心肺耐力与不同代谢表型肥胖青少年脂代谢灵活性的相关性研究

doi:10.12114/j.issn.1007-9572.2024.0237

摘要/Abstract

摘要： 背景目前，中国肥胖青少年数量急剧增加，青春期肥胖不仅与代谢性疾病密切相关，还是成年期冠心病死亡的危险因素。脂代谢灵活性被视为衡量机体代谢健康水平的重要指标。研究证实心肺耐力与脂代谢灵活性相关，但缺少在不同代谢表型肥胖青少年中的研究。目的探究心肺耐力在代谢异常型肥胖（MUO）青少年和代谢健康型肥胖（MHO）青少年中与脂代谢灵活性的关系。方法选取参与2022—2023年深圳减肥夏令营的肥胖青少年91名，按照《中国儿童代谢健康型肥胖定义与筛查专家共识》标准划分为MUO组35人，MHO组56人。使用气体代谢分析仪与心率表采集受试者静息代谢测试、递增负荷跑台测试的气体代谢数据和心率数据；根据心率-摄氧量关系推算最大摄氧量（VO2max）；通过三阶数多项式拟合曲线求得最大脂肪氧化速率（MFO）或与之对应的最大脂肪氧化强度（FATmax）反映脂代谢灵活性。使用线性回归分析VO2max与MFO和FATmax的关系。结果两组肥胖青少年总体MFO为（5.54±1.37）mg·min-1·kg-1，FATmax为（4.19±0.87）MET。MUO组BMI、收缩压、舒张压、三酰甘油水平高于MHO组，高密度脂蛋白胆固醇水平低于MHO组（P<0.05）。调整前，MUO组的MFO低于MHO组（P<0.05）；调整VO2max后，两组肥胖青少年MFO比较，差异无统计学意义（P>0.05）；调整前、调整VO2max后，两组肥胖青少年FATmax比较，差异均无统计学意义（P>0.05）。总体（B=0.077，95%CI=0.011~0.144，P=0.023）及MHO组（B=0.105，95%CI=0.027~0.182，P=0.009）肥胖青少年的VO2max与MFO呈正相关；MHO组（B=0.057，95%CI=0.003~0.111，P=0.041）肥胖青少年的VO2max与FATmax呈正相关；MUO组肥胖青少年的VO2max与MFO和FATmax并无线性关系（P>0.05）。结论 MUO青少年的MFO低于MHO青少年；跑步运动时，不同代谢表型肥胖青少年在（4.19±0.87）MET强度即可达到MFO。心肺耐力是影响MHO青少年脂代谢灵活性的关键因素，MUO青少年可能需转变为MHO青少年，促进脂代谢灵活性提升。

关键词: 肥胖症, 心肺耐力, 脂代谢灵活性, 代谢健康型肥胖, 代谢异常型肥胖, 青少年

Abstract:

Background

Currently, the number of obese adolescents in China is increasing dramatically, and adolescent obesity is not only closely related to metabolic diseases, but also a risk factor for coronary heart disease mortality in adulthood. Lipid metabolic flexibility is regarded as an important indicator of the metabolic health of an organism. Studies confirm that cardiorespiratory fitness is associated with lipid metabolic flexibility, but are lacking in obese adolescents with different metabolic phenotypes.

Objective

To investigate the association of cardiorespiratory fitness with lipid metabolic flexibility in metabolically unhealthy obesity (MUO) adolescents and metabolically healthy obesity (MHO) adolescents.

Methods

Ninety-one obese adolescents were selected to participate in the Shenzhen Weight Loss Camp (2022-2023), and were divided into 35 in the MUO group and 56 in the MHO group in accordance with the "Expert Consensus on the Definition and Screening of Metabolically Healthy Obesity in Chinese Children". The gas metabolism data from the resting metabolic test, incremental load treadmill test and heart rate data were collected using a gas metabolism analyzer and a heart rate meter; the maximum oxygen uptake (VO_2max) was estimated based on the heart rate-oxygen uptake relationship; and the third-order polynomial fitting curve was used to obtain the maximal fat oxidation rate (MFO) or the corresponding maximal fat oxidation intensity (FAT_max) to reflect the flexibility of lipid metabolism. The linear regression analysis was used to explore the correlation between VO_2max and MFO and FAT_max.

Results

The overall MFO and FAT_max of the two groups were (5.54±1.37) mg·min^-1·kg^-1 and (4.19±0.87) MET. The BMI, systolic blood pressure, diastolic blood pressure, and triacylglycerol levels in the MUO group were higher than those in the MHO group, and the level of high-density lipoprotein cholesterol was lower than that in the MHO group (P<0.05). Before adjustment, the MFO in the MUO group was lower than that in the MHO group (P<0.05) ; after adjustment for VO_2max, the difference in MFO between the two groups of obese adolescents was not statistically significant (P>0.05) ; before adjustment and after adjusting VO_2max, there was no statistically significant difference between the two groups of obese adolescents when comparing FAT_max (P>0.05). VO_2max was positively correlated with MFO in obese adolescents in the overall (B=0.077, 95%CI=0.011-0.144, P=0.023) and MHO groups (B=0.105, 95%CI=0.027-0.182, P=0.009) ; VO_2max was positively correlated with FAT_max in obese adolescents in the MHO group (B=0.057, 95%CI=0.003-0.111, P=0.041) ; VO_2max was not linearly related to MFO and FAT_max in obese adolescents in the MUO group (P>0.05) .

Conclusion

MUO adolescents have lower MFO than MHO adolescents; during running exercise, obese adolescents with different metabolic phenotypes could reach MFO at (4.19±0.87) MET intensity. Cardiorespiratory fitness is a key factor influencing lipid metabolic flexibility in MHO adolescents, and MUO adolescents may need to be transformed into MHO adolescents to promote lipid metabolic flexibility.

Key words: Obesity, Cardiorespiratory fitness, Lipid metabolic flexibility, Metabolically healthy obesity, Metabolically unhealthy obesity, Adolescents

中图分类号:

R 589.25

秦煜玲,朱琳,程国栋,等. 心肺耐力与不同代谢表型肥胖青少年脂代谢灵活性的相关性研究[J]. 中国全科医学, 2025, 28(15): 1908-1913. DOI: 10.12114/j.issn.1007-9572.2024.0237.
QIN Yuling,ZHU Lin,CHENG Guodong, et al. Correlation between Cardiorespiratory Fitness and Lipid Metabolic Flexibility in Obese Adolescents with Different Metabolic Phenotypes[J]. Chinese General Practice, 2025, 28(15): 1908-1913. DOI: 10.12114/j.issn.1007-9572.2024.0237.

图/表 4

参考文献 36

[1]	LISTER N B, BAUR L A, FELIX J F, et al. Child and adolescent obesity[J]. Nat Rev Dis Primers，2023，9(1)：24. DOI：10.1038/s41572-023-00435-4.
[2]	TUMAS N, LÓPEZ S R. Double burden of underweight and obesity：insights from new global evidence[J]. Lancet，2024，403(10431)：998-999. DOI：10.1016/S0140-6736(24)00051-5.
[3]	GOODPASTER B H, SPARKS L M. Metabolic flexibility in health and disease[J]. Cell Metab，2017，25(5)：1027-1036. DOI：10.1016/j.cmet.2017.04.015.
[4]	CHÁVEZ-GUEVARA I A. Assessment of metabolic flexibility by measuring maximal fat oxidation during submaximal intensity exercise：can we improve the analytical procedures?[J]. Sports Med Health Sci，2023，5(2)：156-158. DOI：10.1016/j.smhs.2023.02.001.
[5]	AUCOUTURIER J, DUCHÉ P, TIMMONS B W. Metabolic flexibility and obesity in children and youth[J]. Obes Rev，2011，12(5)：e44-53. DOI：10.1111/j.1467-789X.2010.00812.x.
[6]	MAUNDER E, PLEWS D J, KILDING A E. Contextualising maximal fat oxidation during exercise：determinants and normative values[J]. Front Physiol，2018，9：599. DOI：10.3389/fphys.2018.00599.
[7]	AMARO-GAHETE F J, SANCHEZ-DELGADO G, ARA I, et al. Cardiorespiratory fitness may influence metabolic inflexibility during exercise in obese persons[J]. J Clin Endocrinol Metab，2019，104(12)：5780-5790. DOI：10.1210/jc.2019-01225.
[8]	MURRU E, MANCA C, CARTA G, et al. Indirect calorimetry-based novel approach for evaluating metabolic flexibility and its association with circulating metabolic markers in middle-aged subjects[J]. Nutrients，2024，16(4)：525. DOI：10.3390/nu16040525.
[9]	GEBARA N Y, KIM J Y, BACHA F, et al. Metabolic inflexibility in youth with obesity：is it a feature of obesity or distinctive of youth who are metabolically unhealthy?[J]. Clin Obes，2022，12(2)：e12501. DOI：10.1111/cob.12501.
[10]	AL-MALLAH M H, SAKR S, AL-QUNAIBET A. Cardiorespiratory fitness and cardiovascular disease prevention：an update[J]. Curr Atheroscler Rep，2018，20(1)：1. DOI：10.1007/s11883-018-0711-4.
[11]	ROSS R, BLAIR S N, ARENA R, et al. Importance of assessing cardiorespiratory fitness in clinical practice：a case for fitness as a clinical vital sign：a scientific statement from the American heart association[J]. Circulation，2016，134(24)：e653-699. DOI：10.1161/CIR.0000000000000461.
[12]	FRANDSEN J, HANSEN I M D, WISMANN J F, et al. Maximal fat oxidation rate is higher in fit women and unfit women with obesity，compared to normal-weight unfit women[J]. J Clin Endocrinol Metab，2021，106(11)：e4389-4399. DOI：10.1210/clinem/dgab473.
[13]	张勇，李之俊. 训练者和无训练者脂肪氧化动力学与最大脂肪氧化强度研究[J]. 体育科学，2013，33(2)：61-68. DOI：10.3969/j.issn.1000-677X.2013.02.007.
[14]	WALDMAN H S, BRYANT A R, KNIGHT S N, et al. Assessment of metabolic flexibility by substrate oxidation responses and blood lactate in women expressing varying levels of aerobic fitness and body fat[J]. J Strength Cond Res，2023，37(3)：581-588. DOI：10.1519/JSC.0000000000004316.
[15]	FRANDSEN J, AMARO-GAHETE F J, LANDGREBE A, et al. The influence of age，sex and cardiorespiratory fitness on maximal fat oxidation rate[J]. Physiol Appl Nutr Metab，2021，46(10)：1241-1247. DOI：10.1139/apnm-2021-0080.
[16]	国家卫生和计划生育委员会. 学龄儿童青少年超重与肥胖筛查：WS/T 586—2018[S]. 北京：中国标准出版社，2018.
[17]	妇幼健康研究会，妇女儿童肥胖控制专业委员会，中国儿童代谢健康型肥胖定义与管理专家委员会. 中国儿童代谢健康型肥胖定义与筛查专家共识[J]. 中国妇幼健康研究，2019，30(12)：1487-1490. DOI：10.3969/j.issn.1673-5293.2019.12.001.
[18]	中华人民共和国国家卫生健康委员会. 7岁~18岁儿童青少年血压偏高筛查界值：WS/T 610—2018[S]. 北京：中国标准出版社，2018.
[19]	刘景新，朱琳，徐佶，等. 肥胖儿童青少年运动强度的多指标联合诊断标准及价值[J]. 上海体育学院学报，2021，45(10)：54-61. DOI：10.16099/j.sus.2021.10.005.
[20]	MACFARLANE D J. Open-circuit respirometry：a historical review of portable gas analysis systems[J]. Eur J Appl Physiol，2017，117(12)：2369-2386. DOI：10.1007/s00421-017-3716-8.
[21]	FRAYN K N. Calculation of substrate oxidation rates in vivo from gaseous exchange[J]. J Appl Physiol Respir Environ Exerc Physiol，1983，55(2)：628-634. DOI：10.1152/jappl.1983.55.2.628.
[22]	GAVARRY O, AGUER C, DELEXTRAT A, et al. Severely obese adolescent girls rely earlier on carbohydrates during walking than normal-weight matched girls[J]. J Sports Sci，2015，33(18)：1871-1880. DOI：10.1080/02640414.2015.1021274.
[23]	BREITHAUPT P, ADAMO K B, COLLEY R C. The HALO submaximal treadmill protocol to measure cardiorespiratory fitness in obese children and youth：a proof of principle study[J]. Appl Physiol Nutr Metab，2012，37(2)：308-314. DOI：10.1139/h2012-003.
[24]	WEIHRAUCH-BLÜHER S, SCHWARZ P, KLUSMANN J H. Childhood obesity：increased risk for cardiometabolic disease and cancer in adulthood[J]. Metabolism，2019，92：147-152. DOI：10.1016/j.metabol.2018.12.001.
[25]	LU X L, KONG X H, WU H, et al. UBE2M-mediated neddylation of TRIM21 regulates obesity-induced inflammation and metabolic disorders[J]. Cell Metab，2023，35(8)：1390-1405.e8. DOI：10.1016/j.cmet.2023.05.011.
[26]	EGAN B, ZIERATH J R. Exercise metabolism and the molecular regulation of skeletal muscle adaptation[J]. Cell Metab，2013，17(2)：162-184. DOI：10.1016/j.cmet.2012.12.012.
[27]	SAN-MILLÁN I, BROOKS G A. Assessment of metabolic flexibility by means of measuring blood lactate，fat，and carbohydrate oxidation responses to exercise in professional endurance athletes and less-fit individuals[J]. Sports Med，2018，48(2)：467-479. DOI：10.1007/s40279-017-0751-x.
[28]	高峰，崔文丽，焦广发，等. BMI和心肺适能对全代谢综合征男性最大脂代谢水平的影响[J]. 中国体育科技，2011，47(3)：89-94. DOI：10.3969/j.issn.1002-9826.2011.03.016.
[29]	FERRO Y, GAZZARUSO C, COPPOLA A, et al. Fat utilization and arterial hypertension in overweight/obese subjects[J]. J Transl Med，2013，11：159. DOI：10.1186/1479-5876-11-159.
[30]	MONTALCINI T, LAMPRINOUDI T, MORRONE A, et al. Nutrients utilization in obese individuals with and without hypertriglyceridemia[J]. Nutrients，2014，6(2)：790-798. DOI：10.3390/nu6020790.
[31]	CARNERO E A, BOCK C P, DISTEFANO G, et al. Twenty-four hour assessments of substrate oxidation reveal differences in metabolic flexibility in type 2 diabetes that are improved with aerobic training[J]. Diabetologia，2021，64(10)：2322-2333. DOI：10.1007/s00125-021-05535-y.
[32]	张洁，余红艳，李英，等. 代谢灵活性及其影响因素研究进展[J]. 国际内分泌代谢杂志，2022，42(1)：32-35. DOI：10.3760/cma.j.cn121383-20201009-10007.
[33]	CAO Y X, ZHU L, CHEN Z K, et al. Resting and exercise metabolic characteristics in obese children with insulin resistance[J]. Front Physiol，2022，13：1049560. DOI：10.3389/fphys.2022.1049560.
[34]	ARAD A D, BASILE A J, ALBU J, et al. No influence of overweight/obesity on exercise lipid oxidation：a systematic review[J]. Int J Mol Sci，2020，21(5)：1614. DOI：10.3390/ijms21051614.
[35]	HODDY K K, AXELROD C L, MEY J T, et al. Insulin resistance persists despite a metabolically healthy obesity phenotype[J]. Obesity，2022，30(1)：39-44. DOI：10.1002/oby.23312.
[36]	AMARO-GAHETE F J, SANCHEZ-DELGADO G, JURADO-FASOLI L, et al. Assessment of maximal fat oxidation during exercise：a systematic review[J]. Scand J Med Sci Sports，2019，29(7)：910-921. DOI：10.1111/sms.13424.

组别	例数	年龄（岁）	性别（男/女）	身高（cm）	体质量（kg）	BMI（kg/m²）
MUO组	35	13.0±1.9	16/19	160.91±5.81	80.51±13.95	30.9±3.9
MHO组	56	12.7±1.8	34/22	161.09±9.40	76.28±13.58	29.2±3.6
t（χ²）值		0.818	1.958a	-0.097	1.429	2.079
P值		0.416	0.162	0.923	0.156	0.041
组别	FPG（mmol/L）	SBP（mmHg）	DBP（mmHg）	TG（mmol/L）	HDL-C（mmol/L）	VO₂max（mL·kg^-1·min^-1）
MUO组	4.70±0.70	120±11	69±9	1.11±0.52	1.12±0.28	34.34±4.24
MHO组	4.47±0.50	108±9	64±7	0.78±0.28	1.42±0.26	35.51±4.10
t（χ²）值	1.846	5.849	2.991	3.780	-5.076	-1.303
P值	0.068	<0.001	0.004	<0.001	<0.001	0.196

组别	例数	年龄（岁）	性别（男/女）	身高（cm）	体质量（kg）	BMI（kg/m²）
MUO组	35	13.0±1.9	16/19	160.91±5.81	80.51±13.95	30.9±3.9
MHO组	56	12.7±1.8	34/22	161.09±9.40	76.28±13.58	29.2±3.6
t（χ²）值		0.818	1.958a	-0.097	1.429	2.079
P值		0.416	0.162	0.923	0.156	0.041
组别	FPG（mmol/L）	SBP（mmHg）	DBP（mmHg）	TG（mmol/L）	HDL-C（mmol/L）	VO₂max（mL·kg^-1·min^-1）
MUO组	4.70±0.70	120±11	69±9	1.11±0.52	1.12±0.28	34.34±4.24
MHO组	4.47±0.50	108±9	64±7	0.78±0.28	1.42±0.26	35.51±4.10
t（χ²）值	1.846	5.849	2.991	3.780	-5.076	-1.303
P值	0.068	<0.001	0.004	<0.001	<0.001	0.196

指标	总体	MUO组（n=35）	MHO组（n=56）	模型0		模型1
指标	总体	MUO组（n=35）	MHO组（n=56）	F值	P值	F值	P值
MFO（mg·min^-1·kg^-1）	5.54±1.37	5.19±1.39	5.76±1.15	4.493	0.034	3.283	0.073
FAT_max（MET）	4.19±0.87	4.16±0.92	4.21±0.84	0.079	0.779	0.007	0.932

指标	总体	MUO组（n=35）	MHO组（n=56）	模型0		模型1
指标	总体	MUO组（n=35）	MHO组（n=56）	F值	P值	F值	P值
MFO（mg·min^-1·kg^-1）	5.54±1.37	5.19±1.39	5.76±1.15	4.493	0.034	3.283	0.073
FAT_max（MET）	4.19±0.87	4.16±0.92	4.21±0.84	0.079	0.779	0.007	0.932

项目	B	95%CI	SE	β	t值	P值
VO_2max
总体	0.077	0.011~0.144	0.033	0.253	2.312	0.023
MUO组	0.020	-0.109~0.149	0.063	0.061	0.317	0.754
MHO组	0.105	0.027~0.182	0.039	0.371	2.714	0.009