Effects Of Overweight And Obesity On Capillary Glycosylated Haemoglobin And Blood Pressure In Children And Adolescents

Objective The prevalence of overweight and obesity in children and adolescents in China has increased explosively in the past few decades and shows significant geographical differences,while the prevalence of type 2 diabetes mellitus(T2DM)and childhood hypertension(HTN)in children and adolescents has also increased year by year.Considering that overweight and obesity in adults can cause T2 DM and hypertension,it is necessary to clarify the relationship between overweight and obesity in children and adolescents and T2 DM and HTN in children and adolescents.This study aimed to investigate the prevalence of 3-12 years children overweight and obesity in Shanghai,and to identify the independent risk factors for overweight and obesity in children.Also,we built a reference range of capillary Glucosylated haemoglobin(HbA1c)in those children,and analyzed the risk of diet,exercise and sleep behavioral indicators on children’s overweight,obesity and HbA1 c levels,respectively.To further clarify the long-term impact of overweight and obesity on hypertension in children and adolescents,we extracted a cohort of children and adolescents aged 6-18 years from Fuxin,Liaoning Province,China,to analyze the prevalence of overweight and obesity in children and adolescents,and to investigate the effect of body mass index(BMI)growth trajectory on blood pressure in children and adolescents.Method 1.Between January 2018 and December 2019,a multi-stage stratified random wholegroup sampling method was used to randomly select primary schools and kindergartens in three of the 16 districts in Shanghai,with each district randomly selected according to a ratio of two kindergartens per primary school,and to conduct an epidemiological survey of all children and adolescents aged 3-12 years in the sampled schools who met the inclusion and exclusion criteria.The children surveyed were classified as overweight and obese by BMI,and independent risk factors for overweight and obesity in children were analysed using generalised linear mixed models.A generalized additive model based on location,scale and shape was used to model the capillary HbA1 c levels of the entire study population and to establish a reference range of capillary HbA1 c values for children in Shanghai.A structural equation model of the range of reference values of capillary HbA1 c in children and the relationship between overweight and obesity in children and their dietary,exercise and sleep habits were developed to clarify the effect of behavioural habits on peripheral glucosylated haemoglobin levels and overweight and obesity in children.2.Between January 2021 and December 2021,a cohort of children and adolescents aged 6-18 years in Fuxin City,Liaoning Province,China,was extracted for physical examination,and the effect of short-term BMI changes on blood pressure abnormalities was analyzed using generalized linear mixed models,and a latent category growth mixed model was used to classify BMI changes in children and adolescents and analyze the effect of different BMI change trajectories on the risk of developing hypertension in children.Result 1.A total of 4615 children aged 3-12 years were included in the Shanghai Childhood Overweight and Obesity Study,comprising 2322(50.3%)boys and 2293(49.7%)girls,with a mean age of 7.4±2.8 years.The overall child overweight rate was 15.9% and the obesity rate was 7.3%.A total of 239661 person-time physical examination information among school-aged children and adolescents were included in the restrospective cohort study from Fuxin City,Liaoning Province.The average age of baseline populations was 11.3 ± 3.6 years and there were 48058 boys(50.4%)and 47277 girls(50.3%).The overweight rate was 16.0% and the obesity rate was 8.2%.The overweight and obesity rate of children and adolescents in the two cities generally increased with age,with boys higher than girls,and childrens in Fuxin was slightly higher than Shanghai at the same age,showing regional differences in overweight among children and adolescents in China.2.Research on overweight and obesity of children in Shanghai showed boys [Adjusted Odd Ratio(AOR): 1.744,95% Confidence Interval(CI): 1.472-2.066],age(AOR: 1.062,95% CI: 1.016-1.111),local resident(AOR: 1.314,95% CI.1.059-1.631),term delivery(AOR: 1.516,95% CI: 1.054-2.180),systolic blood pressure(AOR: 1.031,95% CI: 1.022-1.041),diastolic blood pressure(AOR: 1.025,95% CI: 1.014-1.037),family history of obesity(AOR: 1.413,95% CI: 1.134-1.761),capillary HbA1c(AOR: 1.246,95% CI: 1.052-1.475),salty diet(AOR: 1.346,95% CI: 1.048-1.728),high-fat diet(AOR: 1.859,95% CI: 1.250-2.764),sugary beverage(AOR: 1.430,95% CI: 1.118-1.829),an average of 8-10 hours of sleep per night(AOR: 1.424,95% CI: 1.185-1.710)and over 12 hours of study time per day(AOR: 2.115,95% CI: 1.018-4.396)were independent risk factors for overweight in children.Not living with grandparents(AOR: 0.832,95% CI: 0.699-0.992)and dancing sports(AOR: 0.764,95% CI: 0.585-0.997)were independent protective factors for overweight children.Boys(AOR: 3.597,95% CI: 2.765-4.680),local resident(AOR: 1.452,95% CI: 1.083-1.947),term delivery(AOR: 1.858,95% CI: 1.192-2.896),systolic blood pressure(AOR: 1.056,95% CI: 1.042-1.069),diastolic blood pressure(AOR: 1.019,95% CI: 1.003-1.035),family history of diabetes(AOR: 2.191,95% CI: 1.259-3.811),family history of obesity(AOR: 1.744,95% CI: 1.298-2.344),sweetened diet(AOR: 1.374,95% CI: 1.053-1.794),salty diet(AOR: 1.578,95% CI: 1.109-2.245),high-fat diet(AOR: 2.259,95% CI: 1.329-3.837),consumption of dairy snacks(AOR: 1.365,95% CI: 1.025-1.817),sugary beverage(AOR: 1.468,95% CI: 1.042-2.068),normal self-rated sleep quality(AOR: 2.688,95% CI: 1.457-4.587),passive smoking(AOR: 1.474,95% CI: 1.000-2.173)and more than 12 hours of study time per day(AOR: 3.667,95% CI: 1.555-8.648)were independent risk factors for childhood obesity,while eating out and choosing staple foods(AOR: 0.632,95% CI: 0.476-0.839),running and jumping sports(AOR: 0.766,95% CI: 0.604-0.971),dancing sports(AOR: 0.519,95% CI.0.334-0.809)were independent protective factors for childhood obesity.3.95 th percentile reference values for capillary HbA1 c levels in children aged 3-12 years in Shanghai ranged from 5.9-6.2%.There was no gender difference in capillary HbA1 c levels,overweight and obesity in children were significantly associated with increased capillary HbA1 c levels.4.Overweight(AOR: 1.652,95% CI: 1.067-2.557),obesity(AOR: 1.709,95% CI: 1.084-2.693),total serum cholesterol levels(AOR: 2.338,95% CI: 1.908-2.869),and less than 1 time exercise per day(AOR: 3.253,95% CI: 2.109-5.017),less than 8 hours sleep duration per night(AOR: 11.928,95% CI: 4.965-28.656)and more than 12 hours of sleep per night(AOR: 2.033,95%CI: 1.281-3.228)were independent risk factors for elevated capillary HbA1 c.The effect of behavioural factors was inconsistent between age subgroups and the effect of behavioural factors was greater in the school-age subgroup.The results of the structural equation modelling showed that dietary factors played a direct role [Path coefficient(PC)= 0.346],exercise factors not only played a direct role(PC = 0.213)but also an indirect role(PC = 0.046)by influencing the level of overweight and obesity in children.The sleep factor played an indirect role in the increase of peripheral glycosylated haemoglobin level by influencing the level of overweight and obesity in children(PC = 0.150).5.The crude prevalence rate of high blood pressure among children and adolescents in Fuxin City was 13.2%,and the crude prevalence rate of abnormal blood pressure was 9.4%,with boys slightly lower than girls.One year physical examination queue found that both baseline BMI and BMI changes in child adolescents were found to lead to an increased risk of abnormal blood pressure.The long-term impact model fitted the whole population into five groups by BMI trajectories in children and adolescents,and the analysis found that compared to the stable normal group,the slow increasing group(AOR:1.610,95% CI:1.304-1.989),the overweight obese group(AOR:3.172,95% CI:2.500-4.023)and the fast-increasing group(AOR:2.708,95% CI: 1.445-5.074)all increased the risk of developing abnormal blood pressure in children and adolescents.Conclusion 1.The rates of overweight and obesity among children in Shanghai and Fuxin are both high and there are regional differences,but in general they are higher among boys than girls.The situation of prevention and control of overweight and obesity among children in China is still serious.2.Overweight and obesity in children are influenced by factors such as diet,exercise and sleep behaviour,and the risk factors are not the same for different age groups,so differential management is needed for different age groups.3.The 95 th percentile reference values for capillary HbA1 c levels in children aged 3-12 years in Shanghai range from 5.9-6.2% for all age groups.The age-specific reference chart for peripheral glycosylated haemoglobin based on all children aged 3-12 years can provide a valuable tool for screening children for pre-diabetes and diabetes.4.Overweight and obesity are independent risk factors for elevated capillary HbA1 c in children,and factors such as diet,exercise and sleep behaviour can affect peripheral glucose haemoglobin levels directly and indirectly,so overweight and obesity rates in children should be reduced to reduce the incidence of abnormal glucose metabolism.5.The risk of abnormal blood pressure varies between groups of children and adolescents with varying body mass index trajectories.Children and adolescents within the normal BMI range(slow growth group)still need to be aware of the trajectory of change in order to prevent the development of blood pressure abnormalities.