目的 探索建立基于体质量指数(BMI)、腰围(WC)和腰围身高比(WHtR)的联合界值,用于我国儿童青少年临床肥胖症的筛查,并进行代谢风险验证。方法 资料来源于一项多中心干预研究中15 850名6～17岁儿童青少年的体格检查和血生化数据。采用BMI、WC和WHtR组合成联合界值,比较联合界值和BMI行业标准筛查人群肥胖检出情况,通过受试者工作特征曲线比较联合界值与BMI行业标准,三种身体测量指标组合预测代谢相关指标的效能,并分析联合界值和BMI行业标准筛查差异人群与代谢相关指标异常的关联。结果 联合界值筛查的肥胖检出率为13.95%,高于BMI行业标准的检出率(12.09%),差异具有统计学意义(P＜0.05)。联合指标预测低高密度脂蛋白胆固醇(HDL-C)、高甘油三酯(TG)、血脂异常、心血管代谢风险聚集(CRFC)的AUC值均高于BMI行业标准,联合界值预测低HDL-C、高TG、血脂异常的AUC值高于三种身体测量指标组合,差异均有统计学意义(P＜0.05)。logistic回归分析显示,联合界值筛查阳性而BMI行业标准筛查阴性的人群发生低HDL-C、高TG、血脂异常及CRFC的风险高于联合界值筛查阴性而BMI行业标准筛查阳性的人群,差异具有统计学意义(P＜0.05)。结论 相较于BMI行业标准,基于BMI、WC和WHtR的联合指标筛查体系更能有效地识别有代谢风险的儿童青少年,尤其有助于发现部分BMI未达肥胖标准但存在中心性肥胖和代谢异常风险的个体。
Abstract
Objective To develop a combined criterion for screening clinical obesity based on body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR), and to evaluate its performance in identifying obesity-related metabolic risk among Chinese children and adolescents. Methods Data were obtained from physical examinations and blood biochemical measurements of 15 850 children and adolescents aged 6 - 17 years who participated in a multicenter intervention study. A positive combined criterion was defined as exceeding the corresponding cutoffs for at least two of the three anthropometric indicators: BMI, WC, and WHtR. The obesity detection rate based on the combined criterion was compared with that based on the national health industry standard for BMI-based screening. Receiver operating characteristic curve analysis was performed to evaluate the predictive performance of the BMI-based standard, the combined criterion, and different pairwise anthropometric combinations for metabolic abnormalities. The associations of discordant screening results based on the combined criterion and the BMI standard with metabolic abnormalities were further analyzed. Results The obesity detection rate using the combined criterion was 13.95%, significantly higher than the 12.09% rate using the BMI-based standard (P<0.05).The AUC values for the combined criterion in predicting low high-density lipoprotein cholesterol(HDL-C), elevated triglycerides(TG), dyslipidemia, and cardiometabolic risk factor clustering(CRFC) were higher than those of the BMIbased standard; the AUC values for the combined criterion in predicting low HDL-C, elevated TG, and dyslipidemia were higher than those of the combination of the three pairwise anthropometric combinations, and all differences were statistically significant (P<0.05).Multivariable logistic regression showed that children and adolescents who were positive according to the composite criterion but negative according to the BMI-based standard had significantly higher risks of low high-density lipoprotein cholesterol, elevated triglycerides, dyslipidemia, and cardiometabolic risk factor clustering than those who were negative according to the composite criterion but positive according to the BMI-based standard (P<0.05). Conclusion Compared with the BMI-based national health industry standard alone, the combined criterion based on BMI, WC, and WHtR may improve the identification of obesity-related metabolic risk in children and adolescents, particularly among individuals who do not meet BMI-defined obesity criteria but have central obesity and metabolic abnormalities.
关键词
临床肥胖症 /
体质量指数 /
腰围 /
腰围身高比 /
儿童青少年
Key words
clinical obesity /
body mass index /
waist circumference /
waist-to-height ratio /
children and adolescents
中图分类号：
R179
R723.14
R339.3+5
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基金
国家重点研发计划(2022YFC2705300)
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