8074, 15 studies) in obese children. We found similar associations between groups in diastolic and 24 h ambulatory systolic blood pressure. Obesity adversely affected concentrations of all blood lipids; total cholesterol and triglycerides were 0.15 mmol/L (0.04 to 0.25, n=5072) and 0.26 mmol/L (0.13 to 0.39, n=5138) higher in obese children, respectively. Fasting insulin and insulin resistance were significantly higher in obese participants but not in overweight participants. Obese children had a significant increase in left ventricular mass of 19.12 g (12.66 to 25.59, n=223), compared with normal weight children. Conclusion Having a body mass index outside the normal range significantly worsens risk parameters for cardiovascular disease in school aged children. This effect, already substantial in overweight children, increases in obesity and could be larger than previously thought. There is a need to establish whether acceptable parameter cut-off levels not considering weight are a valid measure of risk in modern children and whether methods used in their study and reporting should be standardised.
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影响因子：
8
作者：
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