Article(id=1325521245063750395, tenantId=1146029695717560320, journalId=1256213402557890569, issueId=1325521023759691810, articleNumber=null, orderNo=null, doi=10.16835/j.cnki.1000-9817.2025201, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1743091200000, receivedDateStr=2025-03-28, revisedDate=1746460800000, revisedDateStr=2025-05-06, acceptedDate=null, acceptedDateStr=null, onlineDate=1793958491816, onlineDateStr=2026-11-06, pubDate=1753372800000, pubDateStr=2025-07-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793958491816, onlineIssueDateStr=2026-11-06, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793958491816, creator=13701087609, updateTime=1793958491816, updator=13701087609, issue=Issue{id=1325521023759691810, tenantId=1146029695717560320, journalId=1256213402557890569, year='2025', volume='46', issue='7', pageStart='913', pageEnd='1064', issueExtLink='null', onlineDate='null', pubDate='1753372800000', pubDateStr='2025-07-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793958439054, creator='13701087609', updateTime=1793958439054, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=1005, endPage=1008, ext={EN=ArticleExt(id=1325521246766637820, articleId=1325521245063750395, tenantId=1146029695717560320, journalId=1256213402557890569, language=EN, title=Association between different regional fat distribution and total body bone mineral density in children and adolescents, columnId=1259565862181286284, journalTitle=Chinese Journal of School Health, columnName=Growth, Development and Surveillance, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the association between each regional fat mass and total body bone mineral density (BMD) in children and adolescents aged 7-17 years in Beijing, so as to provide theoretical basis and practical guidance for implementing interventions.

Methods

From September to December 2020, a stratified cluster random sampling method was used to select 1 423 children and adolescents aged 7-17 years in Tongzhou District, Beijing. Dual-energy X-ray absorptiometry (DXA) was employed to measure regional body composition and total body BMD. Multiple linear regression was used to analyze the association between regional fat mass and total body BMD.

Results

The median (interquartile range) fat mass values for total body, upper limbs, abdomen, hips, and thighs were 13.51(8.84, 19.21), 1.59(1.08, 2.23), 0.73(0.39, 1.29), 2.32(1.46, 3.26), 5.29(3.59, 7.21)kg, respectively. After adjusting for covariates, the results of multiple linear regression analysis showed that total body fat mass (β=0.010), abdominal fat mass (β=-0.100), and hip fat mass (β=0.104) were significant associations with total body BMD (all P < 0.01). Sex-stratified analysis revealed that in boys, total body fat mass (β=0.008) and hip fat mass (β=0.058) were positively associated with BMD, while thigh fat mass (β=-0.038) showed a negative association with total body BMD (all P < 0.05). In girls, total body fat mass (β=0.013), hip fat mass (β=0.163), and thigh fat mass (β=0.023) were positively associated with total body BMD, whereas abdominal fat mass (β=-0.196) showed a negative association with total body BMD (all P < 0.05). Among children and adolescents with body fat percentage below the standard range, within the standard range and above the standard range, total body fat masses were positively associated with total body BMD (β=0.021, 0.016, 0.015); among children and adolescents with body fat percentage within the standard range while upper limb (β=-0.042), abdominal (β=-0.067), and thigh fat mass (β=-0.018) showed negative associations with total body BMD, and hip fat mass demonstrated a positive association with total body BMD (β=0.082) (all P < 0.05).

Conclusion

Regional fat distribution is associated with total body BMD in children and adolescents, with the nature of these associations varying by sex and body fat percentage.

, authors=Jingran CHEN1, Manman CHEN2, 3, Huiming HE4, Menglong LI4, Mengyang SUN4, Yifei HU*, 4, authorsList=Jingran CHEN, Manman CHEN, Huiming HE, Menglong LI, Mengyang SUN, Yifei HU, authorCompany=null, correspAuthors=Yifei HU, authorNote=null, correspAuthorsNote=null, copyrightStatement=Copyright ©2025 Chinese Journal of School Health. All rights reserved., copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1325521250570871549, articleId=1325521245063750395, tenantId=1146029695717560320, journalId=1256213402557890569, language=CN, title=儿童青少年身体不同部位脂肪分布与全身骨密度的关联, columnId=1259565866786632093, journalTitle=中国学校卫生, columnName=生长发育与健康监测, runingTitle=null, highlight=null, articleAbstract=
目的

分析北京市7~17岁儿童青少年身体各部位脂肪量与全身骨密度的关联,为实施干预提供理论依据和实践指导。

方法

2020年9—12月,采用分层整群随机抽样方法选取1 423名北京市通州区7~17岁儿童青少年为研究对象,使用双能X线吸收法测量评估各部位体成分及全身骨密度,采用多元线性回归分析各部位脂肪量与全身骨密度的关联。

结果

儿童青少年全身脂肪量、上肢脂肪量、腹部脂肪量、臀部脂肪量、大腿脂肪量分别为13.51(8.84,19.21),1.59(1.08,2.23),0.73(0.39,1.29),2.32(1.46,3.26),5.29(3.59,7.21)kg。多元线性回归分析结果显示,调整协变量后,儿童青少年全身、腹部、臀部脂肪量与全身骨密度之间具有一定相关性(β值分别为0.010,-0.100,0.104,P值均 < 0.01)。分性别分析,男生全身脂肪量(β=0.008)和臀部脂肪量(β=0.058)与全身骨密度均呈正相关,大腿脂肪量(β=-0.038)与全身骨密度呈负相关(P值均 < 0.05);女生全身脂肪量(β=0.013)、臀部脂肪量(β=0.163)、大腿脂肪量(β=0.023)与全身骨密度均呈正相关,腹部脂肪量(β=-0.196)与全身骨密度呈负相关(P值均 < 0.05)。体脂率低于标准范围、标准范围、高于标准范围儿童青少年的全身脂肪量与全身骨密度均呈正相关(β值分别为0.021,0.016,0.015),在体脂率标准范围内的儿童青少年的上肢、腹部、大腿脂肪量与全身骨密度均呈负相关(β值分别为-0.042,-0.067,-0.018),臀部脂肪量与全身骨密度呈正相关(β=0.082)(P值均 < 0.05)。

结论

儿童青少年身体不同部位脂肪量与全身骨密度相关,且关联受性别、体脂率影响。

, authors=陈璟然1, 陈曼曼2, 3, 何辉明4, 李梦龙4, 孙梦洋4, 胡翼飞*, 4, authorsList=陈璟然, 陈曼曼, 何辉明, 李梦龙, 孙梦洋, 胡翼飞, authorCompany=null, correspAuthors=胡翼飞, authorNote=

陈璟然(2002-), 女, 山东新汶人, 在读本科生

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胡翼飞,E-mail:
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Comparison of body composition and health behavior characteristics among children and adolescents by genders[M(P25, P75)]

, figureFileSmall=null, figureFileBig=null, tableContent=
性别人数全身脂肪量/kg上肢脂肪量/kg腹部脂肪量/kg臀部脂肪量/kg大腿脂肪量/kg全身骨密度/(g·cm-3)a
男71512.09(8.18, 18.29)1.43(1.01, 2.09)0.67(0.34, 1.27)2.00(1.32, 2.98)4.63(3.33, 6.83)0.93±0.17
女70814.50(9.98, 20.01)1.70(1.21, 2.35)0.79(0.46, 1.29)2.63(1.76, 3.52)5.73(4.11, 7.60)0.94±0.17
总体1 42313.51(8.84, 19.21)1.59(1.08, 2.23)0.73(0.39, 1.29)2.32(1.46, 3.26)5.29(3.59, 7.21)0.94±0.17
t/Z值-4.78-5.28-2.89-7.38-5.98-0.91
P值< 0.01< 0.01< 0.01< 0.01< 0.010.36
性别人数体质量指数/(kg·m-2)a睡眠时间/(h·d-1)a每日中高强度体力活动时间/h每日蔬菜摄入量/份每周含糖饮料摄入量/份每周肉类摄入量/份每日水果摄入量/份
男71520.65±4.767.68±1.200.64(0.38, 1.29)1.71(1.00, 2.00)1.00(0.00, 3.00)7.00(6.00, 14.00)1.00(0.57, 1.71)
女70820.25±4.647.59±1.290.57(0.29, 0.95)2.00(1.00, 2.00)1.00(0.00, 3.00)7.00(6.00, 10.50)1.00(0.71, 2.00)
总体1 42320.45±4.707.64±1.250.62(0.36, 1.13)2.00(1.00, 2.00)1.00(0.00, 3.00)7.00(6.00, 14.00)1.00(0.57, 1.71)
t/Z值1.881.36-3.95-1.83-2.52-3.18-2.88
P值0.060.17< 0.010.070.01< 0.01< 0.01
), ArticleFig(id=1325521279972942649, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521245063750395, language=CN, label=表1, caption=

不同性别儿童青少年体成分及健康行为特征比较[M(P25,P75)]

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性别人数全身脂肪量/kg上肢脂肪量/kg腹部脂肪量/kg臀部脂肪量/kg大腿脂肪量/kg全身骨密度/(g·cm-3)a
男71512.09(8.18, 18.29)1.43(1.01, 2.09)0.67(0.34, 1.27)2.00(1.32, 2.98)4.63(3.33, 6.83)0.93±0.17
女70814.50(9.98, 20.01)1.70(1.21, 2.35)0.79(0.46, 1.29)2.63(1.76, 3.52)5.73(4.11, 7.60)0.94±0.17
总体1 42313.51(8.84, 19.21)1.59(1.08, 2.23)0.73(0.39, 1.29)2.32(1.46, 3.26)5.29(3.59, 7.21)0.94±0.17
t/Z值-4.78-5.28-2.89-7.38-5.98-0.91
P值< 0.01< 0.01< 0.01< 0.01< 0.010.36
性别人数体质量指数/(kg·m-2)a睡眠时间/(h·d-1)a每日中高强度体力活动时间/h每日蔬菜摄入量/份每周含糖饮料摄入量/份每周肉类摄入量/份每日水果摄入量/份
男71520.65±4.767.68±1.200.64(0.38, 1.29)1.71(1.00, 2.00)1.00(0.00, 3.00)7.00(6.00, 14.00)1.00(0.57, 1.71)
女70820.25±4.647.59±1.290.57(0.29, 0.95)2.00(1.00, 2.00)1.00(0.00, 3.00)7.00(6.00, 10.50)1.00(0.71, 2.00)
总体1 42320.45±4.707.64±1.250.62(0.36, 1.13)2.00(1.00, 2.00)1.00(0.00, 3.00)7.00(6.00, 14.00)1.00(0.57, 1.71)
t/Z值1.881.36-3.95-1.83-2.52-3.18-2.88
P值0.060.17< 0.010.070.01< 0.01< 0.01
), ArticleFig(id=1325521280396567354, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521245063750395, language=EN, label=Tab.2, caption=

Association between regional fat mass and total body BMD among children and adolescents of different genders[β(95%CI)]

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脂肪量部位男(n=715)女(n=708)总体(n=1 423)
全身0.008(0.006~0.009)**0.013(0.012~0.014)**0.010(0.009~0.011)**
上肢-0.036(-0.078~0.006)0.009(-0.024~0.041)-0.005(-0.032~0.021)
腹部-0.006(-0.064~0.052)-0.196(-0.247~-0.145)**-0.100(-0.136~-0.064)**
臀部0.058(0.014~0.102)**0.163(0.135~0.191)**0.104(0.081~0.127)**
大腿-0.038(-0.054~-0.022)**0.023(0.009~0.038)**-0.009(-0.020~-0.002)
), ArticleFig(id=1325521280832774971, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521245063750395, language=CN, label=表2, caption=

分性别儿童青少年各部位脂肪量与全身骨密度的关联[β值(95%CI)]

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脂肪量部位男(n=715)女(n=708)总体(n=1 423)
全身0.008(0.006~0.009)**0.013(0.012~0.014)**0.010(0.009~0.011)**
上肢-0.036(-0.078~0.006)0.009(-0.024~0.041)-0.005(-0.032~0.021)
腹部-0.006(-0.064~0.052)-0.196(-0.247~-0.145)**-0.100(-0.136~-0.064)**
臀部0.058(0.014~0.102)**0.163(0.135~0.191)**0.104(0.081~0.127)**
大腿-0.038(-0.054~-0.022)**0.023(0.009~0.038)**-0.009(-0.020~-0.002)
), ArticleFig(id=1325521281138959164, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521245063750395, language=EN, label=Tab.3, caption=

Association between regional fat mass and total body BMD in children and adolescents grouped by body fat percentage[β(95%CI)]

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脂肪量部位低于标准范围(n=233)标准范围(n=927)高于标准范围(n=263)
全身0.021(0.015~0.027)**0.016(0.014~0.017)**0.015(0.014~0.017)**
上肢0.092(-0.006~0.190)-0.042(-0.076~-0.007)*0.028(-0.010~0.066)
腹部-0.115(-0.267~0.038)-0.067(-0.119~-0.016)*-0.041(-0.092~0.010)
臀部-0.119(-0.221~-0.017)*0.082(0.052~0.113)**0.071(0.037~0.105)**
大腿-0.046(-0.085~-0.006)*-0.018(-0.031~-0.004)*0.006(-0.011~0.023)*
), ArticleFig(id=1325521281222845245, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521245063750395, language=CN, label=表3, caption=

不同体脂率儿童青少年各部位脂肪量与骨密度的关联[β值(95%CI)]

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脂肪量部位低于标准范围(n=233)标准范围(n=927)高于标准范围(n=263)
全身0.021(0.015~0.027)**0.016(0.014~0.017)**0.015(0.014~0.017)**
上肢0.092(-0.006~0.190)-0.042(-0.076~-0.007)*0.028(-0.010~0.066)
腹部-0.115(-0.267~0.038)-0.067(-0.119~-0.016)*-0.041(-0.092~0.010)
臀部-0.119(-0.221~-0.017)*0.082(0.052~0.113)**0.071(0.037~0.105)**
大腿-0.046(-0.085~-0.006)*-0.018(-0.031~-0.004)*0.006(-0.011~0.023)*
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儿童青少年身体不同部位脂肪分布与全身骨密度的关联
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陈璟然 1 , 陈曼曼 2, 3 , 何辉明 4 , 李梦龙 4 , 孙梦洋 4 , 胡翼飞 *, 4
中国学校卫生 | 生长发育与健康监测 2025,46(7): 1005-1008
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中国学校卫生 |生长发育与健康监测 2025 , 46 (7) : 1005 -1008
儿童青少年身体不同部位脂肪分布与全身骨密度的关联
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陈璟然1, 陈曼曼2, 3, 何辉明4, 李梦龙4, 孙梦洋4, 胡翼飞*, 4
作者信息
  • 1首都医科大学燕京医学院, 北京 101300
  • 2中国医学科学院/北京协和医学院群医学及公共卫生学院
  • 3北京大学公共卫生学院儿童青少年卫生研究所
  • 4首都医科大学公共卫生学院儿少卫生与妇幼保健学系
通讯作者:
胡翼飞,E-mail:
作者简介:

陈璟然(2002-), 女, 山东新汶人, 在读本科生

Association between different regional fat distribution and total body bone mineral density in children and adolescents
Jingran CHEN1, Manman CHEN2, 3, Huiming HE4, Menglong LI4, Mengyang SUN4, Yifei HU*, 4
Affiliations
  • 1Yanjing Medical College, Capital Medical University, Beijing 101300, China
出版时间: 2025-07-25 doi: 10.16835/j.cnki.1000-9817.2025201
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目的

分析北京市7~17岁儿童青少年身体各部位脂肪量与全身骨密度的关联,为实施干预提供理论依据和实践指导。

方法

2020年9—12月,采用分层整群随机抽样方法选取1 423名北京市通州区7~17岁儿童青少年为研究对象,使用双能X线吸收法测量评估各部位体成分及全身骨密度,采用多元线性回归分析各部位脂肪量与全身骨密度的关联。

结果

儿童青少年全身脂肪量、上肢脂肪量、腹部脂肪量、臀部脂肪量、大腿脂肪量分别为13.51(8.84,19.21),1.59(1.08,2.23),0.73(0.39,1.29),2.32(1.46,3.26),5.29(3.59,7.21)kg。多元线性回归分析结果显示,调整协变量后,儿童青少年全身、腹部、臀部脂肪量与全身骨密度之间具有一定相关性(β值分别为0.010,-0.100,0.104,P值均 < 0.01)。分性别分析,男生全身脂肪量(β=0.008)和臀部脂肪量(β=0.058)与全身骨密度均呈正相关,大腿脂肪量(β=-0.038)与全身骨密度呈负相关(P值均 < 0.05);女生全身脂肪量(β=0.013)、臀部脂肪量(β=0.163)、大腿脂肪量(β=0.023)与全身骨密度均呈正相关,腹部脂肪量(β=-0.196)与全身骨密度呈负相关(P值均 < 0.05)。体脂率低于标准范围、标准范围、高于标准范围儿童青少年的全身脂肪量与全身骨密度均呈正相关(β值分别为0.021,0.016,0.015),在体脂率标准范围内的儿童青少年的上肢、腹部、大腿脂肪量与全身骨密度均呈负相关(β值分别为-0.042,-0.067,-0.018),臀部脂肪量与全身骨密度呈正相关(β=0.082)(P值均 < 0.05)。

结论

儿童青少年身体不同部位脂肪量与全身骨密度相关,且关联受性别、体脂率影响。

脂肪组织  /  骨密度  /  回归分析  /  儿童  /  青少年
Objective

To analyze the association between each regional fat mass and total body bone mineral density (BMD) in children and adolescents aged 7-17 years in Beijing, so as to provide theoretical basis and practical guidance for implementing interventions.

Methods

From September to December 2020, a stratified cluster random sampling method was used to select 1 423 children and adolescents aged 7-17 years in Tongzhou District, Beijing. Dual-energy X-ray absorptiometry (DXA) was employed to measure regional body composition and total body BMD. Multiple linear regression was used to analyze the association between regional fat mass and total body BMD.

Results

The median (interquartile range) fat mass values for total body, upper limbs, abdomen, hips, and thighs were 13.51(8.84, 19.21), 1.59(1.08, 2.23), 0.73(0.39, 1.29), 2.32(1.46, 3.26), 5.29(3.59, 7.21)kg, respectively. After adjusting for covariates, the results of multiple linear regression analysis showed that total body fat mass (β=0.010), abdominal fat mass (β=-0.100), and hip fat mass (β=0.104) were significant associations with total body BMD (all P < 0.01). Sex-stratified analysis revealed that in boys, total body fat mass (β=0.008) and hip fat mass (β=0.058) were positively associated with BMD, while thigh fat mass (β=-0.038) showed a negative association with total body BMD (all P < 0.05). In girls, total body fat mass (β=0.013), hip fat mass (β=0.163), and thigh fat mass (β=0.023) were positively associated with total body BMD, whereas abdominal fat mass (β=-0.196) showed a negative association with total body BMD (all P < 0.05). Among children and adolescents with body fat percentage below the standard range, within the standard range and above the standard range, total body fat masses were positively associated with total body BMD (β=0.021, 0.016, 0.015); among children and adolescents with body fat percentage within the standard range while upper limb (β=-0.042), abdominal (β=-0.067), and thigh fat mass (β=-0.018) showed negative associations with total body BMD, and hip fat mass demonstrated a positive association with total body BMD (β=0.082) (all P < 0.05).

Conclusion

Regional fat distribution is associated with total body BMD in children and adolescents, with the nature of these associations varying by sex and body fat percentage.

Adipose tissue  /  Bone density  /  Regression analysis  /  Child  /  Adolescent
陈璟然, 陈曼曼, 何辉明, 李梦龙, 孙梦洋, 胡翼飞. 儿童青少年身体不同部位脂肪分布与全身骨密度的关联. 中国学校卫生, 2025 , 46 (7) : 1005 -1008 . DOI: 10.16835/j.cnki.1000-9817.2025201
Jingran CHEN, Manman CHEN, Huiming HE, Menglong LI, Mengyang SUN, Yifei HU. Association between different regional fat distribution and total body bone mineral density in children and adolescents[J]. Chinese Journal of School Health, 2025 , 46 (7) : 1005 -1008 . DOI: 10.16835/j.cnki.1000-9817.2025201
随着我国居民生活方式的改变,肥胖等慢性病造成的疾病负担越来越大,骨质疏松等疾病影响着人们的生活质量[1-2]。骨密度是评估骨健康状况和预防骨骼疾病的主要参考指标[3]。儿童期和青春期是骨骼生长的关键时期,在此期间促进骨量增长可以有效降低成年和老年期骨质疏松的发病风险[4]。1985—2019年,我国儿童青少年超重和肥胖合并检出率增长至23.4%[5]。有研究指出,骨密度与脂肪分布存在密切相关性[6],身体不同部位脂肪分布对于身体代谢有一定作用,从而对骨密度产生影响[7]。本研究旨在探讨儿童青少年不同身体部位的脂肪分布与全身骨密度的关联,并通过对不同性别、体脂率的儿童青少年进行比较,更深入理解脂肪与骨骼健康之间的相关性,为实施干预提供理论依据和实践指导。
采用分层整群随机抽样方法,2020年9—12月采用直接抽选法抽取北京市通州区4所中小学(1所小学,1所初中和2所高中),从每个年级中采用直接抽选法抽取2~3个班级,以班级为整体纳入研究;根据性别、年龄、身高、体重、营养状况等分布进行预调查,并剔除各种重要脏器病史者(重度肝肾衰竭、肿瘤等),排除近期手术、体发育缺陷、体内安置金属医疗器械者(如心脏起搏器、金属钢钉等)和学生本人及监护人不同意参与本研究者,最终纳入7~17岁儿童青少年共1 423名。其中男生715名,女生708名;平均年龄(12.51±3.10)岁。本研究已获得北京大学医学伦理委员会审查批准(批准号:IRB00001052-20024),所有研究对象均已签署知情同意书。
调查研究对象的基本情况,包括年龄、性别、过去1个月平均睡眠时间等;收集过去7 d内,每天蔬菜、水果、肉制品等的摄入量。
采用国际体力活动问卷(International Physical Activity Questionnaire, IPAQ)短卷评估儿童青少年过去一周身体活动情况[8],包括研究对象在过去7 d内的高强度体力活动、中等强度体力活动等时长,以及过去一周平均每天的户外活动时间。该问卷由7个问题组成,主要涵盖步行、中等强度体力活动、高强度体力活动和静坐行为4个方面的信息,信、效度良好[9]。采用匹兹堡睡眠国际量表(Pittsburgh Sleep Quality Index, PSQI)评估研究对象过去1个月的睡眠情况[10],该量表包括7个维度,包括睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、药物使用和日间功能障碍。每个维度根据不同的标准评分,总分为0~21分,总分越高代表睡眠质量越差,问卷信、效度良好[11]。
(1) 身高体重:参照2014年中国学生体质与健康调研报告[12],使用统一且经过校准的机械式身高坐高计(TZG,中国)进行身高测量,精确到0.1 cm;使用统一且经过校准的电子秤(RGT-140,中国)进行体重测量,精确到0.1 kg。(2)体成分测量:由专业医务人员采用双能X线骨密度仪(Dual-energy X-ray absorptiometry, DXA)按照仪器标准使用流程和方案要求进行测量,受试者需空腹、衣物轻便,无金属物品或配饰,扫描全身并采集图像,使用enCORE软件16版本分析,获得受试者全身及局部体成分数据,包括全身、上肢、腹部、臀部、大腿脂肪量(kg)、全身骨密度(g/cm3)等。
根据全身体脂率分年龄、性别的均值和标准差分为3组,分别是低于标准范围[ < (x-s)]、在标准范围内[(x-s)~(x+s)]以及高于标准范围[>(x+s)][13]。平均每天摄入量(份)=(每天摄入量×摄入天数)/7,其中每日蔬菜量、每日水果量一份按一个普通成年人拳头大小计算,每日含糖饮料量一份按250 mL计算,每日肉量一份按一个普通成年人掌心大小计算。平均每天中高强度体力活动时间(h)=(每天中高强度体力活动时间×运动天数)/7。
研究开始前制定好规范的研究方案,所有工作人员均按照研究方案和操作手册进行统一严格培训并考核合格。调查过程中身高测量2人一组,一人测量,一人记录,互相核对,保证数据准确。问卷回收后,调查员立即核查,发现问题及时反馈,确保应答质量。所有仪器和器材每日使用前均经过校准,测量时严格按操作规范执行,确保测量数据真实准确。
采用EpiData 3.1软件通过双录入的方式统一录入数据,并进行逻辑核查。录入完成后清理数据,删除极端值和异常值等,形成最终数据文件。使用SPSS 27.0软件对数据进行统计学分析。描述研究对象定量资料的基本特征,符合正态分布用(x ± s)表示,组间比较用独立样本t检验;不符合正态分布以M(P25,P75)表示,组间比较用Mann-Whitney U检验。采用多因素线性回归模型分析儿童青少年不同部位脂肪分布和全身骨密度的关联。双侧检验水准α=0.05。
儿童青少年上肢、腹部、臀部、大腿、全身脂肪量在性别间差异均有统计学意义(P值均 < 0.01)。儿童青少年全身骨密度总体为(0.94±0.17)g/cm3,性别间差异无统计学意义(P=0.36)。见表1。
调整睡眠时间、每日中高强度体力活动时间、每日蔬菜摄入量、每周含糖饮料摄入量、每周肉类摄入量、每日水果摄入量,采用多因素线性回归模型分析全身脂肪量与全身骨密度关联;调整以上6个变量以及全身脂肪量分析其余部位脂肪量与全身骨密度关联。结果显示,儿童青少年全身(β=0.010)和臀部脂肪量(β=0.104)与全身骨密度间均呈正相关,腹部脂肪量(β=-0.100)与全身骨密度呈负相关(P值均 < 0.01)。男生全身脂肪量和臀部脂肪量与全身骨密度之间均呈正相关(β值分别为0.008,0.058),大腿脂肪量与全身骨密度之间呈负相关(β=-0.038)(P值均 < 0.01)。女生全身脂肪量、臀部脂肪量和大腿脂肪量与全身骨密度之间均呈正相关(β值分别为0.013,0.163,0.023),腹部脂肪量与全身骨密度之间呈负相关(β=-0.196)(P值均 < 0.01)。见表2。
将儿童青少年按体脂率分为低于标准范围、在标准范围内和高于标准范围3组,分别分析全身及局部脂肪量与全身骨密度的关系。结果表明,不同体脂率组儿童青少年全身脂肪量均与全身骨密度呈正相关(P值均 < 0.01)。体脂率在标准范围时,上肢、腹部、大腿脂肪量与全身骨密度呈负相关(P值均 < 0.05);体脂率标准范围及高于标准范围时,臀部脂肪量与全身骨密度呈正相关(P值均 < 0.01);而体脂率低于标准范围的儿童青少年中,臀部、大腿脂肪量与全身骨密度呈负相关(P值均 < 0.05)。见表3。
本研究发现儿童青少年总体全身脂肪量及臀部脂肪量与全身骨密度均呈正相关,与程轲等[14]研究结果一致。可能与儿童青少年时期正常的脂肪组织分泌多种生物活性物质有关,这些物质对骨骼的生长和发育具有一定的促进作用[7]。脂肪量的增加与骨骼的生长发育密切相关,应早期监测身体成分并促进骨骼健康发育[15]。本研究结果与一项5岁儿童骨密度调查不一致[16]。提示不同年龄段、性别儿童青少年,其身体成分和骨骼发育的特点可能不同,脂肪量对骨密度的影响也存在差异。本研究与一项银川市12~18岁青少年横断面研究结果基本一致,该研究表明脂肪量与骨代谢的关系受性别影响,不同脂肪量表型的骨矿物质含量在男生中的相关性大于女生[17]。在儿童青少年时期,保持适量的脂肪储存可能有助于骨骼的健康发育。
本研究结果显示,总体儿童青少年腹部脂肪量、大腿脂肪量与全身骨密度均呈负相关。可能与脂肪细胞分泌瘦素水平升高而脂联素水平降低,从而促进破骨细胞的活性有关[18]。与一项美国8~19岁儿童青少年脂肪量与骨密度研究结果部分一致,该研究显示躯干脂肪堆积与低骨密度相关,且这种关联在超重肥胖儿童中更为明显[19]。一项关于美国中年人的研究显示,腹部脂肪与全身骨密度呈负相关,这种关联在腹部的内脏脂肪、皮下脂肪组织上均得到证实[20]。秦皇岛市一项关于21~65岁健康成年人的研究显示[21],大腿脂肪量与股骨颈骨密度和腰椎总骨密度呈正相关,结果的不同可能与测量骨部位或性别差异有关。本研究在女生中发现大腿脂肪量与全身骨密度呈正相关。此外,本研究还发现不同体脂率儿童青少年脂肪量对全身骨密度影响存在差异,体脂率在正常范围时,腹部、大腿脂肪量与全身骨密度呈负相关。一项广州儿童青少年的研究也表明了体脂率影响着骨密度[22]。目前中国实行“体重管理年”活动,强化慢性病防治关口前移,本研究从儿童青少年脂肪量与骨密度角度出发,提供了通过管理身体脂肪量促进儿童青少年骨骼发育和健康的参考依据。
本研究使用DXA法分别测量儿童青少年身体各部位骨密度,按身体部位分析时可以看到不同部位脂肪量与全身骨密度相关的差异性。本研究存在一定局限性:(1)研究设计为横断面调查,结果仅反映变量间的统计相关,无法确定各部位脂肪量与全身骨密度变化的时间先后顺序,未来需纵向或实验研究验证因果关联。(2)研究仅选取北京1个区,结果外推性不足。(3)研究仅收集了个人行为相关影响因素,未能排除骨密度相关家族遗传情况,遗传因素对骨密度有一定影响[23]。但是本研究样本量较大,在统计分析时控制多个变量,减少了混杂因素的影响,且DXA是体成分检测的金标准,故研究对于儿童青少年慢病防控依然有很高价值。
  • 首都医科大学2025年基础科研创新项目(XSKY2025094)
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2025年第46卷第7期
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doi: 10.16835/j.cnki.1000-9817.2025201
  • 接收时间:2025-03-28
  • 首发时间:2026-11-06
  • 出版时间:2025-07-25
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  • 收稿日期:2025-03-28
  • 修回日期:2025-05-06
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首都医科大学2025年基础科研创新项目(XSKY2025094)
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    1首都医科大学燕京医学院, 北京 101300
    2中国医学科学院/北京协和医学院群医学及公共卫生学院
    3北京大学公共卫生学院儿童青少年卫生研究所
    4首都医科大学公共卫生学院儿少卫生与妇幼保健学系

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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