中国中老年人群和高个成年人中心型肥胖的腰围界值点验证

目的 探讨中国中老年人群和高个成年人的适宜腰围界值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数据,分析≥45岁人群和身高在全人群第85百分位数(P85)以上成年人的腰围分布特征,分析不同的腰同界值点与体重指数(BMI:kg/m2)≥24的诊断一致性,采用多元logistic回归分析不同腰围水平的调查对象患糖尿病和空腹血糖受损的相对风险,并以ROC曲线最短距离确定上述人群的适宜腰围界值点.结果 中国中老年人腰围男性均值为80.8 cm,女性均值为79.4 cm;高个男性腰围均值为84.1 cm,女性为77.9 cm.中老年人腰围以男性85 cm、女性80 cm作为界值点,与BMI≥24的诊断一致性最好,预测糖尿病的ROC曲线距离最短.与腰围<85 cm组相比,85 cm～组、90 cm～组和95 cm～组的中老年男性患糖尿病[OR值分别为2.1(95%CI:1.6～2.8)、3.0(95%CI:2.3～4.0)和4.5(95%CI:3.4～5.8)]和空腹血糖受损[OR值分别为1.6(95%CI:1.2～2.2)、2.6(95%CI:1.9～3.5)和3.5(95%CI:2.6～4.6)]的相对风险明显增加.与腰围<80 cm组相比,80 cm～组、85 cm～组和90 cm～组中老年女性患糖尿病[OR值分别为1.9(95% CI:1.4-2.6)、3.2(95%CI:2.4～4.3)和4.8(95%CI:3.7～6.1)]和空腹血糖受损[OR值分别为2.5(95%CI:1.8～3.4)、3.2(95%CI:2.4～4.4)和4.2(95%CI:3.2～5.6)]的相对风险明显增高.高个成年人腰围以男性90 cm、女性85 cm作为界值点,预测糖尿病患病的ROC曲线距离最短.与腰围<85 cm组相比,95cm～组高个男性患糖尿病和空腹血糖受损的相对风险明显增高[OR值分别为3.6(95%CI:2.1～6.4)和5.5(95%CI:3.0～10.1)].与腰围<80cm组相比,85 cm～、90 cm～组高个女性患糖尿病的相对风险明显升高[OR值分别为5.0(95%CI:2.7～9.4)和8.0(95%CI:4.6～14.1)],90 cm～组患空腹血糖受损的相对风险OR=3.7(95%CI:2.0～6.9).结论 男性85 cm和女性80 cm是中老年人群的适宜腰围界值点;对于高个成年人,此腰围界值点对于空腹血糖受损有预测价值;人群中心型肥胖预防指标建议使用男性85 cm和女性80 cm作为腰围界值点.     

农村居民糖尿病及糖调节受损特征分析

目的 分析山东省中西部农村25岁～居民糖尿病及糖调节受损的流行特征.方法 采用多阶段分层随机抽样方法,共调查16 388人,开展同卷调查并测量身高、体重、腰围、血压和空腹血糖.空腹血糖在6.1～7.0mmol/L者再进行口服葡萄糖耐量(OGTT)试验.根据WHO 1999年糖尿病诊断标准将调查人群分为正常人、孤立性空腹血糖受损(I-IFG)、空腹血糖受损合并糖耐量受损(IFG/IGT)和糖尿病(DM).结果 该地区农村居民IFG标化患病率为6.85%,DM为3.38%,I-IFG为4.41%,IFG/IGT为0.83%,且患病率均随年龄、腰围、身高、体质指数(BMI)的增加而升高.年龄＞35岁,I-IFG、IFG/IGT和年龄＞45岁DM患病率升高明显.男性腰围≥85 cm、女性腰围≥80 cm.IFG/IGT和DM患病率升高明显.BMI≥24,I-IFG、IFG/IGT和DM患病率升高明显.调查对象的年龄、腰围、BMI、腰臀比、收缩压和舒张压按正常人→I-IFG→IFG/IGT、DM顺序逐渐升高,但IFG/IGT和DM两者问变化无差异.结论 山东省中西部农村居民I-IFG、IFG/IGT和DM的流行特征基本相同.糖尿病及糖调节受损发病较高,应重视和加强宣传和早期预防控制工作.     

中国成年人群糖尿病筛查肥胖相关身体测量指标分布特征及其适宜切点

目的了解中国成年人群糖尿病(DM)筛查肥胖相关身体测量指标分布特征及其适宜切点,为DM的预防控制提供科学依据。方法于2009年9—12月采用分层整群随机抽样方法对在黑龙江、辽宁、河南、山东、江苏、湖北、湖南、广西和贵州9个省抽取的8 824名中国成年人群进行体格检查和空腹血糖检测;采用受试者工作特征曲线(ROC)分析各肥胖相关身体测量指标筛检DM的价值,并根据约登指数确定其适宜切点值。结果调查的8 824名中国成年人群中,DM患病673例,DM患病率为7.63%;男性DM患病率为8.85%,高于女性的6.50%,差异有统计学意义(χ~2=17.04,P0.001);不同年龄成年人群比较,不同年龄男性和女性人群肥胖相关身体测量指标差异均有统计学意义(均P0.001);在中国成年男性中,腰围(WC)是最适宜筛检DM的肥胖相关身体测量指标,其在18岁~、35岁~、55岁~和≥75岁年龄组筛检DM的受试者工作特征曲线下面积(AUC)均0.70,WC的适宜切点分别为88.10、84.15、86.90和87.5 cm;在中国成年女性中,筛检DM的适宜肥胖相关身体测量指标随年龄不同呈多元化,腰臀比(WHpR)、腰围身高比(WHtR)和体质指数(BMI)分别为18岁~、35岁~、≥55岁女性人群最适宜筛检DM的肥胖相关身体测量指标,各AUC均0.67,18岁~人群WHpR、35岁~人群WHtR、35岁~和≥75岁人群BM I的适宜切点分别为0.824、0.528、23.110 kg/m2和21.432 kg/m~2。结论 WC对中国成年男性人群DM具有较好的筛检价值,WHpR、WHtR和BMI分别对中国18岁~、35岁~、≥55岁女性人群具有较好的筛检价值。     

代谢综合征腰围适宜切点ROC方法预测

目的研究社区20岁人群体质指数(BM I)、腰围(WC)的分布特征及其与代谢综合征的关系,探讨代谢综合征患者腰围的适宜切点。方法于2007年1-6月调查在江苏省徐州市云龙区和泉山区3所医院参加体检的20岁常住居民3 659人,根据中国代谢综合征诊断标准(CDS2004),应用受试者工作特征曲线(ROC),分析代谢综合征患者BM I与WC的相关关系,并以约登指数最大作为腰围适宜切点。结果代谢综合征患病率为15.2%,标化患病率为11.1%;男、女性代谢综合征患者腰围平均值分别为(85.8±9.6),(73.7±9.2)cm,BM I与WC相关性较高(r男性=0.780,r女性=0.788,P0.05);代谢综合征的WC最佳切入点男、女性分别为88.5,78.5 cm。结论中国代谢综合征诊断标准的BM I与WC具有较好的相关性,使用ROC研究中国人群代谢综合征腰围切点与国际糖尿病联盟标准和美国代谢综合征诊断标准的腰围切点相近。     

成人肥胖与糖代谢障碍及其患病率的相关性

目的：探讨成人肥胖及体脂分布与糖代谢障碍指标和糖尿病患病率的相关性。方法：利用四川省泸天华集团公司6387名职工糖尿病流行病调查数据，采用协方差分析比、多重线性回归、相对危险度等方法分析体重指数、腰围与空腹血糖、餐后血糖的关系以及不同体重指数和腰围情况下糖尿病与糖耐量异常的患病率。结果：空腹血糖、餐后血糖以及糖尿病和IGT的患病率都随体重指数和腰围的增加而升高，特别是当体重指数在24，男性腰围在85、女性腰围在80以后，各指标都有显著性的改变。结论：成人肥胖，特别是腹型肥胖与糖尿病发生密切相关，目前推荐的我国成人肥胖标准：BMI≥24，男性腰围≥85，女性≥80是合理的。     

中文版儿童事件影响量表在汶川地震极重灾区中小学生中的应用及分析

目的 评价中文版(简体)儿童事件影响量表(CRIES-13)的信度和效度,探讨利用该量表筛检创伤后应激障碍(PTSD)的价值及最佳评分切割点.方法 采用分层随机整群抽样原则,选取253名汶川地震后幸存儿童作为被评估对象,采用量表白评和临床诊断相结合的方法,分析量表的内部一致性、条目间平均相关系数;总分与各因子间的相关系数、内容区分效度.临床诊断依据DSM-Ⅳ诊断标准中PTSD诊断标准确诊患者.采用受试者工作特征曲线计算曲线下面积和不同切割点下筛检PTSD的灵敏度、特异度及约登指数,以约臀指数最大的点为最佳切割点.结果 CRIES-13的Cronbach's α系数为0.903,条目间平均相关系数0.283～0.689.总分与各因子的相关系数0.836～0.868,各因子间的相关系数0.568～0.718;在总分、闯入、回避和高警觉因子评分方面,PTSD组均高于非PTSD组,差异有统计学意义(P<0.05).因子分析产生两个主成分,解释了总方差的59.68%,主要反映闯入症状和回避症状.汶川地震后7个月儿童PTSD的临床检出率为20.9%,男、女性PTSD患病率差异无统计学意义(P>0.05),CRIES-13以18分为切割点时筛检PTSD的约登指数最大,为57.6%,PTSD患者诊断预测的灵敏度为81.1%,特异度为76.5%,诊断效率81.1%.而选取32分切割点,筛查结果与临床诊断一致性较高(Kappa值=0.529).结论 CRIES-13在汶川地震后幸存儿童中具有良好的信、效度,可作为该群体一个较好的创伤后应激症状测评丁具.CRIES-13评分18分切割点可作为汶川地震后极重灾区中小学生筛检PTSD患者和确诊高危人群的切割点,而32分切割点筛检阳性率可初步预测灾后极重灾区中小学生PTSD患病率,此结论还有待于进一步研究证实.     

广西城乡居民体质指数和腰围与糖尿病关系的研究

目的分析广西城乡居民成人体质指数(BMI)、腰围(WC)与糖尿病(DM)及空腹血糖受损(IFG)的关系。方法根据“2002年中国居民营养与健康状况调查”所确定的多阶段随机整群抽样方法,对广西4个城市和4个县18岁及以上3041名城乡居民进行了身高、体重、腰围测量以及空腹血糖测定,建立数据库,进行统计分析。结果城市居民糖尿病(DM)、空腹血糖受损(IFG)患病率分别为4.2%、1.6%,显著高于农村(0.8%、0.8%)(P<0.01)。BMI为<18.5,18.5～23.9,24～27.9及≥28者DM患病率分别为0.7%、1.4%、5.9%、9.8%,差异显著(P<0.01)。男性WC为<85cm,85～89cm及≥90cmDM患病率分别为1.4%、8.4%、6.0%;女性WC为<75cm,75～79cm,≥80cm者DM患病率分别为0.6%、1.3%、10.6%,均有显著差异(P<0.01)。除18～29岁外其他各年龄组随着BMI增大DM患病率不断上升;男性WC除18～29岁外、女性WC除30～45岁组外,各年龄组均呈现出随着WC增大DM患病率也明显上升趋势;男性30岁以上WC85～89cm的DM患病率达10.0%,是同年龄组WC<85cm的4.95倍,女性组WC≥80cm、18～29岁的DM患病率达11.1%,是同年龄组WC≤75cm组的17.5倍;还发现双重肥胖者(BMI≥28,同时男WC≥90cm或女性WC≥80cm)DM患病率高达10.9%。结论BMI和WC水平与DM/IFG有良好的相关性,尤其是BMI≥28或男性WC≥85cm30岁以上人群或女性WC≥80cm各年龄组以及双重肥胖者均是DM患病高危人群。因此保持或控制BMI≤24和/或WC<85cm(男)、WC<80cm(女)对防范DM、IFG发生至关重要。     

兰州市社区居民糖尿病患病率的流行病学调查

目的掌握兰州市居民糖尿病患病状况,为本地区糖尿病综台防治的开展提供依据。方法采用PPS抽样方法抽取兰州市七里河区18岁以上常住人口进行问卷调查和体格检查,了解本地区社区居民糖尿病患病情况。结果兰州市18岁以上成年人糖尿病粗患病率为3.50%。城市街道居民糖尿病患病率为4.14%,农村居民患病率为1.95%。城市居民糖尿病患病率高于农村;随着年龄的增长,患病率总体呈升高趋势;居民文化程度越高糖尿病患病率越低;缺乏运动人群患病率高于经常锻炼人群;而BMI≥24 kg/m2和腰围男性≥90 cm,女性≥85 cm人群的糖尿病患病率也高于体重控制正常人群。糖尿病患病率性别差异无统计学意义。结论应对中老年群体,特别是体重、腰围超标人群和城市人群进行重点干预。     

应用不同诊断标准诊断代谢综合征的一致性比较

目的 探讨不同诊断标准诊断代谢综合征(MS)的一致性.方法 运用美国国家胆固醇教育计划成人治疗方案第三次报告[NCEP-ATPⅢ(修订)]、国际糖尿病联盟[CDS(2004)]和中华医学会糖尿病分会[IDF(2005)]诊断标准对石港镇18～74岁人群进行MS患病率调查.结果 石港镇人群MS的患病粗率分别为15.8%(IDF),8.5%(CDS)和15.8%(ATPⅢ),女性MS患病率高于男性;ATPⅢ和IDF诊断标准在该人群中应用的一致性较好,Kappa值为0.923,男、女性分别为0.917和0.924;CDS与ATPⅢ、IDF诊断标准的Kappa值分别为0.644,0.671;男性腰围切点为85 cm,女性为80 cm时,预测危险因素聚集的ROC面积分别为0.74和0.68,其在所选择的切点中ROC距离最短.结论 3种MS诊断标准中,A11PⅢ标准诊断MS的患病率及检出危险因素聚集的比例最高;适宜通州石港人群最佳腰围切点为男性85 cm、女性80 cm.     

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.     

Waist circumference percentile criteria for the pediatric metabolic syndrome in Korean adolescents

This study aimed to determine valid waist circumference (WC) thresholds using receiver operating characteristic (ROC) curves for pediatric metabolic syndrome (MS) prediction and to compare validities between the thresholds derived from ROC curves and the WC cut-offs defined by International Diabetes Federation (IDF). Four hundred and sixty four males and 415 females, 10-18 years, who participated in the KNHNES 2005 were included. Subjects were classified as having pediatric MS when a high WC and > or = 2 of the risk factors defined by IDF were present. High WC was defined using either IDF criterion (> or =90th percentile for age and sex-specific WC based on Korean reference in adolescents 10-15 years of age, > or =90cm in males and > or =80cm in females 16-18 years of age) or age-adjusted WC thresholds derived from the ROC curves predicting > or = 2 abnormal risk factors. The AUCs were 0.71-0.81 (sensitivity 74-100%, specificity 52-65%) among males and 0.63-0.76 (sensitivity 71-90%, specificity 37-87%) among females for WC thresholds (55th and 32th percentile for males and females 10-15 years of age, 73cm and 76cm for males and females 16-18 years of age), while the AUCs were 0.65-0.66 (sensitivity 39-45%, specificity 84-93%) among males and 0.53-0.76 (sensitivity 20-57%, specificity 86-96%) among females for IDF-defined WC cut-offs. The prevalence of MS using IDF definition for WC was 4% in males and 2% in females, while those using WC thresholds were 8% and 5%, respectively. The IDF's definition of abdominal obesity may be less sensitive in screening adolescents with pediatric MS compared to WC thresholds.     

体重指数、腰围和腰臀比预测高血压、高血糖的实用价值及其建议值探讨

目的：探讨体重指数（BMI）、腰围（WC）、腰臀比（WHR）对于预测高血压、高血糖患病的实用价值及其诊断建议值，为确定我国肥胖和腹部肥胖的诊断指标及其界值提供科学依据。方法：利用1995－1997年全国糖尿病（DM）流行病学调查资料进行分析，方法包括偏相关分析、logistic多因素回归分析、交互作用分析，计算BMI、WC、WHR在不同截点暴露对高血压、高血糖和二者聚集的相对危险度（RR）、暴露组归因危险百分比（ARP）和人群归因危险百分比（PARP）。结果：①BMI、WC与血压和血糖的相关性比WHR好；②logistic调整了年龄、性别、职业性体力活动强度、休闲活动强度、文化强度和DM家族史后，BMI、WC、WHR是患高血压、高血糖以及二者聚集重要的预测因子，三者的相对重要性以BMI＞WC＞WHR；③BMI、WC、WHR三者之间对于高血压和高血糖患病率有相加交互作用，尤其以BMI与WC的交互作用普遍存在，其归因交互作用百分比[A[（AB）]在5．95－29．34％之间；④BMI≥23、≥24、≥25时，RR在2．5左右，从流行病学角度看，RR值处于暴露因子与疾病关联的中高度有害范围，其ARP在0．580－0．626之间，从流行病学角度看，RR值处于暴露因子与疾病关联中的中高度有害范围，其ARP在0．580－0．626之间，PARP在0．259－3．08之间，⑤男性WC≥85cm、女性WC≥80cm和男性WC≥90cm，女性WC≥80cm，RR分别在2．06－3．08之间，此时腹部肥胖对高血压、高血糖和二者聚集的PR值分别处于中、高度有害；RR分别在0．515－0．676之间，PARP分别在0．241－0．431之间。结论：从暴露对疾病危害的程度，人们对超重和肥胖的可接受性，我国开展肥胖防治处于初期阶段及公共卫生人群预防的角度综合考虑，在BMI、WC、WHR中，预测我国高血压和高血糖的实用价值以BMI和WC为好，建议以BMI为肥胖指标，BMI≥24诊断为超重和肥胖；以WC为腹部肥胖指标，男性WC≥80cm、女性WC≥80cm为诊断界值。     

体脂分布特征与血脂关系及其预测血脂异常的观察

目的 研究体脂分布特征与血脂关系及其预测血脂异常的价值.方法 采用整群抽样方法抽取北京市郊区居民有效样本784名,测量其身高、体重、腰围(WC)、臀围、身体成分与高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)、三酰甘油(TG),并计算体重指数(BMI)与腰臀比(WHR).结果 年龄调整偏相关分析显示WC与HDL-C(r=-0.310)、LDL-C(r =0.204),WHR与TC (r=0.151)、TG (r=0.271)的相关性最好.BMI、WC、WHR、躯干脂肪质量(TFM)分组分析显示WC、WHR、TFM能敏感地反应人体血脂水平的变化;BMI、WC、WHR、TFM能敏感地反应低HDL、高TG及血脂异常的风险.ROC曲线分析显示WC、WHR、BMI、TFM预测血脂异常风险的ROC曲线皆在参考线上方,且男女受试者WHR (0.684、0.630)、WC (0.667、0.616)、TFM(0.661、0.604)的ROC曲线下面积有大于BMI (0.629、0.597)的趋势,但差异均无统计学意义(P＞0.05).结论 体脂分布特征指标如WHR、WC、TFM与BMI相比,在预测血脂异常风险中的应用价值更高;以Youden指数最大值为判定依据预测血脂异常风险,男性理想界值点BMI为24 kg/m2,WHR为0.91,WC为85 cm,TFM为7.5 kg;女性BMI为25 kg/m2,WHR为0.91,WC为87 cm,TFM为9.Skg.由于样本量较少,有待进一步扩大范围的研究.     

空腹血糖与糖化血红蛋白在2型糖尿病诊断中的应用

目的评估空腹血糖（FPG）和糖化血红蛋白（HbAlc）诊断2型糖尿病（T2DM）的敏感性和特异性。探讨FPG、HbAlc及联合指标诊断T2DM的最佳切点。方法采用WHO糖尿病诊断标准,将423例研究对象分为T2DM组（n=60）和非T2DM组（n=363）,所有受试者均行口服葡萄糖耐量试验（OGTT）,同时测定其FPG及HbAlc。绘制FPG和HbAlc诊断糖尿病的受试者工作曲线（ROC曲线）。结果①HbAlc诊断T2DM的切点为6．1％,此时灵敏度为91．7％,特异度为78．5％,曲线下面积0．910（95％CI,0．873～0．946）,阳性预测值（＋PV）为41．4％,阴性预测值（-PV）为98．3％,You＆n指数为O．702,正确率为80．4％,Kappa值为0．465。HbAlc≥6．5％时,灵敏度为61．7％,特异度为93．7％,＋PV为61．7％、-Py为93．7％,Youden指数为0．553,正确率为89．1％,Kappa值为O．553。②FPG诊断T2DM的切点为6．09mmol／L,此时灵敏度83．3％,特异度89．3％,曲线下面积0．898（95％CI,0．885-0,957）,＋PV50．5％,一州96．9％。Youden指数0．726,正确率86．1％,Kappa值0．549。当FPG≥7．00mmol／L时,灵敏度33．3％,特异度99．2％,＋w87．0％、-PV90．0％、Youden指数0．325、正确率89．8％、Kappa值0．438。③HbAlc≥6．1％和FPG≥6．09mmol／L联合指标具有较好的诊断性能。且优于单个指标,此时的灵敏度83．3％．特异度93．7％,＋PV68．5％,-PV97．1％,Youden指数0．770,正确率92．2％,Kappa值0．706。结论HbAlc≥6．1％和FPG≥6．09mmol／L联合指标具有很好的灵敏度和特异度,且Youden指数、正确率、Kappa值都高于其他指标,与OGTT有很好的一致性,对T2DM的诊断有较好应用价值。     

通辽市部分蒙古族牧民空腹血糖状况调查

目的了解通辽市部分蒙古族牧民空腹血糖异常率及其与性别、年龄、吸烟、饮酒、文化水平、体质指数、腰围等因素的关系,为评估本地区糖尿病现状并采取相应的预防措施,提供依据。方法采用整群随机抽样方法,对通辽市部分牧区蒙古族牧民共1108人进行调查,并进行危险因素分析。结果空腹血糖异常率随年龄增长而增高,50岁年龄组高达25.9%。当腰围（WC）男≥85cm、女≥80cm时,空腹血糖异常率是WC男〈85cm、女〈80cm时的2倍,经趋势性χ2检验,空腹血糖异常率随WC的增加而增加（P〈0.05）。结论腰围的增加和年龄的增长是空腹血糖异常的主要危险因素。     

A simple valid tool for measuring obesity-related-CHD risk in Sri Lankan adults

Background

The significance of anthropometric measures of obesity that determine coronary-heart-disease (CHD) risk varies among populations. This study compares waist circumference (WC) and body mass index (BMI) in identifying the “obesity-related-CHD risk” among Sri Lankan adults.

Methods

A population-based cross-section of 515 adults aged 20–64 years, residing in the district of Colombo in 2004 was selected by a multi-stage, stratified, probability sampling method. WC, height and weight were measured. Demographic, socio-economic and lifestyle characteristics, smoking and obesity-related-CHD risk factors (hypertension, dyslipidaemia, diabetes) were assessed by questionnaires, physical measurements and biochemical assessments. “Obesity-related CHD risk” was defined by the presence of ?1 obesity-related-CHD risk factors.

Results

Compared to BMI, WC was a stronger correlate of systolic and diastolic blood pressure, triglycerides among both sexes and of plasma glucose among males. It was also an independent predictor of obesity-related-CHD risk in both males (beta co-efficient = 0.046; standard error = 0.013) and females (0.024; 0.012) in contrast to BMI, which was significant only among males (0.138; 0.037) in the logistic regression models adjusted for confounders. At the same level of obesity-related-CHD risk corresponding with BMI of 25 kg/m² (OR = 1.7) and 30 kg/m² (OR = 3.5), the corresponding WC values were 90.5 cm and 105.5 cm for males and 100 cm and 129 cm for females. The derived optimal risk thresholds of WC for identifying obesity-related-CHD risk was 88.5 cm for males and 82 cm for females.

Conclusions

WC with its sex-specific cutoff values can serve as a better screening tool than BMI in identifying individuals at risk of obesity-related CHD in low-resource settings.     

Relationship of Anthropometric Indicators of General and Abdominal Obesity with Hypertension and Their Predictive Performance among Albanians: A Nationwide Cross-Sectional Study

Anthropometric indicators of general and abdominal obesity can predict cardiovascular disease outcomes. Their performance in predicting hypertension (HTN) varies across populations. We aimed to analyze the relationship of body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR) and conicity index (CI) with HTN, to examine their predictive performance and to determine their optimal cut-offs in a nationally representative sample of Albanians aged 15–59 years (n = 20,635). Logistic regression models were fitted and sex-specific receiver-operating characteristic (ROC) curves were constructed. The indicators were positively associated with HTN. Sex modified the relationships, as associations appeared significantly stronger among females than males in the highest categories of the indicators. The area under ROC curves (AUCs) for BMI were 0.729 (95% confidence interval (CI): 0.720–0.738) among females and 0.648 (95% CI: 0.633–0.663) among males, and AUCs for WHtR were 0.725 (95% CI: 0.716–0.734) among females and 0.637 (95% CI: 0.622–0.652) among males. However, the AUCs for BMI and WHtR did not differ significantly among females (p = 0.279) and males (p = 0.227). BMI outperformed WC and CI in both sexes. The optimal BMI cut-offs were 27.0 kg/m² among females and 25.6 kg/m² among males, and that for WHtR were 0.53 among females and 0.54 among males. BMI and WHtR demonstrated similar discriminatory power, and the identified cut-offs may inform initiatives for structured HTN screening in Albania.     

Receiver-operating characteristic analyses of body mass index, waist circumference and waist-to-hip ratio for obesity: Screening in young adults in central south of China

BACKGROUND & AIMS: Recent data suggest that current obesity diagnostic criterion based on body mass index (BMI) above 30 in Caucasians may not be appropriate for Asian populations. Our aim was to identify the usefulness of BMI, waist circumference (WC) and waist-to-hip ratio (WHR) in screening for obesity in an Asian population. METHODS: A cross-sectional sample of 1109 males and 879 females aged 20-45-yr were recruited. Height, weight, WC, hip circumference and percentage body fat (PBF) were measured in all subjects. Then receiver-operating characteristic analyses were used to evaluate the performances of the three anthropometric indices. RESULTS: BMI, WC and WHR showed strong positive correlation with PBF (r=0.47-0.75) in both males and females within both age groups. True-positive rates ranged from 82.4% to 94.1% and 68.8% to 86.3% in males and females, respectively. True-negative rates ranged from 64.1% to 84.7% and from 56.9% to 79.0%, respectively. The areas under the curves (AUCs) for WC and BMI were high (0.76-0.92) in both sexes and divided age groups (20-30-yr and 31-45-yr), and those for WHR were a little lower (0.74-0.88). CONCLUSIONS: BMI and WC are two important predictors for obesity in Chinese, and WHR is an alternative.     

Anthropometric cutoff points for predicting chronic diseases in the Mexican National Health Survey 2000

OBJECTIVE: To determine optimum anthropometric cutoffs for predicting the likelihood ratios of type 2 diabetes mellitus (DM) and hypertension (HT) in Mexicans. RESEARCH METHODS AND PROCEDURES: Data from a randomly selected, nationally representative health survey (2000) with 11,730 men [37.4 (+/- 12.9) years] and 26,647 women [37.3(+/- 12.9) years] were assessed for values of body mass index (BMI) and waist circumference (WC) for predicting DM or HT by receiver operating characteristic curve analyses. Likelihood ratios for DM and HT were calculated, and BMIs or WCs for public-health screening were developed. Subanalyses included regional data. RESULTS: Likelihood ratios of DM and HT increased from BMI values of 22 to 24 kg/m(2) in both sexes and with WC values of 75 to 80 cm in men and 70 to 80 cm in women. The best BMI cutoffs for predicting DM were 26.3 to 27.4 kg/m(2) in men and 27.7 to 28.9 kg/m(2) in women, with similar values for HT, i.e., 26.2 to 27.0 kg/m(2) and 27.7 to 28.5 kg/m(2), for men and women, respectively; WC cutoffs for DM were 93 to 98 cm in men and 94 to 99 cm in women, and cutoffs for HT were 92 to 96 cm and 93 to 96 cm for men and women, respectively. The WC cutoffs had higher sensitivity and specificity than those of BMI. DISCUSSION: The risk for DM and HT starts at lower levels of BMI and WC than those suggested by WHO. WC is a better discriminator than BMI measures for use in public health.