| BackgroundWith the prevalence of western diet and unhealthy lifestyles,the prevalence of metabolic risk factors in children is increasing year by year.At present,metabolic syndrome(MetS)is used to describe the clustering of metabolic risk factors,namely,more than 3 of 5 types of metabolic risk factors[including:abdominal obesity,high blood pressure,high blood sugar,low high-density lipoprotein cholesterol(HDL-C),and high triglyceride(TG)],which is diagnosed as MetS.Several studies have confirmed that MetS is an important risk factor for cardiovascular disease in adults.MetS is a dichotomous definition(≥3 vs.<3),thus,only those with 3 or more metabolic risk factors will be diagnosed as MetS,the healthy risk of those with 1 or 2 metabolic risk factors will be ignored.Current researches mainly focus on the adverse effects of a single metabolic risk factor or MetS on cardiovascular health,while studies focusing on the association between the clustering of metabolic risk factors(that is,adding 5 metabolic risk factors,further defining as 0,1,2,≥3 metabolic risk factors)and high carotid intima-media thickness(cIMT)are rarely reported in children.This study used data from a cross-sectional survey of 1167 children aged 8 to 13 in the "Huantai Childhood Cardiovascular Health Cohort Study " established in Huantai County,Zibo City,Shandong Province,to investigate the relationship of metabolic risk factors and their clustering with high cIMT among children,to prevent and control cardiovascular damage from childhood.ObjectivesTo explore the relationship betweenmetabolic risk factors and its clusting and cIMT levels and the detection rate of high cIMT in children.MethodsThis study relied on data from a cross-sectional survey—the "Huantai Childhood Cardiovascular Health Cohort Study" in 2019.Using the convenient cluster sampling method,a total of 1243 children aged 8-13 years were collected from a primary school in Huantai County,Zibo City.For data analysis,excluding children with missing variables,1167 participants with complete data were included in our study.Questionnaire survey,physical examination,blood biochemical test and ultrasonography examination were performed to collect information on the general characteristics(age,gender,lifestyle,disease history,etc.),anthropometric variables[height,weight,waist circumference(WC),blood pressure,etc.],blood biochemicals indices[fasting blood glucose(FBG),HDL-C and TG]and cIMT.There are 5 metabolic risk factors:abdominal obesity,high blood pressure,high FBG,low HDL-C,and high TG,and the clustering of metabolic risk factors was further divided into 4 subgroups according to the number of metabolic risk factors:0,1,2,≥3.The 90th percentiles of sex and age of cIMT in the present population were used as the diagnostic cut-off value,and high cIMT was diagnosed above this cut-off value.Statistical analysis was performed on SAS 9.4 software.After standardizing the z-score of each metabolic factor,the receiver operating characteristic curve(ROC)was drawn to evaluate the ability of each metabolic factor to screen children’s high cIMT,and the area under curve(AUC)was compared.After adjusting gender and age of the subjects,the multivariate logistic regression model was used to analyze the relationship between each metabolic risk factor and its clustering and high cIMT in children.The results were presented as odds ratio(OR)and 95%confidence interval(95%CI).A two-sided P<0.05 was defined as having a statistical association.Results1.The cIMT levels and the detection rate of high cIMT in metabolic risk factors and their clustering groups1167 children with complete data aged 8-13 were included in our study,among them 615 are boys,accounting for 52.7%.The mean age of them was 10.6±1.5 years old.The ROC curve showed that the ability of WC to screening high cIMT in children was stronger than other metabolic risk factors,and the AUC(95%CI)was 0.83(0.79-0.87,P<0.05).After adjusting for gender and age,except for the high FBG group,compared to normal children,the cIMT level in other subgroups was significantly higher(P<0.05).Regarding the detection rate of high cIMT,except for the high FBG group,the detection rate of high cIMT in the other metabolic risk factor groups were higher than that in the normal subgroup(P<0.05).2.The relationship between the clustering of the metabolic risk factors and high cIMT in childrenAdjusted for sex and age of children,the multivariate logistic regression model indicated that abdominal obesity,high blood pressure,low HDL-C and high TG were statistically associated with increased risk of high cIMT in childhood,high FBG was not associated with high cIMT in children,and the OR were 15.00(95%CI:8.97～25.10),4.99(95%CI:3.26～7.63),1.58(95%CI:1.02～2.45),3.38(95%CI:2.10～5.45),1.19(95%CI:0.79～1.80),respectively.Adjusted for their sex and age,the multiple linear regression model showed that with the increase of metabolic risk factors,the cIMT level in children showed an upward trend(Ptrend<0.001).Likewise,the number of factors increased,the detection rate of high cIMT in children showed an upward trend(Ptrend<0.001).After adjusting for gender and age,the clustering of metabolic risk factors was related to the high cIMT in children.Taking the group with 0 metabolic risk factor as the reference,the OR of the groups with 1,2 and≥3 metabolic risk factors were 5.58(95CI:2.85～10.95),11.80(95CI:5.92～23.49)and 21.54(95CI:10.44～44.45),respectively.Conclusion1.The cIMT level and high cIMT detection rate in children with abdominal obesity,elevated blood pressure,low HDL-C and high TG were higher than those in children with normal metabolism,while there was no correlation between high FBG and high cIMT.2.In children,a dose-response relationship exists between number of metabolic risk factors carried by individuals and cIMT level and the prevalence of high cIMT.The cIMT levels and the detection rate of high cIMT increased gradually with the clustering of the metabolic risk factors.3.The clusting of the metabolic risk factors increased the risk of high cIMT in children. |
PDF Full Text Request