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。     

简易体脂参数估测腹内型肥胖的可靠性评价

目的：评价体重指数（BMI）、腰围（WC）、腰臀比（WHR）估测腹内型肥胖的最佳临界点及敏感度、特异度。方法：应用核磁共振（MRI）对690名受试者（男305人，女385人）进行腹内脂肪（VA）测量，同时测量BMI、WC、WHR。以受试者工作特性（ROC）曲线评价简易体脂参数对腹内型肥胖的诊断价值。结果：①经MRI诊断，超重／肥胖者中61．7％，正常体重者中14．2％呈腹内型肥胖（VA≥100cm^2）；②BMI、WC、WHR与腹内脂肪面积呈显著正相关，尤以WC的相关性最好;③简易体脂参数估测腹内脂肪积聚的最佳切割点为BMI：26kg/m^2,WC:90cm,WHR:0.93;④BMI≥28kg/m^2、WC≥95cm时，95％的男性及90％左右的女性呈腹内型肥胖。结论：BMI、WC及WHR都可估测腹内型肥胖，但以腰围的准确率稍高。     

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。     

Evaluation of waist circumference to predict cardiova scular risk factors in an overweight Tehranian population: findings from Tehran Lipid and Glucose Study

This study was conducted to evaluate the waist circumference (WC) cut-off points to predict cardiovascular risk factors in the overweight Tehranian population. Anthropometric measures, blood pressure, and biochemical analyses were evaluated for the 15,005 participants of the Tehran Lipid and Glucose Study. Three thousand sixty-five subjects aged 18-74 years with a body mass index of 25-29.9 were enrolled in this study. Abdominal obesity was defined as WC > or =102 cm for men and > or =88 cm for women. Sensitivity of WC > or =102 cm to detect various cardiovascular risk factors for men aged 35-54 years was between 5% and 14%, and for men aged 55-74 years, was between 12% and 19%. The specificity of this cut-off point was between 93% and 98% and between 86% and 96% for corresponding age-categories, respectively. WC > or =88 cm had a sensitivity of between 28% and 41 % for identifying cardiovascular risk factors in women aged 18-34 years. Sensitivity tended to increase with age and specificity tended to decrease with age in both genders. These cut-off points had the highest positive predictive value for the more prevalent risk factors in both genders. The negative predictive values were different for various risk factors among age groups. The classic cut-off points of WC failed to provide adequate evidence for the use of WC in detecting cardiovascular risk factors. Further studies should be conducted to determine optimal WC cut-off points for Iranians.     

Predictive values of waist circumference for dyslipidemia, type 2 diabetes and hypertension in overweight White, Black, and Hispanic American adults

Waist circumferences (WC) >/=102 cm for men and >/=88 cm for women have been proposed by an expert panel as cut-points for identifying increased risk for the development of obesity comorbidities for most adults. The aim of this investigation was to examine the predictive values of these WC cut-points for hypercholesterolemia, low concentration of high (HDL-C), and high concentration of low (LDL-C) density lipoprotein cholesterol, hypertriglyceridemia, type 2 diabetes, and hypertension in overweight American adults. Data from NHANES III were utilized for the analysis. Predictive abilities were determined by calculating sensitivity, specificity, positive (PV+) and negative (PV-) predictive values in overweight subjects with BMI 25-29.9 kg/m(2). Sensitivity of WC cut-point was stronger for high LDL-C compared to other risk factors with the highest values recorded in the 40-59 and 60-69 year age groups in men and women, respectively. PV+ of WC cut-points for dyslipidemia, type 2 diabetes, and hypertension were low in men compared to women. PV+ tended to increase with age, from 19-39, 40-59 to 60-90 year age groups in Whites, Blacks, and Hispanic men. In men, the highest PV+ were recorded for hypertriglyceridemia in the 60-90 years old groups, with values of 71.6%, 52.5%, and 43.3% in Whites, Blacks, and Hispanics, respectively. The CVD risk factor associated with the highest PV+ in women was diabetes with values of 97.2% in Whites and 88.9% in Blacks, and hypertriglyceridemia with a value of 93.8% in the 17-39 year age group in Hispanics. Among Black men 40-59 years of age, only 32% of a population of overweight hypertensives were detected by the WC cut-points, and among Black women, 40-59 years of age, only 54% were detected. Given the low sensitivity of these cut-points for detecting hypertension, one of the major co-morbidities of obesity, these cut-points failed to provide adequate evidence for the use of WC in determining or evaluating patients as to co-morbid states. We recommend further studies to determine a set of specific cut-points associated with increased risk of CVD in different population groups.     

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。     

Varying sensitivity of waist action levels to identify subjects with overweight or obesity in 19 populations of the WHO MONICA Project

It has been suggested in the literature that cut-off points based on waist circumference (waist action levels) should replace cut-off points based on body mass index (BMI) and waist-to-hip ratio in identifying subjects with overweight or obesity. In this article, we examine the sensitivity and specificity of the cut-off points when applied to 19 populations with widely different prevalences of overweight. Our design was a cross-sectional study based on random population samples. A total of 32,978 subjects aged 25–64 years from 19 male and 18 female populations participating in the second MONICA survey from 1987 to 1992 were included in this study. We found that at waist action level 1 (waist circumference ≥94 cm in men and ≥80 cm in women), sensitivity varied between 40% and 80% in men and between 51% and 86% in women between populations when compared with the cut-off points based on BMI (≥25 kg/m²) and waist-to-hip ratio (≥0.95 for men, ≥0.80 for women). Specificity was high (≥90%) in all populations. At waist action level 2 (waist circumference ≥102 cm and ≥88 cm in men and women, respectively, BMI ≥30 kg/m²), sensitivity varied from 22% to 64% in men and from 26% to 67% in women, whereas specificity was >95% in all populations. Sensitivity was in general lowest in populations in which overweight was relatively uncommon, whereas it was highest in populations with relatively high prevalence of overweight. We propose that cut-off points based on waist circumference as a replacement for cut-off points based on BMI and waist-to-hip ratio should be viewed with caution. Based on the proposed waist action levels, very few people would unnecessarily be advised to have weight management, but a varying proportion of those who would need it might be missed. The optimal screening cut-off points for waist circumference may be population specific.     

BMI is strongly associated with hypertension, and waist circumference is strongly associated with type 2 diabetes and dyslipidemia, in northern Chinese adults

Background

Obesity is closely associated with chronic diseases such as hypertension, type 2 diabetes mellitus (T2DM), and dyslipidemia. We analyzed the optimal obesity index cut-off values for metabolic syndrome (MetS), and identified the obesity index that is more closely associated with these chronic diseases, in a population of northern Chinese.

Methods

We surveyed 8940 adults (age, 20–74 years) living in northern China for chronic diseases. Receiver operating characteristics (ROC) analysis, relative risk, and multivariate regression were used to develop an appropriate index and optimal cut-off values for MetS and obesity-related chronic diseases.

Results

Waist circumference (WC) and body mass index (BMI) were good markers for MetS, WC was a good marker for T2DM and dyslipidemia, and BMI was a good marker for hypertension. The optimal BMI cut-off value of MetS was 24 kg/m², and the optimal WC cut-offs were 86 cm and 78 cm in men and women, respectively. Relative risk regression models showed that BMI was associated with hypertension, T2DM, and hypertriglyceridemia and a higher prevalence ratio (PR) for hypertension: 2.35 (95% CI, 2.18–2.50). WC was associated with T2DM, hypertension, and hypertriglyceridemia, with PRs of 2.05 (1.63–2.55) for T2DM and 2.47 (2.04–2.85) for hypertriglyceridemia. In multivariate regression models, the standardized regression coefficients (SRCs) of BMI were greater for SBP and DBP, and the SRC of WC was greater for fasting blood glucose, 2-hour postload blood glucose, triglyceride, and total cholesterol.

Conclusions

Our analysis of a population of northern Chinese indicates that the optimal cut-off values for MetS are WCs of 86 cm in men and 78 cm in women and a BMI of 24 kg/m² in both sexes. BMI was strongly associated with hypertension, while WC was strongly associated with T2DM and dyslipidemia.Key words: obesity, chronic disease, cut-off value     

海口市7~14岁儿童腰围界值点及其肥胖相关性分析

目的分析海口市7~14岁儿童在超重和肥胖层面的腰围界值点,为儿童超重和肥胖防治策略制定提供科学依据。方法利用2016—2019年“海南省学生健康档案管理系统”,采用PPS抽样方法抽取海口220所中小学校,对学校整群抽样7~14岁儿童调取身高、体重和腰围数据进行整理分析。结果共计分析283054名7~14岁儿童,各年龄组儿童的平均腰围值和百分位点腰围值均低于全国平均腰围,腰围均随着年龄增长而持续增加。各年龄组儿童腰围男生均大于女生(P<0.0001),城市均高于农村(P<0.0001)。在超重层面,男童和女童界值点集中P 75~P 80(56.50~71.75 cm)、P 80~P 85(54.50~68.50 cm)。在肥胖层面,男童7~11岁和12~14岁的界值点分别是P 85(58.5~72.50 cm)、P 90(75.50~79.50 cm),女生7岁和8~14岁的界值点范围在分别是P 85(56.50 cm)和P 90(59.85~71.50 cm)。结论该地区在超重层面,男童和女童的界值点分别为56.50~71.75 cm和54.50~68.50 cm;肥胖层面,男童和女童的界值点分别是58.50~79.50 cm和56.50~71.50 cm。除了男生7岁和女生9岁超重界值点及女生青春期前8~10岁肥胖界值点外,其他各年龄组超重和肥胖界值点与全国的一致。     

Anthropometric indices as screening tools for cardiovascular risk factors in Singaporean women

Previous studies have suggested the need to revise the World Health Organization (WHO) cut-off values for the various indices of obesity and fat distribution in Singapore. The purpose of this study was to delineate cut-off points of body mass index (BMI), waist-hip ratio (WHR), waist circumference (WC), and waist-stature ratio (WSR) as screening tools for cardiovascular risk factors in Singaporean women. Anthropometric indices were measured in a cross sectional survey of 566 subjects (60% Chinese individuals, 28% Malay individuals and 12% Indian individuals). Cardiovascular risk factors were determined by measuring blood pressure, serum lipids, and fasting blood glucose levels. Receiver Operating Characteristic (ROC) curves were constructed to determine cut-off points. Forward logistic regression and area under curves (AUC) were used to determine the best anthropometric index. For at least one cardiovascular risk factor (hypertension, dyslipidaemia and diabetes mellitus), the cut-off points for BMI, WHR, WC and WSR were around 23.6 kg/m(2), 0.80, 77.8 cm and 0.48 for Singaporean females. The AUC of WSR was the highest for all three risk factors in females (0.79 for hypertension, 0.70 for dyslipidaemia, 0.88 for diabetes mellitus). Regression analyses revealed that WSR was independently associated with all risk factors. For Singaporean female adults, the cut-off points were lower than the criteria suggested by the WHO, but were in agreement with those reported for Asians. BMI, WHR, WC and WSR may be used as screening tools for cardiovascular risk factors, of which WSR may be the best anthropometric index.     

体质指数、腰围、腰臀比与高血压、高血糖的关系及三者对高血压、高血糖的预测价值

目的探讨体质指数（BMI）、腰围（WC）、腰臀比（WHR）与高血压、高血糖的关系及三者对高血压高血糖的预防价值。方法2006年4-9月整群抽取黑龙江省电力医院健康检查中心体检的1751人,测量身高、体重、腰围、臀围、血压和空腹血糖。结果①BMI、WC与血压的相关性比WHR好;WHR、WC与血糖的相关性比BMI好;②logistic回归分析表明3个指标中BMI是高血压重要的预测因子,而WC是高血糖及二者聚集重要的预测因子;③BMI、WC与WHR三者之间两两指标同时存在时对高血糖、高血压及二者聚集都存在交互作用;④当BMI≥25kg/m2时,其OR值在3.02-4.01之间,ARP在58.13%-69.21%之间,PARP在43.79%-55.77%之间;当WC≥85cm（男性）、WC≥80cm（女性）时,其OR值在4.04-6.70之间,PARP在56.47%-75.52%之间;敏感度和特异度均较好,正确指数高,具有较高的公共卫生价值。结论BMI、WC分别是高血压、高血糖重要的预测因子,以BMI≥25kg/m2或WC≥85cm（男性）、WC≥80cm（女性）为超重肥胖切点时,诊断价值最高,建议以此为诊断界值。     

Waist circumference, body mass index and health risk factors among middle aged Thais

Body mass index (BMI) and waist circumference (WC) are important contributors to major causes of health risk factors such as high blood cholesterol, high fasting blood sugar and high blood pressure. This analysis was designed to assess the associations between WC, BMI and each health risk factor in suitable cut-off points for WC and BMI among middle aged men and women of Thai population. Cross sectional data from the Second National Health Survey in Thailand was analysed. This set of data collected by the Ministry of Public Health from 1996 to 1997 was obtained from a total of 998 subjects (comprising 396 men and 602 women) aged 45-50. Results from the Receiver Operating Characteristic curve (ROC curve) identified those with health risk factors demonstrating cut-off points for WC between 81.5-84 centimeters for men and 76-80.5 centimeters for women and BMI between 23.3-23.9 kg/m2 for both genders, respectively. Results from the Multiple logistic regression analysis demonstrated lower risks of having high blood cholesterol, high fasting blood sugar and high blood pressure with cutoff points 84 cm for men, 80 cm for women and BMI 23 kg/m2 for both genders compared to cut-off points 102 cm for men, 88 cm for women and BMI 25 kg/m2 for both genders as specified for the population in Western countries. This study has proposed a waist circumference of 84 cm (33.6 inches) for middle aged Thai men and 80 cm (32 inches) for middle aged Thai women and BMI of 23 kg/m2 for both genders. Monitoring changes in the waist circumference over time along with BMI may be convenient and useful for middle aged Thais to prevent health risk conditions, even in the absence of a change in BMI.     

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.     

BMI and metabolic disorders in South Korean adults: 1998 Korea National Health and Nutrition Survey

OBJECTIVE: The prevalence of overweight, obesity, and metabolic disorders and their relationship with BMI were studied in South Korean adults. The appropriate BMI categories for overweight and obesity for Koreans were evaluated. RESEARCH METHODS AND PROCEDURES: The 1998 Korea National Health and Nutrition Examination Survey was the first such survey, to our knowledge, conducted on a cross-sectional and nationally representative population. The survey provided data on body weight; height; fasting serum glucose; triacylglycerol; total, low-density lipoprotein, and high-density lipoprotein cholesterol; blood pressure; and various other questions that were incorporated into this study. A total of 39,060 persons over the age of 1 year from 12,283 households participated in the Health and Nutrition Interview Survey. Of these, 10,876 people over the age of 10 years old participated in the Health Examination. We analyzed data from 7962 adults over the age of 20 years old. RESULTS: The overweight (BMI, >/=25.0 to <30.0) and obesity (BMI, >/=30) rates were low among Korean adults: 23.4% and 1.7% in men and 24.9% and 3.2% in women, respectively. However, the prevalences of diabetes, hypertension, and abnormal concentrations of serum triacylglycerol and total, low-density lipoprotein, and high-density lipoprotein cholesterol were high at 10.5%, 27.1%, 29.0%, 34.5%, 28.4%, and 37.4%, respectively. These disorders were age dependent, and, in general, there was a strong linear relationship between BMI and the disorders. The relative risk of disorders doubled at a BMI of 23.0 to 24.0 and tripled at a BMI of 26.0, compared with a baseline BMI of 18.5 to 22.0. DISCUSSION: High rates of diabetes, hypertension, and dyslipidemia were noted in middle-aged and elderly Koreans even at relatively low BMI. It might be appropriate to lower the BMI classification from the current >/=25.0 for overweight and >/=30.0 for obesity for this group of Koreans.     

Comorbidity of overweight and obesity in a nationally representative sample of German adults aged 18-79 years

ABSTRACT: BACKGROUND: Overweight has increased in many countries over the past 20 years and excessive body weight is an established risk factor for adverse health outcomes and chronic diseases. This study aimed to determine comorbidity associated with overweight and obesity in a nationally representative sample of German adults. METHODS: In the German National Health Interview and Examination Survey 1998 standardized measures of body weight, height and waist circumference (WC) were obtained for 7,124 men and women 18 to 79 years of age. Information on pre-existing health conditions, health-related behaviors, and sociodemographic characteristics was collected using physician-administered computer-assisted interviews and self-administered questionnaires. World Health Organization (WHO) cut-off criteria were applied to define overweight (BMI: 25.0-29.9 kg/m2) and obesity (BMI [GREATER-THAN OR EQUAL TO]30.0 kg/m2) and abdominal obesity (men: WC [GREATER-THAN OR EQUAL TO]102 cm; women: WC [GREATER-THAN OR EQUAL TO]88 cm). RESULTS: The crude prevalence of persons with cardio metabolic risk factors, diabetes mellitus, cardiovascular disease (CVD), gall bladder disease, and osteoarthritis showed a significant stepwise increase from the lowest to the highest BMI category in both sexes. In multiple logistic regression models adjusting for age, social status, and smoking, significant associations with overweight and obesity persisted for cardio metabolic risk factors and osteoarthritis. For example, obese persons had a three- to fourfold higher chance of having any cardio metabolic risk factor compared to normal weight persons (odds ratio (OR) = 4.07, 95% CI: 3.16-5.25 for men; OR = 3.40 (2.60-4.46) for women). Only in women, overweight and obesity as well as abdominal obesity, independent of BMI category, were significantly and consistently associated with diabetes (overweight: OR = 1.85 (1.03-3.30); obesity: OR = 2.94 (1.63-5.31); abdominal obesity: OR = 1.44 (1.08-1.92) and gall bladder disease (overweight: OR = 1.65 (1.22-2.25); obesity: OR = 3.06 (2.26-4.14); abdominal obesity: OR = 1.73 (1.25-2.39)). CONCLUSION: Current estimates of disease burden underline the public health importance and clinical relevance related to overweight and obesity and needs to take into account comorbidity aspects.     

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。     

Abdominal adiposity and clustering of multiple metabolic syndrome in White, Black and Hispanic americans

PURPOSE: The aim of this study was to evaluate the association of abdominal adiposity assessed by waist circumference (WC) with clustering of multiple metabolic syndromes (MMS) in White, Black and Hispanic Americans. MMS was defined as the occurrence of two or more of either hypertension, type 2 diabetes mellitus, dyslipidemia, hypertriglyceridemia or hyperinsulinemia. METHODS: The number of MMS and fasting insulin (a surrogate measure of MMS) were each used as dependent variables in gender-specific multiple linear regression models, adjusting for age, smoking and alcohol intake. The contribution of WC to interethnic differences in clustering of MMS and fasting insulin concentration was assessed in gender-specific linear regression models. The risk of MMS due to large waist was estimated by comparing odds ratio for men with WC >/= 102 cm with those with WC < 102, and women with WC >/= 88 cm with women with WC < 88 cm in the logistic regression model adjusting for age, smoking and alcohol intake. RESULTS: WC was positively and independently associated with clustering of MMS and increased fasting insulin concentration adjusting for age, smoking and alcohol intake in the three ethnic groups (p < 0.01). Black ethnicity was associated with clustering of MMS and fasting insulin concentration (p < 0.01). Hispanic ethnicity was also associated with clustering of MMS in men and associated with fasting insulin concentration in both men and women (p < 0.01). In both men and women, the risk of MMS clustering was strongly associated with increased WC in all ethnic groups independent of BMI. CONCLUSION: WC appears to be a marker for multiple metabolic syndromes in these ethnic groups. The results of this investigation lend support to the view that waist measurement should be considered as a clinical variable for assessing the risk of cardiovascular diseases.     

湖南省13个监测点60岁及以上老人肥胖指标与高血压及血脂异常的切点研究

目的 探讨体质指数(body mass index,BMI)、腰围(waist circumference,WC)、腰高比(waist-to-height ratio,WHtR)三类肥胖指标判定的肥胖率分别与湖南省13个监测点60岁以上老人高血压、血脂异常的相关性,预测高血压及血脂异常患病风险的能力。 方法 采用具有省级代表性的中国慢性病与危险因素调查数据,通过受试者工作特征曲线分析,确定湖南省老年人不同肥胖指标预测高血压及血脂异常适宜的BMI、WC、WHtR切点。 结果 湖南省13个监测点60岁以上老年人超重肥胖率(BMI≥24)为42.91%,中心性肥胖率为31.26%,WHtR≥0.5的肥胖率68.97%。以高血压为因变量绘制受试者工作特征曲线,显示男、女性WHtR的曲线下面积相对较高,其切点值分别为0.50、0.53;以血脂异常为因变量,结果显示BMI的曲线下面积最高,其切点值分别为21.40、22.06。 结论 评价肥胖的不同指标对高血压及血脂异常的预测效果不同,其中腰高比在预测老年人高血压中的效果最好;BMI是诊断老年人血脂异常的最佳简易指标。     

Dyslipidemia and abdominal obesity: an assessment in three general populations

Several studies show a relationship between abdominal obesity and cardiovascular diseases, partially mediated through an altered metabolism of dyslipidemia. The present study was aimed at testing the robustness of this association across three contrasted populations and at assessing the performances of abdominal obesity as a screening tool for dyslipidemia. Data were drawn from three population health surveys recently conducted in two regions of a developed country (Switzerland, mostly of Caucasian origin, n = 2650) and in a less developed country (Seychelles, Indian Ocean, mostly of black descent, n = 806). Dyslipidemia was defined as a ratio of total cholesterol to high-density lipoprotein cholesterol (TC-HDL) greater than 5. Two anthropometric circumference measurements, waist-to-hip ratio (WHR) and waist circumference (WC), were used to define abdominal obesity either as WHR >/= 0.9 in men and WHR >/= 0.8 in women or as WC >/= 94 cm and WC >/= 80 cm, respectively. A consistent direct association between abdominal obesity and dyslipidemia (odds ratios varying from 1.85 to 4.56) was found in the three populations, independently of gender, age, body mass index, blood pressure, and smoking. This consistency across ethnicities and environments strengthens the hypothesis of a common etiopathological mechanism. The sensitivity for detecting dyslipidemia was generally higher for abdominal obesity, based on either WHR or WC, than for criteria based on the other risk factors under study. In addition, the sensitivity was higher in the study populations with a low prevalence of dyslipidemia (Swiss women and Seychellois of both sexes) than in the others. These findings support that WHR and WC may be useful as simple and inexpensive screening tools to select individuals eligible for more sophisticated and costly serum lipid determinations, especially in developing countries.     

我国中年人群超重率和肥胖率的现状及发展趋势

目的：了解我国中年人群超重率和肥胖率现状，定量估价近十余年来超重率和肥胖率发展趋势。方法：选择城乡不同地区、不同职业的15个人群（每个人群1000人左右，男女各半，年龄35－59岁）共计15389人为调查对象，以BMI≥25为超重，BMI≥30为肥胖，分别计算超重率和肥胖率，并与20世纪80年代初和90年代初可比资料比较。结果：①各地人群超重率和肥胖率存在极大差异。在超重严重的地区，中年人群超重率已超过50％；②一般来说这种人群差别表现为：北方高于南方，中城市高于内地农村，女性高于男性；③中年人群的超重目前尚主要表现为“肥胖前期”，肥胖率在绝大多数人群中低于10％；④与80年代初相比，90年代初各人群超重率和肥胖率均上升；与90年代初相比，90年代末多数人群超重率肥胖率均再次 大幅度上升。结论：对我国人群超重和肥胖的干预迫在眉睫。