北京与全国7～18岁儿童青少年腰围适宜界值对心血管危险因素筛查效度的对比分析

目的 比较北京与全国7～18岁儿童青少年腰围(WC)适宜界值对心血管危险因素的筛查效度和预测价值.方法 采用LMS曲线拟合法拟合北京市21 787名3～18岁儿童青少年WC百分位曲线,以性别、年龄别第75百分位数(P75)及第90百分位数(P90)作为北京市7～18岁儿童青少年WC适宜界值.在4927名7～18岁儿童青少年组成的验证人群中,比较北京和全国7～18岁儿童青少年WC适宜界值对高血压、脂代谢紊乱、糖耐量受损及非酒精性脂肪肝(NAFLD)等心血管危险因素诊断的特异度和灵敏度,通过回归分析比较该2个界值对心血管危险因素的预测价值.结果 北京市3～18岁儿童青少年WC适宜界值分别为:男童:P75为51.8～78.2 cm,P90为54.0～86.0 cm;女童:P75为50.8～72.1 cm,P90为53.3～77.3 cm.北京与全国界值筛查心血管危险因素的灵敏度分别为:高血压:男童分别为0.74和0.82,女童分别为0.68和0.73;低高密度脂蛋白胆固醇:男童分别为0.69和0.80,女童分别为0.64和0.71;NAFLD:男童分别为0.98和1.00,女童均为0.93.北京与全国界值筛查心血管危险因素的特异度分别为:高血压:男童分别为0.62和0.53,女童分别为0.68和0.63;低高密度脂蛋白胆固醇:男童分别为0.59和0.50,女童分别为0.66和0.61;NAFLD:男童分别为0.60和0.50,女童分别为0.56和0.51.北京和全国7～18岁儿童青少年WC的P90适宜界值预测心血管危险因素的OR(95%CI)值分别为:高血压分别为6.3(5.2～7.7)和6.0(4.9～7.4);空腹血糖受损均为1.3(1.1～1.5);脂代谢紊乱均为2.9(2.5～3.4);NAFLD分别为49.1(12.0～201.6)和69.8(9.7～504.2).结论 北京市7～18岁儿童青少年WC适宜界值可提高对心血管危险因素筛查的特异度;除对NAFLD预测价值低于全国界值外,北京界值对其他心血管危险因素的预测价值与全国界值没有明显差别.

Abstract：

Objective To compare the optimal references of waist circumference (WC) between Beijing and China in detecting cardiovascular risk factors in school-age children.Methods Percentile curves for WC were drawn by sex using LMS method based on 21 787 children and adolescents aged 7-18 from Beijing Child and Adolescent Metabolic Syndrome Study. The 75th and the 90th percentiles by age and by gender of WC percentile curves were chosen as the optimal WC reference for 3-18 years old children and adolescents in Beijing. The sensitivities(Se) and specificities(Sp) were compared between Beijing and China WC references based on the evaluation of cardiovascular risk factors including hypertension, dyslipidmia, impaired fasting glucose and non-alcoholic fatty liver disease (NAFLD) in the test population being composed of 4927 school children aged 7-18 years. The predictive values for those cardiovascular risk factors were compared between the two optimal thresholds through comparison of the odds ratio(OR) in regression analysis.Results The optimal reference for Beijing children and adolescents aged 3-18 years ranged from 51.8 to 78.2 cm for the 75th percentile in boys and 50.8 to 72.1 cm in girls, and the 90th percentile increased from 54.0 to 86.0 cm in boys and 53.3 to 77.3 cm in girls. The Ses of Beijing and China WC references in detecting hypertension were 0.74 and 0.82 in boys and 0.68 and 0.73 in girls; the Ses were 0.69 and 0.80 in detecting low-high density lipoprotein in boys and 0.64 and 0.71 in girls; and they were 0.98 and 1.00 in boys and both were 0.93 in girls for NAFLD. The Sps of Beijing and China WC references in screening hypertension were 0.62 and 0.53 in boys and 0.68 and 0.63 in girls, respectively. In predicting low-high density lipoprotein, the Sps were 0.59 and 0.50 in boys and 0.66 and 0.61 in girls, the Sps were 0.60 and 0.50 in boys and 0.56 and 0.51 in girls for predicting NAFLD. After adjustment for age and gender,ORs and their 95% credibility intervals(CI) of the 90th WC percentiles of Beijing and China school children were 6.3 (5.2-7.7) and 6.0 (4.9-7.4) in predicting hypertension. Both predictive ORs and their 95%CIs were 1.3 (1.1-1.5) in predicting impaired fasting glucose and the both were 2.9 (2.5-3.4) for dyslipdmia. In predicting NAFLD the ORs and their 95%CIs were 49.1(12.0-201.6) and 69.8 (9.7-504.2) for Beijing and China WC optimal references, separately.Conclusion Compared with Chinese WC reference, WC reference of Beijing had high Sps in screening cardiovascular risk factors in 7-18 years old children. The predictive values were not significant different between Beijing and China WC references for almost all cardiovascular risk factors except NAFLD. The WC reference in Beijing was more practical and handy for reference in Beijing and other north developed metropolises.

Waist circumference reference values in Beijing versus the national values in detecting cardiovascular risk factors in 7-18 years old children

Objective To compare the optimal references of waist circumference (WC) between Beijing and China in detecting cardiovascular risk factors in school-age children.Methods Percentile curves for WC were drawn by sex using LMS method based on 21 787 children and adolescents aged 7-18 from Beijing Child and Adolescent Metabolic Syndrome Study. The 75th and the 90th percentiles by age and by gender of WC percentile curves were chosen as the optimal WC reference for 3-18 years old children and adolescents in Beijing. The sensitivities(Se) and specificities(Sp) were compared between Beijing and China WC references based on the evaluation of cardiovascular risk factors including hypertension, dyslipidmia, impaired fasting glucose and non-alcoholic fatty liver disease (NAFLD) in the test population being composed of 4927 school children aged 7-18 years. The predictive values for those cardiovascular risk factors were compared between the two optimal thresholds through comparison of the odds ratio(OR) in regression analysis.Results The optimal reference for Beijing children and adolescents aged 3-18 years ranged from 51.8 to 78.2 cm for the 75th percentile in boys and 50.8 to 72.1 cm in girls, and the 90th percentile increased from 54.0 to 86.0 cm in boys and 53.3 to 77.3 cm in girls. The Ses of Beijing and China WC references in detecting hypertension were 0.74 and 0.82 in boys and 0.68 and 0.73 in girls; the Ses were 0.69 and 0.80 in detecting low-high density lipoprotein in boys and 0.64 and 0.71 in girls; and they were 0.98 and 1.00 in boys and both were 0.93 in girls for NAFLD. The Sps of Beijing and China WC references in screening hypertension were 0.62 and 0.53 in boys and 0.68 and 0.63 in girls, respectively. In predicting low-high density lipoprotein, the Sps were 0.59 and 0.50 in boys and 0.66 and 0.61 in girls, the Sps were 0.60 and 0.50 in boys and 0.56 and 0.51 in girls for predicting NAFLD. After adjustment for age and gender,ORs and their 95% credibility intervals(CI) of the 90th WC percentiles of Beijing and China school children were 6.3 (5.2-7.7) and 6.0 (4.9-7.4) in predicting hypertension. Both predictive ORs and their 95%CIs were 1.3 (1.1-1.5) in predicting impaired fasting glucose and the both were 2.9 (2.5-3.4) for dyslipdmia. In predicting NAFLD the ORs and their 95%CIs were 49.1(12.0-201.6) and 69.8 (9.7-504.2) for Beijing and China WC optimal references, separately.Conclusion Compared with Chinese WC reference, WC reference of Beijing had high Sps in screening cardiovascular risk factors in 7-18 years old children. The predictive values were not significant different between Beijing and China WC references for almost all cardiovascular risk factors except NAFLD. The WC reference in Beijing was more practical and handy for reference in Beijing and other north developed metropolises.