目的 建立我国3~6岁儿童体脂率百分位数的参考标准,并确定用于辅助体质量指数(BMI)进行肥胖筛查的体脂率阈值,为我国儿童肥胖早期识别提供科学的参考依据。方法 2020—2023年,采用分层随机抽样,从全国27个省份的120所幼儿园中抽取25 604名3~6岁儿童进行体格和体成分测试。利用基于位置、尺度和形状的广义加性模型建立儿童体脂率百分位数参考值。通过受试者工作特征曲线(ROC)比较不同形态指标反映体脂率的敏感性;通过ROC对比不同体脂率百分位数识别肥胖的表现,优选出适用于3~6岁儿童肥胖识别的最佳百分位数。结果 1)男童的身高、体重、BMI和腰围均高于女童(P<0.01),而体脂率低于女童(P<0.01)。身高、体重、腰围随着年龄增长而增加,体脂率和腰围身高比整体呈下降趋势,BMI则波动较小。2)与身高、体重、腰围相比,BMI和身高别体重(WFH)能更为敏感的反映3~6岁儿童体脂率水平。3)体脂率P90在特异度和敏感度之间取得了平衡,是最适宜的肥胖识别阈值。结论 BMI和WFH是反映儿童体脂水平的敏感指标;建立了适用于我国3~6岁儿童的体脂率百分位数参考值;体脂率P90在3~6岁儿童肥胖筛查中表现最佳,推荐使用该阈值辅助BMI进行儿童肥胖的筛查,避免误诊/漏诊。
Abstract
Objective To establish percentile reference standards for body fat percentage (BFP) in Chinese children aged 3 - 6 years, and to determine BFP thresholds to complement BMI in obesity screening, so as to provide a scientific reference for the early identification of childhood obesity in China. Methods From 2020 to 2023, a stratified random sampling method was used to select 25 604 children aged 3 - 6 years from 120 kindergartens across 27 provinces in China.Physical and body composition measurements were conducted.The generalized additive model for location, scale, and shape (GAMLSS) was applied to establish percentile references for BFP.Receiver operating characteristic (ROC) curves were used to compare the sensitivity of different anthropometric indicators in reflecting BFP and to evaluate the performance of different BFP percentiles in identifying obesity.The optimal percentile for obesity screening in children aged 3 - 6 years was selected. Results 1) Boys had significantly greater height, weight, body mass index (BMI), and waist circumference than girls (P<0.01), while BFP was lower in boys (P<0.01).Height, weight, and waist circumference increased with age, whereas BFP and waist-to-height ratio generally decreased, and BMI showed minor fluctuations.2) Compared to height, weight, and waist circumference, BMI and weight-for-height (WFH) were more sensitive indicators of BFP in children aged 3 - 6 years.3) The 90th percentile of BFP (P90) achieved the best balance between sensitivity and specificity and was identified as the most suitable threshold for obesity screening. Conclusions BMI and WFH are sensitive indicators of body fat levels in children.Percentile reference values for BFP specific to Chinese children aged 3 - 6 years were established.The P90 percentile of BFP demonstrated the best performance in obesity screening for this age group and is recommended as a complementary threshold to BMI to improve screening accuracy and reduce misdiagnosis/underdiagnosis.
关键词
3~6岁 /
肥胖 /
评价标准 /
体脂率
Key words
3 - 6 years /
obesity /
evaluation standards /
body fat percentage
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