T C . D D & T P 1 0 ( 2 ) - _ 2 0 1 4 Summary
STUNTING AND DEFICIENCY OF VITAMIN D, ZINC AND IODINE AMONG STUDENTS IN TWO PRIMARY SCHOOLS IN HOCHIMINH CITY VIETNAM
Objective of the study: To assess the prevalence of stunting, vitamin D, zinc and iodine deficiency among primary school students in Ho Chi Minh city (HCMC) Viet Nam.
Methodology: a cross sectional study on 350 primary school students in one school in urban district and one school in rural district of HCMC. Students were measured body weight, height by using standard method, taken blood samples for measuring serum vita- min D and zinc concentration, taken urine samples for measuring urinary iodine level.
Serum vitamin D, zinc concentration, and urinary iodine were analyzed by Medical lab Diag Center HCMC, Center of Analytical Services, and laboratory of HCMC Nutrition Center, respectively. Results: Mean height of primary school students is 4-8 em lower than WHO standard. Prevalence of mild to severe stunting (height for age from -1 SD to - 3SD) is 28.7%. The prevalence of overweight is very high at 46.2%. Low serum vitamin D (<30ng/ml), low serum zinc (<70mcg/dl) and low urinary iodine (<10 mcg/dl) are 37.5%, 22.3% and 51.0% respectively. Conclusions: Height and micronutrient deficien- cies are alarming problems among primary school students in HCMC.
Keywords: stunting, vitamin D, zinc, iodine, primary school students, Ho Chi Minh city.
ROJ LOAN LIPID MAU v A HOI CHtTNG CHUYEN HOA 6 TRE EM THfA CAN, BEG PHI
Ttf 10 DEN 15 TUOI
Hd Van Thilu'
?n nay cac benh man tinh khong ISy dang gia tang nhanh chong a cac q trien 1
Hien nay cac benh man tinh Ichong lay dang gia tang nhanh chong a cac quoc gia dang phat Irien hon la cac qu6c gia phat trien. Thira c^n - beo phi (TC-BP) la r6i loan dinh dirong pho biln nhat co lien quan chat che voi hai chung chuy6n hoa (HCCH), la nBn cho su phat triSn cua nhieu b?nh man tinh. Muc tieu nghien cilu: xac djnh ty le HCCH va xac djnh diem cjt BMI (chi so kh6i ca the), vong eo dil doan HCCH ciia tre TC-BP. Phucmg phap: Nghien ciru cM ngang tren 510 tre TC-BP tir 10 d6n 15 tu6i nam 2010-2012 tai Bien H6a-D6ng Nai va chan doan HCCH theo IDF 2007. K6t qua; Co sir lien quan giua BMI va roi loan lipid mau (p<0,05).
Co 31,37% tre TC-BP mjc HCCH (nu > nam, p>0,05), dang phS bien nhjt cua HCCH trong nghien ciiu nay la VE-HA-TG (Vong eo-Huyft ap-Triglicerid) 41,15%. Gia tri dilm ctt ciia cac chi so nhan trac du doan HCCH: BMI d6i voi nam la 25 va nir la 24,5; vong eo ddi vai nam la 82cm va nii la 80cm. Ket luan: Ty le HCCH 6 tre em TC-BP la 31,37%. Co tM diing cac di6m cat toi uu cua vong eo, BMI du doan HCCH a tre em TC-BP tir 10 dSn 15 tu6i.
Tir khoa: Thkacdn. l>eo phi: Hoi chimg chuyin hoa & tre em.
TS.BS-BV Nhi ddng-Dong Nai Ngaynhanbai: 16/6/2014 DT: 01667.697788 Ngay phan bien danh gia: 08/07/2014 Email: [email protected] Ngay dang bai: 25/7/2014
TC. DD&TP 10 (2)-2014 I. DAT VAN DE
Hoi chung chuyen hoa (HCCH) la m6t trong nhimg van d^ sue khoe cpng d6ng dugc quan tam nhat trong thi ky XXI nay.
Beo phi (BP) dang gia tang nhanh cung voi HCCH 6 nguoi truong thanh ciing nhu 6 tre em [5],[6]. Caceres M. nghien ciru 61 tre em 5-18 tuoi co BMI>95th pencertile theo tuoi va gioi (nam 2006-2007) tai Bo- livia, ket qua 36% tre em co HCCH (nam 40% va nii la 32,2%). Giam dung nap glu- cose la 8,2%, triglycerid (TG) tang la 42,6%, Lipoprotein ty trong eao (HDL-C) giam 55,7%, huyit ap (HA) tang la 24,5%
va de khang insulin la 39,4% [1]. Tre em CO nguy CO cao ve benh tim mach co thS dugc nhan biet qua VE, Vong eo/chieu cao [11]. Tai Viet Nam, nghien cuu vh HCCH 6 tre em cijng con tuong doi khiem ton, do do ehiing toi tien hanh nghien cuu de tai nay voi cac muc tieu sau:
1. Xac dinh dac diem roi l o ^ lipid mau va glucose mau o tre em TC, BP.
2. Xac dinh dac diem lam sang, can lam sang va gia tri diem cat vong eo (VE), chi s6 BMI du doan HCCH 6 tre em TC, BP til 10 den 15 tuoi.
II. DOI TirONG VA PHU'ONG PHAP NGHIEN Ctru
1. Thiet ke nghiSn cihi:
De tai dugc tiSn hanh theo thiet ke nghien cuu cat ngang mo ta.
2. Doi tirong nghien ciru: Hoc sinh 10-15 tu6i du tieu chuan ehSn doan thira can (TC), beo phi (BP) dang hgc tai cac trucmg Trung hoc co so (THCS) thanh pho Bien Hoa.
3. Thoi gian nghien cihi: nam 2010- 2012.
4. Co- mau: Tim ty le tre em TC-BP trong cpng dong mac HCCH, eo m^u dugc tinh theo cong thiic uoc lugng ty le
n=-—P.q d^
(dieu tra thu co mau nho ty le mac HCCH 6 tre em TC-BP khoang 15%);
196^x0,15x0,85
= 306 0,04^
Do chgn mau theo truong, dieu chinh de ban che tae dgng do thiet ke bang each nhan voi design effect=l,5. KJii do co mlu la 306x1,5= 459.
Uoc tinh ty le dong y tham gia la 95%
nen cfif mlu cSn thiit la n=459/0,95=483.
Chiing toi chgn khoang 500 doi tugng hge sinh thira can, beo phi tu 10-15 tuoi.
5. Ky thuat chon mau: Chgn mau nhieu buoc.
* Tieu chu&i chan doan tre em TC-BP, dua theo CDC-2000. Chiing t6i chia 3 muc do: Mijrc 1: 85* < BMI < 90*, mijrc 2: 90*<BMI<95*vamurc3:BMI>95'h percentile.
* Tieu chuan chan doan HCCH:
- Vong eo (VE) > 90* percentile dua theo percentile eua Riata YT Sung [11].
- TG> 150 mg/dL; HDL-C<40mg/dL;
HA tam thu > 130mmHg hoac HA tam truong > 85mmHg; Glucose mau >
100mg/dL[12].
- Theo IDF (2007): VE va su hien dien it nhat 2 tieu chuan da dugc liet kS theo tuoi va gioi thi dugc xem la tre c6 HCCH.
- Do can nang (CN), ehieu cao (CC), VE, vong mong (VM) theo qui djnh cua WHO. Do ty le mo co thi (BFP) theo phan tich dien tro sinh hgc (BIA: Bio- electrical Impedance Analysis) voi thiet bi Omron (Nhat ban). Cac doi tugng dugc yeu cau nhin doi 8 glo truoc khi lay mau xet nghiem.
6. Xu* li so lieu: Xii ly so lieu bang phan mem EPI-6.
27
TC. D D & T P 10 ( 2 ) - 2 0 1 4 III. K E T QUA N G H I E N CUtJ
M l u nghien ciiu g6m 510 tre TC-BP, trong do nam (49,80%) va nir (50,20%).
1. Dac diem roi loan lipid mau va glucose mau Bdng 2. Tri so trung binh lipid mdu vd glucose ittdu
Tieu chi CT (mg/dL) TG (mg/dL) HDL-C (mg/dL) LDL-C (mg/dL) Glucose (mg/dL)
Chung (X±SD) n=510 184,78±45,48 157,29±78,8I 5I,58±7,86 1IO,20±39,04 88,51±14,36
Nam (X±SD)n=254
182,50±45,84 156,27±70,31 52,14±7,39 I07,15±36,91 88,30±15,54
Nir (X±SD) n=2S6 187,04±45,11 158,31±67,41 51,03±8,28 113,27±40,89
88,72±13,10
P 0,307 0,738 0,111 0,076 0,739 Cholesterol (CT); Triglycerid (TG); High density lipoprotein (HDL); Low density lipoprotein (LDL);
t-test cho cdc sd lieu trung binh.
Nhan xet; Khong co su khac biet \l tri s6 trung binh lipid mau CT, TG, LDL-C, HDL- C va Glucose mau giiia 2 gioi, p>0,05.
Bdng 2. Roi logn lipid tnau theo cdc mire Ct6 BMI
Lipid man
Mirc 1 n=34 IMirc 2 n=180 Miic 3 n=296
Tong c6ng n=5lb Khong roi loan 14
Co rdi loan 20 1 chi s6 9 (3,77%) 2 chi s6 6 (5,56%)
> 3 c h i s 6 5(9,81%)
49 49 112(21,96%) 131 247 398(78,04%) 91(38,07%) 139(58,16%) 239(60,05%) 32(29,63%) 70(64,81%) 108(27,14%) 8(15,68%) 3 8 (74,51 %) 51(12,81%)
Nhan xet: Co sir lien quan giira cac miic do BMI vai miic do r6i loan lipid miu p<0,001.
2. Hoi chimg chuyen hoa
DJc diSm lam sang va can lam sang cila HCCH Bdng 3. Ty le HCCH vd ly le theo gi&i
HCCH Khong HCCH Tong cong 183 (52,29%) 254 (49,80%) 167(47,21%) 256(50,20%) 350(68,63%) 510(100,00%) Nhan xet: Ty le HCCH la 31,37%, nir cao hon nam (p>0,05).
Nam Nu Toan bp
71 (44,38%) 89 (55,62%) 160(31,37%)
0,097
TC. DD&TP 10 (2)-2014 Bdng 4. Bac diem tam sang vd CQn lam sang cda HCCH
Tieu chi Khong HCCH
(X±SD, 0=350)
_C6HCCH (X±SD, n=160) VE(cm)
VE/VM VE/CC BIVIl HAtt (mmHg) HAttr (mmHg) TG (mg/dL) HDL-C(mg/dL) CT/HDL Glucose (mg/dL)
84,07 ±6,12 0,94 ±0,05 0,55 ± 0,04 25,91 ±2,63 117,30± 11,31
69,29 ±8,57 139,17± 57,57
53,01 ±6,76 3,63 ±1,17 86,04 ±12,59
87,44 ±7,11 0,95 ± 0,06 0,56 ± 0,04 26,94 ±2,67 130,91 ± 13,53
75,34 ±9,73 196,94 ±74,67
48,45 ±9,41 3,79 ±1,08 93,92 ± 16,39
0,001 *•
0,233 0,158 0,001 • • 0,001**
0,001**
0,001**
0,001**
0,144 0,001**
t-test cho cdcsd li^u trung binh, p*<0,05 vap**<0,001.
Nh^n xet: VE, BMI, HAtt, HAttr, TG, HDL-C, Glucose mau (X±SD) nhom c6 HCCH khac biet co y nghia voi nhom khong co HCCH, p<0,05.
Bang S. Cdc dang ket hfp cda HCCH
VE-HA-TG ^ " ™ ' '^'^' Glucose Glucose
% 41,15% 21,05% 14,84%
VE-HA- HDL-C 9,57%
VE-TG- HDL-C 8,61%
VE-Glucose- HDL-C
4,78%
Nhan xet: Dang kat hgp ph6 bifa nhSt (VE-HA-TG) chiem 41,15%.
Cdc gia tri diem cat dir doan HCCH Gia tri diem cat BMI du- doan HCCH
Bk vffi nam: Gia tri BMI = 25,00; Dp nhay (Se) = 70,42%, Dp dac hieu (Sp) = 39,34%. Chi s6 Youden = 0,0976 la gia tri dupe chpn lam gia tri c5t de dir doan HCCH (khoang tin cay 95%: 54,68- 70,39). Dien tich duoi duong cong ROC, AUC = 0,6254.
Doi vfri nir: Gia tri BMI = 24,5; Se = 78,63%, Sp = 33,93%. Chi s6 Youden = 0,1256 la gi^ tri dupe chpn lam gia tri cat dk dk du doan HCCH (khoang tin cay
95%: 51,68-66,30). Dien tich duoi duong cong ROC, AUC = 0,5899.
Gia tri dilm cjt VE dir doan HCCH Doi vol nam: Giatri VE = 82cm;Se = 76,06%, Sp = 43,08%.' Chi s6 Youden = 0,1914 la gia tri dupe chpn lam gia tri cat dS du doan HCCH (khoang tin cay 95%:
56,73-71,66). Dien tich duoi dirong cong ROC, AUC = 0,6420.
Doi vol nu: Gia tri VE = 80cm; Se = 79,78%, Sp = 31,54%. Chi s6 Youden = 0,1062 la gia tri dirpc chpn lam gia tri cat de de du doan HCCH (khoang tin cay 95%: 55,88-70,56). Dien tich duoi duong cong ROC, AUC= 0,6322.
TC. DD &TP10(2)-2014 IV. BAN L U ^
1. Dac diem roi loan lipid mau va glucose man
Hee Man Kim nghien cuu 2272 nam va nil tu6i 10-18 tai Korean ghi nhan TC-BP sir biSn ddi TG (p<0,0001), HDL-C (p=0,011), LDL-C Cp=0,001), CT (p<0,0001) a nam va TG (p<0,0001), HDL-C (p=0,003), LDL-C (p=0,004), CT (p<0,002) 6 nir khi so voi nhom co chi so BMI binh thuong.
Khashayar P nam 2013, nghien cuu 5.738 tre em tai Iran tir 10 den 18 tuoi (trong do CO 17,7% la TC, BP). K& qua co roi loan 1; 2; 3 va 4 chi so lipid mau la 34,7%; 6,4%; 1,2% va 0,4% theo thil tu
ffl.
Vi mau nghien cim nay chi co 17,7% la TC, BP nen dac diem roi loan lipid m^u co the thap hon nghien cim chung toi la phii hop. Ty le mac HCCH ciia nghien cuu nay la 2,5%, rieng nhom TC-BP ty le nay la 15,4% theo tieu chuin IDF [8]. Kk qua nghien curu cua chung toi tuong doi phii hop voi cac tac gia khac.
2. Hyi chung chuyen hoa Bac diem lam sdng vd can lam sang cua HCCH
Ferreira AP va cpng sir (2011) nghien ciiu cit ngang 958 tre em tir 7-11 tudi tai Braxil trong do co 10,8% la TC va 7,7%
la BP Ty le HCCH 23% 6 tre em BP (13,3% doi voi nam va 36% doi voi nu, p<0,05) [4]. Olza J [10] nghien ciiu 478 tre em beo phi (213 nii va 265 nam) nam 2011 tai Tay Ban Nha, kh qua HCCH hrong d6i cao o tre em BP giai doan tiSn day thi tir 8,3 den 34,2% va giai doan tuoi day till tit 9,7 dSn 41,2%. Ty le HCCH cua Caceres M d6i voi tre BP la 36% [1]. Nghien clhi chiing toi ghi nhanty le HCCH la 31,37%
(nO>nam, p>0,05), phu hop voi cac nghien ciru tren [1],[4].
Khi so sanh TG, HDL-C, Glucose, VE, HA tam thu, HA tam tnrong giiia co HCCH va khong co HCCH tac gia ghi nhan ddu co su khac biet co y nghia [2].
Tuong tit nghien ciiu cua Caianti DA [3]
ciing cho k6t qua tuong tit. Nghien ciiu chiing toi ghi nhan ciing co su khac nhau timg tieu chi trong Bang 4, giOa co HCCH va khong co HCCH.
Nghien ciiu 1844 tre em 7-14 tuoi, trong do CO 11,1% la TC va 7,2% la BP HCCH la 6,6%, trong do 33,1% o nhom BP, 20,5% o nhom TC va 2,3% a nhom binh thuong. Co 49,3% tre em co it nhat 1 thanh t6 ciia HCCH (Liu WeiJia, 2010) PI-
Dang ket hop pho bien chiing toi ghi nhan VE-HA-TG chiSm 41,15% vi VE- TG-Glucose chiSm 21,05%.
Gia tri cdc diem cat dtf doan HCCH Mot nghien ciiu tai Y nam 2005, tre em TC-BP CO VE>90th pencertile co nhiSu yeu to nguy co tim mach hon tre em c6 VE<90th percentile. Gia tri cat cua VE>70th percentile du doan bat thuong chuySn hoa dua tren ROC (Se=76%, Sp=81%) [3].
Nam 2007 nghien ciiu cua HirschlerV vS BMI va VE dh du doan HCCH a fre em tu6i trung binh 8,7±2,4. Gia tri cit cua VE> 75th percentile la nguong t6i uu du doan HCCH 6 tre em. Nguong toi uu cho VE la 71,3cm voi Se la 58,9% (95% CI:
48,4-68,9) va Sp la 63,1%(95% CI: 58,4- 67,7) chSn doan HCCH [7].
Ferreira AP va cpng sir (2011) nghien ciiu cat ngang 958 tre em tir 7-11 tu6i tai Braxil trong do co 10,8% la TC va 7,7%
la BR Ty le HCCH 23% o tre em BP (13,3% doi voi nam va 36% ddi voi nii, p<0,05) theo tieu chuin NCEP- ATP3. Gia tri cat cua BMI la 24,5kg/m2, BFP la 41%
theo phuong phap do hap thu X quang
TC. D D & T P 10 ( 2 ) - 2 0 1 4 nang lugng kep (DXA), VE la 78cm,
VEA^M la 0,92 du doan HCCH 6 tre em TC, BP [2].
Saffari Fatemeh (2012) [8] nghien cuu tien hanh tren 100 tre em khoe manh tuoi tir 6-16 tai Iran (58% la nfi) co BMI 26,02±4,38 voi 20% la TC va 80% la BP.
Tan suat de khang insulin la 8 1 % , HCCH chiSm 50% nhom d6i Urgng TC; 66,2%
nhom BP (tieu chu4n NCEP ATP III).
HCCH chiam 25% nhom ddi tugng TC va 42,5% nhom BP (tieu chdln Weiss et al).
Nghien cuu chiing toi tap trung vao d6i tugng tir 10-15 tu6i la TC-BP. BMI>95th chiem 58,04% va dugc thuc hien tai cgng d6ng, ty le HCCH la 31,37% va gia tri cac diem cat du doan HCCH phu hgp voi nghien curu cdc tac gia nuoc ngoai. Hon niJa, chung toi ciing chua tim duge nhieu cae nghien cim khac de so sanh, nen gia tri dua ra eiing mang tinh chat tham khao.
Can CO them cac so lieu nghien cuu de xac dinh dilm ck vk VE, BMI du doan HCCH trong thoi gian toi.
IV. K E T LUAN
1. Ty le roi loan lipid mau cua tre em TC, BP tir 10 dSn 14 tu6i nam 2010-2012 la 78,04%, CO su lien quan giira eae mue do BMI voi mue d6 roi loan lipid mau, p<0,001.
2. Ty le mac HCCH nghien cihi nay la 31,37%.
- Dang ket hgp pho bien nhat ciia HCCH tren cac doi tugng nay la (VE-HA- TG) chi6m 41,15%.
- Cac gia tri diem cat toi uu du doan HCCH tim duge trong nghien eihi nay lan lugt:
+ BMI ddi voi nam la 25,00, AUC - 0,6254 va nir la 24,50, AUC = 0,5899.
+ VE ddi voi nam la 82cm, AUC =0 ,6420 va nu la 80cm, AUC = 0,6322.
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Summary
THE DYSLIPffiEMIA AND METABOLIC SYNDROME IN OVERWEIGHT AND OBESITY CHILDREN FROM 10 TO 15 YEARS OLD
It is widely agreed that non-communicable chronic diseases are escalating much more rapidly in developing than developed countries. Obesity is a one of the most common nutrhional disorders worldwide, clearly associated with the metabolic syndrome (Mets), a condition with implications for the development of many chronic diseases. Objective of the study: to determine the prevalence of Mets and cut-off values of waist circumference and body mass index to predict Mets in children with overweight and obesity. Methods: We conducted a cross-sectional analysis on 510 overweight and obese children from 10 to 15 years old in Bien Hoa- Dong Nai (2010-2012) and the diagnosis of Mets was defined according to 2007 International Diabetes Federation (IDF). Results: There was an association between BMI and the dyslipidemia (p<0.05). Of total participants, 31.37% met the.criteria for Mets (female>male, p>D.05).The most common manifestation of Mets in this study was "WC-Blood pressure-TG" (41.15%). Cut-otf values of anthropometric to predict Mets: BMI was 25.00 in boys and 24.50 tn girls; WC was 82cm in boys and 80cm in girls. Conclusions: The Mets was 31.37% among children with overweight and obesity. Cut-off values of WC and BMI in this study could be the optimal threshold to predict Mets in overweight and obese children from 10 to 15 years old.
Keywords: Overweight, obesity; metabolic syndrome in children.
