我国中年人群向心性肥胖和心血管病危险因素及其聚集性

目的 分析在中国人群中，反映向心性肥胖的指标－－腰围与心血管病危险因素及其聚集性的关系。并探讨中国人群适宜的腰围切点。方法 分析数据来自1993－1994年对14组中年（35－59）岁人群进行的抽样调查，职业包括产业工人，农民，城市居民和渔民，地点分布于东北，华北，华东，华南，西南和中部。调查项目均采用国际标准化方法，由合作中心进行统一培训，考核和质量控制。资料完整可供分析16466人。结果 显示中国人群腰均值男，女性均小于西方人群，北方高于南方，城市居民和工人高于农民，将腰围从＜65cm至大于等于100cm,每5cm进行分层，可见无论男性或女性，高血压，高血清总胆固醇，低高密度脂蛋白胆固醇和空腹血糖升高的检出率及具有2个及以上危险因素的聚集率均随腰围的增大而逐步上升。危险因素聚集的年龄调整比值比（OR值）男性和女性分别增高7．8倍和8．5倍，以不同腰围切点计算对于检出危险因素聚集的敏感度和特异度，显示男性腰围大于等于85cm，检出危险因素聚集的敏感度为54．2％，特异度为77．3％，女性腰围大于等于80cm，相应的敏感度和特异度为59．8％和70．3％，较其他各切点为优，结论 研究表明，向心性肥胖的程度和心血管病危险因素升高及聚集密切相关，应重视对以腹部肥胖为特征的向心性肥胖进行防治，;男性腰围应控制在85cm以下，女性应控制在80cm以下。

Relationship of central obesity to cardiovascular risk factors and their clustering in middle aged Chinese populations

Objective　To analyze the relationship of waist circumference (WC) as index of central obesity to cardiovascular (CVD) risk factors and their clustering and to explore the optimal cut-off point of WC for Chinese populations. Methods　Data analyzed were collected from the surveys in 14 middle-aged (35－59 years) random samples undertaken in 1993－1994, including factory workers, farmers, city residents and fishermen, located in northeast, north, east, south, southwest and the middle part of China. The survey methods were internationally standardized, all the local investigators were trained, certified and quality controlled by the Coordinating Center and Central laboratory in Department of Epidemiology, Fu Wai Hospital. The data of 16466 participants had available for analysis. Results　The means of WC of both male and female Chinese were smaller than those of western populations. Those of the north were higher than the south, and of the city residents were higher than the farmers. Stratifying WC by every 5 cm from <65 cm to ≥100cm, the prevalence rates of high blood pressure, high serum total cholesterol, low HDL-C, high fasting glucose and the rate of their clustering (≥2 risk factors) were all increased significantly with higher levels of WC. The age-adjusted OR for clustering of risk factors increased by 7.8 and 8.5 times for men and women, respectively. For men at WC ≥85 cm, the sensitivity and specificity for identifying clustering of risk factors were 54.2% and 77.3%, and for women at WC≥80 cm the sensitivity and specificity were 59.8% and 70.3%, respectively. Both were better than other cut-off points. Conclusions　The extent of central obesity correlates closely with the elevation of cardiovascular risk factors and their clustering, thus the prevention and control of central obesity should be emphasized in Chinese populations. It is better to keep the waist circumference under 85 cm in men and under 80 cm in women.