Mediating effects of metabolic-related indicators on the association between childhood overweight/obesity and left ventric-ular hypertrophy
Objective To examine the mediating effects of blood pressure,glucose,lipids,and serum uric acid on the associa-tion between childhood overweight/obesity and left ventricular hypertrophy(LVH),and to provide scientific evidence for the pre-vention and control of cardiovascular diseases during childhood.Methods One public school in Huantai County,Zibo City was se-lected to conduct the baseline survey from November 2017 to January 2018 using a convenient cluster sampling method.A total of 1 400 children aged 6 to 11 were included in the study.According to the classification criteria based on body mass index(BMI),participants were divided into the non-overweight/obese group(n=787)and the overweight/obese group(n=613).The mediating effects of metabolic variables on the association between childhood overweight/obesity and left ventricular hypertrophy(LVH)were analyzed using the"mediation"package in R software.Results Children who were overweight/obese had higher levels of BMI-Z score(2.0±0.8),systolic blood pressure(SBP)(109.1±8.9 mmHg),diastolic blood pressure(DBP)(65.4±6.8 mmHg),fasting plasma glucose(FPG)(4.8±0.5 mmol/L),insulin(INS)(11.3±7.6 μU/mL),apolipoprotein B(ApoB)(0.7±0.2 g/L),low-density lipoprotein cholesterol(LDL-C)(2.4±0.7 mmol/L),total cholesterol(TC)(4.2±0.9 mmol/L),triglycerides(TG)(0.9± 0.4 mmol/L),and serum uric acid(SUA)(321.2±91.4 µmol/L)compared to those who were non-overweight/obese[the corre-sponding values were(-0.2±0.7),(104.3±8.8)mmHg,(62.2±6.2)mmHg,(4.7±0.6)mmol/L,(6.1±4.2)µU/mL,(0.6±0.2)g/L,(2.2±0.6)mmol/L,(4.1±0.7)mmol/L,(0.7±0.2)mmol/L,and(278.6±74.7)µmol/L,respectively],whereas the levels of high-density lipoprotein cholesterol(HDL-C)were lower in overweight/obese children(1.5±0.3 mmol/L)than in non-over-weight/obese children(1.7±0.4 mmol/L).All differences were statistically significant(t=53.66,9.88,9.19,3.60,16.32,7.36,5.11,2.55,11.08,9.58,-10.31,P＜0.05).After adjusting for potential covariates,overweight/obese children had 8.72 times in-creased risk of developing LVH compared to the non-overweight/obese children(OR=8.72,95％CI=5.45-14.66,P＜0.01).Medi-ation analysis showed that INS,HDL-C,LDL-C,TG,ApoB,and SUA partially mediated the association between childhood over-weight/obesity and LVH,and among these,INS and TG had relatively strong mediating effects,accounting for 28.05％and 13.71％of the total effects,respectively.Conclusions INS,HDL-C,LDL-C,TG,ApoB,and SUA are intermediate risk factors on the association between childhood overweight/obesity and LVH.Keeping metabolic indicators(especially INS and TG)at healthy levels is particularly important for reducing the burden of cardiovascular diseases in overweight/obese children.
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