目的 探讨膳食支链氨基酸(branched-chain amino acids, BCAAs)摄入与儿童青少年超重肥胖风险的关系。方法 基于“中国儿童与乳母营养健康监测”数据纳入12 183名6~18岁儿童青少年,依据《学龄儿童青少年超重与肥胖筛查》(WS/T 586-2018)判定超重或肥胖;通过食物频率问卷结合3 d 24 h膳食回顾调查法评估膳食摄入,结合《中国食物成分表》计算BCAAs 摄入量;采用多因素Logistic回归方法分析不同BCAAs摄入水平与超重肥胖风险的关联并进行分层分析,通过限制性立方样条分析探索剂量-反应关系,应用LightGBM机器学习结合Shapley加性解释算法,明确BCAAs各组分重要性排序。结果 研究共纳入正常体重8974人(73.7%)、超重1650人(13.5%)、肥胖1559人(12.8%);调整混杂因素后,与BCAAs低摄入组相比,高摄入组发生超重(OR: 1.318, 95%CI: 1.141-1.523)、肥胖(OR: 1.596, 95%CI: 1.373-1.855)及超重或肥胖(OR: 1.442, 95%CI: 1.289-1.612)的风险均显著升高(P<0.01);分层分析显示,不同性别、年龄、体力活动及能量摄入各亚组中,BCAAs摄入与超重肥胖风险均呈正相关(P<0.01),且无显著交互效应(P>0.05);限制性立方样条分析发现,BCAAs摄入与超重肥胖风险间存在非线性关系(非线性P=0.001),拐点为8.38g/1000 kcal,低于该值时风险快速上升,超过拐点后增速放缓;机器学习分析进一步揭示,亮氨酸是BCAAs中驱动超重肥胖风险的首要组分。结论 膳食BCAAs摄入增加是儿童青少年超重肥胖的独立危险因素;优化膳食蛋白来源,控制高BCAAs食物摄入可能有助于降低儿童青少年超重肥胖风险。
Abstract
Objective To explore the association between dietary branched-chain amino acids (BCAAs) intake and the risks of overweight and obesity among children and adolescents. Methods A total of 12 183 children and adolescents aged 6~18 years were included based on data from the “China Children and Lactating Women Nutrition and Health Surveillance (CCLWNHS)”. Overweight and obesity were defined according to the “Screening for overweight and obesity among school-age children and adolescents” (WS/T 586-2018). Dietary intake was assessed using a food frequency questionnaire in combination with the 3-day 24-hour dietary recall method, and BCAAs intake was calculated based on the Chinese Food Composition Table. Multivariate logistic regression was employed to analyze the association between different BCAAs intake levels and the risks of overweight and obesity, with further stratified analyses conducted. Restricted cubic spline regression was used to explore the dose-response relationship. The LightGBM machine learning model was applied in combination with the SHAP algorithm to determine the importance ranking of the individual BCAAs components. Results The study included 8974 participants with normal weight (73.7%), overweight (13.5%), and obesity (12.8%). After adjusting for confounders, compared with the low BCAAs intake group, the high-intake group exhibited significantly increased risks of overweight (OR: 1.318, 95%CI: 1.141-1.523), obesity (OR: 1.596, 95%CI: 1.373-1.855), and overweight or obesity combined (OR: 1.442, 95%CI: 1.289-1.612) (all P<0.01). Stratified analyses revealed consistent positive associations between BCAAs intake and risks of overweight and obesity across all subgroups stratified by gender, age, physical activity, and energy intake (all P<0.01), with no significant interaction effects (all P>0.05). Restricted cubic spline analysis identified a nonlinear relationship (P for nonlinearity=0.001), with an inflection point at 8.38g/1000 kcal. Machine learning analysis further revealed that leucine was the primary component among BCAAs driving the risk of overweight and obesity. Conclusion Higher dietary BCAAs intake is an independent risk factor for overweight and obesity in children and adolescents. Optimizing dietary protein sources and limiting high-BCAAs foods may help mitigate the risks of overweight and obesity in children and adolescents.
关键词
支链氨基酸 /
超重 /
肥胖 /
儿童青少年
Key words
branched-chain amino acids /
overweight /
obesity /
children and adolescents
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基金
山东省自然科学基金项目（No.ZR2023QH157）; 国家卫生健康委公共营养与健康重点实验室开放课题（No.WLKFZ202505）; （No.202519010527）; 日照市自然科学基金（No.RZ2024ZR64）; 日照市社会科学研究课题（No.ZX2026108）
