儿童青少年膳食及血清锌状况与心血管疾病代谢危险因素的关系

doi:10.11852/zgetbjzz2021-0703

摘要/Abstract

摘要： 目的了解2016-2017年江苏省儿童青少年膳食及血清锌状况,探索其与营养相关心血管疾病代谢危险因素之间可能存在的关系。方法采用多阶段分层随机抽样的方法,2016-2017年从江苏省12个监测点抽取1 251名6~17岁儿童青少年进行体格测量(身高、体重、腰围)、血液生化检验(血清锌、空腹血糖、血脂),并采用连续3 d 24 h膳食回顾法对其进行膳食调查。统计学方法采用Pearson χ²检验、Kruskal-Wallis检验及线性回归分析。结果最终有1 122名6～17岁儿童青少年纳入本研究。其膳食锌摄入低于平均需要量(EAR)比例为39.39%,其中13~17岁年龄组、一般农村的被调查对象比例较高,分别为56.7%和54.8%;血清锌水平低于参考值的比例较低,为0.5%,但在不同性别、地区间存在差异,其中男性、大城市儿童青少年血清锌水平较高。线性回归分析结果表明,膳食锌与血清锌无线性关系;膳食锌与高密度脂蛋白呈正相关(β=0.072,95%CI: 0.034~0.111,P<0.001);血清锌与空腹血糖呈负相关(β=-0.506,95%CI:-0.575~-0.437,P<0.001)。结论江苏省儿童青少年存在膳食锌摄入不足风险的比例依然较高,充足的膳食锌摄入及较高的血清锌水平与儿童青少年良好的代谢状况有关。

关键词: 锌, 心血管疾病, 代谢危险因素, 儿童青少年

Abstract: Objective To estimate the level of dietary zinc intake and serum zinc among children and adolescents in Jiangsu province from 2016 to 2017, and to explore the association of dietary zinc intake or serum zinc concentrations with nutrition-related cardiovascular disease risk factors. Methods A total of 1 251 children and adolescents aged from 6 to 17 years were selected from 12 monitoring sites in Jiangsu Province from 2016 to 2017 by multi-stage stratified random sampling.Participants took physical examinations (height, weight, waist circumference), biochemical tests (serum zinc, fasting blood glucose and lipids) and dietary intake assessment (24-hour dietary recall for 3 consecutive days).Pearson χ² test, Kruskal-Wallis test and linear regression model were used to conduct statistical analysis. Results A total of 1 122 children and adolescents aged 6 to 17 years were included in this study.The amount of zinc intake in 39.39% of the participates was below average requirement, whereas it was 56.7% for the participates aged from 13 to 17 and 54.8% for rural participates.The proportion of participants whose serum zinc levels were lower than the reference value was low (0.5%).But there were differences in serum zinc levels among different genders and regions, among which male and urban participants had higher serum zinc levels.Linear regression showed that there was no linear association between dietary zinc intake and serum zinc levels, and there was a weak positive association between dietary zinc intake and high density lipoprotein (β=0.072, 95%CI:0.034 - 0.111, P<0.001) and a negative association between serum zinc and fasting blood glucose(β=-0.506,95%CI:-0.575 - 0.437, P<0.001). Conclusions Children and adolescents in Jiangsu Province are still at a high risk of insufficient dietary zinc intake.Adequate dietary zinc intake and high serum zinc level in children and adolescents are related to good metabolic status.

Key words: zinc, cardiovascular disease, metabolic risk factors, children and adolescents

中图分类号:

R179

朱谦让, 戴月, 张坚, 张静娴, 谢玮. 儿童青少年膳食及血清锌状况与心血管疾病代谢危险因素的关系[J]. 中国儿童保健杂志, 2021, 29(12): 1304-1308.

ZHU Qian-rang, DAI Yue, ZHANG Jian, ZHANG Jing-xian, XIE Wei. Dietary zinc intake and serum zinc level and their association with cardiovascular diseases risk factors in children and adolescents[J]. Chinese Journal of Child Health Care, 2021, 29(12): 1304-1308.

参考文献

[1] 胡盛寿,高润霖,刘力生, 等.《中国心血管病报告2018》概要[J].中国循环杂志,2019,34(3):209-220.
[2] DeBoer MD, Gurka MJ, Woo JG, et al.Severity of the metabolic syndrome as a predictor of type 2 diabetes between childhood and adulthood:the Princeton lipid research cohort study[J].Diabetologia,2015,58(12):2745-2752.
[3] Llewellyn A, Simmonds M, Owen CG, et al.Childhood obesity as a predictor of morbidity in adulthood:a systematic review and meta-analysis[J].Obes Rev,2016,17(1):56-67.
[4] 马淑婧,张艳青,羊柳, 等.1991~2015年中国9个省份儿童青少年超重和肥胖率的变化趋势分析[J].中华预防医学杂志,2020,54(2):133-138.
[5] 马淑婧,羊柳,赵敏, 等.1991~2015年中国儿童青少年血压水平及高血压检出率的变化趋势[J].中华流行病学杂志,2020,41(2):178-183.
[6] 迟学彭,于冬梅,琚腊红, 等.2002~2012年中国7～17岁儿童青少年糖尿病患病现状及变化[J].卫生研究,2018,47(5):705-709,715.
[7] Samman S.Zinc[J].Nutr Diet, 2007, 64(Suppl 1):131-134.
[8] Yubero-Serrano EM, Delgado-Lista J, Peña-Orihuela P, et al.Oxidative stress is associated with the number of components of metabolic syndrome:LIPGENE study[J].Exp Mol Med, 2013,45(6):e28.
[9] Ahn BI, Kim MJ, Koo HS, et al.Serum zinc concentration is inversely associated with insulin resistance but not related with metabolic syndrome in nondiabetic korean adults[J].Biol Trace Elem Res, 2014, 160(2):169-175.
[10] Khazdouz M, Djalalinia S, Sarrafi ZS, et al.Effects of zinc supplementation on cardiometabolic risk factors:a systematic review and meta-analysis of randomized controlled trials[J].Biol Trace Elem Res, 2020,195(2):373-398.
[11] Ho M,Baur LA, Cowell CT, et al.Zinc status, dietary zinc intake and metabolic risk in Australian children and adolescents: Nepean longitudinal study[J].Eur J Nutr, 2017,56(7):2407-2414.
[12] Zhang Y, Zhang DZ .Relationship between serum zinc level and metabolic syndrome:a meta-analysis of observational studies[J].J Am Coll Nutr, 2018,37(8):708-715.
[13] 杨月欣,王光亚,潘兴昌.中国食物成分表[M].2版.北京:北京大学医学出版社,2009:1-181.
[14] 中华人民共和国国家卫生和计划生育委员会.WS/ T 586-2018 学龄儿童青少年超重与肥胖筛查[S].北京:中国标准出版社, 2018.
[15] 中国营养学会.中国居民膳食营养素参考摄入量 2013 版[M].北京:科学出版社,2014:89-90.
[16] King JC, Brown KH, Gibson RS, et al.Biomarkers of nutrition for development (BOND)-zinc review[J].J Nutr, 2015,146(Suppl 4):858-885.
[17] International Zinc Nutrition Consultative Group (IZNCG), Brown KH, Rivera JA, et al.International Zinc Nutrition Consultative Group (IZiNCG) technical document #1.Assessment of the risk of zinc deficiency in populations and options for its control[J].Food Nutr Bull, 2004,25(Suppl 2):99-203.
[18] Black RE,Victora, CG,Walker SP, et al.Maternal and child undernutrition and overweight in low-income and middle-income countries[J].Lancet,2013,382(9890):427-451.
[19] 张继国,张兵,王惠君, 等.1991~2009年中国九省区膳食营养素摄入状况及变化趋势(十)7～17岁儿童青少年膳食锌的摄入状况及变化趋势[J].营养学报,2013,35(2):131-133.
[20] 谭维维,许诚,黄建萍, 等.南通市青少年学生不健康饮食行为及其影响因素[J].江苏预防医学,2018,29(4):474-476.
[21] 王琴,索朗德吉,罗央措.我国项目地区青少年膳食知识知晓情况调查[J].中国保健营养,2020,30(36):318.
[22] Moran VH, Stammers AL, Medina MW, et al.The relationship between zinc intake and serum/plasma zinc concentration in children:a systematic review and dose-response meta-analysis[J].Nutrients, 2012,4(8):841-858.
[23] Miranda ER, Dey CS .Effect of chromium and zinc on insulin signaling in skeletal muscle cells[J].Biol Trace Elem Res, 2004, 101(1):19-36.
[24] Suliburska J, Cofta S, Gajewska E, et al.The evaluation of selected serum mineral concentrations and their association with insulin resistance in obese adolescents[J].Eur Rev Med Pharmacol Sci, 2013,17(17):2396-2400.
[25] Fang C, Wu W, Gu X, et al.Association of serum copper, zinc and selenium levels with risk of metabolic syndrome:a nested case-control study of middle-aged and older Chinese adults[J].J Trace Elem Med Biol, 2019,52:209-215.
[26] Olechnowicz J, Tinkov A, Skalny A, et al.Zinc status is associated with inflammation, oxidative stress, lipid, and glucose metabolism[J].J Physiol Sci, 2018,68(1):19-31.
[27] Foster M, Petocz P, Samman S.Effects of zinc on plasma lipoprotein cholesterol concentrations in humans:a meta-analysis of randomised controlled trials[J].Atherosclerosis, 2010,210(2):344-352.