低體重和肥胖兒童身體成分特點(diǎn)及脂肪肌肉含量與骨密度相關(guān)性研究

張海燕，周群英

(眉山市婦幼保健院，四川 眉山 620010)

低體重和肥胖兒童身體成分特點(diǎn)及脂肪肌肉含量與骨密度相關(guān)性研究

張海燕，周群英

(眉山市婦幼保健院，四川 眉山 620010)

目的 探討低體重和肥胖兒童身體成分特點(diǎn)及其脂肪肌肉含量與骨密度的相關(guān)性。方法 選擇2015年6月至2016年6月于眉山市婦幼保健院兒保門診體檢的5～7歲兒童為研究對(duì)象，按體質(zhì)量指數(shù)(BMI)分為低體重組、肥胖組和對(duì)照組，測(cè)量身體成分各項(xiàng)指標(biāo)，包括體脂比、全身脂肪含量、肌肉含量及局部和全身骨密度，并對(duì)結(jié)果進(jìn)行分析。結(jié)果 同性別兒童低體重組的體脂比、全身脂肪含量、肌肉含量及局部和全身骨密度均分別明顯低于對(duì)照組，二者之間差異均具有統(tǒng)計(jì)學(xué)意義(t=3.076～3.326，均P<0.05)；同性別兒童對(duì)照組的體脂比、全身脂肪含量、肌肉含量及局部和全身骨密度均分別明顯低于肥胖組，二者之間差異均具有統(tǒng)計(jì)學(xué)意義(t=2.998～3.427，均P<0.05)。經(jīng)Logistic回歸分析：低體重組兒童的肌肉含量與不同部位骨密度均呈正相關(guān)性(r=0.779～0.889，均P<0.05)；肥胖組男性兒童的肌肉含量與下肢骨密度、體脂比和全身脂肪含量與軀干骨密度均呈正相關(guān)性(r=0.779～0.882，均P<0.05)，肥胖組女性兒童肌肉含量與上肢骨密度，以及體脂比、全身脂肪含量和肌肉含量與下肢骨密度均呈正相關(guān)性(r=0.781～0.901，均P<0.05)；對(duì)照組兒童的肌肉含量與不同部位骨密度均呈正相關(guān)性(r=0.779～0.912，均P<0.05)，對(duì)照組女性兒童的體脂比、全身脂肪含量和肌肉含量均與下肢骨密度和全身骨密度均呈正相關(guān)性(r=0.805～0.912，均P<0.05)。結(jié)論 與正常兒童相比，低體重和肥胖兒童身體成分構(gòu)成，各指標(biāo)與骨密度的相關(guān)關(guān)系明顯不同于正常兒童。在對(duì)兒保門診兒童管理中，體重、體脂比、全身脂肪含量、肌肉含量的變化均是需要關(guān)注的重要指標(biāo)，從而促進(jìn)其骨骼健康發(fā)育。

體重；體脂比；全身脂肪含量；肌肉含量；骨密度

通過對(duì)處于生長發(fā)育期的兒童身體成分的分析可以了解兒童的營養(yǎng)健康和身體發(fā)育狀況。處于不同狀態(tài)生長發(fā)育期的兒童，其身體成分構(gòu)成不盡相同[1]，如身體成分構(gòu)成明顯異常，將嚴(yán)重影響兒童骨骼及身體的健康發(fā)育[2-4]。本文分析了2015年6月至2016年6月于眉山市婦幼保健院兒保門診體檢的5～7歲兒童的身體成分特點(diǎn)及其脂肪肌肉含量與骨密度的相關(guān)性，為兒保門診就診兒童的常規(guī)化管理中的關(guān)注重點(diǎn)提供理論依據(jù)及數(shù)據(jù)參考。

1對(duì)象與方法

1.1研究對(duì)象

選取2015年6月至2016年6月于眉山市婦幼保健院兒保門診體檢的5～7歲兒童為研究對(duì)象，排除合并有內(nèi)科外科基礎(chǔ)疾病的兒童、早產(chǎn)兒、低體重出生兒，以及母親孕期有妊娠期高血壓疾病、妊娠期糖尿病等任何可能影響胎兒及嬰幼兒生長發(fā)育疾病的兒童。

1.2研究方法

由專業(yè)人員測(cè)量每位研究對(duì)象的身高、體重，計(jì)算體質(zhì)量指數(shù)(BMI)=體重(kg)/身高2(m2)。利用生物電阻抗分析儀測(cè)量身體成分各項(xiàng)指標(biāo)：體脂比、全身脂肪含量、肌肉含量。利用DXA骨密度測(cè)量儀檢測(cè)各個(gè)研究對(duì)象的上肢、下肢、軀干和全身骨密度。根據(jù)BMI將所納入的研究對(duì)象分為三組，分別為低體重組、肥胖組和正常對(duì)照組。

1.3統(tǒng)計(jì)學(xué)方法

采用SPSS 22.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析，計(jì)量資料用均值±標(biāo)準(zhǔn)差表示，采用單因素方差分析進(jìn)行組間比較，Logistic回歸分析體脂比、全身脂肪含量、肌肉含量與局部和全身骨密度的相關(guān)性，以P<0.05為差異有統(tǒng)計(jì)學(xué)意義。

2結(jié)果

2.1研究對(duì)象基本特點(diǎn)

本次共納入符合標(biāo)準(zhǔn)的研究對(duì)象749例，其中低體重組198例(男：102例，女:96例)、肥胖組237例(男：126例，女：111例)和對(duì)照組314例(男：162例，女：152例)。各組研究對(duì)象的年齡等基線相同。

2.2納入研究的兒童身體成分特點(diǎn)

肥胖組男性兒童和女性兒童的BMI均分別高于低體重組的男性兒童和女性兒童；同性別兒童低體重組的體脂比、全身脂肪含量、肌肉含量及局部和全身骨密度均分別明顯低于對(duì)照組，二者之間差異均具有統(tǒng)計(jì)學(xué)意義(均P<0.05)；同性別兒童對(duì)照組的體脂比、全身脂肪含量、肌肉含量及局部和全身骨密度均分別明顯低于肥胖組，二者之間差異均具有統(tǒng)計(jì)學(xué)意義(均P<0.05)，見表1。

表1 納入研究的兒童身體成分測(cè)量比較結(jié)果

注：t1、P1為低體重組與對(duì)照組比較；t2、P2為肥胖組與對(duì)照組比較。

2.3Logistic回歸分析情況

經(jīng)Logistic回歸分析顯示，低體重組男女兒童的肌肉含量與被研究各部位骨密度均呈正相關(guān)性(均P<0.05)；肥胖組男性兒童的肌肉含量與下肢骨密度、體脂比和全身脂肪含量與軀干骨密度均呈正相關(guān)性(均P<0.05)，肥胖組女性兒童肌肉含量與上肢骨密度，以及體脂比、全身脂肪含量和肌肉含量與下肢骨密度均呈正相關(guān)性(均P<0.05)；對(duì)照組兒童的肌肉含量與不同部位骨密度均呈正相關(guān)性(均P<0.05)，對(duì)照組女性兒童的體脂比、全身脂肪含量和肌肉含量與下肢骨密度和全身骨密度均呈正相關(guān)性(均P<0.05)，見表2。

表 2 Logistic回歸分析納入研究各組兒童的體脂比、脂肪含量和肌肉含量與骨密度之間的關(guān)系

(轉(zhuǎn)下表)

(續(xù)上表)

分組性別 上肢骨密度(g/cm3) 下肢骨密度(g/cm3) 軀干骨密度(g/cm3) 全身骨密度(g/cm3) 體脂比全身脂肪含量肌肉含量體脂比全身脂肪含量肌肉含量體脂比全身脂肪含量肌肉含量體脂比全身脂肪含量肌肉含量對(duì)照組男r0.2980.3020.8090.3360.3910.7790.2070.3080.8060.3110.3050.887P>0.05>0.05<0.05>0.05>0.05<0.05>0.05>0.05<0.05>0.05>0.05<0.05女r0.401.0.3350.8830.8050.9120.8860.4010.3920.8050.8120.8360.883P>0.05>0.05<0.05<0.05<0.05<0.05>0.05>0.05<0.05<0.05<0.05<0.05

3討論

3.1兒童身體成分科學(xué)管理及預(yù)防肥胖的重要性

本研究結(jié)果顯示，低體重組同性別兒童的體脂比、全身脂肪含量均低于對(duì)照組，二者之間差異均具有統(tǒng)計(jì)學(xué)意義(均P<0.05)。對(duì)照組同性別兒童的體脂比、全身脂肪含量均低于肥胖組，二者之間差異均具有統(tǒng)計(jì)學(xué)意義(均P<0.05)。脂肪細(xì)胞只在1～5歲內(nèi)增加，而體積要到青春前期才增大，小兒肥胖容易發(fā)展為成人肥胖，如發(fā)展為成人肥胖，其治療效果很不理想，并且有增加高血壓、糖尿病、心血管疾病等發(fā)病率的危險(xiǎn)[5-8]。因此，對(duì)于青少年單純性肥胖的預(yù)防，不僅要提前到青春前期，還要提前到兒童期。

3.2各身體成分指標(biāo)與骨密度之間的關(guān)系及其科學(xué)管理的重要性

本研究中，經(jīng)Logistic回歸分析顯示，低體重組兒童的肌肉含量與不同部位骨密度均呈正相關(guān)性(均P<0.05)。本研究中低體重男性、女性兒童，對(duì)照組男性、女性兒童表現(xiàn)一致，即僅肌肉含量對(duì)局部和全身骨密度影響顯著；與諸多研究結(jié)果一致[9-13]。兒童時(shí)期是骨骼礦物化的最關(guān)鍵時(shí)期之一，這一時(shí)期的骨密度會(huì)直接影響其成年后理想的骨密度峰值，肌肉力量的改變會(huì)引起骨強(qiáng)度發(fā)生相應(yīng)的變化，肌肉可影響骨代謝，通過收縮產(chǎn)生應(yīng)力促進(jìn)成骨，增加骨密度和骨量[14-17]。因此，對(duì)于這一年齡段低體重兒童可以通過加強(qiáng)鍛煉，增加肌肉含量，以便達(dá)到促進(jìn)骨骼健康發(fā)展的目的。

總之，與正常兒童相比，低體重和肥胖兒童身體成分構(gòu)成，各指標(biāo)與骨密度的相關(guān)關(guān)系明顯不同于正常兒童。在兒保門診兒童管理中，體重、體脂比、全身脂肪含量、肌肉含量的變化均是需要關(guān)注的重要指標(biāo)，從而促進(jìn)兒童骨骼的健康發(fā)育。

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[專業(yè)責(zé)任編輯： 史曉薇]

Characteristics of body composition and relativity of fat and lean masses with bone mineral density in low weight and obese children

ZHANG Hai-yan, ZHOU Qun-ying

(Meishan Maternal and Child Health Care Hospital, Sichuan Meishan 620010, China)

Objective To analyze the characteristics of body composition and relativity of fat and lean masses with bone mineral density (BMD) in low weight and obese children. Methods Children aged 5-7 years old receiving physical examination in Child Health Care Department of Meishan Maternal and Child Health Care Hospital from June 2015 to June 2016 were selected as study subjects and divided into low weight group, obese group and control group according to body mass index (BMI). Body composition indexes including percentage of body fat (PBF), fat mass (FM), lean mass (LM) and local and systemic BMD were measured and analyzed. Results Percentage of body fat, fat mass, lean mass and local and systemic bone mineral density in low weight group were significantly lower than those of children of same sex in control group, and differences had statistical significance (tvalue ranged 3.076 to 3.326, allP<0.05). Percentage of body fat, fat mass, lean mass and local and systemic bone mineral density in control group were significantly lower than those of children of same sex in obese group, and differences had statistical significance (tvalue ranged 2.998 to 3.427, allP<0.05). Logistic regression analysis showed that lean mass of children in low weight group was positively associated with bone mineral density at different parts (rvalue ranged 0.779 to 0.889, allP<0.05), lean mass was positively associated with lower limb bone mineral density and percentage of body fat and fat mass positively associated with trunk bone mineral density in obese group male children (rvalue ranged 0.779 to 0.882, allP<0.05), lean mass was positively associated with upper limb bone mineral density and percentage of body fat, fat mass and lean mass positively associated with lower limb bone mineral density in obese group female children (rvalue ranged 0.781 to 0.901, allP<0.05), and lean mass of children in control group was positively associated with bone mineral density at different parts (rvalue ranged 0.779 to 0.912, allP<0.05) and percentage of body fat, fat mass and lean mass were all positively associated with lower limb and systemic bone mineral density in control group female children (rvalue ranged 0.805 to 0.912, allP<0.05). Conclusion Body composition and correlation of each index with bone mineral density in low weight and obese children are different from those in normal children. In child health care department outpatient management, changes in body weight, percentage of body fat, fat mass, lean mass are important indicators demanding attention to enhance healthy bone development.

body weight; percentage of body fat (PBF); fat mass (FM); lean mass (LM); bone mineral density (BMD)

2016-08-15

張海燕(1981-)，女，主治醫(yī)師，主要從事兒童保健工作。

周群英，副主任醫(yī)師。

10.3969/j.issn.1673-5293.2017.07.003

R788

A

1673-5293(2017)07-0758-03