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Ubudlelwane phakathi kwempilo efanelekileyo yentliziyo kunye ne-vascular phenotype yoomama abatyebileyo kunye nabantwana babo abaneminyaka eyi-6
Ababhali: Litwin L, Sundholm JKM, Meinilä J, Kulmala J, Tammelin TH, Rönö K, Koivusalo SB, Eriksson JG, Sarkola T
Linda Litwin,1,2 Johnny KM Sundholm,1,3 Jelena Meinilä,4 Janne Kulmala,5 Tuija H Tammelin,5 Kristiina Rönö,6 Saila B Koivusalo,6 Johan G Eriksson,7–10 Taisto Sarkola1,31Children's Hospital, University of IYunivesithi yaseHelsinki kunye nezibhedlele zeYunivesithi yaseHelsinki, eHelsinki, eFinland;I-2 yeSebe leZiphene zeNtliziyo ye-Congenital kunye ne-Cardiology yabantwana, iYunivesithi yezoNyango yaseSilesian, eKatowice, ePoland, eZabrze FMS;I-3 Minerva Foundation Medical Research Institute, eHelsinki, eFinland;4 ISebe lokuTya kunye neSondlo, iYunivesithi yaseHelsinki, eHelsinki, eFinland;5LIKES uMsebenzi weMidlalo kunye neZiko loPhando lwezeMpilo, iJyvaskyla, eFinland;6 iYunivesithi yaseHelsinki iSibhedlele sabasetyhini kunye neSibhedlele seYunivesithi yaseHelsinki eHelsinki, eFinland;7 iZiko loPhando laseFolkhälsan, eHelsinki, eFinland;I-8 yeYunivesithi yaseHelsinki kunye ne-Helsinki iSebe leMisebenzi Jikelele kunye noNonophelo lweMpilo ePhambili, iSibhedlele seYunivesithi, eHelsinki, eFinland;INkqubo ye-9 yoPhando lweNguqu yoMntu kunye neSebe le-Obstetrics kunye ne-Gynecology, i-Yang Luling School of Medicine, iYunivesithi yeSizwe yaseSingapore, eSingapore;I-10 yaseSingapore Institute of Clinical Sciences (SICS), iSayensi, iTekhnoloji kunye noPhando lweBureau (A & AST; STAR), i-Singapore Communications: uLinda Litwin iSebe leZiphene zeNtliziyo ye-Congenital kunye ne-Cardiology yabantwana, i-Zabrze FMS, i-Silesian Medical University, i-M.Sklodowskiej-Curie 9, Zabrze, 41-800, Poland Tel +48 322713401 Fax +48 322713401 Email [i-imeyile ekhuselweyo] Imvelaphi: I-Genetics kunye nendlela yokuphila ekwabelwana ngayo nosapho inokubangela umngcipheko wentliziyo, kodwa ubungakanani obuchaphazela ubume kunye nomsebenzi wemithambo ebuntwaneni ayicacanga.Sijonge ukuvavanya umanyano phakathi kwempilo efanelekileyo ye-cardiovascular kubantwana kunye noomama, i-maternal subclinical atherosclerosis, kunye ne-arterial phenotypes ebantwaneni.Iindlela: Ukususela kwi-Finnish Gestational Diabetes Prevention Study (RADIEL) i-longitudinal cohort, uhlalutyo olunqamlekileyo lwe-201 yabantwana babantwana abaneminyaka eyi-6.1 ± 0.5 ubudala bavavanya impilo efanelekileyo ye-cardiovascular (BMI, uxinzelelo lwegazi, i-blood glucose fasting, i-cholesterol epheleleyo, umgangatho wokutya, Umsebenzi woMzimba, ukutshaya), ukubunjwa komzimba, i-carotid ultra-high frequency ultrasound (25 kunye ne-35 MHz) kunye ne-pulse wave velocity.Iziphumo: Sifumene ukuba akukho kulungelelaniswa phakathi kwempilo efanelekileyo ye-cardiovascular yomntwana kunye nomama, kodwa ubungqina bobungqina bokulungelelaniswa kwezibonakaliso ezithile: i-cholesterol epheleleyo (r = 0.24, P = 0.003), BMI (r = 0.17, P = 0.02), uxinzelelo lwegazi lwe-Diastolic (r = 0.15, P = 0.03) kunye nomgangatho wokutya (r = 0.22, P = 0.002).I-phenotype ye-arterial yabantwana ayinanto yakwenza nempilo efanelekileyo ye-cardiovascular yomntwana okanye umama.Kwimodeli ye-multivariate regression toliko elungelelaniselwe isini sabantwana, ubudala, uxinzelelo lwegazi lwe-systolic, ubunzima bomzimba obhityileyo, kunye nepesenti yamafutha omzimba, ubukhulu be-carotid artery intima-media ebantwaneni babunxulunyaniswe ngokuzimeleyo kuphela nobukhulu be-carotid artery intima. -imidiya (ukwanda kwe-0.1 mm [95 %] CI 0.05, 0.21, P = 0.001] Ubunzima be-artery carotid artery intima-media yanda nge-1 mm).Abantwana boomama abane-subclinical atherosclerosis banciphisa ukuvuleka komthambo we-carotid (1.1 ± 0.2 vs 1.2 ± 0.2% / 10 mmHg, P = 0.01) kunye nokwandisa umthambo we-carotid intima-media ubukhulu (0.37 ± 0.04 vs 0.35) ± 0.04 mm) ± 0.04 mm) Isiphelo: Iimpawu ezifanelekileyo zempilo yentliziyo nemithambo yegazi zinxulumene ngokungafaniyo nezibini ezingumama nomntwana ebuntwaneni.Asifumananga bungqina besiphumo sempilo yentliziyo yabantwana okanye kamama kwi-arterial phenotypes yabantwana.Umthambo we-carotid woomama we-intima-media ubukhulu unokuqikelela ubungakanani be-carotid artery intima-media ebantwaneni, kodwa indlela esisiseko sayo ayikacaci.I-atherosulinosis ye-maternal subclinical inxulumene nokuqina komthambo we-carotid kwindawo ebuntwaneni.Amagama angundoqo: isifo sentliziyo, i-atherosclerosis, i-carotid artery intima-media ubukhulu, izinto ezinobungozi, abantwana
Imiba yemveli yengozi ye-cardiovascular inegalelo kwisehlo kunye nophuhliso lwe-atherosclerosis.I-1,2 Izinto ezinobungozi zivame ukudibanisa kunye, kwaye ukudibanisa kwabo kubonakala kuqikelele ngakumbi kwingozi ye-cardiovascular.3
I-American Heart Association ichaza impilo efanelekileyo ye-cardiovascular health (ICVH) njengeseti yezibonakaliso ezisixhenxe zempilo (i-body mass index (BMI), uxinzelelo lwegazi (BP), i-glucose yegazi ngokukhawuleza, i-cholesterol epheleleyo, umgangatho wokutya, umsebenzi womzimba, ukutshaya) ukukhuthaza i-primitive. ukuthintela isifo senhliziyo kubantwana nakubantu abadala.I-4 ICVH ihambelana kakubi kunye ne-subclinical atherosclerosis xa umntu omdala.I-5 ICVH kunye ne-phenotypes embi ye-vascular yi-predictors ethembekileyo yeziganeko ze-cardiovascular and mortality kubantu abadala.6-8
Isifo senhliziyo sabazali sandisa umngcipheko weziganeko zentliziyo kwinzala.I-9 imiba yokusingqongileyo enxulumene ne-genetics kunye neendlela zokuphila eziqhelekileyo zombini zithathwa njengezinto ezinokuthi zenziwe, kodwa igalelo labo alikaqinisekiswa.10,11
Unxulumano phakathi komzali nomntwana ICVH sele kubonakala kubantwana 11-12 iminyaka ubudala.Kweli nqanaba, i-ICVH yabantwana inxulumene nokunwebeka komthambo we-carotid kwaye inxulumene kakubi nesantya somlomo wesibeleko se-femoral pulse wave (PWV), kodwa ayibonakali kwi-carotid artery intima-media thickness (IMT).12 Nangona kunjalo, ingozi ye-cardiovascular risk phakathi kwe-12-18 yeminyaka ubudala ihambelana nokunyuka kwe-carotid IMT kubomi obuphakathi, kwaye ayinanto yakwenza nezinto ezinobungozi ngexesha elifanayo.13 Ubungqina obuphathelele ukomelela kwale mibutho ebuntwaneni abukho.
Kumsebenzi wethu wangaphambili, asizange sifumane imiphumo yesifo sikashukela sokukhulelwa okanye ukungenelela kwendlela yokuphila komama kwi-anthropometry yobuntwana, ukubunjwa komzimba okanye ubungakanani be-arterial kunye nomsebenzi.I-14 Ingqwalasela yolu hlalutyo yinkqubo ye-cross-generational ye-cardiovascular risk aggregation.Iklasi kunye nefuthe layo kwi-arterial phenotype yabantwana.Sicinga ukuba i-ICVH yomama kunye ne-vascular substitutes ye-cardiovascular disease iya kubonakaliswa kwi-ICVH yobuntwaneni kunye ne-arterial phenotypes ebuntwaneni bokuqala.
Iinkcukacha ezinqamlezayo zivela kwiminyaka emithandathu yokulandelwa kweFinnish Gestational Diabetes Prevention Study (RADIEL).Uyilo lokuqala lophando luye lwacetywa kwenye indawo.I-15 Ngamafutshane, abafazi abaceba ukukhulelwa okanye kwisiqingatha sokuqala sokukhulelwa kwaye banomngcipheko ophezulu wesifo sikashukela sokukhulelwa (ukutyeba kakhulu kunye / okanye imbali yesifo sikashukela sokukhulelwa) baqeshwe (N = 728).Ulandelelwano lwe-cardiovascular lweminyaka emi-6 lwenziwe njengophononongo lokuqwalaselwa koomama nosana, kunye nenani elilinganayo loomama abanesifo seswekile sokukhulelwa kunye nabangenayo, kunye nobukhulu beqela elichazwe kwangaphambili (~200).Ukususela ngoJuni 2015 ukuya kuMeyi 2017, izimemo eziqhubekayo zathunyelwa kubathathi-nxaxheba kwaze kwaba yilapho umda ufikeleleke, kwaye i-201 pairs of two-tuples yafunyanwa.Ulandelelwano lwenzelwe abantwana abaneminyaka eyi-5-6 iminyaka yokuqinisekisa intsebenziswano ngaphandle kwe-sedation, kubandakanywa novavanyo lweqela lesibini lomntwana wosana kunye nobukhulu bomzimba kunye nokubunjwa, uxinzelelo lwegazi, ukuzila i-glucose yegazi kunye ne-lipids yegazi, umsebenzi womzimba usebenzisa i-accelerometers, umgangatho wokutya kunye imibuzo yokutshaya (oomama), imithwalo yegazi I-Ultrasound kunye ne-intraocular pressure measurement kunye ne-echocardiography kubantwana.Ukufumaneka kwedatha kudweliswe kwiTheyibhile eyoNgezelelweyo S1.IKomiti yezokuziphatha ye-Obstetrics kunye ne-Gynecology, i-Pediatrics kunye ne-Psychiatry yeSibhedlele seYunivesithi yase-Helsinki ivume i-protocol yophando (20/13/03/03/2015) yovavanyo olulandelelweyo lweminyaka emithandathu.Imvume ebhaliweyo yoomama bonke ifunyenwe ngexesha lobhaliso.Uphononongo luqhutywe ngokuhambelana neSibhengezo saseHelsinki.
Umphandi onobuchule (TS) usebenzisa i-25 MHz kunye ne-35 MHz i-transducers nge-Vevo 770 inkqubo, kwaye isebenzisa i-UHF22, i-UHF48 (i-frequency efanayo yeziko) kunye nenkqubo ye-Vevo MD (i-VisualSonics, i-Toronto, eCanada) njenge-52 izibini zokugqibela zomama nomntwana.Umthambo we-carotid oqhelekileyo wawunomfanekiso oyi-1 cm esondele kwiibhalbhu ze-carotid zamacala amabini, kwaye indawo yokuphumla yayikwimo engasentla.Sebenzisa ezona zihlandlo ziphezulu ezinokubona udonga olukude ukuze ufumane imifanekiso yefilimu ekumgangatho ophezulu egubungela imijikelo ye-3-4 yentliziyo.Sebenzisa iVevo 3.0.0 (Vevo 770) ene-manual calipers electronic and VevoLab (Vevo MD) software ukuhlalutya imifanekiso ngaphandle kweintanethi.I-16 Ububanzi be-Lumen kunye ne-IMT yalinganiswa ngumbonisi onamava (JKMS) ekupheleni kwe-diastole usebenzisa iindlela zokusika), engazi ngeempawu zesifundo (i-Supplementary Figure S1).Siye saxela kwangaphambili ukuba i-coefficient ye-intra-observer yokuhluka okulinganiswa yi-ultra-high-resolution ultrasound kubantwana nakubantu abadala yi-1.2-3.7% kwi-lumen diameter, i-IMT yi-6.9-9.8%, kunye ne-inter-observer coefficient of variation. I-1.5-4.6% kwi-lumen diameter., 6.0-10.4% ye-IMT.Inqaku le-carotid IMT Z elilungelelaniselwe ubudala kunye nesini libalwe kusetyenziswa ireferensi yabantwana abamhlophe abasempilweni abangatyebanga.17
I-carotid artery lumen diameter yalinganiswa kwi-systole ephezulu kunye ne-end-diastole ukuvavanya i-carotid umthambo we-β stiffness index kunye ne-coefficient yokwandisa umthambo we-carotid.Ukusebenzisa i-cuff yobungakanani obufanelekileyo, indlela ye-oscillometric (i-Dinamap ProCare 200, GE) yayisetyenziselwa ukurekhoda i-systolic kunye ne-diastolic uxinzelelo lwegazi lwe-elastic performance calculations ngexesha le-imaging ye-ultrasound kwindawo ye-supine yesandla sokunene.I-coefficient yokwandisa umthambo we-carotid kunye ne-carotid ye-β-stiffness index ibalwa ukusuka kwi-carotid artery usebenzisa le fomula ilandelayo:
Phakathi kwabo, i-CCALAS kunye ne-CCALAD yindawo eqhelekileyo ye-carotid artery lumen ngexesha le-systole kunye ne-diastole ngokulandelanayo;I-CCALDS kunye ne-CCALDD yi-carotid artery lumen ububanzi be-lumen ngexesha le-systole kunye ne-diastole ngokulandelanayo;I-SBP kunye ne-DBP zi-systolic kunye noxinzelelo lwegazi lwe-diastolic.I-18 I-coefficient of variation ye-coefficient yokwandisa umthambo we-carotid kumbonisi ngu-5.4%, i-coefficient of variation of the carotid artery β stiffness index yi-5.9%, kunye ne-inter-observer coefficient of variation of the carotid artery expansion is 11.9% coefficient kunye ne-12.8% yomthambo we-carotid β ukuqina kwesalathisi.
I-ultrasound ye-high-resolution yesiqhelo ye-Vivid 7 (GE) exhotyiswe nge-12 MHz ye-transducer yomgca yasetyenziswa ukuqhubela phambili i-carotid artery yomama kwi-plaque.Ukuqala kwi-carotid artery eqhelekileyo kufuphi nebhalbhu, umthambo we-carotid uhlolwe kabini nge-bifurcation kunye nenxalenye esondeleyo ye-carotid arteries yangaphakathi nangaphandle.Ngokutsho kwesivumelwano saseMannheim, i-plaque ichazwa njenge-1. Ukuqina kwendawo yodonga lomkhumbi nge-0.5 mm okanye i-50% ye-IMT ejikelezileyo okanye i-2. Ubuninzi bodonga lwe-arterial budlula i-1.5 mm.19 Ubukho be-plaque bavavanywa nge-dichotomy.Umkhangeli oyintloko (i-JKMS) wenza ngokuzimeleyo imilinganiselo ephindaphindiweyo kwi-subset yemifanekiso (N = 40) ukuvavanya ukuhlukahluka kwe-intra-observer, kwaye umkhangeli wesibini (TS) uvavanya ukuhluka phakathi kombukeli.I-Cohen κ yokuhluka kwe-intra-observer kunye nokuhluka kwe-inter-observer yayiyi-0.89 kunye ne-0.83, ngokulandelanayo.
I-PWV yalinganiswa ngumongikazi wophando oqeqeshiweyo ukuvavanya ukuqina komthambo wengingqi usebenzisa i-sensor mechanical (Complior Analyse, Alam Medical, Saint-Quentin-Fallavier, France) ngelixa ephumle kwindawo yokulala.20 Izivamvo zibekwe kumthambo we-carotid wasekunene, umthambo we-radial wasekunene, kunye nomthambo wasekunene we-femoral ukuvavanya indawo esembindini (i-right carotid artery-femoral artery) kunye neperipheral (right carotid artery-radial artery) ixesha lokuhamba.Sebenzisa iteyiphu yokulinganisa ukulinganisa umgama othe ngqo phakathi kwamanqaku okurekhoda ukuya kwi-0.1 cm ekufutshane.Umgama ochanekileyo we-carotid femoral artery uphindaphindwa ngo-0.8 kwaye emva koko usetyenziswe kumbindi wokubalo we-PWV.Phinda urekhode kwindawo yokulala.Iirekhodi ezimbini zifunyenwe xa irekhodi lesithathu lenziwe kwindawo apho umahluko phakathi kwemilinganiselo yayinkulu kune-0.5 m / s (10%).Ekumiselweni kwemilinganiselo engaphezu kwembini, isiphumo esinexabiso eliphantsi lokunyamezela lisetyenziselwa uhlalutyo.Ukunyamezela yiparameter esemgangathweni eyenza ukuguquguquka kwe-pulse wave ngexesha lokurekhoda.Sebenzisa umyinge ubuncinane wemilinganiselo emibini kuhlalutyo lokugqibela.I-PWV yabantwana be-168 inokulinganiswa.I-coefficient yokuhluka kwemilinganiselo ephindaphindiweyo yayiyi-3.5% ye-carotid-femoral artery PWV kunye ne-4.8% ye-carotid-radial artery PWV (N = 55).
Iseti yezalathi ezithathu zokubini zisetyenziselwa ukubonisa i-atherosclerosis engaphantsi komama: ubukho be-carotid artery plaque, i-carotid artery IMT ehlengahlengisiweyo ubudala kwaye idlule ipesenti ezingama-90 kwisampulu yethu, kwaye ngaphezulu kwama-90 ekhulwini I-PWV yentamo kunye ne-femur iyahambelana. ngobudala kunye noxinzelelo lwegazi olufanelekileyo.amashumi amabini ananye
I-ICVH iyiseti yezibonakaliso ze-binary ezi-7 ezinoluhlu oluqokelelweyo ukusuka kwi-0 ukuya kwi-7 (amanqaku aphezulu, ngakumbi ngokuhambelana nezikhokelo).I-4 Izibonakaliso ze-ICVH ezisetyenzisiweyo kolu cwaningo zihambelana nenkcazo yokuqala (iinguqulelo ezintathu zenziwe) -Itheyibhile eyoNgezelelweyo ye-S2) kwaye ibandakanya:
Umgangatho wokutya uhlolwe ngumntwana weFinnish Child Healthy Eating Index (uluhlu lwe-1-42) kunye nesalathiso sokutya okunempilo komama (uluhlu lwe-0-17).Zombini izalathisi zibandakanya i-4 kwiindidi ze-5 ezibandakanyiweyo kwisalathisi sokutya sokuqala (ngaphandle kokuthatha i-sodium).I-23,24 Ixabiso elibalulekileyo lomgangatho wokutya ofanelekileyo kunye nokungalungiyo uchazwa njenge-60% okanye ngaphezulu ukubonisa umgangatho wokutya kwasekuqaleni.Inkcazo yesalathisi (ifanelekile ukuba ngaphezu kwe-3 kwiikhrayitheriya ezi-5 zidibene).Ngokubhekiselele kwimpilo yamva nje yempilo yabantwana baseFinland (87.7% yamantombazana, i-78.2% yamakhwenkwe), ukuba umyinge othe ngqo ngokwesini kubantwana abatyebileyo ugqithisiwe, i-BMI yomntwana ichazwa njengengafanelekanga, eyahluke kancinane kwi-85. Ipesenti yabemi baseFinland.22 Ngenxa yenani elikhulu labafundi abashiya isikolo kunye nexabiso eliphantsi kakhulu localucalulo (iTheyibhile eyoNgezelelweyo S1, i-96% yoomama bahlangabezana nemilinganiselo ye-ICVH), ukujima kwabasetyhini abakhulelweyo nabalele ngaphakathi akuzange kuqukwe.I-ICVH yahlulahlulwe ngokwahlukileyo ngokwala macandelo alandelayo: aphantsi (abantwana 0-3, oomama 0-2), abaphakathi (abantwana 4, oomama 3-4) kunye nabaphezulu (abantwana kunye noomama 5-6), enika ithuba lokuthelekisa iindidi ezahlukeneyo. .
Sebenzisa izixhobo ze-elektroniki (Seca GmbH & Co. KG, eJamani) ukulinganisa ubude kunye nobunzima kwi-0.1 cm ekufutshane kunye ne-0.1 kg.Amanqaku eBMI Z aBantwana aveliswa ngokubhekisele kwiseti yedatha yamva nje yabantu baseFinland.I-22 yokwakheka komzimba iphumelele uvavanyo lwe-bioelectrical impedance (InBody 720, InBody Bldg, South Korea).
Uxinzelelo lwegazi lokuphumla lulinganiswa ngendlela ye-oscillometric ukusuka kwingalo yasekunene kwindawo ehleliyo (Omron M6W, Omron Healthcare Europe BV, The Netherlands) ene-cuff eyaneleyo.Umyinge we-systolic kunye noxinzelelo lwegazi lwe-diastolic lubalwa ukusuka kwimilinganiselo emibini ephantsi (ubuncinci bemilinganiselo emithathu).Uxinzelelo lwegazi lwabantwana ixabiso le-Z libalwa ngokwezikhokelo.25
Iisampuli zegazi ze-plasma glucose kunye ne-lipids zaqokelelwa phantsi kweemeko zokuzila ukutya.Iziphumo ezivela kubantwana be-3 ngokuthotyelwa kokuzila ukutya okungaqinisekanga (i-triglycerides ephezulu kakhulu, i-blood glucose esheshayo, kunye ne-glycosylated hemoglobin A1c (HbA1c) yayingabandakanywanga kuhlalutyo.I-cholesterol epheleleyo, i-low-density lipoprotein (LDL) i-cholesterol, i-high-density lipoprotein (HDL) i-cholesterol kunye ne-triglycerides inqunywe yindlela ye-enzymatic, i-plasma glucose kunye ne-enzymatic hexokinase determination, kunye ne-HbA1c kunye ne-immunoturbidimetric analyzer (i-Roche Diagnostics, i-Basel, i-Switzerland) yokuvavanya .
Umthamo womama wokutya wavavanywa yikhweshine yamaxesha okutya kwaye yavavanywa ngakumbi ngesalathiso sokutya okunempilo.I-Index ye-Healthy Food Intake Index iye yaqinisekiswa ngaphambili njengesixhobo esiluncedo sokubonisa ukuthotyelwa kweNgcebiso ye-Nordic Nutrition 26 kwiqela lokuqala le-RADIEL.24 Ngamafutshane, iqulethe izithako ezili-11, ezigubungela ukusetyenziswa kwemifuno, iziqhamo kunye namajikijolo, i-cereals high-fiber, intlanzi, ubisi, ushizi, ioli yokupheka, iisosi ezinamafutha, i-snacks, iziselo ezinoshukela kunye nokutya okukhawulezayo.Amanqaku aphezulu abonisa iqondo eliphezulu lokuthotyelwa kweziphakamiso.Umgangatho wokutya kwabantwana uhlolwe ngeerekhodi zokutya zeentsuku ze-3 kwaye zavavanywa ngakumbi yi-Finnish Children's Healthy Eating Index.I-Finnish Children's Healthy Eating Index iye yaqinisekiswa ngaphambili kubantwana baseFinland.23 Kubandakanya iintlobo ezintlanu zokutya: imifuno, iziqhamo namaqunube;ioli kunye nemargarine;ukutya okuneswekile eninzi;intlanzi kunye nentlanzi kunye nemifuno;kunye nobisi oluncitshisiweyo.Ukusetyenziswa kokutya kufakwe amanqaku ukwenzela ukuba ukusetyenziswa okuphezulu, kuphezulu amanqaku.Ngaphandle kokutya okuqulethe iswekile eninzi, amanqaku aguqulwa.Ngaphambi kokufaka amanqaku, lungisa ukuthathwa kwamandla ngokwahlula i-intake (iigram) ngokuthatha amandla (kcal).Okukhona amanqaku aphezulu, kokukhona uphucuka umgangatho wokutya kwabantwana.
I-Moderate ukuya kwi-vigory physical activity (MVPA) yalinganiswa kusetyenziswa i-accelerometer ye-hip yomntwana (ActiGraph GT3X, ActiGraph, Pensacola, USA) kunye ne-armband kamama (SenseWear ArmBand Pro 3).Uyalelwe ukuba unxibe imonitha ngexesha lokuvuka nokulala, kodwa ixesha lokulala lalingabandakanyi kuhlalutyo.Umntwana obeka iliso uqokelela idatha kwireyithi yesampulu ye-30 Hz.Idatha idla ngokuhluzwa, iguqulelwe kwi-10-second epoch count, kwaye ihlalutywe kusetyenziswa i-Evenson (2008) cut point (≥2296 cpm).27 Umama obeka iliso uqokelela amaxabiso e-MET kwi-epoch ye-60-yesibini.I-MVPA ibalwa njengoko ixabiso le-MET lidlula 3. Umlinganiselo osebenzayo uchazwa njengobuncinane beentsuku ezi-2 zokusebenza kunye nempelaveki e-1 (ukurekhoda ubuncinane imizuzu engama-480 ngosuku) kunye neentsuku zokusebenza ezi-3 kunye nempelaveki e-1 (ukurekhoda ubuncinane imizuzu engama-720 ngosuku) umama.Ixesha le-MVPA libalwa njengomyinge olinganisiweyo [(umyinge wemizuzu yeMVPA / imini ngeentsuku zeveki × 5 + umyinge wemizuzu yeMVPA / imini ngeempelaveki × 2)/7], ukongeza, njengepesenti yexesha elipheleleyo lokunxiba.Idatha yamva nje yokusebenza ngokomzimba yabantu baseFinland isetyenziswe njengesalathiso.28
Uluhlu lwemibuzo lwasetyenziselwa ukufumana ulwazi malunga nokutshaya kukamama, izifo ezingapheliyo, amayeza kunye nemfundo.
Idatha ichazwa njengentsingiselo ± SD, i-median (uluhlu lwe-interquartile) okanye izibalo (ipesenti).Vavanya ulwabiwo oluqhelekileyo lwazo zonke iinguqu eziqhubekayo ezisekelwe kwi-histogram kunye nesakhiwo se-QQ esiqhelekileyo.
Uvavanyo lwesampula oluzimeleyo, uvavanyo lwe-Mann-Whitney U, uhlalutyo lwendlela enye yokuhluka, i-Kruskal-Wallis, kunye novavanyo lwe-chi-square zisetyenziswe ngokufanelekileyo kumaqela okuthelekisa (umama nomntwana, inkwenkwe kunye nentombazana, okanye i-ICVH ephantsi kunye nephakathi kunye nephezulu ).
I-Pearson okanye i-Spearman i-coefficient yokulungelelaniswa kwerenki isetyenziselwe ukuphonononga ubudlelwane obungaguqukiyo phakathi kweempawu zomntwana kunye nomama.
Imodeli ye-multivariate linear regression model isetyenziselwe ukuseka imodeli echazayo ye-HDL cholesterol yabantwana kunye ne-carotid IMT.Ukhetho oluguquguqukayo lusekwe kulungelelwaniso kunye nomgwebo weklinikhi oyingcali, ugwema i-multicollinearity ebalulekileyo kwimodeli, kwaye ibandakanya izinto ezinokudideka.I-Multicollinearity ivavanywa ngokusebenzisa i-inflation factor, enexabiso eliphezulu le-1.9.I-Multivariate linear regression isetyenziswe ukuhlalutya intsebenziswano.
I-T-tailed P ≤ 0.05 yayimiselwe ukuba ibaluleke kakhulu, ngaphandle kokuhlaziywa kokulungelelaniswa kwemimiselo ye-carotid artery IMT kubantwana abane-P ≤ 0.01.
Iimpawu zabathathi-nxaxheba ziboniswe kwiThebhile 1 kunye neTheyibhile eyoNgezelelweyo ye-S3.Xa kuthelekiswa nereferensi yabemi, inqaku labantwana leBMI Z kunye neBP Z linyukile.Umsebenzi wethu wangaphambili uchaze idatha eneenkcukacha malunga ne-arterial morphology kubantwana.14 Kuphela yi-15 (12%) yabantwana kunye ne-5 (2.7%) yoomama abaye bahlangabezana nazo zonke iinqobo ze-ICVH (Amanani abongezelelweyo 2 kunye ne-3, iiTheyibhuli ezongezelelweyo S4-S6).
Amanqaku e-ICVH kanina nosana anxulumene kuphela namakhwenkwe (amakhwenkwe: rs=0.32, P=0.01; amantombazana: rs=-0.18, P=0.2).Xa kuhlalutywa njengento eguquguqukayo eqhubekayo, uhlalutyo lokulungelelaniswa komntwana kunye nosana lunentsingiselo ebalulekileyo ekulinganisweni kwe-lipids yegazi, i-HbA1C, ukukhuluphala, uxinzelelo lwegazi lwe-diastolic, kunye nomgangatho wokutya (IiFigure ezongezelelweyo ze-S4-S10).
I-LDL yabantwana kunye nomama, i-HDL, kunye ne-cholesterol epheleleyo zihambelana (r = 0.23, P = 0.003; r = 0.35, P <0.0001; r = 0.24, P = 0.003, Umfanekiso 1).Xa kucalulwa ngokwesini somntwana, unxulumano phakathi kwe-LDL yomntwana kunye nomama kunye ne-cholesterol epheleleyo yahlala ibalulekile kuphela emakhwenkweni (iTheyibhile eyoNgezelelweyo S7).I-Triglycerides kunye ne-HDL ye-cholesterol ihambelana nepesenti yamanqatha omzimba wamantombazana (rs = 0.34, P = 0.004; r = -0.37, P = 0.002, ngokulandelanayo, i-Figure 1, i-Supplementary Table S8).
Umfanekiso woku-1 Ubudlelwane phakathi komntwana kunye negazi likamama.Iploti yokusasaza ngomgca wokubuyisela umgca (i-95% yexesha lokuzithemba);(AC) amanqanaba egazi likamama kunye nosana;(D) ipesenti yamafutha omzimba wentombazana kunye ne-high-density lipoprotein cholesterol.Iziphumo ezibalulekileyo ziboniswa ngokugqamile (P ≤ 0.05).
Izifinyezo: i-LDL, i-lipoprotein ephantsi;I-HDL, i-high-density lipoprotein;r, Pearson coefficient yokulungelelanisa.
Sifumene ukuba kukho ukuhambelana okubalulekileyo phakathi kwe-HbA1C yomntwana kunye nomama (r = 0.27, P = 0.004), kodwa yayingahambelani nokuzila ukutya kwe-glucose yegazi (P = 0.4).Inqaku le-BMI Z labantwana, kodwa ingeyiyo ipesenti yamafutha omzimba, inxibelelene ngokubuthathaka kunye ne-BMI kamama kunye nomlinganiselo wesinqe ukuya kwi-hip (r = 0.17, P = 0.02; r = 0.18, P = 0.02, ngokulandelanayo).Ixabiso lika-Z loxinzelelo lwegazi lwe-diastolic kubantwana lunxulunyaniswa buthathaka noxinzelelo lwegazi lwe-diastolic lukamama (r=0.15, P=0.03).Isalathiso sokutya okunempilo kwabantwana baseFinland sihambelana nesalathiso sokutya okunempilo kukamama (r = 0.22, P 0.002).Olu dlelwane lwabonwa kuphela kumakhwenkwe (r=0.31, P=0.001).
Emva kokungabandakanyi oomama ababenyangelwe i<em>hypertension, hypercholesterolemia, okanye hyperglycemia, iziphumo zazifana.
I-arterial phenotype eneenkcukacha iboniswe kwiTheyibhile eyoNgezelelweyo ye-S9.Isakhiwo se-vascular yabantwana sizimeleyo kwiimpawu zabantwana (i-Supplementary Table S10).Asizange sigcine nayiphi na intlangano phakathi kwe-ICVH yobuntwaneni kunye nesakhiwo se-vascular or function.Kuhlalutyo lwabantwana abahlulwe ngamanqaku e-ICVH, siye saqaphela ukuba amanqaku e-carotid IMT Z abantwana abanamanqaku aphakathi kuphela anyukile xa kuthelekiswa nabantwana abanamanqaku aphantsi (ithetha ± SD; amanqaku aphakathi 0.41 ± 0.63 vs amanqaku aphantsi- 0.07 ± 0.71, P = 0.03, iTheyibhile eyoNgezelelweyo ye-S11).
I-ICVH yomama ayihambelani ne-vascular phenotype yabantwana (i-Supplementary Tables S10 kunye ne-S12).Abantwana kunye nomthambo we-carotid womama we-IMT bayanxulunyaniswa (Umfanekiso 2), kodwa ulungelelwaniso lukamama nomntwana phakathi kweeparamitha ezahlukeneyo zokuqina kwemithambo alubalulekanga ngokweenkcukacha-manani (iTheyibhile eyoNgezelelweyo yesi-9, uMzobo owoNgezelelweyo S11).Kwimodeli ye-multivariate regression toliko elungelelaniselwe isini sabantwana, ubudala, uxinzelelo lwegazi lwe-systolic, ubunzima bomzimba obhityileyo, kunye nepesenti yamanqatha omzimba, i-maternal carotid IMT ikuphela kwe-predictor ezimeleyo ye-carotid IMT yabantwana (ilungisiwe i-R2 = 0.08).Ngalo lonke ulwandiso lwe-1 mm kwi-IMT ye-carotid yoomama, i-carotid ye-IMT yobuntwana inyuke nge-0.1 mm (95% CI 0.05, 0.21, P = 0.001) (Itheyibhile eyoNgezelelweyo S13).Isini somntwana asizange sinciphise le mpembelelo.
Umfanekiso wesi-2 Unxulumano phakathi kwe-carotid artery intima-media ubukhulu ebantwaneni nakoomama.Iploti yokusasaza ngomgca wokubuyisela umgca (i-95% yexesha lokuzithemba);(A) I-IMT ye-carotid kamama nomntwana, (B) i-IMT yepesenti ye-IMT kunye ne-carotid yomntwana IMT z-score.Iziphumo ezibalulekileyo ziboniswa ngokugqamile (P ≤ 0.05).
Umlinganiselo wegazi lomama uhambelana ne-coefficient yokwandisa umthambo we-carotid kunye ne-β stiffness index kubantwana (rs=-0.21, P=0.007, rs=0.16, P = 0.04, i-Supplementary Table S10, ngokulandelanayo).Abantwana abazalwa ngoomama abane-vascular score ye-1-3 bane-coefficient ephantsi yokwandiswa komthambo we-carotid kunabo bazalwa ngoomama abanamanqaku e-0 (intsingiselo ± ukuphambuka okuqhelekileyo, 1.1 ± 0.2 vs 1.2 ± 0.2%/10 mmHg, P= 0.01) kwaye kukho ukuthambekela kokwandisa umthambo we-carotid β ukuqina kwesalathisi (i-median (IQR), 3.0 (0.7) kunye ne-2.8 (0.7), P = 0.052) kunye ne-carotid artery IMT (ithetha ± SD, 0.37 ± 0.04 ± 0.35 kunye ne-0.3 ± 0.35 mm, P = 0.06) (Umfanekiso 3), iTheyibhile eyoNgezelelweyo ye-S14).
Umzobo 3 I-phenotype yomntwana ye-vascular stratified yi-maternal vascular score.Idatha ichazwa njengentsingiselo + SD, P kunye novavanyo oluzimeleyo lwesampuli t (A kunye noC) kunye novavanyo lweMann-Whitney U (B).Iziphumo ezibalulekileyo ziboniswa ngokugqamile (P ≤ 0.05).Amanqaku emithanjeni yegazi kamama: uluhlu lwe-0-3, iseti yezalathi ezithathu zokubini: ubukho be-carotid plaque, ubukhulu be-carotid artery intima-media ehlengahlengiswa ngobudala kwaye yadlula i-90% kwisampulu yethu, kunye ne-wave ye-pulse yomlomo wesibeleko-femoral. isantya esigqithileyo kwi-90% sihambelana nobudala kunye noxinzelelo lwegazi oluphezulu.amashumi amabini ananye
Amanqaku oomama (i-ICVH, i-vascular score) kunye nokudibanisa kwamanqaku omntwana kunye nomama awahambelani ne-arterial phenotype yabantwana (i-Supplementary Table S10).
Kolu hlalutyo lwamacandelo oomama kunye nabantwana babo abaneminyaka eyi-6, siye saphanda umbutho phakathi kwe-ICVH yobuntwana, i-ICVH yomama, kunye ne-atherosclerosis engaphantsi komama kunye nesakhiwo kunye nomsebenzi wemithambo yabantwana.Eyona nto ifunyaniswayo kukuba kuphela i-atherosclerosis ye-subclinical yomama, ngelixa abantwana kunye nomama bemingcipheko yesiqhelo ye-cardiovascular risk ayihambelani notshintsho olubi kwi-phenotypes ye-vascular phenotypes yobuntwana.Olu lwazi lutsha ekukhuleni kwemithambo yobuntwana kwandisa ukuqonda kwethu impembelelo ephakathi kwezizukulwana ze-subclinical atherosclerosis.
Sinika ingxelo ngobungqina bokuhla kwe-carotid artery dilatation kunye nentsingiselo kwi-carotid artery beta stiffness kunye ne-carotid artery IMT kubantwana boomama abane-cardiovascular disease vascular substitutes.Nangona kunjalo, akukho kulungelelaniswa ngokuthe ngqo phakathi kwezalathi ze-vascular function yomama kunye nosana.Sicinga ukuba kubandakanywa i-plaque yomama kwi-vascular score kakhulu kwandisa ixabiso layo lokuxela kwangaphambili.
Siye saqaphela unxulumano oluhle phakathi komthambo we-carotid IMT ebantwaneni nakoomama;nangona kunjalo, umatshini awukacaci kuba umthambo we-carotid IMT ebantwaneni uzimele kwiimpawu zomntwana kunye nomama.Unxulumano phakathi kwamanqaku e-ICVH yabantwana kunye ne-carotid IMT ibonise ukungangqinelani, kuba asikhange siqwalasele nawuphi na umahluko phakathi kwe-ICVH ephantsi kunye ne-ICVH ephezulu.
Siyazi ukuba ezinye izinto zinokudlala indima, kubandakanywa i-circumference yentloko yabantwana, enokuthi ibe yinto ebalulekileyo yobungakanani be-carotid artery kwizigaba zokuqala zokukhula.Ukongezelela, iziphumo zethu zinokuthi zibangelwa izinto ezingenakulinganiswa ezichaphazela ukuphuhliswa kwe-vascular vascular.Nangona kunjalo, siye saxela kwangaphambili ukuba ukukhulelwa kwangaphambili / ukutyeba kakhulu kunye nesifo seswekile sokukhulelwa akunampembelelo kwi-IMT yabantwana be-carotid.14 Uphando olongezelelweyo luyimfuneko ukuphonononga impembelelo yokwakheka kwemithambo kunye nomsebenzi ekukhuleni kwabantwana kunye nemvelaphi yemfuza.
Imibutho exeliweyo ihambelana nezifundo zangaphambili eziqhutywe kwishumi elivisayo, ezibonelele ubungqina bobudlelwane phakathi kwe-phenotypes ye-vascular phenotypes yomzali nomntwana, kuquka i-carotid IMT, nangona ubukhulu bomzimba bungalungiswanga kuhlalutyo.29 Ufuzo olukhulu lwe-carotid IMT luqinisekisa ngakumbi oku kunye nokuqina kwemithambo yabantu abadala.30,31
Umbutho oqatshelweyo phakathi kwe-atherosclerosis ye-subclinical yomama kunye ne-phenotype ye-vascular phenotype ayizange yandiswe yi-ICVH yomama.Oku kuhambelana nezifundo zangaphambili apho inxalenye enkulu yokwahluka kwi-phenotype ye-vascular yabantwana ichazwa yizinto zofuzo ezizimeleyo kwiimeko eziqhelekileyo zengozi ye-cardiovascular yabazali kunye nabantwana.29
Ukongezelela, utshintsho lwe-vascular oluphawulweyo alunanto yakwenza ne-ICVH yobuntwaneni, ebonisa impembelelo ephambili yemvelaphi yemfuza yobuntwana.Igalelo lezinto ezisingqongileyo libonakala litshintshile kunye nobudala babantwana, njengoko uphando lwangaphambili lwabantwana abaneminyaka eyi-11-12 luchaze umbutho obalulekileyo phakathi kwe-vascular function yabantwana kunye ne-ICVH.12
Ixesha lokuposa: Jul-14-2021