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Ubudlelwano phakathi kwempilo enhle yenhliziyo nemithambo yegazi kanye ne-vascular phenotype yomama abakhuluphele kanye nezingane zabo ezineminyaka engu-6 ubudala
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 Izibhedlela zaseNyuvesi yaseHelsinki naseHelsinki University, eHelsinki, eFinland;2 Umnyango Wokukhubazeka Kwenhliziyo Yokuzalwa kanye Nezokwelapha Zenhliziyo Yezingane, Inyuvesi Yezokwelapha E-Silesian, Katowice, Poland, Zabrze FMS;3 Minerva Foundation Medical Research Institute, Helsinki, Finland;4 Umnyango Wokudla Nokudla Okunempilo, eNyuvesi yaseHelsinki, eHelsinki, eFinland;5LIKES Isikhungo Somsebenzi Wezemidlalo Nezempilo, Jyvaskyla, Finland;6 Isibhedlela Sabesifazane saseNyuvesi yase-Helsinki kanye neSibhedlela SeNyuvesi yase-Helsinki e-Helsinki, e-Finland;7 Folkhälsan Research Centre, Helsinki, Finland;8 iNyuvesi yaseHelsinki kanye noMnyango Wezokuziphatha Okujwayelekile kanye Nokunakekelwa Kwezempilo Okuyisisekelo, Isibhedlela saseNyuvesi, eHelsinki, eFinland;9 Uhlelo Lokucwaninga Ngenguquko Engenzeka Kumuntu kanye Nomnyango Wezokubelethisa Nezabesifazane, i-Yang Luling School of Medicine, i-National University of Singapore, Singapore;10 Singapore Institute of Clinical Sciences (SICS), Science, Technology and Research Bureau (A*STAR), Singapore Communications: Linda Litwin Department of Congenital Heart Defects and Pediatric Cardiology, Zabrze FMS, Silesian Medical University, M.Sklodowskiej-Curie 9, Zabrze, 41-800, Poland Tel +48 322713401 Fax +48 322713401 I-imeyili [email protected] Isendlalelo: Ufuzo kanye nendlela yokuphila eyabelwe umndeni kungabangela izingozi zenhliziyo nemithambo yegazi, kodwa izinga okuthinta ngalo ukwakheka nokusebenza kwemithambo ebuntwaneni akucaci.Sihlose ukuhlola ukuhlobana phakathi kwempilo ekahle yenhliziyo nemithambo yegazi ezinganeni nakubama, i-atherosclerosis engaphansi komama, kanye ne-arterial phenotypes ezinganeni.Izindlela: Kusukela ku-Finnish Gestational Diabetes Prevention Study (RADIEL) longitudinal cohort, ukuhlaziya okuhlangene kwezingane ezingama-201 zomama ezineminyaka engu-6.1 ± 0.5 ubudala kuhlolwe impilo ekahle yenhliziyo nemithambo yegazi (BMI, umfutho wegazi, ukuzila ukudla kweglucose, i-cholesterol ephelele, ikhwalithi yokudla, Umsebenzi womzimba, ukubhema), ukwakheka komzimba, i-carotid ultra-high frequency ultrasound (25 kanye no-35 MHz) kanye nesivinini se-pulse wave.Imiphumela: Sithole ukuthi kwakungekho ukuhlobana phakathi kwempilo ekahle yenhliziyo nemithambo yegazi yengane kanye nomama, kodwa sabika ubufakazi bokuhlobana kwezinkomba ezithile: i-cholesterol ephelele (r=0.24, P=0.003), BMI (r=0.17, P =0.02), umfutho wegazi we-Diastolic (r=0.15, P=0.03) kanye nekhwalithi yokudla (r=0.22, P=0.002).I-phenotype ye-arterial yezingane ayihlangene nempilo efanelekile yenhliziyo yengane noma kamama.Kumodeli yokuhumusha yokuhlehla okuxubile elungiselwe ubulili bezingane, ubudala, umfutho wegazi we-systolic, isisindo somzimba esithambile, namaphesenti wamafutha omzimba, ukujiya kwe-carotid artery intima-media ezinganeni kwahlotshaniswa ngokuzimele kuphela nobukhulu be-carotid artery intima. -imidiya (ukwanda ngo-0.1 mm [95 %] CI 0.05, 0.21, P=0.001] Ukuqina komthambo womama we-carotid intima-media kukhuphuke ngo-1 mm).Izingane zomama abane-subclinical atherosclerosis zehle ukunwetshwa komthambo we-carotid (1.1 ± 0.2 vs 1.2 ± 0.2%/10 mmHg, P=0.01) nokwanda kwe-carotid artery intima-media ukujiya (0.37 ± 0.04 vs 0.35) ± 0.04 mm, P=0.04 mm) Isiphetho: Izinkomba ezikahle zempilo yenhliziyo nemithambo yegazi zihlobene ngokuhlukahlukana kumama nomama wengane ebuntwaneni.Asitholanga bufakazi bomthelela wempilo ekahle yenhliziyo nemithambo yegazi yezingane noma kamama kuma-arterial phenotypes ezingane.Ugqinsi lwe-carotid artery intima-media lungabikezela ukushuba kwe-carotid artery intima-media ezinganeni, kodwa ukusebenza kwawo okuyisisekelo akukacaci.I-atherosulinosis ye-subclinical yomama ihlobene nokuqina komthambo we-carotid lapho isencane.Amagama angukhiye: isifo senhliziyo nemithambo yegazi, isifo sokuqina kwemithambo yegazi, ukuqina kwe-carotid artery intima-media, izici eziyingozi, izingane
Izici zendabuko eziyingozi zenhliziyo nemithambo yegazi zifaka isandla ekwakhiweni nasekuthuthukisweni kwe-atherosclerosis.I-1,2 izici zobungozi zivame ukuhlangana ndawonye, futhi inhlanganisela yazo ibonakala ibikezela ingozi yenhliziyo yomuntu ngamunye.3
I-American Heart Association ichaza impilo enhle yenhliziyo (ICVH) njengesethi yezinkomba eziyisikhombisa zezempilo (inkomba yesisindo somzimba (BMI), umfutho wegazi (BP), ushukela wegazi ozila ukudla, i-cholesterol ephelele, ikhwalithi yokudla, ukuvivinya umzimba, ukubhema) ukuvimbela isifo senhliziyo ezinganeni nakubantu abadala.I-4 ICVH ihlotshaniswa kabi ne-subclinical atherosclerosis lapho usumdala.I-5 ICVH kanye nama-phenotypes angalungile e-vascular yizibikezelo ezinokwethenjelwa zezenzakalo zenhliziyo nokufa kwabantu abadala.6-8
Isifo senhliziyo yabazali sandisa ingozi yezenzakalo zenhliziyo nemithambo yegazi enzalweni.9 Izici zemvelo ezihlobene nezakhi zofuzo kanye nezindlela zokuphila ezivamile zombili zibhekwa njengezindlela ezingase zibe khona, kodwa umnikelo wazo awukakanqunywa.10,11
Ukuhlobana phakathi kwe-ICVH yomzali nengane sekuvele kubonakala ezinganeni ezineminyaka engu-11-12 ubudala.Kulesi sigaba, i-ICVH yezingane ihlobene nokunwebeka komthambo we-carotid futhi ihlobene kabi ne-cervical femoral pulse wave velocity (PWV), kodwa ayiboniswa kugqinsi lwe-carotid artery intima-media thick (IMT).12 Nokho, ingozi yenhliziyo nemithambo yegazi ephakathi kweminyaka eyi-12-18 ihlotshaniswa nokwanda kwe-carotid IMT empilweni yabantu abaneminyaka ephakathi nendawo, futhi ayihlanganise lutho nezici zobungozi ngesikhathi esifanayo.13 Ubufakazi obuphathelene namandla alezi zinhlangano ebuntwaneni abukho.
Emsebenzini wethu odlule, asizange sithole imiphumela yesifo sikashukela sokukhulelwa noma ukungenelela kwendlela yokuphila komama ku-anthropometry yengane yasekuqaleni, ukwakheka komzimba noma usayizi we-arterial kanye nomsebenzi.14 Lokhu kuhlaziya okugxilwe kukho ukuthambekela kwezizukulwane eziningi zokuhlanganisa ubungozi benhliziyo nemithambo yegazi.Ikilasi kanye nomthelela walo ku-arterial phenotype yezingane.Sicabanga ukuthi i-ICVH yomama kanye ne-vascular substitutes ye-cardiovascular disease izobonakala ku-ICVH yobuntwana kanye ne-arterial phenotypes ebuntwaneni.
Idatha yezigaba ezahlukene isuka ekulandeleni kweminyaka eyisithupha kwe-Finnish Gestational Diabetes Prevention Study (RADIEL).Idizayini yokuqala yocwaningo iphakanyiswe kwenye indawo.15 Kafushane, abesifazane abahlela ukukhulelwa noma abasengxenyeni yokuqala yokukhulelwa futhi banengozi eyengeziwe yokuba nesifo sikashukela sokukhulelwa (ukukhuluphala kanye/noma umlando wesifo sikashukela sokukhulelwa) baqashwa (N=728).Ukulandelela kwenhliziyo nemithambo yegazi yeminyaka engu-6 kwaklanywa njengocwaningo lokuqaphela lwamapheya omama nosana, nenani elilinganayo lomama abanesifo sikashukela sokukhulelwa nabangenaso, abanosayizi weqembu oshiwo ngaphambili (~200).Kusukela ngoJuni 2015 kuya kuMeyi 2017, izimemo eziqhubekayo zathunyelwa kubahlanganyeli kuze kube yilapho kufinyelelwa khona umkhawulo, futhi kwaqashwa amapheya angu-201 wama-tuple amabili.Ukulandelela kuklanyelwe izingane ezineminyaka engu-5-6 ukuze kuqinisekiswe ukusebenzisana ngaphandle kokulaliswa, okuhlanganisa ukuhlolwa kweqembu likamama nengane encane ngobukhulu nokwakheka komzimba, umfutho wegazi, ukuzila ukudla kweglucose kanye nama-lipids egazi, ukuvivinya umzimba kusetshenziswa ama-accelerometer, ikhwalithi yokudla kanye imibuzo yokubhema (omama), imithambo yegazi I-Ultrasound kanye ne-intraocular pressure measurement kanye ne-echocardiography ezinganeni.Ukutholakala kwedatha kufakwe kuhlu lwe-Supplementary Table S1.IKomidi Lezimiso Zokuziphatha Lezifo Zabesifazane Nezifo Zabesifazane, Izifo Zezingane NezeNgqondo Lesibhedlela SeNyuvesi Yase-Helsinki ligunyaze umthetho olandelwayo wocwaningo (20/13/03/03/2015) ukuze kube nokuhlolwa okulandelanayo kweminyaka eyisithupha.Imvume ebhaliwe yabo bonke omama benolwazi yatholwa ngesikhathi sokubhaliswa.Ucwaningo lwenziwe ngokuhambisana neSimemezelo saseHelsinki.
Umcwaningi onekhono (TS) usebenzisa ama-transducer angu-25 MHz kanye nama-35 MHz anesistimu ye-Vevo 770, futhi usebenzisa i-UHF22, UHF48 (imvamisa yesikhungo efanayo) kanye nohlelo lwe-Vevo MD (VisualSonics, Toronto, Canada) njengamapheya okugcina angu-52 kamama nengane.Umthambo we-carotid ovamile uboniswe ngo-1 cm usondelene nezigaxa ze-carotid zamazwe amabili, futhi indawo yokuphumula yayisendaweni engenhla.Sebenzisa imvamisa ephezulu kakhulu engakwazi ukubona ngeso lengqondo udonga olukude ukuze uthole izithombe zefilimu zekhwalithi ephezulu ezimboza imijikelezo yenhliziyo emi-3-4.Sebenzisa i-Vevo 3.0.0 (Vevo 770) enama-caliper e-electronic manual kanye nesofthiwe ye-VevoLab (Vevo MD) ukuze uhlaziye izithombe ungaxhunyiwe ku-inthanethi.I-16 Ububanzi be-Lumen kanye ne-IMT kukalwa yisibukeli esinolwazi (JKMS) ekupheleni kwe-diastole kusetshenziswa amasu okusika), engazi izici zesihloko (Supplementary Figure S1).Sike sabika ngaphambilini ukuthi i-coefficient ye-intra-observer yokuhluka kukalwa nge-ultra-high-resolution ultrasound ezinganeni nakubantu abadala ingu-1.2-3.7% kububanzi belumen, i-IMT ingu-6.9-9.8%, futhi i-coefficient ye-inter-observer yokuhluka I-1.5-4.6% kububanzi be-lumen., 6.0-10.4% ye-IMT.Isikolo se-carotid IMT Z esilungiselwe ubudala nobulili sibalwa kusetshenziswa inkomba yezingane ezinempilo ezimhlophe ezingakhuluphele.17
I-carotid artery lumen diameter yalinganiswa ku-systole ephezulu kanye ne-end-diastole ukuze kuhlolwe umthambo we-carotid β inkomba yokuqina kanye ne-coefficient yokwandisa umthambo we-carotid.Kusetshenziswa i-cuff enosayizi ofanele, indlela ye-oscillometric (i-Dinamap ProCare 200, GE) yasetshenziswa ukurekhoda umfutho wegazi we-systolic kanye ne-diastolic ukuze kubalwe ukusebenza okunwebekayo ngesikhathi sokuthwebula kwe-ultrasound endaweni ephansi yengalo yesokudla.I-coefficient yokwandisa umthambo we-carotid kanye nenkomba yokuqina komthambo we-carotid ibalwa kusukela kumthambo we-carotid kusetshenziswa ifomula elandelayo:
Phakathi kwazo, i-CCALAS ne-CCALAD iyindawo evamile ye-carotid artery lumen ngesikhathi se-systole ne-diastole ngokulandelanayo;I-CCALDS ne-CCALDD yi-carotid artery lumen ububanzi obuvamile ngesikhathi se-systole ne-diastole ngokulandelanayo;I-SBP ne-DBP yi-systolic ne-diastolic blood pressure.18 I-coefficient of variation ye-coefficient yokwandisa umthambo we-carotid kusibukeli ingu-5.4%, i-coefficient of variation ye-carotid artery β stiffness index ingu-5.9%, kanye ne-inter-observer coefficient of variation yokunwetshwa komthambo we-carotid yi-coefficient engu-11.9%. kanye no-12.8% we-carotid artery β inkomba yokuqina.
I-ultrasound ye-high-resolution yendabuko i-Vivid 7 (GE) efakwe i-transducer engumugqa engu-12 MHz yasetshenziswa ukuze kuqhutshekwe kuhlolwe umthambo we-carotid kamama weplaque.Kusukela emthanjeni ovamile we-carotid eduze ne-bulb, umthambo we-carotid uhlolwa ngokubili nge-bifurcation kanye nengxenye eseduze yemithambo yangaphakathi nengaphandle ye-carotid.Ngokuvumelana ne-Mannheim, i-plaque ichazwa ngokuthi 1. Ukuqina kwendawo yodonga lomkhumbi ngo-0.5 mm noma u-50% we-IMT ezungezile noma 2. Ubukhulu obuphelele bodonga lwe-arterial budlula u-1.5 mm.19 Ukuba khona kwe-plaque kwahlolwa nge-dichotomy.Isibukeli esiyinhloko (i-JKMS) senza ngokuzimela izilinganiso eziphindaphindiwe kusethi encane yezithombe (N = 40) ukuze sihlole ukuhlukahluka kwe-intra-observer, futhi isibukeli sesibili (i-TS) sihlola ukuhlukahluka phakathi kwezibukeli.I-Cohen κ yokuhlukahluka kwe-intra-observer kanye nokuhlukahluka phakathi kwe-inter-observer bekuyi-0.89 kanye ne-0.83, ngokulandelanayo.
I-PWV ikalwe umhlengikazi wocwaningo oqeqeshiwe ukuze ahlole ukuqina komthambo wesifunda kusetshenziswa inzwa yomshini (I-Complior Analyse, i-Alam Medical, i-Saint-Quentin-Fallavier, e-France) ngenkathi iphumule endaweni ephansi.20 Izinzwa zibekwe emthanjeni ongakwesokudla we-carotid, umthambo we-radial ongakwesokudla, kanye nomthambo wesifazane ongakwesokudla ukuze kuhlolwe indawo emaphakathi (i-carotid artery-femoral artery) kanye ne-peripheral (right carotid artery-radial artery) isikhathi sokuhamba.Sebenzisa i-tape measure ukuze ulinganise ibanga eliqondile phakathi kwamaphoyinti okurekhoda ukuya ku-0.1 cm eseduze.Ibanga elilungile le-carotid femoral artery liphindaphindwa ngo-0.8 bese lisetshenziswa esibalweni se-PWV esimaphakathi.Phinda ukurekhodwa endaweni yokulala.Amarekhodi amabili atholwe lapho irekhodi lesithathu lenziwa endaweni lapho umehluko phakathi kwezilinganiso wawumkhulu kuno-0.5 m/s (10%).Esimisweni sezilinganiso ezingaphezu kwezimbili, umphumela onevelu yokubekezelela ephansi kakhulu usetshenziselwa ukuhlaziywa.Ukubekezelela ipharamitha yekhwalithi elinganisa ukuhlukahluka kwegagasi lokushaya kwenhliziyo phakathi nokurekhoda.Sebenzisa isilinganiso okungenani sezilinganiso ezimbili ekuhlaziyeni kokugcina.I-PWV yezingane eziyi-168 ingakalwa.I-coefficient yokuhluka kwezilinganiso eziphindaphindiwe kwaba ngu-3.5% we-carotid-femoral artery PWV kanye no-4.8% we-carotid-radial artery PWV (N=55).
Iqoqo lezinkomba ezintathu kanambambili lisetshenziselwa ukukhombisa i-subclinical atherosclerosis kamama: ukuba khona kwe-carotid artery plaque, i-carotid artery IMT elungisiwe ubudala futhi idlule i-90th percentile kusampula yethu, futhi ngaphezu kwamaphesenti angu-90 I-PWV yentamo ne-femur ifanisiwe. ngeminyaka kanye nomfutho wegazi ofanele.amashumi amabili nanye
I-ICVH iyisethi yezinkomba kanambambili ezingu-7 ezinobubanzi obukhulayo obusuka ku-0 kuye ku-7 (uma amaphuzu aphezulu, ahambisana kakhulu nemihlahlandlela).I-4 Izinkomba ze-ICVH ezisetshenziswe kulolu cwaningo zihambisana nencazelo yokuqala (ukulungiswa okuthathu kwenziwe) -Ithebula Le-Supplementary S2) futhi zihlanganisa:
Izinga lokudla lihlolwa yi-Finnish Child Healthy Eating Index yengane (ububanzi obungu-1-42) kanye nenkomba yokudla okunempilo kamama (ibanga 0-17).Zombili izinkomba zihlanganisa izigaba ezi-4 kwezi-5 ezifakwe kunkomba yokuqala yokudla (ngaphandle kokuthatha i-sodium).23,24 Inani elibalulekile lekhwalithi yokudla ekahle nengelona iqiniso lichazwa ngokuthi 60% noma ngaphezulu ukukhombisa ikhwalithi yokudla kwasekuqaleni.Incazelo yenkomba (ilungile uma kuhlangatshezwana nemibandela engaphezu kwezi-3 kwezi-5).Uma kukhulunywa ngesibalo sakamuva esinempilo sezingane zase-Finnish (87.7% yamantombazane, 78.2% yabafana), uma umkhawulo oqondene nobulili wezingane ezikhuluphele weqiwe, i-BMI yengane ichazwa njengengafanelekile, ehluke kancane ku-85. % yabantu baseFinland.22 Ngenxa yenani elikhulu labafundi abashiya isikole kanye nenani eliphansi kakhulu lokubandlulula (Ithebula Lesengezo S1, 96% omama bahlangabezana nenqubo ye-ICVH), ukuvivinya umzimba kwabesifazane abakhulelwe nabalele ngaphakathi akuzange kufakwe.I-ICVH ihlukaniswe ngokuzimele ngezigaba ezilandelayo: okuphansi (izingane 0-3, omama 0-2), okuphakathi (izingane 4, omama 3-4) kanye naphezulu (izingane nomama 5-6), okunikeza ithuba lokuqhathanisa izigaba ezahlukene .
Sebenzisa okokusebenza kwe-elekthronikhi (Seca GmbH & Co. KG, Germany) ukukala ubude nesisindo ku-0.1 cm eseduze no-0.1 kg.Izikolo ze-BMI Z zezingane zikhiqizwa ngokubhekiselwa kusethi yedatha yabantu base-Finnish yakamuva.22 Ukwakheka komzimba kuphumelele ukuhlolwa kwe-bioelectrical impedance (InBody 720, InBody Bldg, South Korea).
Umfutho wegazi ophumule ukalwe ngendlela ye-oscillometric kusuka engalweni yesokudla endaweni ehlezi (Omron M6W, Omron Healthcare Europe BV, The Netherlands) ngecuff eyanele.Isilinganiso somfutho wegazi we-systolic ne-diastolic sibalwa kusukela ezilinganisweni ezimbili eziphansi kakhulu (okungenani izilinganiso ezintathu).Umfutho wegazi wezingane u-Z value ubalwa ngokuvumelana neziqondiso.25
Amasampula egazi we-plasma glucose kanye ne-lipids aqoqwe ngaphansi kwezimo zokuzila.Imiphumela evela ezinganeni ezi-3 ezinokuthobela ukudla okungaqinisekile (i-triglycerides ephezulu ngokweqile, ushukela wegazi ozila ukudla, ne-glycosylated hemoglobin A1c (HbA1c)) ayifakwanga ekuhlaziyweni.Isamba se-cholesterol, i-low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol kanye ne-triglycerides kunqunywa ngendlela ye-enzymatic, i-plasma glucose kanye ne-enzymatic hexokinase determination, kanye ne-HbA1c kanye ne-immunoturbidimetric analyzer (Roche Diagnostics, Basel, Switzerland) ukuze kuhlolwe .
Ukudla komama okudlayo kwahlolwa ngohlu lwemibuzo lwezikhathi zokudla futhi kwabuye kwahlolwa inkomba yokudla okunempilo.I-Healthy Food Intake Index ike yaqinisekiswa ngaphambilini njengethuluzi eliwusizo lokubonisa ukuthotshelwa kwe-Nordic Nutrition Recommendation 26 eqenjini lokuqala le-RADIEL.24 Kafushane, iqukethe izithako eziyi-11, ezihlanganisa ukudliwa kwemifino, izithelo namajikijolo, okusanhlamvu okunefibre ephezulu, inhlanzi, ubisi, ushizi, amafutha okupheka, amasoso anamafutha, ukudla okulula, iziphuzo ezinoshukela nokudla okusheshayo.Ukuphakama kwamaphuzu kubonisa izinga eliphezulu lokuthobela izincomo.Izinga lokudla kwezingane lahlolwa ngamarekhodi okudla ezinsuku ezi-3 futhi labuyekezwa yi-Finnish Children's Healthy Eating Index.Inkomba Yokudla Okunempilo Kwezingane yase-Finnish iye yaqinisekiswa ngaphambilini kuzibalo zezingane zase-Finnish.23 Kuhlanganisa izinhlobo ezinhlanu zokudla: imifino, izithelo namajikijolo;amafutha kanye nemajarini;ukudla okunoshukela omningi;izinhlanzi nezinhlanzi nemifino;kanye nobisi oluncibilikisiwe.Ukudla okusetshenziswayo kunikezwa amaphuzu ukuze ukusetshenziswa okuphezulu, amaphuzu aphezulu.Ngaphandle kokudla okuqukethe ushukela omningi, amaphuzu ahlehlisiwe.Ngaphambi kokufaka amaphuzu, lungisa ukuthathwa kwamandla ngokuhlukanisa ukudla (amagremu) ngokuthatha amandla (kcal).Uma amaphuzu aphezulu, izinga lokudla kwezingane lingcono.
Umsebenzi womzimba omaphakathi ukuya konamandla (MVPA) ukalwe kusetshenziswa i-accelerometer ye-hip yengane (ActiGraph GT3X, ActiGraph, Pensacola, USA) kanye nebhande lengalo likamama (SenseWear ArmBand Pro 3).Uyalelwe ukuthi ugqoke imonitha ngesikhathi sokuphapheme nokulala, kodwa isikhathi sokulala asifakwanga ekuhlaziyweni.Imonitha yengane iqoqa idatha ngesilinganiso samasampula esingu-30 Hz.Idatha ivamise ukuhlungwa, iguqulelwe ekubenila imizuzwana eyi-10, bese ihlaziywa kusetshenziswa iphoyinti lokusika le-Evenson (2008) (≥2296 cpm).27 Umama wokuqapha uqoqa amanani we-MET esikhathini esingamasekhondi angama-60.I-MVPA ibalwa njengoba inani le-MET lidlula 3. Ukulinganisa okuphumelelayo kuchazwa okungenani njengezinsuku zokusebenza ezi-2 nempelasonto engu-1 (irekhodwa okungenani imizuzu engu-480 ngosuku) kanye nezinsuku zokusebenza ezingu-3 kanye nempelasonto engu-1 (irekhodwa okungenani imizuzu engu-720 ngosuku) umama.Isikhathi se-MVPA sibalwa njengesilinganiso esilinganiselwe [(isilinganiso semizuzu/usuku lwe-MVPA phakathi neviki × 5 + isilinganiso samaminithi we-MVPA/usuku ngezimpelasonto × 2)/7], ngaphezu kwalokho, njengephesenti lesikhathi sokugqoka esiphelele.Idatha yakamuva kakhulu yokusebenza ngokomzimba yabantu base-Finnish isetshenziswe njengereferensi.28
Uhlu lwemibuzo lwasetshenziswa ukuze kutholwe ulwazi mayelana nokubhema kukamama, izifo ezingamahlalakhona, imithi, kanye nemfundo.
Idatha ichazwa njengesho ukuthi ± SD, i-median (ububanzi be-interquartile) noma izibalo (iphesenti).Linganisa ukusatshalaliswa okuvamile kwakho konke okuguquguqukayo okuqhubekayo ngokusekelwe ku-histogram nesakhiwo esivamile se-QQ.
Ukuhlolwa kwesampula okuzimele, ukuhlolwa kwe-Mann-Whitney U, ukuhlaziywa kwendlela eyodwa yokuhluka, i-Kruskal-Wallis, nokuhlolwa kwe-chi-square kusetshenziswe njengokufanelekile kumaqembu okuqhathanisa (umama nengane, umfana nentombazane, noma i-ICVH ephansi nemaphakathi nephezulu. ).
I-Pearson noma i-Spearman isikhundla sokuhlanganisa i-coefficient yasetshenziswa ukuhlola ukuhlobana okungaguquki phakathi kwezici zengane nomama.
Imodeli ye-multivariate yomugqa wokuhlehla yasetshenziswa ukusungula imodeli echazayo ye-HDL cholesterol yezingane kanye ne-carotid IMT.Ukukhetha okuguquguqukayo kusekelwe ekusebenzelaneni nasekwahluleleni komtholampilo kochwepheshe, kugwema i-multicollinearity ebalulekile kumodeli, futhi kufaka phakathi izici ezingase zidide.I-Multicollinearity ihlolwa kusetshenziswa i-inflation factor, enenani eliphakeme elingu-1.9.Ukuhlehla komugqa we-multivariate kusetshenziswe ukuhlaziya ukusebenzisana.
I-P enemisila emibili ≤ 0.05 isethwe ukuthi ibaluleke, ngaphandle kokuhlaziywa kokuhlobana kwezinqumo ze-carotid artery IMT ezinganeni ezine-P ≤ 0.01.
Izici zombambi qhaza zikhonjiswe kuThebula 1 kanye neThebula Lokwengeza S3.Uma kuqhathaniswa nenani lenkomba, isikolo sezingane se-BMI Z kanye nesikolo se-BP Z sinyukile.Umsebenzi wethu wangaphambilini ubike idatha enemininingwane nge-arterial morphology ezinganeni.14 Izingane eziyi-15 (12%) kuphela kanye nomama abangu-5 (2.7%) bahlangabezana nazo zonke izindlela ze-ICVH (Amanani Awengeziwe 2 no-3, Amathebula Engeziwe S4-S6).
Isikolo se-ICVH esiqongelelwe komama nezinsana sihlobene kuphela nabafana (abafana: rs=0.32, P=0.01; amantombazane: rs=-0.18, P=0.2).Uma kuhlaziywa njengokuguquguquka okuqhubekayo, ukuhlaziywa kokuhlotshaniswa kwe-univariate yomama nosana kunokubaluleka okubalulekile esilinganisweni se-lipids yegazi, i-HbA1C, ukukhuluphala, umfutho wegazi we-diastolic, kanye nekhwalithi yokudla (Izibalo Ezingeziwe S4-S10).
I-LDL yezingane nomama, i-HDL, kanye nengqikithi ye-cholesterol kuhlobene (r=0.23, P=0.003; r=0.35, P<0.0001; r=0.24, P=0.003, Umfanekiso 1).Lapho ihlukaniswa ngobulili bengane, ukuhlobana phakathi kwe-LDL yengane nomama kanye nenani le-cholesterol kuhlale kuphawuleka kubafana kuphela (Ithebula Elingeziwe S7).I-Triglycerides ne-HDL cholesterol kuhlotshaniswa nephesenti lamafutha omzimba wamantombazane (rs=0.34, P=0.004; r=-0.37, P=0.002, ngokulandelana, Umfanekiso 1, Ithebula le-Supplementary S8).
Umfanekiso 1 Ubudlelwano phakathi kwama-lipids egazi lengane nomama.Isakhiwo se-scatter esinomugqa wokuhlehla womugqa (isikhawu sokuzethemba esingu-95%);(AC) amazinga egazi likamama nelengane;(D) iphesenti lamafutha omzimba wentombazane kanye ne-high-density lipoprotein cholesterol.Imiphumela ebalulekile iboniswa ngokugqamile (P ≤ 0.05).
Izifinyezo: LDL, low-density lipoprotein;HDL, high-density lipoprotein;r, i-Pearson coefficient yokuhlanganisa.
Sithole ukuthi kunokuhlobana okubalulekile phakathi kwe-HbA1C yengane nomama (r=0.27, P=0.004), kodwa kwakungahlobene nokuzila ukudla kweglucose yegazi (P=0.4).Isikolo sezingane se-BMI Z, kodwa hhayi iphesenti lamafutha omzimba, lihlobene kancane ne-BMI kamama kanye nesilinganiso sokhalo-to-hip (r=0.17, P=0.02; r=0.18, P=0.02, ngokulandelana).Inani lika-Z lomfutho wegazi we-diastolic wezingane lihlobene kancane nomfutho wegazi we-diastolic kamama (r=0.15, P=0.03).Inkomba yokudla okunempilo yezingane zase-Finnish ihlotshaniswa nenkomba yokudla okunempilo kamama (r=0.22, P 0.002).Lobu budlelwano bubonwe kuphela kubafana (r=0.31, P=0.001).
Ngemva kokungabandakanyi omama ababelashelwa umfutho wegazi ophakeme, i-hypercholesterolemia, noma i-hyperglycemia, imiphumela yayingashintshile.
I-arterial phenotype enemininingwane ikhonjiswe ku-Supplementary Table S9.Isakhiwo semithambo yezingane sizimele ezicini zezingane (Ithebula le-Supplementary S10).Asizange sibone noma yikuphi ukuhlangana phakathi kwe-ICVH yobuntwana kanye nesakhiwo se-vascular noma umsebenzi.Ekuhlaziyeni izingane ezihlelwe ngamaphuzu e-ICVH, siphawule ukuthi izikolo ze-carotid IMT Z zezingane ezinamaphuzu amaphakathi kuphela zinyukile uma ziqhathaniswa nezingane ezinamaphuzu aphansi (kusho ± SD; amaphuzu amaphakathi 0.41 ± 0.63 vs amaphuzu aphansi- 0.07 ± 0.71, P = 0.03, Ithebula Lokwengeza S11).
I-ICVH yomama ayihlobene ne-vascular phenotype yezingane (I-Supplementary Tables S10 ne-S12).Izingane nomthambo we-carotid womama we-IMT kuhlobene (Umfanekiso 2), kodwa ukuhlobana kukamama nengane phakathi kwemingcele ehlukene yokuqina kwemithambo akubalulekile ngokwezibalo (Ithebula Lokwengeza 9, Umfanekiso Owengeziwe S11).Kumodeli yokuhumusha yokuhlehla okuxubile elungiselwe ubulili, ubudala, umfutho wegazi we-systolic, isisindo somzimba esithambile, namaphesenti wamafutha omzimba, i-carotid yomama i-IMT ukuphela kwesibikezelo esizimele se-carotid IMT yezingane (elungiswe ngo-R2 = 0.08).Kukho konke ukwanda ngo-1 mm ku-IMT ye-carotid yomama, i-carotid ye-IMT yengane inyuke ngo-0.1 mm (95% CI 0.05, 0.21, P = 0.001) (Ithebula Elingezelelwe S13).Ubulili bengane abuzange buwunciphise lo mphumela.
Umfanekiso 2 Ukuhlobana phakathi kwe-carotid artery intima-media ukujiya ezinganeni nakomama.Isakhiwo se-scatter esinomugqa wokuhlehla womugqa (isikhawu sokuzethemba esingu-95%);(A) I-IMT ye-carotid kamama nengane, (B) i-IMT ye-carotid yomama kanye ne-IMT z-score ye-carotid yengane.Imiphumela ebalulekile iboniswa ngokugqamile (P ≤ 0.05).
Isilinganiso somkhumbi wegazi kamama sihlotshaniswa ne-coefficient yokunwetshwa komthambo we-carotid kanye nenkomba engu-β yokuqina ezinganeni (rs=-0.21, P=0.007, rs=0.16, P=0.04, Ithebula Le-Supplementary S10, ngokulandelana).Izingane ezizalwa omama abane-vascular score engu-1-3 zine-coefficient ephansi yokunwetshwa komthambo we-carotid kunalezo ezizalwa omama abanamaphuzu angu-0 (okusho ukuchezuka ± okujwayelekile, 1.1 ± 0.2 vs 1.2 ± 0.2%/10 mmHg, P= 0.01) futhi kukhona ukuthambekela kokwandisa inkomba yokuqina komthambo we-carotid β (i-median (IQR), 3.0 (0.7) kanye ne-2.8 (0.7), P=0.052) nomthambo we-carotid IMT (okusho ukuthi ± SD, 0.37 ± 0.04 ± 0.35 kanye no-0.3 mm, P=0.06) (Umfanekiso 3), Ithebula Lokwengeza S14).
Umfanekiso 3 I-phenotype yemithambo yengane ehlukaniswe ngesilinganiso semithambo kamama.Idatha ichazwa njenge-mearon + SD, P enesampula esizimele sokuhlolwa (A no-C) kanye nokuhlolwa kukaMann-Whitney U (B).Imiphumela ebalulekile iboniswa ngokugqamile (P ≤ 0.05).Isikolo somkhumbi wegazi kamama: ibanga 0-3, isethi yezinkomba ezintathu kanambambili: ukuba khona kwe-carotid plaque, ukujiya kwe-carotid artery intima-media elungiswa ngobudala futhi yedlula u-90% kusampula yethu, kanye negagasi lokushaya kwenhliziyo yomlomo wesibeletho isivinini esingaphezu kuka-90% silingana neminyaka futhi umfutho wegazi usezingeni eliphezulu.amashumi amabili nanye
Isikolo sikamama (i-ICVH, i-vascular score) kanye nenhlanganisela yezikolo zengane kanye nomama azihlobene ne-arterial phenotype yezingane (Ithebula le-Supplementary S10).
Kulokhu kuhlaziywa kwezingxenye ezihlukene zomama nezingane zabo ezineminyaka engu-6 ubudala, siphenye ukuhlobana phakathi kwe-ICVH yengane, i-ICVH yomama, kanye ne-atherosclerosis engaphansi komama enesakhiwo nokusebenza kwemithambo yezingane.Okutholakele okuyinhloko ukuthi kuphela i-subclinical atherosclerosis yomama, kuyilapho izici ezivamile zengozi yenhliziyo nemithambo yegazi yezingane nomama azihlobene noshintsho olubi lwe-phenotypes yemithambo yezingane.Lokhu kuqonda okusha ekuthuthukisweni kwemithambo yezingane kusencane kukhulisa ukuqonda kwethu umthelela ophakathi kwezizukulwane we-subclinical atherosclerosis.
Sibika ubufakazi bokuncipha kokunwetshwa komthambo we-carotid namathrendi e-carotid artery beta stiffness kanye ne-carotid artery IMT ezinganeni zomama abanesifo senhliziyo nemithambo yegazi.Nokho, akukho ukuhlobana okuqondile phakathi kwezinkomba zokusebenza kwemithambo komama nezinsana.Sicabanga ukuthi ukufaka i-plaque kamama kumphumela we-vascular kukhulisa kakhulu inani lalo lokubikezela.
Sibone ukuhlobana okuhle phakathi komthambo we-carotid IMT ezinganeni nakubama;kodwa-ke, umshini awukacaci ngoba umthambo we-carotid IMT ezinganeni uzimele ezicini zengane nomama.Ukuhlotshaniswa phakathi kwesikolo se-ICVH sezingane ne-carotid IMT kubonise ukungahambisani, ngoba asibonanga noma yimuphi umehluko phakathi kwe-ICVH ephansi ne-ICVH ephezulu.
Siyazi ukuthi ezinye izici zingadlala indima, okuhlanganisa ukuzungeza kwekhanda lezingane, okungase kube isibikezelo esibalulekile sosayizi womthambo we-carotid ezigabeni zokuqala zokukhula.Ngaphezu kwalokho, imiphumela yethu ingase ibangelwe yizici ezingakaliwe ezithinta ukukhula kwemithambo ye-fetus.Kodwa-ke, sike sabika ngaphambilini ukuthi ngaphambi kokukhulelwa ukukhuluphala ngokweqile/ukukhuluphala kanye nesifo sikashukela sokukhulelwa akunawo umthelela ku-IMT yengane ye-carotid.14 Ucwaningo olwengeziwe luyadingeka ukuhlola umthelela wokwakheka kwemithambo kanye nokusebenza ekukhuleni kwezingane nesizinda sofuzo.
Izinhlangano ezibikiwe zihambisana nezifundo zangaphambilini ezenziwa entsheni, ezinikeze ubufakazi bokuhlobana phakathi kwama-phenotypes emithambo yomzali nengane, kuhlanganise ne-carotid IMT, nakuba ubukhulu bomzimba bungazange bulungiswe ekuhlaziyeni.29 Ufuzo olukhulu lwe-carotid IMT luqinisekisa futhi lokhu kanye nokuqina kwemithambo yabantu abadala.30,31
Ukuhlangana okuphawuliwe phakathi kwe-atherosclerosis engaphansi komama kanye ne-phenotype yemithambo yezingane akuzange kunwetshwe yi-ICVH yomama.Lokhu kuhambisana nezifundo zangaphambilini lapho ingxenye enkulu yokuhluka kwe-phenotype ye-vascular yezingane ichazwa yizici zofuzo ezizimele ezicini ezivamile zengozi yenhliziyo yabazali nezingane.29
Ngaphezu kwalokho, izinguquko ze-vascular eziphawuliwe azihlangene ne-ICVH yobuntwana, okubonisa ithonya eliyinhloko lesizinda sofuzo sezingane.Umnikelo wezici zemvelo ubonakala ushintsha ngeminyaka yezingane, njengoba ucwaningo lwangaphambilini lwezingane ezineminyaka engu-11-12 lubike ukuhlangana okubalulekile phakathi kokusebenza kwemithambo yezingane kanye ne-ICVH.12
Isikhathi sokuthumela: Jul-14-2021