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中国循证儿科杂志

中国循证儿科杂志 ›› 2024, Vol. 19 ›› Issue (5): 378-384.DOI: 10.3969/j.issn.1673-5501.2024.05.011

• 论著 • 上一篇    下一篇

中国和美国儿童青少年骨骼肌发育规律与参照标准的比较研究

李民俊1,董虹孛1,熊静帆2,程红3,肖培1,单馨影3,米杰1   

  1. 1 国家儿童医学中心，首都医科大学附属北京儿童医院儿童慢病管理中心 北京，100020；2 深圳市慢性病防治中心儿童青少年慢性病防控科 深圳，518020；3 首都儿科研究所流行病学研究室 北京，100020

  • 收稿日期:2024-10-25 修回日期:2024-10-25 出版日期:2024-10-25 发布日期:2024-10-25
  • 通讯作者: 米杰

Comparative study on skeletal muscle development patterns and reference standards of children and adolescents in China and US: A crosssectional survey

LI Minjun1, DONG Hongbo1,  XIONG Jingfan2, CHENG Hong3, XIAO Pei1, SHAN Xinying3, MI Jie1   

  1. 1 Center for Noncommunicable Disease Management, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045; 2 Child and Adolescent Chronic Diseases Prevention and Control Department, Shenzhen Center for Chronic Disease Control, Shenzhen 518020；3 Department of Epidemiology, Capital Institute of Pediatrics, Beijing 100020
  • Received:2024-10-25 Revised:2024-10-25 Online:2024-10-25 Published:2024-10-25
  • Contact: MI Jie

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摘要： 背景：骨骼肌作为人体成分的重要组成，是维持儿童正常生长发育与全面健康的根基。不同社会环境与人种背景下儿童青少年骨骼肌生长发育水平有所差别。 目的：提供中国3~18岁儿童青少年性别、年龄别骨骼肌发育参照标准，并比较中美两国骨骼肌质量发育规律与参照标准。 设计：横断面调查。 方法：基于2013至2019年中国儿童青少年心血管健康研究（CCACH）中的数据，选取了3~18岁共12 583名中国儿童青少年。从美国国家健康与营养调查(NHANES)的数据中，选取2011至2018年度8~18岁儿童青少年共6 467名。通过双能X线吸收法（DXA）测量全身肌肉和四肢骨骼肌质量，并采用位置、尺度和形状的广义加性模型（GAMLSS）方法估算性别和年龄特异性参考值。 主要结局指标：四肢骨骼肌质量指数（ASMI），四肢骨骼肌质量百分比（ASMR），上肢骨骼肌质量指数（ULSMI），下肢骨骼肌质量指数（LLSMI）。 结果：儿童青少年ASMI、ULSMI和LLSMI随年龄不断增加，男童在14岁后增长趋于平缓，女童13岁后增长逐渐放缓且出现下降。在所有年龄段，美国儿童青少年在相同Z评分下的ASMI水平普遍高于中国儿童青少年，且这一差异随着年龄增长，尤其在14岁以后不断扩大。ASMR发育特点略有不同，表现为先增加后下降的趋势，但中国儿童青少年在10~14岁增长速率高于美国儿童青少年。4项肌肉指标均表现出明显的性别差异，男童在各项指标的数值均高于女童。 结论：中美两国儿童青少年四肢骨骼肌的发育特点与差异，应基于本国儿童青少年标准进行骨骼肌发育水平的评估。

关键词: 骨骼肌, 参考值, 儿童, 青少年

Abstract: Background: Skeletal muscle is a vital component of body composition, playing a key role in maintaining normal growth, development, and overall health in children. However, the levels of skeletal muscle development in children and adolescents differ across various social environments and ethnic backgrounds. Objective: To provide genderand agespecific reference standards for skeletal muscle development in children and adolescents, and to compare the patterns of appendicular skeletal muscle development between Chinese and U.S. children and adolescents. Design: Crosssectional study. Methods: A nationwide sample of 12,583 Chinese children and adolescents aged 318 years was drawn from the China Child and Adolescent Cardiovascular Health study (20132019). Data from the National Health and Nutrition Examination Survey (NHANES) for U.S. children and adolescents, aged 818 years from 2011 to 2018 (n=6,467), were also included. Wholebody and appendicular skeletal muscle mass were measured using dualenergy Xray absorptiometry (DXA). Generalized Additive Models for Location Scale and Shape (GAMLSS) method was utilized to estimate the genderand agespecific reference values. Main outcome measures: Appendicular Skeletal Muscle Index (ASMI), Appendicular Skeletal Muscle Ratio (ASMR), Upper Limb Skeletal Muscle Index (ULSMI), and Lower Limb Skeletal Muscle Index (LLSMI). Results: Overall, ASMI, ULSMI, and LLSMI increased with age in children and adolescents. Boys showed a gradual slowing trend of growth after 14 years of age, while girls exhibited a deceleration and even a decrease after 13 years of age. Additionally, for all age groups, U.S. children had higher values for the same Zscores compared to Chinese children, with this difference widening after 14 years of age. ASMR showed a slightly different developmental pattern, with an initial increase followed by a decrease, but the rate of increase was faster in the Chinese population between the ages of 1014 years. All indicators demonstrated significant gender differences, with boys having higher values in all measures. Conclusion: Developmental patterns and disparities of skeletal muscle mass between Chinese and U. S. pediatric population should be assessed based on the sexand agespecific skeletal muscle reference standards of their respective countries.

Key words: Skeletal muscle, Reference values, Children, Adolescents