Anthropometric features as predictors of atherogenic dyslipidemia and cardiovascular risk in a large population of school-aged children

BackgroundAutopsy studies reveal that atherosclerosis lesions can be found as early as two years of age. To slow the development of this early pathology, obesity and dyslipidemia prevention should start from childhood making it urgent to explore new ways to evaluate dyslipidemia risk in children that can be applied widely, such as the non-invasive anthropometric evaluation.ObjectiveAssess the metabolic profile of a pediatric population at a specific age to describe the association between anthropometric and biochemical cardiovascular disease risk factors; and evaluate selected anthropometric variables as potential predictors for dyslipidemic cardiovascular risk.Design and methodsAnthropometric features, bioimpedance parameters and fasting clinical profile were assessed in Lisbon and the Tagus Valley region pre-pubertal nine-year-old children (n = 1.496) from 2009–2013 in a descriptive, cross-sectional study. Anthropometric variables predictive power was evaluated through regression analysis.ResultsAt least one abnormal lipid parameter was found in 65% of “normal weight”, 73% of “overweight” and 81% of “obese” children according to the International Obesity Task Force (IOTF) standards. Dyslipidemia was present in 67.8% of children. Waist-hip ratio (WHR) explained 0.4% of total cholesterol (TC) variance. Waist circumference (WC) explained 2.8% of apolipoprotein (APO) A1 variance. Waist-circumference-to-height-ratio (WHtR) explained 2.7%, 2.8% and 1.9% of low-density lipoprotein cholesterol (LDL-c), APO B, and N_HDL-c variance, respectively. Children with abnormally high WHR levels had an increase in risk of 4.49, 3.40 and 5.30 times, respectively, for developing cardiovascular disease risk factors measured as high-risk levels of TC, LDL-c and non-HDL-c (N_HDL-c) (pConclusionA large proportion of school age children have at least one lipid profile abnormality. BMI, zBMI, calf circumference (CC), hip circumference (HC), WC, and WHR are directly associated with dyslipidemia, whereas HC and calf circumference (CC) adjusted to WC, and mid-upper arm circumference (MUAC), are all inversely associated with dyslipidemia. Selected anthropometric variables are likely to help predict increased odds of having CV risk factors.

**背景** 尸检研究显示，动脉粥样硬化（atherosclerosis）病变最早可在2岁儿童中被检出。为延缓这一早期病理进程，需从儿童时期启动肥胖与血脂异常（dyslipidemia）的防控工作，因此亟需探索可广泛应用的儿童血脂异常风险评估新方法，例如无创人体测量评估手段。
**研究目的** 评估特定年龄儿童群体的代谢特征，阐明人体测量指标与心血管疾病（cardiovascular disease, CVD）生化风险因子间的关联；并评估选定的人体测量变量作为血脂异常相关心血管风险潜在预测因子的效能。
**设计与方法** 本研究为描述性横断面研究，于2009-2013年在里斯本与塔霍河谷地区开展，纳入1496名青春期前9岁儿童，对其人体测量特征、生物阻抗参数及空腹临床特征进行评估。通过回归分析检验人体测量变量的预测能力。
**研究结果** 按照国际肥胖任务组（International Obesity Task Force, IOTF）的标准，65%的「体重正常」、73%的「超重」及81%的「肥胖」儿童至少存在一项血脂参数异常。整体受试儿童的血脂异常检出率为67.8%。腰臀比（waist-hip ratio, WHR）可解释总胆固醇（total cholesterol, TC）0.4%的变异度；腰围（waist circumference, WC）可解释载脂蛋白A1（apolipoprotein A1, APO A1）2.8%的变异度；腰围身高比（waist-circumference-to-height-ratio, WHtR）可分别解释低密度脂蛋白胆固醇（low-density lipoprotein cholesterol, LDL-c）、载脂蛋白B（APO B）及非高密度脂蛋白胆固醇（non-HDL-c, N_HDL-c）2.7%、2.8%及1.9%的变异度。WHR水平异常升高的儿童，其出现TC、LDL-c及非高密度脂蛋白胆固醇（N_HDL-c）高危水平等心血管疾病风险因子的风险分别升高4.49倍、3.40倍及5.30倍（原文此处p值未完整给出）。
**研究结论** 相当比例的学龄儿童存在至少一项血脂谱异常。体重指数（body mass index, BMI）、体重指数z评分（zBMI）、小腿围（calf circumference, CC）、臀围（hip circumference, HC）、腰围（WC）及腰臀比（WHR）与血脂异常呈正相关；而校正腰围后的臀围、小腿围及上臂中段围（mid-upper arm circumference, MUAC）则与血脂异常呈负相关。选定的人体测量变量有望助力预测心血管（cardiovascular, CV）风险因子升高的发生概率。