腹型肥胖对炎性因子及代谢综合征的影响

目的腹型肥胖则是一系列代谢紊乱的始动因素,本研究的目的是研究腹型肥胖与体内炎性因子水平及代谢综合征(metabolic syndrome,MS)之间的关系,为儿童肥胖尤其是腹型肥胖的治疗提供一定理论依据。方法选取2011-2012年于西安交通大学第二附属医院儿科内分泌门诊就诊的单纯性肥胖儿童85例,根据腰围将其分为腹型肥胖组及非腹型肥胖组。测量研究对象的身高,体重,腰围及臀围;抽取空腹血并检测血脂,血糖以及超敏C反应蛋白(highsensitivity C-reactive protein,hs-CRP)及内脂素水平。结果腹型肥胖患儿体质指数(body mass index,BMI)、腰围、腰臀比均显著高于非腹型肥胖患儿(P均0.05);腹型肥胖组MS检出率显著高于非腹型肥胖组(P0.05);腹型肥胖患儿与非腹型肥胖患儿比较,高血压、高血糖、高TG血症、低HDL-C血症的患病人数在两组间差异均具有统计学意义(P0.05);腹型肥胖患儿血清中hs-CRP及内酯素的水平均显著高于非腹型肥胖组。结论腹型肥胖儿童比非腹型肥胖儿童更容易患MS,儿童腹部脂肪分布与甘油三酯及体内炎症因子增高关系较为密切。因此,应积极防治肥胖,尤其是腹型肥胖。     

Waist circumference measurement in clinical practice

The obesity epidemic is a major public health problem worldwide. Adult obesity is associated with increased morbidity and mortality. Measurement of abdominal obesity is strongly associated with increased cardiometabolic risk, cardiovascular events, and mortality. Although waist circumference is a crude measurement, it correlates with obesity and visceral fat amount, and is a surrogate marker for insulin resistance. A normal waist circumference differs for specific ethnic groups due to different cardiometabolic risk. For example, Asians have increased cardiometabolic risk at lower body mass indexes and with lower waist circumferences than other populations. One criterion for the diagnosis of the metabolic syndrome, according to different study groups, includes measurement of abdominal obesity (waist circumference or waist-to-hip ratio) because visceral adipose tissue is a key component of the syndrome. The waist circumference measurement is a simple tool that should be widely implemented in clinical practice to improve cardiometabolic risk stratification.     

Prospective study of optimal obesity index cutoffs for predicting development of multiple metabolic risk factors: the korean genome and epidemiology study

Background: In this prospective cohort study, we estimated the risk of developing more than 1 metabolic risk factor, using different obesity indices. In addition, we investigated the relative usefulness of the obesity indices for predicting development of such risk factors and calculated optimal cutoffs for the obesity indices.Methods: The cohort comprised 10 038 representative residents of a small city and a rural county who were recruited in 2001-2002. Follow-up examinations were conducted every 2 years. Among the 3857 participants without metabolic syndrome at baseline, 1102 new cases occurred during the 6-year follow-up. Receiver operating characteristic (ROC) curves for the obesity indices were plotted to compare the usefulness of the obesity indices.Results: The numbers of new cases of multiple metabolic risk factors among people in the highest quintiles of body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), and waist-height ratio at the baseline examination were 2 to 3 times those in the lowest quintiles. The area under the ROC curve for WHR was significantly higher than that for BMI. The optimal BMI cutoff was 24 kg/m(2) in men and women, and the optimal WC cutoffs were 80 cm and 78 cm in men and women, respectively.Conclusions: Both overall obesity and central obesity predicted risk of developing multiple metabolic risk factors, and WHR appeared to be a better discriminator than BMI. To prevent development of metabolic diseases among Koreans, it might be useful to lower the cutoff for abdominal obesity, as defined by WC.     

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.     

2006年青岛市35岁以上人群腰围与糖耐量调查及3年后转归情况分析

[目的]了解35岁以上人群腰围与糖耐量情况,探讨影响糖耐量正常人群糖耐量转归的因素,为糖尿病预防提供科学依据。[方法]在青岛市城乡选取2006年糖耐量正常的684名35～74岁人群,测量其腰围值,3年后进行随访。[结果]2006年684名糖耐量正常者中,腹型肥胖罹患率为53.22%。3年后随访上述684人,IGR累积发病率为28.07%,其中腹型肥胖组为34.89%,腰围正常组为20.31%(P<0.01);DM累积发病率为3.51%,其中腹型肥胖者为4.67%,腰围正常组为2.19%(P>0.05)。684人中,2006年腰围为82.38±9.23cm,2009年腰围为85.29±9.45cm(P<0.01)。多因素非条件Logistic回归分析结果,影响糖耐量情况的因素有收缩压(SBP)、腰围(WC)、低密度脂蛋白胆固醇(LDL)、总胆固醇(TC)、尿酸(UA),OR值分别为1.011、1.047、0.643、1.584、1.003。[结论]腹型肥胖者较腰围正常者易发生IGR;收缩压高、腰围值高、低密度脂蛋白胆固醇含量低、总胆固醇含量高、尿酸高的人容易转归为IGR和/或DM。     

Longitudinal Association of Dietary Energy Density with Abdominal Obesity among Chinese Adults from CHNS 1993–2018

Few studies have explored the longitudinal association between dietary energy density and waist circumference and abdominal obesity in adults in China. This study aimed to analyze the relationship between dietary energy density and waist circumference and abdominal obesity in Chinese residents aged 18–64. Using data from the CHNS from 1993 to 2018, 25,817 adult residents aged 18 to 64 were selected for the study. Three consecutive 24-h dietary recalls and home-weighed seasonings were used to assess food intake. A multilevel model was used to analyze the relationship between dietary energy density and waist circumference and abdominal obesity. The results showed that compared with the lowest dietary energy density group, females had an increased risk of abdominal obesity (OR = 1.16, 95% CI: 1.05, 1.29), and females’ waist circumference increased significantly by 0.24 cm (95% CI: 0.39–1.09) in the highest dietary energy density group. No association between dietary energy density and waist circumference and abdominal obesity was observed in males. This study shows that higher dietary energy density is significantly associated with females’ waist circumference and abdominal obesity. Further research on high dietary energy density and abdominal obesity will provide scientific basis for the effective control of abdominal obesity.     

扬州市城区学龄前儿童腰围特征及影响因素分析

目的 研究扬州市城区学龄前儿童腰围特征,并分析其影响因素,为我国学龄前儿童腹型超重/肥胖筛查与防治提供依据。方法 于2015年4-5月分层整群抽取7所幼儿园2 531名儿童,对家长进行问卷调查;采用集中体检的方式,测量儿童体重、身高、腰围等;对其腰围和腰围身高比进行描述性分析,并通过单因素和多因素Logistic回归分析腰围的影响因素。结果 扬州市城区学龄前儿童腰围随年龄增长逐渐增加,各年龄组男童均大于女童;女童腰围身高比随年龄增长逐渐减低,男童则有波动。单因素分析结果显示,父母体重指数(BMI)、母亲学历、儿童每日睡眠时间、户外活动时间、视屏时间等对儿童腰围有影响(P<0.05)。多因素Logistic回归分析结果显示,父母高BMI是学龄前儿童高腹围的危险因素(母亲BMI:OR=1.15,95%CI:1.09~1.18,P＜0.001;父亲BMI:OR=1.12,95%CI:1.07~1.15,P＜0.001)。结论 需逐步建立我国学龄前儿童腰围正常范围与腹型超重/肥胖腰围筛查界值点,为学龄前儿童腹型超重/肥胖筛查与防治提供依据;要控制腹型肥胖需进行以家庭为中心的饮食、生活方式的综合性干预。     

Country of birth, acculturation status and abdominal obesity in a national sample of Mexican-American women and men

BACKGROUND: Few studies have examined the influence of country of birth and acculturation status on indicators of obesity using national samples of Mexican-American women and men. METHODS: We analysed data for 1387 Mexican-American women and 1404 Mexican- American men, ages 25-64, from the third National Health and Nutrition Examination Survey (1988-1994). We examined whether waist circumference and abdominal obesity varied by country of birth and acculturation status (primary language spoken), and whether among those with abdominal obesity, number of associated cardiovascular disease (CVD) risk factors varied by country of birth and acculturation status. RESULTS: Both country of birth and, to a lesser degree, acculturation status were significantly associated with waist circumference and abdominal obesity. Mexican-born women and men had the smallest waist circumference (90.4 cm, 94.0 cm respectively), US-born English-speaking women and men had intermediate waist circumference (93.6 cm, 97.3 cm), and US-born Spanish-speaking women and men had the largest waist circumference (96.9 cm, 97.7 cm), after accounting for age, education, per cent of energy from dietary fat, leisure-time physical activity, and smoking. All women had high prevalences of abdominal obesity, particularly US-born Spanish-speaking women (68.7%). In addition, US-born Spanish-speaking women with abdominal obesity were significantly more likely than their counterparts to have one or more of the following CVD risk factors: high serum insulin, non-insulin dependent diabetes, high blood lipids, and/or hypertension. CONCLUSIONS: These findings illustrate the heterogeneity of the Mexican-American population and suggest that country of birth and lack of acculturation to the majority culture, as well as secondary lifestyle changes, may explain the significant clinical differences observed in abdominal obesity within Mexican-American population subgroups.     

腰围/身高比值与非肥胖者心血管危险因素聚集关系

目的本研究旨在探讨腰围/身高比值（WHtR）这一腹型肥胖指标用于评价非肥胖者心血管危险因素聚集的价值。方法 BMI〈25 kg/m2的健康体检者,测量血压、身高、体重、腰围（WC）、臀围,计算体重指标（BMI）、WHtR及腰臀围比（WHR）,并检测血糖、血脂等。采用偏相关系数分析WHtR、BMI、WC及WHR与危险因素聚集的关系,受试者工作特征（receiver operator characteristic,ROC）曲线分析各肥胖指标预测危险因素聚集的效能。结果偏相关分析与显示,调整年龄的影响后,各肥胖指标与心血管危险因素聚集呈显著相关（P〈0.05）,男女均以WHtR的相关系数最大。ROC分析显示：针对≥2个危险因素聚集,男女性均以WHtR的曲线下面积最大。结论 WHtR是有效的预测非肥胖者心血管危险因素聚集的中心性肥胖指标。     

中国育龄女性腹型肥胖相关因素的纵向多水平分析

目的纵向分析身体活动、静坐时间和膳食摄入水平对中国育龄女性腰围、腹型肥胖的影响。方法在"中国健康与营养调查"于2004、2006、2009、2011、2015年的五轮调查中,选择至少参加过两轮调查的2951名15~49岁的育龄女性为研究对象,采用问卷调查收集身体活动和静坐时间数据、采用连续3天24小时回顾法收集食物消费数据。采用方差分析对连续性变量的时间差异进行分析,采用卡方检验对分类变量的时间分布差异进行分析,采用线性多水平模型分析不同身体活动、静坐时间和膳食摄入水平与腰围的关系,采用Logistic多水平模型分析不同身体活动、静坐时间和膳食摄入水平与腹型肥胖的患病风险。结果将身体活动、静坐时间和膳食摄入水平分别纳入多水平模型后,与低水平休闲身体活动相比,中等水平休闲身体活动组的腰围增加了0.47 cm(P=0.025);与低水平电视时间相比,中、高水平电视时间组的腰围分别增加0.49 cm(P=0.033)和0.58 cm(P=0.013),发生腹型肥胖的相对危险度分别是1.13(P=0.049)和1.17(P=0.010);与深色蔬菜摄入不足组相比,摄入充足组的腰围减少0.82 cm(P<0.001),发生腹型肥胖的相对危险度是0.87(P=0.028);与低水平糕点摄入组相比,高水平摄入组的腰围增加1.16 cm(P<0.001),发生腹型肥胖的相对危险度是1.33(P<0.001)。将身体活动、静坐时间和膳食摄入水平同时纳入多水平模型后,电视时间和膳食摄入水平与腰围及腹型肥胖仍然存在统计学意义,且统计值相差不大。与低水平电视时间相比,中、高水平电视时间组的腰围分别增加0.54 cm (P=0.028)和0.58 cm (P=0.025),发生腹型肥胖的相对危险度为1.15(P=0.034)和1.18(P=0.011);与深色蔬菜摄入不足组相比,摄入充足组的腰围减少0.80 cm(P<0.001),发生腹型肥胖的相对危险度是0.87(P=0.027);与低水平糕点摄入组相比,高水平摄入组的腰围增加1.13 cm(P<0.001),发生腹型肥胖的相对危险度是1.32(P<0.001)。身体活动水平与腰围及腹型肥胖无统计学意义。结论电视时间、膳食因素(深色蔬菜摄入不足、糕点摄入过多)是影响中国育龄女性腹型肥胖的独立危险因素。除了加强体育活动外,预防育龄女性腹型肥胖还应该加强减少电视时间、推广适当膳食行为(增加深色蔬菜摄入、减少糕点摄入)的干预措施。     

Body fat measurements in children as predictors for the metabolic syndrome: focus on waist circumference

The global epidemic of obesity in children will see a rise in the number of cases of metabolic syndrome, which is a clustering of CVD risk factors, including atherogenic levels of blood lipids, hyperinsulinaemia and raised blood pressure. Rather than excess general fatness (assessed by BMI), more specifically it is excess abdominal fatness, quantified by waist circumference measurement, which is a better measure of risk for these metabolic abnormalities in children of all ages. Insulin resistance, a consequence of excess visceral fat, is understood to be the driving force underpinning the metabolic syndrome. Consequently, assessment of abdominal fatness in children is proving to be more clinically useful. Waist circumference centile charts have now been developed for the UK and other paediatric populations to assist in this process. Furthermore, studies in the UK and elsewhere have shown that abdominal fatness has increased in infants, children and adolescents to a greater extent than overall fatness over the past 10-20 years, suggesting that obesity prevalence may be underestimated when based entirely on BMI. Additionally, ethnic differences in fat distribution have been demonstrated in children, with those from south Asian backgrounds having a greater abdominal distribution compared with Caucasian children and consequently having a much greater risk for type 2 diabetes. The information that can be provided by waist circumference measurement in children, as in adults, together with the recent changes in body fat distribution should provide the impetus for its measurement to be standardised and routinely taken in clinical and epidemiological settings.     

Association of total and central obesity with mortality in postmenopausal women with coronary heart disease

Overweight and abdominal obesity increase mortality risk, although the risk may be mediated by traditional cardiac risk factors. The authors assessed the association of baseline measures, change in overall body weight and abdominal obesity (waist circumference), and weight and waist circumference cycling with total mortality among postmenopausal women with known heart disease. They used data from 2,739 US women who participated in the Heart and Estrogen/progestin Replacement Study between 1993 and 2001. Over 6.8 years of follow-up, 498 women died. In adjusted Cox models that included either baseline waist circumference or body mass index (BMI), each was associated with mortality. However, after further adjustment for diabetes, hypertension, and lipoproteins, these associations disappeared. In models including both waist circumference and BMI, larger waist circumference (hazard ratio=1.40 per standard deviation, 95% confidence interval: 1.16, 1.68) was associated with increased risk and higher BMI (hazard ratio=0.81 per standard deviation, 95% confidence interval: 0.67, 0.97) was associated with decreased risk of total mortality, independent of cardiac risk factors. Weight and waist circumference cycling were not associated with mortality. Results show that both BMI and waist circumference are associated with mortality among postmenopausal women with established heart disease, but waist circumference may be more important than BMI, and their effects may be largely mediated by other cardiac risk factors.     

Abdominal Obesity and Endometrial Cancer in Egyptian Females With Postmenopausal Bleeding

Endometrial cancer is the most common type of female genital tract malignancies. We intended to assess the relation between different measures of obesity and the risk to develop endometrial cancer in Egyptian females with postmenopausal bleeding (PMB). The study was conducted in Alexandria, Egypt and included all postmenopausal females presenting to the University Hospital of Gynecology and Obstetrics with PMB within the study period (from January 1 to September 30). A questionnaire was completed, and data about anthropometric measurements including weight, height, and waist circumference were collected. Vaginal sonography, dilatation and curettage, and pathological examination were done by experts for all participants. Endometrial cancer was diagnosed in 38% of females presenting with PMB. Using ROC curve analysis, only the measure of abdominal obesity (waist circumference) showed significant accuracy in predicting endometrial cancer (area = 0.63, P < .05). The best cutoff point that maximizes accuracy was 88 cm. Body mass index (≥30 vs. ≤30) showed no significant relation (OR = 1.1, 95%CI 0.5–2.3), and the ratio between upper and lower body obesity (W/H ratio) showed border line significant relation (OR = 2, 95% CI 1–4.1), whereas waist circumference (≥88 vs. ≤88 cm) showed strikingly high OR (OR = 13.6, 95%CI 4–46.6). The risk of abdominal obesity on endometrial cancer remains very high (OR = 15.8, 95%CI 4.1–60.9) even after adjustment, in a logistic model, for other risk factors such as age at presentation, age at menarche, age at menopause, family history of malignancy, and gravidity. Abdominal obesity (waist circumference >88 cm) is the best measure of obesity to be used in predicting the risk of endometrial cancer in Egyptian females with PMB.     

Abdominal obesity and endometrial cancer in egyptian females with postmenopausal bleeding

Endometrial cancer is the most common type of female genital tract malignancies. We intended to assess the relation between different measures of obesity and the risk to develop endometrial cancer in Egyptian females with postmenopausal bleeding (PMB). The study was conducted in Alexandria, Egypt and included all postmenopausal females presenting to the University Hospital of Gynecology and Obstetrics with PMB within the study period (from January 1 to September 30). A questionnaire was completed, and data about anthropometric measurements including weight, height, and waist circumference were collected. Vaginal sonography, dilatation and curettage, and pathological examination were done by experts for all participants. Endometrial cancer was diagnosed in 38% of females presenting with PMB. Using ROC curve analysis, only the measure of abdominal obesity (waist circumference) showed significant accuracy in predicting endometrial cancer (area = 0.63, P < .05). The best cutoff point that maximizes accuracy was 88 cm. Body mass index (≥30 vs. ≤30) showed no significant relation (OR = 1.1, 95%CI 0.5-2.3), and the ratio between upper and lower body obesity (W/H ratio) showed border line significant relation (OR = 2, 95% CI 1-4.1), whereas waist circumference (≥88 vs. ≤88 cm) showed strikingly high OR (OR = 13.6, 95%CI 4-46.6). The risk of abdominal obesity on endometrial cancer remains very high (OR = 15.8, 95%CI 4.1-60.9) even after adjustment, in a logistic model, for other risk factors such as age at presentation, age at menarche, age at menopause, family history of malignancy, and gravidity. Abdominal obesity (waist circumference >88 cm) is the best measure of obesity to be used in predicting the risk of endometrial cancer in Egyptian females with PMB.     

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。     

Appropriate waist circumference cutoff values for persons with multiple cardiovascular risk factors in Japan: a large cross-sectional study

BACKGROUND: In Japan, the current standard waist circumference cutoff value for persons with multiple cardiovascular risk factors remains controversial. In this study we aimed to analyze the health-check examination data from a large Japanese population and propose a revised waist circumference cutoff value. METHODS: Subjects of this study were 12,725 adults who underwent a health-check by thorough medical examination between April 2006 and March 2007. Medical examinations included measurement of waist circumference, fasting blood triglycerides, HDL cholesterol, glucose concentrations, blood pressure and collection of demographic characteristics. Receiver operating characteristic (ROC) curve analysis was utilized to find appropriate waist circumference cutoff values in relation to multiple cardiovascular risk factors with two or more of the following: dyslipidemia (hypertriglyceridemia or low HDL cholesterol), hypertension, and hyperglycemia defined by the Japanese criteria of metabolic syndrome. RESULTS: The average age of the subjects was 50.7 years (standard deviation [SD]: 8.8) for men and 49.7 years (SD: 8.6) for women. ROC curve analysis showed maximum sensitivity plus specificity at a waist circumference of 87 cm in men (0.66 and 0.62, respectively) and 83 cm in women (0.73 and 0.70). When analyzed by ten-year age groups, the ROC curves for younger age groups were shifted up and to the left compared to older age groups, but associations between cutoff values and age were not clear. CONCLUSION: In Japan, the appropriate cutoff value of waist circumference for persons with multiple cardiovascular risk factors is 87 cm for men and 83 cm for women.     

心血管病传统危险因素与糖尿病及其前期关系

目的探讨传统心血管病危险因素与糖尿病及其前期的关联性,为糖尿病的防治提供参考依据。方法采用随机抽样方法对在浙江省湖州市爱山、龙泉和飞英3个街道共1 197名55～75岁的常住居民进行体格检查和血糖检测,采用Logistic回归分析方法分析传统心血管病危险因素与糖尿病及其前期的关联性。结果 1 197名常住居民中,血糖正常者807名,占67.42%,糖尿病前期者267例,占22.31%,糖尿病者123例,占10.27%;3组人群空腹血糖和餐后2 h血糖值分别为(4.83±0.61)、(5.76±0.61)、(6.99±1.43)mmol/L和(5.46±1.65)、(7.94±2.63)、(13.45±4.01)mmol/L;年龄、体质指数(BMI)、中心性肥胖、腹围、臀围、腰臀比和血压等传统心血管病危险因素在正常血糖组、糖尿病前期组和糖尿病组3组人群中分布不同,差异均有统计学意义(P<0.05);多因素Logistic回归分析结果表明,以正常血糖组为参照组,年龄、BMI、中心性肥胖、腹围、臀围、腰臀比和血压与糖尿病前期存在关联性;以正常血糖组为参照组,年龄、BMI、中心性肥胖、腹围、臀围、腰臀比和血压与糖尿病存在关联性;以糖尿病前期组为参照组,中心性肥胖、腹围和腰臀比与糖尿病存在关联性。结论年龄、BMI、中心性肥胖、腹围、臀围、腰臀比、血压等传统心血管病危险因素与糖尿病及其前期均存在关联性。     

Pocket tape measure for waist circumference: training medical students and residents on a simple assessment of body composition

Metabolic syndrome, the clustering of hyperglycemia, hypertension and dyslipidemia, increases the risk of coronary heart disease. Abdominal obesity is an important cue for the clinician to consider metabolic syndrome. Measurement of waist circumference is a simple means of identifying abdominal obesity. The development and distribution of pocket tape measures to medical students, residents and attending physicians were initiated to enhance identification and treatment of metabolic syndrome. Distribution of the tape measures was added to a cardiovascular nutrition component in a 4th-y medical school curriculum. The nutrition component continued to include computer-based cases and pocket reference cards. Limited data suggest that the addition of pocket tape measures to the nutrition component of an ambulatory care clerkship may increase the percentage of medical students who use waist circumference to identify patients at risk for metabolic syndrome. It is anticipated that student use will increase with role modeling by residents and attending physicians.     

Obesity and central adiposity in Japanese immigrants: role of the Western dietary pattern

We examined the association of nutritional factors with body fat deposition in a representative sample (n=530, aged 40-79 years) of first and second-generation Japanese-Brazilian population who was submitted to standardized questionnaires, including nutritional data, clinical examination and laboratory procedures. Dietary data were compared between groups of subjects defined by the presence of obesity or central adiposity. Associations of body mass index or waist circumference (dependent variables) with energy and nutrient intakes (main exposure of interest) were analyzed by multiple linear regression, with adjustment for gender, age, physical activity and generation. Groups of obese subjects and those with central adiposity consumed higher proportions of energy as fat and lower as carbohydrate than those without obesity and central adiposity (p<0.05). Stratifying by generation, second-generation was shown to take more energy as fat than the first-generation (p<0.05). In the regression models, protein intake was the only variable significantly associated with body mass index. Replacing body mass index by the waist circumference, male sex and protein intake were shown to be independent predictors of central adiposity. When second-generation was taken, total energy intake and all macronutrient intakes became significantly associated with body mass index (p<0.05) but only protein intake predicted waist circumference. We speculate that Japanese-Brazilians, genetically prone to insulin resistance, when exposed to unfavorable environment will express a number of metabolic disturbances. A deleterious dietary pattern may contribute to weight gain, was associated with abdominal fat deposition in particular a protein-rich diet, and reflected by their waist circumference. Intra-abdominal fat could be triggering insulin resistance, which would explain the increased prevalence rates of diabetes, dyslipidemia and hypertension seen in Japanese-Brazilians.     

A comparison of ultrasound and magnetic resonance imaging to assess visceral fat in the metabolic syndrome

Visceral adipose tissue (VAT) plays a key role in the metabolic syndrome. Easy detection of VAT could be an important tool to increase understanding of the metabolic syndrome. To study the relationship between the area of the inferior part of the perirenal fat (AIPPF) and anthropometric, imaging and cardiovascular risk factors of metabolic syndrome, seventy two subjects with metabolic syndrome were recruited including 44 men and 28 women (age: 26-68 yr). Each subject underwent ultrasound detection of AIPPF, intraabdominal fat thickness and magnetic resonance imaging (MRI) to calculate abdominal VAT (MRI VAT). Anthropometric and cardiovascular risk factors were also evaluated. AIPPF measured by ultrasonography demonstrated excellent reproducibility. Receiver operating characteristic analysis revealed that AIPPF has the best sensitivity for women, specificity for men and accuracy of the various measures to predict visceral obesity (MRI VAT value > or = 110 cm2) for both genders. AIPPF was related to MRI VAT, ultrasound measured intraabdominal fat, waist circumference, the ratio of waist and hip circumferences (of men), body mass index and the main cardiovascular risk factors of metabolic syndrome. Multiple stepwise linear regression analysis suggested that MRI VAT affected AIPPF independent of other investigated obesity indices. This study showed that AIPPF could be applied as an easy and reliable imaging indicator of visceral obesity and cardiovascular risk factors in the metabolic syndrome.