高血压病患者肥胖指数与心血管危险因素相关性的研究

[目的]探讨高血压病患者肥胖指数与心血管危险因素的相关性. [方法]收集到我院就诊及体检 538例高血压病患者,收集一般临床资料,测量血压、身高、体重,腰围(WC),臀围,计算体重指数(BMI),腰围身高比(WHtR)及腰臀比(WHR),测定空腹血糖,空腹胰岛素,总胆固醇(Tc)和甘油三酯(TG),高密度脂蛋白(HDL-C)等指标,用胰岛素抵抗指数(IRI)作为胰岛素敏感性评价指标,并分析各肥胖指数与胰岛素抵抗指数、血脂,血糖等的关系. [结果]经单因素及非条件Logistic多因素逐步回归分析显示:WHtR是高血压病患者空腹血糖调节异常(IGR)、高TG的主要危险因素,预测IGR、高TG的OR值最大,分别为1.819 (95%CI:1.09-3.29),2.21(95%CI:1.15-423) (均P＜0.05);WC是高血压病患者胰岛素抵抗(IR)、低HDL-C的主要危险因素,预测IR、低HDL-C的OR值最大,分别为1.1(95%CI:1.03-1.16),1.30(95%CI:1.03-1.63)(均P＜0.05). [结论]中心性肥胖的腰围和腰围身高比能更好地预测高血压病患者心血管危险因素.     

不同肥胖指标对糖尿病风险预测效果分析

目的探讨体质指数(BMI)、腰围(WC)、腰臀比(WHR)、腰围身高比(WHtR)4种肥胖指标对预测糖尿病风险的效果。方法利用四川成都市2008年调查5 205名40～70岁人群数据,分析4种指标及身高的相关关系;应用受试者特性曲线(ROC)、Logistic回归分析比较4个指标对糖尿病的预测效果。结果 WHtR与腰围相关性最高(男性r=0.938 4,女性r=0.956 2,P0.05);4个指标中,ROC曲线下面积男性WHR最大,女性WHtR最大(男性c=0.641 5,女性c=0.669 2);Logistic回归分析中,男性WHR,女性WC预测价值最佳(男性OR=3.107,女性OR=2.684),调整4个指标交互作用后,BMI结合WC、WHR、WHtR并不能明显提高模型预测效果。结论本研究人群糖尿病风险模型中,男性选择WHR作为肥胖评定指标,最佳切点为0.90,女性选择WC作为肥胖评定指标,最佳切点为83 cm,但在不同地区和人群的应用需要进一步研究。     

中国三省成年居民肥胖指标与高血压和血脂异常的关系

目的探讨中国成年居民肥胖指标与高血压和血脂异常的关系。方法于2012年采用多阶段随机抽样法,测量辽宁、河南、湖南三省1022名18~69岁成年居民的身体数据,描述体质指数(BMI)、腰围(WC)、腰高比(WHtR)、腰臀比(WHR)和体脂率(BF%)判定的超重/肥胖率,绘制受试者工作特征(ROC)曲线,分析不同体测指标预测高血压及血脂异常患病风险的能力。结果各项身体测量指标的比较中,男性WC显著高于女性[(86.1±10.2)vs.(80.7±9.9),P0.001],腿围(ThC)差异无统计学意义[(51.5±5.3)vs.(51.7±4.5)],而腿围身高比(THtR)男性低于女性[(0.31±0.03)vs.(0.33±0.03),P0.001]。根据各肥胖指标判定我国成年居民的超重/肥胖率:WHtR(58.7%)WHR(50.4%)BMI(49.1%)BF%(35.7%)WC(35.3%),其中BMI的肥胖检出率为13.2%,大幅低于其他指标。以高血压为因变量绘制受试者工作特征曲线(ROC),曲线结果显示男、女性WHtR的ROC曲线下的面积(area under curve,AUC)均最高,切点值分别为0.53和0.56;以高胆固醇血症为因变量,结果显示男、女性WHR的AUC均最大且在男性中为唯一有意义的指标;以高甘油三酯血症为因变量,结果显示BMI、WC、WHtR、WHR、BF%的预测效果相当;以低高密度脂蛋白胆固醇血症为因变量,结果显示ThC和THtR的预测效果优于BMI、WC、WHR等常用指标,尤其在男性居民中差异更加显著,得到男、女性ThC的切点值分别为52.50和55.40,THtR的切点值分别为0.31和0.35。结论男性脂肪更易囤积于腹部,女性脂肪易于在腿部蓄积;WHtR是预测高血压的最佳肥胖指标,在预测高血压和血脂异常的患病风险中切点值较稳定且性别差异小,适宜切点值在0.51~0.54之间;血脂异常的不同临床分类与肥胖指标间的关系不尽相同:WHR在预测高胆固醇血症患病风险中效果最好,ThC和THtR在预测低高密度脂蛋白血症的患病风险中效果优于BMI、WC等常用指标,在男性居民中尤为明显。     

儿童血清ghrelin水平与血脂、瘦素、脂联素及胰岛素关系的分析

目的探讨儿童血清ghrelin水平与血脂、瘦素、脂联素及胰岛素的关系。方法采用多阶段随机抽样的方法,随机抽取879名8～10岁小学生作为调查对象。测量身高、体重、腰围,计算体质指数(BMI)、体脂百分比(%BF),测定血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖、ghrelin、脂联素、胰岛素及瘦素。结果随血清ghrelin水平的升高,体重、腰围、BMI、%BF、血清瘦素水平逐渐降低(P<0.0001),血清HDL-C水平呈现逐渐增高的趋势(P<0.0001),血清TC、胰岛素和脂联素水平变化趋势不明显;与ghrelin密切相关的指标为体成分指标,包括身高、体重、腰围、BMI、%BF以及瘦素,其次是血脂代谢指标,包括TG、HDL-C、TC、LDL-C,第三是血糖代谢指标,包括空腹血糖和胰岛素。结论ghrelin与体成分指标、瘦素、脂联素、胰岛素以及血脂有不同程度的关联,但和身高、体重、腰围、BMI、%BF以及瘦素的相关最为密切。     

CT测量腹内脂肪面积/皮下脂肪面积在评价胰岛素抵抗中的价值

目的 探讨CT测量腹内脂肪面积/皮下脂肪面积在评价胰岛素抵抗中的价值.方法 选择以腹型肥胖为特征的血糖正常者35例(A组),糖耐量异常或空腹血糖受损及空腹血糖＜10 mmol/L的糖尿病患者65例(B组),测量或计算两组患者腰围、臀围、腰臀比、体重指数(BMI),采用螺旋CT取仰卧位屏气状态下在脐平面进行扫描,测量腹内脂肪面积和皮下脂肪面积,并计算二者的比值;采空腹血测定空腹血糖、空腹胰岛素(FINS)、空腹C肽、三酰甘油(TG)、高密度脂蛋白-胆固醇(HDL-C)、低密度脂蛋白-胆固醇(LDL-C),用稳态模型评估2法计算胰岛素抵抗指数(HOMA2-IRI).结果 腹内脂肪面积和腹内脂肪面积/皮下脂肪面积在B组[(130.30±43.79)cm2和0.98±0.36]均明显高于A组[(101.90±44.45)cm2和0.60±0.32],差异有统计学意义.当腹内脂肪面积/皮下脂肪面积≥0.60时,采用Pearson相关分析,lnHOMA2-IRI与腹内脂肪面积/皮下脂肪面积的相关系数为0.802(P＜0.01).结论 腹内脂肪过度堆积是胰岛素抵抗的重要标志之一,腹内脂肪面积/皮下脂肪面积≥0.60则提示存在明显的胰岛素抵抗,但＜0.60不能说明无胰岛素抵抗.     

代谢综合征肥胖指标诊断及其切点研究

目的 评价各种肥胖指标诊断代谢综合征(MS)的效果,确定最佳切点.方法 对辽宁省沈阳市某高校1 907名在职及退休职工进行人体测量、检测生理及血液指标;MS标准采用国际糖尿病联盟标准(IDF标准)和中华医学会糖尿病学分会建议标准(CDS标准);应用受试者工作特征曲线(ROC曲线)筛选腰围、体重指数(BMI)、腰围身高比(WSR)、腰臀比(WHR)中诊断MS效果最好的肥胖指标,以最大约登指数确定切点.结果 WSR最佳切点为男性53,女性为51;IDF标准下,腰围最佳切点男性为90 cm,女性为80 cm;CDS标准下,BMI最佳切点男性为24.6,女性为25.6;WSR在ROC曲线下面积最大,诊断MS的效果显著优于BMI(均P＜0.05);WSR最佳切点以上者与正常者比较,MS危险因素聚集的危险度明显升高(P＜O.05).将WSR控制在切点以下,可能防止人群中41.3%-44.6%的MS危险因素聚集.结论 WSR是诊断MS最简单有效的肥胖指标.     

不同体格测量指标对血糖异常预测的分析

目的比较不同体格测量指标对于血糖异常的预测价值,探索适宜预测血糖异常的体格测量指标。方法通过绘制受试者工作特征(Receiver Operating Characteristic, ROC)曲线,比较某社区1 087名35岁及以上人群的体质指数(BMI)、腰臀比(WHR)、腰高比(WHtR)、腰围(WC)等体格测量指标对血糖异常的预测价值,并计算各指标预测血糖异常的最佳截断值及其相应灵敏度和特异度。结果四个体格测量指标对于血糖异常均有一定预测价值(AUC为0.639～0.653),约登指数依次为WHtR(26.03%)、WHR (22.52%)、WC (22.35%)、BMI(21.59%),敏感性依次为BMI (84.85%)、WHtR(76.86%)、WC (59.23%)、WHR (48.76%)。结论体格测量指标的异常可以早期预测血糖异常;BMI、WHR及WC预测血糖异常有性别差异;WHtR无性别差异,约登指数及敏感性均较高,对于血糖异常的预测价值优于BMI、WHR及WC。     

人体测量指标预测肥胖儿童非酒精性脂肪肝的研究

目的 研究人体测量指标对儿童肥胖伴非酒精性脂肪肝的预测作用,探讨不同指标筛查非酒精性脂肪肝的切点值。方法 选取自2018年6月—2019年12月在西安交通大学第二附属医院小儿内分泌门诊就诊的94例肥胖儿童为研究对象,进一步分为肥胖伴非酒精性脂肪肝组与肥胖不伴非酒精性脂肪肝组,52例正常儿童为对照组。测量身高(H)、体重(W)、腰围(WC)、臀围(HC)和血甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C);行肝脏B超的检查。计算体质指数(BMI)、腰臀比(WHR)、腰高比(WHtR)、腹部体积指数(AVI)、脂质蓄积指数(LAP)和内脏脂肪指数(VAI)等指标。通过绘制人体测量指标的受试者工作特征曲线(ROC曲线)评估人体测量指标与肥胖儿童非酒精性脂肪肝的相关性,并比较各项人体测量指标的曲线下面积(AUC)确定切点值。结果 肥胖组BMI、WC、WHR、WHtR、AVI、LAP、VAI及TG均高于对照组(t=23.090、21.068、12.547、22.855、17.578、8.159、5.394、6.183,P＜0.001)。肥胖伴非酒精性脂肪肝组BMI、WC、AVI、LAP、VAI均高于肥胖不伴非酒精性脂肪肝组(t=2.180、2.389、2.362、3.643、2.839,P＜0.05)。人体测量指标的ROC曲线下面积按从大到小的顺序依次为 LAP、VAI、 WC、 AVI、 BMI。对肥胖伴非酒精性脂肪肝的联合诊断指标进行筛查效能分析结果显示,LAP+AVI 曲线下面积为0.706(95%CI:0.595~0.817,P＜0.001);AVI+VAI 曲线下面积为0.685(95%CI:0.570~0.800,P＜0.01);BMI+WC 曲线下面积为0.652(95%CI:0.537~0.768,P＜0.05)。联合指标的ROC曲线下面积从大到小为LAP+AVI、AVI+VAI、BMI+WC。结论 LAP联合AVI对儿童肥胖伴非酒精性脂肪肝具有较好的筛查作用。     

脂肪肝患者A-FABP与胰岛素抵抗关系

目的探讨非酒精性脂肪肝病(NAFLD)患者血清脂肪细胞型脂肪酸结合蛋白(A-FABP)与胰岛素抵抗(IR)的关系。方法选择NAFLD患者119例,正常对照120人,测量身高、体重、腰围、臀围、体质指数及腰臀比,检测血清中总胆固醇、甘油三酯、高密度脂蛋白胆固醇、空腹血糖、空腹胰岛素抵抗指数及脂肪细胞型脂肪酸结合蛋白,并进行对比分析。结果NAFLD组血清A-FABP水平(13.45±5.06),明显高于对照组(9.14±5.00)μg/L(P0.01);且血清A-FABP水平与体质指数(BMI)、腰围(WC)、腰臀比(WHR)、收缩压(SBP)、舒张压(DBP)、甘油三酯(TG)、空腹胰岛素(FINS)、空腹血糖(FPG)及胰岛素抵抗指数(HOMA-IR)呈正相关(r依次分别为0.560,0.538,0.384,0.426,0.341,0.302,0.345,0.256,0.359,P均0.01),而与HDL-C呈负相关(r=-0.337,P0.001)。结论NAFLD患者存在胰岛素抵抗,且血清A-FABP水平与胰岛素抵抗密切相关。     

四项体脂测量指标与非酒精性脂肪肝的关联性研究

目的探讨天津市体检人群腰围、体质指数(BMI)、内脏脂肪面积、皮下脂肪体积与非酒精性脂肪肝(NAFLD)的关联性和诊断价值。方法选取364例体检者为研究对象,根据2010年中华医学会非酒精性脂肪肝诊断标准及B超结果,分为NAFLD组182例和对照组182例。对所有研究对象均进行一般检查、腹部B超检查、人体成分分析和生化指标测定,内科医生询问饮酒史、既往病史、用药史等情况,采用4项体脂测量指标(腰围、BMI、内脏脂肪面积和皮下脂肪体积)反映肥胖者脂肪堆积情况,并比较各指标与NAFLD间的关联。结果无论男女,NAFLD组腰围、BMI、内脏脂肪面积和皮下脂肪体积平均水平均高于对照组,差异均有统计学意义(P0.05)。受试者工作特征(ROC)曲线分析发现,男性BMI、女性腰围对NAFLD具有最高诊断效能,且男性内脏脂肪面积诊断效能高于女性,而皮下脂肪体积低于女性。ROC曲线确定各体脂测量指标诊断发生NAFLD的最佳切点值,男女性腰围分别为91.50和86.50 cm;男女性BMI分别为26.07和25.68 kg/m2;男性内脏脂肪面积为112.40 cm2,女性为95.60 cm2;男性皮下脂肪体积为193.70 cm3,女性为226.37cm3。非条件logistic回归分析发现,内脏脂肪面积更易增加NAFLD发生风险[男性OR=7.240(95%CI:3.099~16.913),女性OR=9.360(95%CI:3.563~24.487),增加1标准差]。结论 4项体脂测量指标(腰围、BMI、内脏脂肪面积和皮下脂肪体积)与NAFLD之间存在关联,其中女性腰围、男性BMI对NAFLD具有最高诊断效能,同时确定了各体质指标诊断NAFLD发生的最佳切点值,内脏脂肪面积比其他指标更易增加NAFLD的发病风险。     

胰岛素抵抗对血糖异常人群膳食干预效果的影响

目的 探讨胰岛素抵抗对血糖异常人群膳食十预效果的影响。方法从高脂血症人群社区综合干预项目中筛出血糖异常者194例作为研究对象，分为干预组（111例）和对照组（83例）。测定空腹血糖（FBG）和空腹胰岛素（FINS），计算胰岛素抵抗（IR）指数和胰岛素敏感性指数（IAI）值，分析IR和IAI与血糖、血脂及体检指标变化的关系。结果FBG、甘油三酯（TG）、腰围、腰臀比最低组与最高组之间，IR、IAI值差别有统计学意义。干预组中，胰岛素敏感性高的组干预后FBG、TG降低较明显。结论血糖、血脂、腰围及腰臀比与IR之间存在相关性，体重和体质指数与IR的相关性不显著。IR的程度与干预效果之间存在相关性。     

Waist and hip circumferences have independent and opposite effects on cardiovascular disease risk factors: the Quebec Family Study

BACKGROUND: A high waist-to-hip ratio is associated with unfavorable cardiovascular disease risk factors. This could be due to either a relatively large waist or a small hip girth. OBJECTIVE: We sought to define the separate contributions of waist girth, hip girth, and body mass index (BMI) to measures of body composition, fat distribution, and cardiovascular disease risk factors. DESIGN: Three-hundred thirteen men and 382 women living in the greater Quebec City area were involved in this cross-sectional study. Percentage body fat, anthropometric measurements, and abdominal fat distribution were obtained and BMI (in kg/m2) and waist-to-hip ratio were calculated. Serum blood lipids were determined from blood samples collected after subjects had fasted overnight RESULTS: A large waist circumference in men and women (adjusted for age, BMI, and hip circumference) was associated significantly with low HDL-cholesterol concentrations (P < 0.05) and high fasting triacylglycerol, insulin, and glucose concentrations (P < 0.01). In women alone, a large waist circumference was also associated with high LDL-cholesterol concentrations and blood pressure. A narrow hip circumference (adjusted for age, BMI, and waist circumference) was associated with low HDL-cholesterol and high glucose concentrations in men (P < 0.05) and high triacylglycerol and insulin concentrations in men and women (P < 0.05). Waist and hip girths showed different relations to body fat, fat-free mass, and visceral fat accumulation. CONCLUSIONS: Waist and hip circumferences measure different aspects of body composition and fat distribution and have independent and often opposite effects on cardiovascular disease risk factors. A narrow waist and large hips may both protect against cardiovascular disease. These specific effects of each girth measure are poorly captured in the waist-to-hip ratio.     

Diagnostic value of anthropometric indices for initial stage of atherosclerosis in adult women

Excess body weight is a cardiovascular risk factor. The relationship between anthropometric indices and cardiovascular health is not completely understood. Carotid Intima-Media Thickness (CIMT) is a subclinical marker of atherosclerosis. This study aimed to investigate the best anthropometric obesity indicator for diagnosis of initial stage of atherosclerosis by CIMT. This cross-sectional study included 100 adult women, aged 18-50 years. Anthropometric indices were measured with standard protocol and CIMT was measured by non-invasive ultrasound. Receiver Operating Characteristics (ROC) curve analysis was carried out to determine the optimal cut-off values of anthropometric indices, and the best indices for atherosclerosis diagnosis. On ROC curve analysis the suggested appropriate cut-offs of waist circumference (WC), waist to hip ratio (WHR), waist to height ratio (WHtR), body mass index (BMI) and percentage body fat (%BF) were 96 cm, 0.86, 0.64, 31.29 kg/m2 and 30.42%, respectively. The area under the ROC curve of BMI (AUC=0.74, 95%CI=0.62-0.86) and WHtR (AUC=0.74, 95%CI=0.63-0.85) were greater than other anthropometric indices. The AUC for WHR was the lowest among the studied obesity indices AUC=0.68 (95% CI=0.54-0.81). In our study, WHtR and BMI were the best diagnostic parameters of initial stage of atherosclerosis while WHR was the worst based on AUC.     

成人BMI与体脂含量和脂肪分布的关系

目的 :　调查成人超重和肥胖的发生率 ,探讨体质指数 ( BMI)与体脂含量、腰臀围之间的关系。方法 :　对 1 0 0 5名健康成年人进行人体测量 ,按 WHO对亚洲成年人的 BMI新定义分为 5组 ,对腰围、臀围、腰臀围比值和生物电阻抗法 ( BIA法 )及皮褶厚度法体脂含量的分布进行分析。结果 :　以 BMI法判断超重和肥胖的发生率 ,男性超重率和 度肥胖率明显高于女性 ,男女人群中 度肥胖发生率均较低 ;在相同 BMI组中 ,男性的平均年龄比女性低 ( P<0 .0 1 )。而 BIA法和皮褶厚度法肥胖检出率明显低于 BMI法 ,且女性体脂含量、三头肌皮褶厚度及肩胛下皮褶厚度显著高于男性。不同年龄组 BMI均与体脂含量呈显著正相关。女性超重组的腰围平均值为 80 cm,而男性 度肥胖组的腰围平均值 >90 cm。结论 :　男性超重和肥胖发生的年龄早于女性。以 BMI法判断肥胖和以 BIA法及皮褶厚度法体脂含量法判断肥胖有很大差别 ,仅以 BMI判断肥胖不够准确 ,尚需考虑年龄、性别及运动情况等影响因素。     

Waist circumference as a screening tool for weight management: evaluation using receiver operating characteristic curves for Malay subjects

Body Mass Index (BMI) is the most established anthropometric indicator used for assessment of nutritional status. Other anthropometric indicators which are related closely to BMI are waist hip ratio (WHR) and waist circumference. In this paper, receiver operating characteristics (ROC) curves were constructed to assess the value of waist circumference and waist hip ratio as a screening measure for the need of weight management using BMI as the reference test. Sensitivity and specificity were calculated at several cut-offs. The areas under the ROC curve calculated by comparing waist circumference with BMI were high (0.70 - 0.86) while the areas calculated for WHR were low (0.46 - 0.67). Sensitivities of 0.745 and 0.800 were observed at cut-off points of waist circumference at 90cm and 80cm for males and females respectively, while the false positive rates were 0.233 for males and 0.250 for females. These cut-off points could be considered as a fair trade-off. Therefore it is concluded that waist circumference performed better than WHR as a screening test. It is indicative that waist circumference could be used as a tool in raising awareness of weight management in this population.     

Larger thigh and hip circumferences are associated with better glucose tolerance: the Hoorn study

OBJECTIVE: A higher waist-to-hip ratio, which can be due to a higher waist circumference, a lower hip circumference, or both, is associated with higher glucose levels and incident diabetes. A lower hip circumference could reflect either lower fat mass or lower muscle mass. Muscle mass might be better reflected by thigh circumference. The aim of this study was to investigate the contributions of thigh and hip circumferences, independent of waist circumference, to measures of glucose metabolism. RESEARCH METHODS AND PROCEDURES: For this cross-sectional study we used baseline data from the Hoorn Study, a population-based cohort study of glucose tolerance among 2484 men and women aged 50 to 75. Glucose tolerance was assessed by a 75-g oral glucose tolerance test; hemoglobin A(1c) and fasting insulin were also measured. Anthropometric measurements included body mass index (BMI) and waist, hip, and thigh circumferences. RESULTS: Stratified analyses and multiple linear regression showed that after adjustment for age, BMI, and waist circumference, thigh circumference was negatively associated with markers of glucose metabolism in women, but not in men. Standardized beta values in women were -0.164 for fasting, -0.206 for post-load glucose, -0.190 for hemoglobin A(1c) (all p < 0.001), and -0.065 for natural log insulin levels (p = 0.061). Hip circumference was negatively associated with markers of glucose metabolism in both sexes (standardized betas ranging from -0.093 to -0.296, p < 0.05) except for insulin in men. Waist circumference was positively associated with glucose metabolism. DISCUSSION: Thigh circumference in women and hip circumference in both sexes are negatively associated with markers of glucose metabolism independently of the waist circumference, BMI, and age. Both fat and muscle tissues may contribute to these associations.     

单纯性肥胖症儿童血清同型半胱氨酸水平与糖尿病、心血管疾病发生的相关性

目的 探讨单纯性肥胖症儿童血清同型半胱氨酸水平与糖尿病、心血管疾病发生的相关性,为临床防治儿童单纯性肥胖提供参考依据。 方法 选择2016年8月-2017年12月来深圳市儿童医院儿童保健门诊就诊的53例单纯性肥胖儿童纳入肥胖组,以及同期在本院进行体格检查的82例健康儿童为正常组。采用化学发光法测定血清同型半胱氨酸(Hcy),分别检测两组儿童身高、体重、臀围、腰围,计算体重指数(BMI)、腰臀比(WHR)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、空腹血糖(FBG)、空腹胰岛素(FINS)、计算胰岛素分泌功能指数(HOMA-β)、稳态模型胰岛素抵抗指数(HOMA-IR);并对Hcy与各指标进行相关性分析。 结果 肥胖组儿童的血清Hcy水平明显高于正常组儿童的水平,差异有统计学意义(t=3.136,P＜0.05)。两组儿童身高比较差异无统计学意义(P＞0.05)。肥胖组体重、臀围、腰围、BMI、WHR均高于正常组,差异有统计学意义(P＜0.05)。肥胖组儿童的FBG、FINS、HOMA-IR高于对照组,HOMA-β低于对照组,差异均有统计学意义(P<0.05)。血清Hcy与BMI、WHR、FBG、FINS、HOMA-IR、TG、TC、LDL-C水平呈正相关(r=0.473~0.732,P＜0.05),与HOMA-β、HDL-C呈负相关(r=-0.774,-0.725,P＜0.05) 。 结论 单纯性肥胖儿童血清同型半胱氨酸升高,与糖尿病及心血管疾病密切相关,单纯性肥胖儿童应定期监测血清同型半胱氨酸水平。     

Predicting incident diabetes in Jamaica: the role of anthropometry

OBJECTIVE: To evaluate the performance of the body mass index (BMI), waist circumference, waist-to-hip ratio (WHR), and waist-to-height ratio (WHTR) in predicting incident diabetes in Jamaica. RESEARCH METHODS AND PROCEDURES: A cohort of 728 nondiabetic adults (290 men and 438 women), ages 25 to 74 years and residents of Spanish Town, Jamaica, were followed for a mean of 4 years. Participants had fasting and 2-hour postchallenge glucose concentrations measured at baseline and follow-up. RESULTS: There were 51 cases of incident diabetes (17 men and 34 women). All indices were independent predictors of diabetes, and none was clearly superior. The area under the receiver operating characteristics curves (95% confidence interval) for BMI was 0.74 (0.59 to 0.88) for men and 0.62 (0.51 to 0.72) for women. For waist circumference, these values were 0.78 (0.65 to 0.91) in men and 0.61 (0.50 to 0.71) in women. Similar results were obtained for WHR and WHTR. "Optimal" cut-off points for BMI were 24.8 kg/m(2) (men) and 29.3 kg/m(2) (women). For waist circumference, these were 88 cm and 84.5 cm for men and women, respectively. Corresponding values for WHR were 0.87 and 0.80 and for WHTR were 0.51 and 0.54, respectively. DISCUSSION: Cut-off points for waist circumference and WHR were similar to those proposed in developed countries for women but lower in men. Waist circumference could be useful in health promotion as an alternative to BMI.     

Evaluation of waist circumference, waist-to-hip ratio, and the conicity index as screening tools for high trunk fat mass, as measured by dual-energy X-ray absorptiometry, in children aged 3-19 y

BACKGROUND: A central fat pattern has adverse health implications in both children and adults. Because adiposity tracks from childhood into adulthood, the ability of simple anthropometric techniques to correctly measure truncal adiposity in childhood needs to be assessed. OBJECTIVES: We sought to assess the validity of waist circumference, waist-to-hip ratio (WHR), and the conicity index as indicators of trunk fat mass in children and adolescents. DESIGN: Trunk fat mass (kg) was measured with dual-energy X-ray absorptiometry in 278 girls and 302 boys aged 3-19 y. Receiver operating characteristic (ROC) curves and areas under the curves (AUCs) for the ROCs were calculated to compare the relative abilities of the anthropometric measures to correctly identify children with high trunk fat mass (z score for our study population of > or =1). RESULTS: The 80th percentile for waist circumference correctly identified 89% of girls and 87% of boys with high trunk fat mass (sensitivity) and 94% of girls and 92% of boys with low trunk fat mass (specificity). Waist circumference performed significantly better as an index of trunk fat mass than did WHR or the conicity index, as shown by the AUCs in girls and boys, respectively: waist circumference AUCs = 0.97 and 0.97, conicity index AUCs = 0.80 and 0.81, and WHR AUCs = 0.73 and 0.71. Our cutoffs for high trunk fat mass and high waist circumference are provided for both sexes for each year of age. CONCLUSION: Waist circumference provides a simple yet effective measure of truncal adiposity in children and adolescents.