BMI指数过低的风险

背景超重和肥胖问题已经成为全球面临的重大公共卫生问题。育龄女性孕前身体质量指数(Body Mass Index,BMI)对孕产妇和出生婴儿的健康有着重要影响,体重过低的母亲发生小于胎龄婴儿和早产的几率增加,而超重和肥胖母亲发生剖宫产、妊娠期糖尿病、妊娠期高血压、引产、产后出血、先兆子痫、胎膜早破等不良妊娠结局的几率增加。越来越多的研究结果表明,育龄女性不健康的孕前或孕早期BMI与出生缺陷的发生密切相关,但基于中国人群的相关证据缺乏。本研究旨在基于大规模人群分析近年来中国育龄女性孕前BMI分布情况,系统分析育龄女性孕前及孕早期BMI与子代出生缺陷之间的关联性,探索中国育龄女性适宜的孕前和孕早期BMI范围,为我国育龄女性的孕前-孕期全程体重管理和出生缺陷的防治提供数据基础和科学证据。方法本研究第一部分纳入2013和2019年参加国家免费孕前优生健康检查项目的9220664名育龄女性,分析其体重过低、超重和肥胖流行情况,以2010年全国人口普查数据计算年龄标化率,采用Logistic回归分析相关影响因素。本研究第二部分基于中国孕前-孕期-出生缺陷队列,采用回顾性队列研究,纳入2010～2019参加孕前优生健康检查且在全国出生缺陷监测有完整信息登记的67603名研究对象,分别采用Logistic回归模型分析母亲孕前BMI与子代出生缺陷的关联性,通过限制性立方样条探索母亲孕前BMI与子代出生缺陷的暴露反应关系,通过亚组分析进一步评估不同亚组母亲孕前BMI对子代出生缺陷的影响。本研究第三部分纳入2018～2022年参加前瞻性队列研究的信息登记完善的24861名研究对象,分别用Logistic回归模型母亲孕早期BMI与子代出生缺陷的关联,通过限制性立方样条探索母亲孕早期BMI与子代出生缺陷的暴露反应关系,通过亚组分析进一步评估不同亚组母亲孕早期BMI对子代出生缺陷的影响。结果1.中国育龄女性体重过低率由2013年的8.93%下降至2019年的7.47%;育龄女性超重率由2013年的18.62%上升至2019年的21.05%;肥胖率由2013年的4.54%上升至2019年的6.08%。低龄、受教育程度高是体重过低的危险因素,高龄、农民、少数民族是超重肥胖的危险因素,而素食习惯、吸烟或被动吸烟均可能增加体重过低或超重肥胖的发生风险。2.纳入母亲孕前BMI与子代出生缺陷关联研究的67603名研究对象中,共监测到出生缺陷患儿1192例,出生缺陷总发生率为176.32/万。母亲孕前体重过低与子代患生殖器官出生缺陷的风险显著相关,调整OR为1.90(95%CI:1.09～3.30)。母亲孕前肥胖与子代患唇腭裂的风险显著相关,调整OR为4.30(95%CI:1.47～12.57)。3.纳入母亲孕早期BMI与子代出生缺陷关联研究的24861名研究对象中,共监测到出生缺陷患儿507例,出生缺陷总发生率为203.93/万。母亲孕早期体重过低与子代患先天性心脏病的风险显著相关,调整OR为1.41(95%CI:1.01～1.97)。母亲孕早期肥胖与子代患先天性心脏病的风险显著相关,调整OR为2.64(95%CI:1.43～4.86)。结论1.近年来中国育龄女性孕前面临营养不良和营养过剩的双重挑战。我国育龄女性体重过低虽呈现下降趋势,但仍在部分人群中流行,超重和肥胖呈现明显上升趋势,已成为影响母婴健康的重要公共卫生问题之一。2.母亲孕前体重过低与子代患生殖器官出生缺陷的风险显著相关,而孕前肥胖与子代患唇腭裂的风险显著相关。建议科学管理育龄女性怀孕前BMI水平,提高孕产健康,促进优生优育。3.母亲孕早期体重过低与子代患先天性心脏病的风险显著相关,母亲孕早期肥胖与子代患先天性心脏病的风险显著相关。制定切实可行和有效的孕期体重管理措施迫在眉睫。

BACKGROUND Effective management of major cardiovascular risk factors is of great importance to reduce mortality from cardiovascular disease(CVD).The Survey of Risk Factors in Coronary Heart Disease(SURF CHD)II study is a clinical audit of the recording and management of CHD risk factors.It was developed in collaboration with the European Association of Preventive Cardiology and the European Society of Cardiology(ESC).Previous studies have shown that control of major cardiovascular risk factors in patients with established atherosclerotic CVD is generally inadequate.Azerbaijan is a country in the South Caucasus,a region at a very high risk for CVD.AIM To assess adherence to ESC recommendations for secondary prevention of CVD based on the measurement of both modifiable major risk factors and their therapeutic management in patients with confirmed CHD at different hospitals in Baku(Azerbaijan).METHODS Six tertiary health care centers participated in the SURF CHD II study between 2019 and 2021.Information on demographics,risk factors,physical and laboratory data,and medications was collected using a standard questionnaire in consecutive patients aged≥18 years with established CHD during outpatient visits.Data from 687 patients(mean age 59.6±9.58 years;24.9%female)were included in the study.RESULTS Only 15.1%of participants were involved in cardiac rehabilitation programs.The rate of uncontrolled risk factors was high:Systolic blood pressure(BP)(SBP)(54.6%),low-density lipoprotein cholesterol(LDL-C)(86.8%),diabetes mellitus(DM)(60.6%),as well as overweight(66.6%)and obesity(25%).In addition,significant differences in the prevalence and control of some risk factorssmoking,body mass index(BMI),waist circumference,blood glucose(BG),and SBPbetween female and male participants were found.The cardiovascular health index score(CHIS)was calculated from the six risk factors:Non-or ex-smoker,BMI<25 kg/m2,moderate/vigorous physical activity,controlled BP(<140/90 mmHg;140/80 mmHg for patients with DM),controlled LDL-C(<70 mg/dL),and controlled BG(glycohemoglobin<7%or BG<126 mg/dL).Good,intermediate,and poor categories of CHIS were identified in 6%,58.3%,and 35.7%of patients,respectively(without statistical differences between female and male patients).CONCLUSION Implementation of the current ESC recommendations for CHD secondary prevention and,in particular,the control rate of BP,are insufficient.Given the fact that patients with different comorbid pathologies are at a very high risk,this is of great importance in the management of such patients.This should be taken into account by healthcare organizers when planning secondary prevention activities and public health protection measures,especially in the regions at a high risk for CVD.A wide range of educational products based on the Clinical Practice Guidelines should be used to improve the adherence of healthcare professionals and patients to the management of CVD risk factors.

BACKGROUND The diagnosis of type 2 diabetes(T2D)in younger adults,an increasingly common public health issue,is associated with a higher risk of cardiovascular complications and mortality,which may be due to a more adverse cardiovascular risk profile in individuals diagnosed at a younger age.AIM To investigate the association between age at diagnosis and the cardiovascular risk profile in adults with T2D.METHODS A pooled dataset was used,comprised of data from five previous studies of adults with T2D,including 1409 participants of whom 196 were diagnosed with T2D under the age of 40 years.Anthropometric and blood biomarker measurements included body weight,body mass index(BMI),waist circumference,body fat percentage,glycaemic control(HbA1c),lipid profile and blood pressure.Univariable and multivariable linear regression models,adjusted for diabetes duration,sex,ethnicity and smoking status,were used to investigate the association between age at diagnosis and each cardiovascular risk factor.RESULTS A higher proportion of participants diagnosed with T2D under the age of 40 were female,current smokers and treated with glucose-lowering medications,compared to participants diagnosed later in life.Participants diagnosed with T2D under the age of 40 also had higher body weight,BMI,waist circumference and body fat percentage,in addition to a more adverse lipid profile,compared to participants diagnosed at an older age.Modelling results showed that each one year reduction in age at diagnosis was significantly associated with 0.67 kg higher body weight95%confidence interval(CI):0.52-0.82 kg