中国成年人中心性肥胖腰围切点值的进一步验证

目的描述中国人群腰围的分布特征,进一步探讨和验证中国成年人中心性肥胖的腰围切点及其对糖尿病患病危险的预测价值.方法利用2002年中国居民营养与健康状况调查的大样本数据,分析中国人群腰围的分布特征、南方和北方人群腰围的分布特征以及身材高大人群的腰围分布特征.分析不同的腰围切点与体重指数（BMI）≥24的诊断一致性.以ROC曲线的最短距离确定适合的腰围切点.用多元logistic回归分析不同腰围水平下调查对象的糖尿病患病相对风险.结果中国人群腰围分布呈正偏态;对腰围进行年龄调整后,男性腰围均值为79.0 cm,女性为74.8 cm.男性腰围均值大于女性;腰围水平随年龄增长而逐渐增加;不论男女,北方人群的腰围均大于南方;身材高大的人腰围水平大于总人群.男性腰围以85 cm、女性80 cm作为切点,与BMI≥24的诊断一致性最好,且ROC曲线的距离最短.男性腰围超过85 cm、女性腰围超过80 cm,患糖尿病的相对危险均增加1.1倍,空腹血糖受损的患病相对危险会增加1.0倍和1.7倍;当男性腰围超过95 cm、女性腰围超过90 cm时,患糖尿病的相对危险就会增加2.6倍和3.0倍,空腹血糖受损的患病相对危险会增加2.2倍和2.3倍.腰围越大,糖尿病的患病风险及空腹血糖受损的患病风险则越大.结论中国卫生部颁发的〈中国成年人超重与肥胖症预防与控制指南〉中推荐的腰围以85 cm和80 cm分别作为诊断男性和女性中心性肥胖的切点,得到了进一步的验证,应在预防中应用.     

超重、肥胖与生活方式关系的分析

[目的]分析保定市六一社区居民生活方式与超重、肥胖之间的关系,为制定健康教育策略提供依据。[方法]资料来自保定市六一社区年龄≥40岁的城市居民,通过问卷调查和体检收集生活方式、膳食、身高、体重、腰围等资料。[结果]该社区男性和女性的BMI均值分别为24.90和24.06,其中男性142(40.34%)人超重,34(9.66%)人肥胖,女性198(38.45%)人超重,55(10.68%)人肥胖。反映腹部脂肪水平的指标腰围男性和女性平均值分别为85.21和79.35,其中男性182(51.70%)人≥85cm,女性249(48.35%)人≥80cm。男性和女性中经常体力劳动、锻炼的组BMI值和腰围明显大于相应的不经常体力劳动、锻炼组;每天吃肉组的BMI值和腰围明显大于不经常或不吃的组,饮酒者比非饮酒者BMI值和腰围明显偏高,而牛奶、鱼类、豆类及豆制品、蛋类的分组男女都没有统计学的差别。[结论]该社区居民超重、肥胖情况严重,生活方式与其存在密切关系,应加强改变生活方式等方面的宣教,以降低心脑血管疾病发病的危险因素。     

我国成人体重指数和腰围对相关疾病危险因素异常的预测价值:适宜体重指数和腰围切点的研究

目的：确定我国成人适宜的体重指数（BMI）范围和超重肥胖的划分界限。国际生命科学学会中国办事处中国肥胖问题工作组，对国内现有体量指标和相关疾病危险因素的研究数据组织了汇总分析。方法：有13项1990年以后的调查资料人选，共计20－70岁以上成人23972人，有腰围数据者111411人，有血脂和血糖化验数据者8万余人。数据进入分析的人群分布于大陆21个省市、自治区儿台湾。汇总方法是由各负责单位根据统一制定的表格和标准提供数据，汇总分析中心进行核对、汇总和统计分析。结果；高血压、糖尿病、血清总胆固醇升高、高密度脂蛋白胆固醇过低、甘油三酯升高和危险因素聚集（一个人具有2个及以上危险因素）的现患率均随BMI或腰围的增高而上升。通过不同BMI和腰围切点对于检出各项危险因素异常的敏感度和特异度分析，提出敏感度特异度较好、假阳性率较低的BMI切24为中国成人超重的界限，特异度达90％的BMI切点28为肥胖的界限；男性腰围≥85cm，女性≥80cm为腹部脂肪蓄积的界限。结论：切点以上的人群归因危险度百分比显示：将BMI控制到24以下，可能防止人群中45％－50％的危险因素聚集。对BMI在28及以上者药物控制到此点以下，可能防止15％－17％的危险因素聚集，从而降低心血管病和糖尿病的发病危险。男性腰围控制在85cm以下，女性腰围控制到80cm以下， 可能防止约47％－58％的解除因素聚集。根据以上分析结果，提出了对中国成人超重和肥胖界限的建议。     

成人肥胖与高血糖高血压血脂紊乱聚集的关系

目的探讨成人肥胖与与高血糖、高血压、血脂紊乱聚集的关系。方法采用分层整群随机抽样方法,随机调查杭州市城乡社区居民20～79岁1600人。应用logistic回归模型分析肥胖的两个主要指标体质指数(BMI)和腰围对发生高血糖、高血压、血脂紊乱聚集的OR值。结果调整年龄、吸烟史、饮酒史、体育锻炼等影响因素后,男性超重(24kg/m2≤BMI28kg/m2)和肥胖(BMI≥28kg/m2)均比正常体重更易引起聚集发生,OR值分别为3.187(95%CI:1.731～5.869)和3.050(95%CI:1.248～7.453);女性中心性肥胖(腰围≥80cm)对聚集发生的OR值为2.330(95%CI:1.440～3.771)。结论成人发生高血糖、高血压、血脂紊乱聚集与肥胖存在一定关联,男性体质指数和女性腰围对心血管病的一级预防具有重要意义。     

体重指数、腰围与代谢性健康风险的关系

目的比较体重指数（BMI）、腰围（WC）与代谢性健康风险的大小。方法对苏州市和常熟市两个社区的江苏省多代谢异常和代谢综合征（MS）防治研究中，经济发达地区基线资料的1604例对象按BMI和WC分组，在正常体重（BMI：18～23．9）、超重（BMI：24～27．9）、肥胖（BMI≥28）类别中，计算高血压、高血糖、血脂异常的相对危险度（RR），并对WC类别中腹型肥胖（男≥85cm，女≥80cm）和WC正常个体进行比较。结果无论是男性还是女性，其高血压、糖脂代谢各项指标以及MS的罹患率均与BMI和WC相关，控制混杂因素后，这样的相关性依然存在；但仅BMI超重时，各项表示代谢性健康风险的aRR值基本上都低于BMI超重合并腹型肥胖的aRR值；男、女性BMI正常但有腹型肥胖时，均较BMI超重而WC正常者的健康风险高。结论WC在表示代谢性健康风险方面比BMI更为有效。     

中国九省区1993—2006年成年人腰围分布的变化及中心性肥胖流行趋势分析

目的 分析1993-2006年中国9省区20～65岁的成年居民腰围分布的变化及中心性肥胖的流行趋势.方法 以1993、1997、2000、2004和2006年"中国健康与营养调查"资料中20～65岁健康成年人作为研究对象,应用Stata软件分析成年人腰围分布的变化,并使用LMS方法分别拟合男性和女性各调查年份P15、P50和P85百分位数曲线;以2002年由卫生部疾病控制司颁布实施的<中国成年人超重和肥胖症预防控制指南>中男性腰围≥85 cm、女性腰围≥80 cm作为判断成年人中心性肥胖的标准,应用SAS软件分析成年人腰围分布和中心性肥胖率的城乡差别及腰围与BMI的相关性.结果 1993-2006年中国20～65岁成年男性腰围均值从77.1 cm增加至82.9 cm,中心性肥胖率从17.9%增加至42.5%,平均增长速度为1.9%;女性腰围均值从75.8 cm增加至78.9 cm,中心性肥胖率从28.8%增加至46.9%,平均增长速度为1.4%.男性和40岁以上农村女性是腰围和中心性肥胖率增长最快的人群.由于农村女性腰围和中心性肥胖率的增长均高于城市女性,到2006年女性腰围和中心性肥胖率的城乡差异消失.BMI处于正常范围的成年人中心性肥胖率呈现增加的趋势,2006年BMI正常的男性中有21.6%、女性中有27.4%处于中心性肥胖状态. 结论 1993-2006年中国20～65岁成年居民腰围呈现逐年增大的趋势;随着腰围的增大,中心性肥胖率也呈现逐年增加,男性腰围及中心性肥胖率的增长幅度高于女性;只有控制成年人腰围和中心性肥胖率过快增长,才能有效地控制与肥胖相关的慢性非传染性疾病患病率的增加.     

中国成年人代谢异常相关的体质指数和腰围切点研究

目的 研究中国成年人BMI和腰围与各项代谢危险因素之间的相关性,确定超重肥胖的适宜BMI和腰围切点。方法 中国慢性病前瞻性研究于2004-2008年进行基线调查,并于2013-2014年随机抽取了5%的研究对象进行第2次重复调查。本研究剔除体格指标或代谢危险因素变量缺失或极端值、自报患有恶性肿瘤者,基线纳入501 201人,第2次重复调查纳入19 201人。比较不同BMI和腰围下代谢危险因素异常率,通过受试者工作特征（ROC）曲线分析,确定预测高血压、糖尿病、血脂异常和危险因素聚集的适宜BMI和腰围切点。结果 随BMI或腰围的增加,高血压、糖尿病、血脂异常和危险因素聚集患病率均呈现上升的趋势。依据正确指数最大的原则选取BMI超重切点和腰围切点,男性和女性BMI超重切点均接近24.0 kg/m²,男性腰围切点接近85 cm,女性腰围切点约为80~85 cm。男性和女性中,检出各项代谢危险因素特异度达到90%的BMI切点范围为27.0~28.9 kg/m²,多数接近28.0 kg/m²,以28.0 kg/m²作为肥胖切点。结论 本研究在更新开展的大样本调查中进一步验证了中国肥胖问题工作组2002年推荐的超重和肥胖标准,超重和肥胖的BMI切点分别为24.0和28.0 kg/m²;中心性肥胖的腰围适宜切点男性为85 cm,女性为80~85 cm。     

贵州成人腰围体质指数与高血压的关系研究

目的:采用腰围、体质指数综合评价成人高血压患病风险。方法:按多阶段整群随机抽样的方法,抽取贵州省12个县(市/区)18岁及以上9280名常驻居民进行调查。结果:高血压患病率有随BMI增高而增高的趋势,正常体重组、超重组和肥胖组的高血压患病率分别为22.37%、36.59%和51.73%,青年人中肥胖人群患高血压风险最大男性OR=4.171(95%CI=2.872~6.058),女性OR=5.071(95%CI=3.402~7.560),而在超重人群中则以老年组患高血压风险最大,男性OR=1.983(95%CI=1.339~2.937),女性OR=2.503(95%CI=1.801~3.479)。结论:与正常体重相比,超重肥胖人群患高血压危险逐步增加,控制青年人肥胖和老年人群超重对于降低人群的高血压患病水平有重要意义。     

腹型肥胖

腹型肥胖(abdominalobesity)又称中心性(或向心性)肥胖,是反映脂肪过多沉积于腹部或腹腔内脏的指标。腹型肥胖对代谢的影响很大,是多种慢性病的最重要危险因素之一。目前国内外通常使用腰臀比作为间接判断腹型肥胖的指标,但判断界点不一致。WHO建议男性≥1.0、女性≥0 .85作为腹型肥胖的判断标准,我国尚无腰臀比的标准。目前公认腰围是衡量腹型肥胖最简单实用的指标,不同人群腰围的诊断界点不同,西方人群的标准为男性≥10 2cm ,女性≥88cm ;我国的标准为男性≥85cm ,女性≥80cm。腹型肥胖@米杰 @张力…     

新疆博尔塔拉地区多民族血压正常高值人群中伴随心血管病危险因素的分析

目的 分析新疆博尔塔拉州(博州)维吾尔族(维)、哈萨克族(哈)、蒙古族(蒙)、汉族正常高值血压(SBP 120～139 mm Hg和或DBP 80～89 mm Hg)的人群分布特点及其他心血管病(CVD)危险因素的伴随情况.方法 利用2004年博州维、哈、蒙、汉族高血压的流行病学调查资料(4325人,其中维、哈、蒙、汉族各1247、1047、817、1214人),比较分析多民族正常高值血压人群的其他CVD危险因素伴随情况.结果 (1)维、哈、蒙、汉族正常高值血压检出率分别为39.2%、34.5%、36.0%、36.5%,维、哈、蒙族<40岁组的正常高值血压比例高于同民族40～60岁(分别P=0.000、0.006、0.016)和>60岁组(均P=0.000).(2)正常高值血压人群中,SBP和DBP均高者最多(>45%),单纯DBP高者最少(>13%).(3)4民族正常高值血压者的超重肥胖(BMI≥24.0 kg/m~2)比例≥57%、腹型肥胖(腰围:男85 cm/女80 cm及以上)≥62%、血脂异常≥43%、1个其他CVD危险因素及以上≥82%.(4)多元回归分析表明,增龄、超重肥胖、男性是正常高值血压的危险因素.结论 新疆博州20～79岁维、哈、蒙、汉族正常高值血压比例很高,尤其在<40岁人群中,并伴多项其他CVD危险因素,应该加强对该人群的早期积极干预.     

深圳市成人体质指数和腰围与血脂水平关系的研究

目的研究深圳市成人体质指数(BMI)和腰围(WC)与血脂各组分的水平及其脂代谢异常风险之间的相关性。方法按照多阶段分层整群随机抽样法,从深圳市8个行政区中抽取12个社区,每个社区随机抽取75户常住居民进行入户调查、体格检查和血脂测定。结果不同BMI组和不同腰围组的TG、TC、HDL-c、LDL-c水平的差异有统计学意义(P<0.05),单因素线性回归分析发现,随着BMI和WC的增加,TG、TC、LDL-c水平均呈递增趋势(P<0.05),HDL-c水平均呈递减趋势(P<0.05);多因素logistic回归结果表明,随着BMI的增加,罹患高TG、高TC、低HDL-c、高LDL-c和血脂异常的风险呈增加趋势(P<0.05),随着WC的增加,罹患高TG、高TC、高LDL-c和血脂异常的风险呈增加趋势(P<0.05);偏相关分析结果显示,BMI与HDL-c的相关性比WC大(P<0.05),WC与TC的相关性比BMI大(P<0.05)。结论体质指数和腰围与血脂各组分的水平独立相关,高体质指数和腰围是血脂各指标异常的危险因素。     

Are waist circumference and body mass index independently associated with cardiovascular disease risk in Chinese adults?

BACKGROUND: In Western populations, waist circumference (WC) is more predictive of cardiovascular disease (CVD) risk than is body mass index (BMI). It is unclear whether the same is true in Asian populations. OBJECTIVE: The objective was to examine the independent effects of WC and BMI on CVD risk factors in China. DESIGN: CVD risk factors, BMI, and WC were measured in a nationally representative cross-sectional study of 15 540 Chinese adults aged 35-74 y. RESULTS: Higher WC tertiles were associated with higher blood pressure and higher cholesterol, triacylglycerol, and glucose concentrations within each tertile of BMI and vice versa. In men, the odds of hypertension, dyslipidemia, and the metabolic syndrome (MS) increased with successive WC tertiles (1.0, 1.1, and 1.8, respectively, for hypertension; 1.0, 1.4, and 2.0, respectively, for dyslipidemia; and 1.0, 2.3, and 4.8, respectively, for MS; P for trend < 0.001 for all), even after adjustment for BMI. Similarly, the odds of hypertension, dyslipidemia, and MS increased with successive BMI tertiles (1.0, 1.5, and 2.6, respectively, for hypertension; 1.0, 1.3, and 1.8, respectively, for dyslipidemia; 1.0, 1.3, and 2.9, respectively for MS; P for trend < 0.001 for all), even after adjustment for WC. However, BMI tertiles were not associated with the odds of diabetes after adjustment for WC (P for trend = 0.67), whereas tertiles of WC were significantly associated with the odds of diabetes after adjustment for BMI (1.0, 1.6, and 2.1, respectively; P for trend = 0.002). The results were similar in women. CONCLUSIONS: These data show that WC adds additional risk information to that of BMI in Chinese adults. Measurement of both WC and BMI in Chinese adults may enhance CVD risk stratification.     

Combination of BMI and Waist Circumference for Identifying Cardiovascular Risk Factors in Whites

OBJECTIVE: BMI (kilograms per meters squared) and waist circumference (WC) (measured in centimeters) are each associated with the risk of developing cardiovascular disease (CVD). Therefore, a combination of the two may be more effective in identifying subjects at risk than either alone. The present study sought to identify the combination of BMI and WC that has the strongest association with CVD risk factors in whites. RESEARCH METHODS AND PROCEDURES: Subjects were 8712 white men and women from the Third National Health and Nutrition Examination Survey. The optimal combination of BMI and WC was developed using logistic regression models with BMI and WC as predictors and CVD risk factors as outcomes. The combined measure of BMI and WC using current cut-off points was also examined. Sensitivity, specificity, and receiver operating characteristics curves were compared between the combined measures and BMI alone. RESULTS: For white men, the optimal combination of BMI and WC for identifying CVD risk factors was 0.68 x BMI + 0.32 x WC. This combination generated a score that better estimated the odds of having CVD risk factors than either alone. For white women, WC alone largely determined the likelihood of having CVD risks. The combination of BMI and WC using current cut-off points may provide an improved measure of CVD risk. Combined measures showed a higher sensitivity or a shorter distance in receiver operating characteristic curves in the identification of CVD risk factors. DISCUSSION: Combined measures of BMI and WC may provide a higher overall test performance for CVD risk factors and may be useful in some ethnic groups as an improved means of screening subjects for further evaluation in the clinical setting.     

Body Mass Index,Waist-circumference and Cardiovascular Disease Risk Factors in Iranian Adults: Isfahan Healthy Heart Program

Considering the main effect of obesity on chronic non-communicable diseases, this study was performed to assess the association between body mass index (BMI), waist-circumference (WC), cardiometabolic risk factors and to corroborate whether either or both BMI and WC are independently associated with the risk factors in a sample of Iranian adults. This cross-sectional study was performed on data from baseline survey of Isfahan Healthy Heart Program (IHHP). The study was done on 12,514 randomly-selected adults in Isfahan, Najafabad and Arak counties in 2000-2001. Ages of the subjects were recorded. Fasting blood glucose (FBG), 2-hour post-load glucose (2hpp), serum lipids, systolic and diastolic blood pressure (SBP and DBP), BMI, WC, smoking status, and total daily physical activity were determined. Increase in BMI and WC had a significant positive relation with the mean of FBG, 2hpp, SBP, DBP, serum lipids, except for HDL-C (p<0.001 for all). After adjustment for age, smoking, physical activity, socioeconomic status (SES), and BMI, the highest odds ratio (OR) (95% CI) for diabetes mellitus (DM) according to WC was 3.13 (1.93-5.08) and 1.99 (1.15-3.44) in women and men respectively. Moreover, the highest ORs based on BMI with adjustment for age, smoking, physical activity, SES, and WC were for dyslipidaemia (DLP) [1.97 (1.58-2.45) in women and 2.96 (2.41-3.63) in men]. The use of BMI or WC alone in the models caused to enhance all ORs. When both BMI and WC were entered in the model, the ORs for all risk factors, in men, according to BMI, were more compared to WC. However, in women, ORs for DM and hypertension (HTN) in WC quartiles were more than in BMI quartiles. BMI is the better predictor of DM, HTN, and DLP in men compared to WC. Conversely, in women, WC is a superior predictor than BMI, particularly for DM and HTN. Furthermore, the measurement of both WC and BMI in Iranian adults may be a better predictor of traditional risk factors of CVDs compared to BMI or WC alone.Key words: Body mass index, Diabetes mellitus, Dyslipidaemia, Hypertension, Obesity, Risk Factor, Waist-circumference, Iran     

The associations between current recommendation for physical activity and cardiovascular risks associated with obesity

OBJECTIVE: To examine associations between current recommended physical activity levels and body mass index (BMI) with some cardiovascular disease (CVD) risk factors (total cholesterol, high-density lipoprotein cholesterol (HDL-C), non-HDL-cholesterol (non-HDL-C), C-reactive protein (CRP), fibrinogen, and blood pressure), general health score (GHQ12) and predicted coronary heart disease (CHD) risk. DESIGN: Further analysis of the cross-sectional Scottish Health Survey 1998 data. SUBJECTS: Five thousand four hundred and sixty adults 16-74 years of age. RESULTS: After controlling for some confounding factors, obesity was significantly associated with higher odds ratio (OR) for elevated cholesterol, CRP, systolic blood pressure, non-HDL-C and lower HDL-C (P<0.001), and with greater predicted CHD risk compared to BMI <25 kg/m(2). Regular self-reported physical activity was associated with smaller OR of lower HDL-C and higher CRP, and average predicted 10-year CHD risk in obese subjects, but did not eliminate the higher risk of the measured CVD risk factors in this group. The OR of these two risk factors were still high 4.39 and 2.67, respectively, when compared with those who were inactive with BMI <25 kg/m(2) (P<0.001). Those who reported being physically active had better GHQ scores in all BMI categories (P<0.001). CONCLUSION: Reporting achievement of recommended physical activity levels may reduce some CVD risk factors, predicted CHD risk and improve psychosocial health, but may not eliminate the extra risk imposed by overweight/obesity. Therefore, increasing physical activity and reducing body weight should be considered to tackle CVD risk factors.     

不同体重指数和腰围水平与其他心血管病危险因素聚集的关系

目的探讨不同体重指数(BMI)和腰围水平对人群中其他心血管病危险因素聚集的影响.方法将1992～1994年和1998年在我国不同地区中年人群中进行的2次心血管病危险因素调查资料合并共30 561人,比较不同BMI和腰围分组的研究对象其他心血管病危险因素聚集率和聚集的相对危险,其中危险因素聚集定义为同一研究对象具有高血压、高血清总胆固醇、低高密度脂蛋白胆固醇或空腹血糖异常之中的任意2项或2项以上者.结果随着BMI和(或)腰围的增加,人群其他心血管病危险因素的聚集率呈明显上升趋势, 按BMI分层各组中,男女两性腰围与其他心血管病危险因素的聚集率均呈明显的线性上升趋势,同样在不同的腰围分组中,BMI均与其他心血管病危险因素的聚集率呈明显的线性趋势.男性和女性年龄调整心血管病危险因素聚集率在BMI<24 kg/m2、腰围(男/女)<85/80 cm组分别为11.1%和10.4%,BMI<24 kg/m2、腰围(男/女)85～95.9/80～89.9 cm组分别为24.2%和16.9%, BMI 24.0～27.9 kg/m2、腰围(男/女)<85/80 cm组分别为24.0%和17.0%,BMI 24～27.9 kg/m2、腰围(男/女)85～95.9 /80～89.9 cm组分别为34.3%和24.0%. BMI 24.0～27.9 kg/m2、腰围(男/女)≥95/90 cm组分别为40.8%和29.6%,BMI≥28 kg/m2、腰围(男/女)85～95.9/80～89.9 cm组分别为44.2%和29.9%,BMI≥28 kg/m2、腰围(男/女)≥95/90 cm组分别为54.7%和35.4%.结论 BMI和腰围水平均与其他心血管病危险因素的聚集有独立的正相关性.保持BMI和腰围均在正常范围对心血管健康是很重要的.     

Race-ethnicity-specific waist circumference cutoffs for identifying cardiovascular disease risk factors

BACKGROUND: Waist circumferences (WCs) in white men and women that represent a risk of cardiovascular disease (CVD) equivalent to that of body mass indexes (BMIs; in kg/m2) of 25 and 30 have been identified. However, WC cutoffs for other race-ethnicity groups remain unknown. OBJECTIVE: The objective was to determine WC cutoffs for CVD risk in non-Hispanic blacks (blacks), Mexican Americans (MA), and non-Hispanic whites (whites). DESIGN: Data from 10,969 participants in the third National Health and Nutrition Examination Survey (1988-1994) were analyzed. The presence of CVD risk factors was the main outcome. Sex- and race-ethnicity-specific WC cutoffs were determined with logistic regression models by linking WC cutoffs with equivalent CVD risk based on BMI cutoffs for overweight and obesity. WC cutoffs for metabolic syndrome risk factors were similarly calculated. RESULTS: Correlations between WC and lipid profiles, blood pressure, and glucose were significantly higher than those between BMI and these same variables in all groups. The WC cutoffs were approximately 5-6 cm greater for white than for black men at BMIs between 25 and 40, and those for MA were intermediate. In women, few differences in WC cutoffs were observed between the groups. Simplified WC cutoffs corresponding to BMIs of 25 and 30, largely independent of age, for the 3 race-ethnicity groups were 89 and 101 cm for men and 83 and 94 cm for women. Minimal distances in receiver operating characteristic curves tended to be shorter when WC cutoffs rather than BMI cutoffs were used. CONCLUSIONS: WC is a better indicator of CVD risk than is BMI in the 3 race-ethnicity groups studied. The proposed WC cutoffs are more sensitive than are BMI cutoffs in predicting CVD risk.     

腰围、腰围身高比、体重指数预测儿童青少年代谢紊乱的效果比较

目的 探讨腰围(WC)、腰围身高比(WHtR)和体重指数(BMI)预测儿童青少年代谢紊乱的效果,为儿童青少年代谢紊乱的早期预警提供科学依据。方法 选取济南市城区1 170名7~17 岁儿童青少年,利用受试者工作特征曲线(ROC)比较WC、WHtR和BMI预测代谢紊乱的曲线下面积(AUC),采用Logistic回归模型分析WC、WHtR和BMI诊断的肥胖预测儿童青少年代谢紊乱的风险。结果 WC预测4种代谢紊乱(高血糖、高血压、低HDL-C和高TG)中≥1项或≥2项组分的ROC曲线下面积(AUC,95%CI)分别为0.63(0.59~0.66)和0.74(0.69~0.79),WHtR对应值分别为0.62(0.58~0.65)和0.74(0.69~0.79),BMI对应值分别为0.64(0.60~0.67)和0.75(0.70~0.80)。WC诊断的腹型肥胖(WC≥性别和年龄别的P₉₀)预测儿童青少年4种代谢紊乱中的≥1项或≥2项组分的OR(95%CI)值分别为2.88(2.15~3.86)和6.83(4.47~10.44),WHtR诊断的腹型肥胖(WHtR≥0.50)对应的OR(95%CI)值分别为2.63(1.86~3.71)和5.77(3.65~9.13),BMI诊断的肥胖(BMI≥性别和年龄别的肥胖界值) 对应的OR(95%CI)值分别为3.03(2.17~4.23)和6.35(4.03~10.00)。结论 WC、WHtR和BMI均可作为儿童青少年代谢紊乱的重要预测因子,WC、WHtR和BMI预测代谢紊乱的效果相当。考虑到WHtR 界值的简单易记性,WHtR或许可替代WC和BMI作为儿童青少年代谢紊乱的早期预警指标。     

Obesity in the elderly and its relationship with cardiovascular risk factors in Taiwan

OBJECTIVES: The obese elderly are at increased risk of mortality, morbidity, and functional disability. In this study, we examined the prevalence of obesity and relationship between various anthropometric indices (AI) and cardiovascular disease (CVD) risk factors in the elderly. RESEARCH METHODS AND PROCEDURES: A stratified multistage clustered sampling scheme was used in the Elderly Nutrition and Health Survey in Taiwan during 1999 to 2000. 2432 non-institutionalized subjects (age, 72.8+/-9.4 years; BMI, 23.6+/-6.4 kg/m2) were recruited. The receiver operating characteristic analysis was used to compare predictive validity of CVD risk factors among various AI, including BMI, waist circumference (WC), and waist-to-hip ratio (WHR). RESULTS: The prevalence of obesity was 29.0% in men and 36.8% in women by obesity criteria for Asians (BMI>or=25 kg/m2) and 13.3% in men and 21.0% in women by the Taiwanese definition (BMI>or=27 kg/m2). Odds ratios of acquiring various CVD risk factors increased significantly with increment of WC, WHR, and BMI. The areas under the curve predicting metabolic syndrome were all <0.8. The cut-off values of WC corresponding to the highest sensitivity and the highest specificity in predicting various CVD risk factors were 86.2-88.0 cm in men and 82.0-84.0 cm in women, respectively. DISCUSSION: Obesity was prevalent in the Taiwanese elderly. WC was related to CVD risk factors to a greater extent than BMI and WHR. However, none of them alone was a good screening tool for CVD risk factors. Therefore, how to apply AI prudently to screen elderly for CVD risk factors needs further research.     

Discrimination of health risk by combined body mass index and waist circumference

OBJECTIVE: NIH Clinical Guidelines (1998) recommend the measurement of waist circumference (WC, centimeters) within body mass index (BMI, kilograms per square meter) categories as a screening tool for increased health risk. RESEARCH METHODS AND PROCEDURES: The Canada Heart Health Surveys (1986 through 1992) were used to describe the prevalence of the metabolic syndrome in Canada and to test the use of the NIH guidelines for predicting metabolic risk factors. The sample included 7981 participants ages 20 to 74 years who had complete data for WC, BMI, high-density lipoprotein-cholesterol, triglycerides, diabetic status, and systolic and diastolic blood pressures. National Cholesterol Education Program Adult Treatment Panel III risk categories were used to identify the metabolic syndrome and associated risk factors. Logistic regression was used to test the hypothesis that WC improves the prediction of the metabolic syndrome, within overweight (25 to 29.9 kg/m(2)) and obese I (30 to 34.9 kg/m(2)) BMI categories. RESULTS: The prevalence of the metabolic syndrome was 17.0% in men and 13.2% in women. The odds ratios (OR) for the prediction of the metabolic syndrome were elevated in overweight [OR, 1.85; 95% confidence interval (95%CI), 1.02 to 3.35] and obese (OR, 2.35; 95%CI, 1.25 to 4.42) women with a high WC compared with overweight and obese women with a low WC, respectively. On the other hand, WC was not predictive of the metabolic syndrome or component risk factors in men, within BMI categories. DISCUSSION: In women already at increased health risk because of an elevated BMI, the additional measurement of WC may help identify cardiovascular risk.