青少年腰围与代谢综合征相关性分析

目的 探讨青少年腰围与代谢综合征(MS)之间的关系.方法 选取2006年河北省秦皇岛市流行病学调查中检出的18岁腹型肥胖青少年49例,随机选取同期18岁腹围正常青少年49名,测量所有入选者的身高、体重、腰围、血压、空腹血糖(FPG)、三酰甘油(TG)、胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)及低密度脂蛋白胆固醇(LDL-C),比较两组MS检出率,分析腰围与MS的关系.结果 腹型肥胖组中MS检出6例(12.2%).腹型肥胖组95.9%存在至少1种MS组分.男女腹型肥胖组青少年体重、体重指数(BMI)、收缩压(SBP)、舒张压(DBP)、TG明显升高,HDL-C明显下降.超重肥胖、高血压、高SBP、高DBP、高TG和低HDL-C检出率均明显高于对照组.腰围与BMI(r=0.694)、体重(r=0.878)、SBP(r=0.508)、DBP(r=0.391)、LDL-C(r=0.398)呈显著正相关(P＜0.05).结论 腹型肥胖与MS密切相关,腰围测量有助于青少年MS筛查.     

Effect of aging on the relationship between multiple risk factors and waist circumference

OBJECTIVE: To examine the relationship between various coronary risk factors and the different levels of fat distribution in younger (<65 years) and older (> or = 65 years) men and women, using the classifications proposed by the National Heart, Lung and Blood Institute (NHLBI) and the World Health Organization (WHO). DESIGN: Cross-sectional study of subjects enrolled in the Baltimore Longitudinal Study of Aging. MEASUREMENTS: Systolic blood pressure, diastolic blood pressure, fasting glucose, 2-hour glucose, fasting insulin, homeostasis model assessment insulin resistance (HOMAIR), triglyceride, total cholesterol, high-density lipoprotein (HDL)-cholesterol, and low-density lipoprotein (LDL)-cholesterol were measured as risk factors. The proportion of subjects with abnormal risk factor levels by waist circumference classifications was determined in the age and gender subgroups. RESULTS: There were significant adverse effects of age per se on all risk factors with the exception of fasting insulin and HOMAIR in both men and women, total cholesterol in men, and diastolic blood pressure in women. HDL-cholesterol was higher in older subjects. There were significant correlations between waist circumference and all of the risk factors in the younger group. Waist circumference did not have a significant correlation with total cholesterol in older men, or with total cholesterol and LDL-cholesterol in older women. The proportion of subjects with an abnormal risk factor level increased with increasing waist circumference for most risk factors in both younger and older subjects, but proportions of subjects in each individual waist group were higher in older than in younger groups for systolic blood pressure, diastolic blood pressure, fasting glucose, and 2-hour glucose in men, and for systolic blood pressure, fasting glucose, 2-hour glucose, total and LDL-cholesterol, and triglyceride in women. CONCLUSIONS: Our data indicate that the waist circumference cutpoints proposed by NHLBI and WHO standards are useful for the prediction of cardiovascular disease risk factors in older as well as in younger men and women.     

中国成人多重心血管危险因素聚集的最佳腰围切割点

目的探讨中国成人多重心血管危险因素聚集的最佳腰围切割点。方法分析1994年全国糖尿病普查的15628例年龄≥25岁的中国成人资料。以腰围〈70cm组（每隔5cm分为一组）作为对照,计算其他各组发生多重心血管危险因素的优势比OR值和95％CI。采用ROC曲线分析计算不同腰围水平对多重心血管危险因素聚集识别的敏感性和特异性,以诊断指数（诊断指数=1-假阳性-假阴性）最大的腰围作为最佳切割点。结果无论男性还是女性。胰岛素抵抗、血脂异常、高血压和高血糖的百分比均随着腰围的增加而增加。男性腰围≥85cm、女性腰围≥80cm后发生代谢综合征的OR值显著增加[分别为2．08（95％CI1．80-2．39）和1．66（95％CI1．41-1．97）1。ROC分析显示以上相应腰围切割点具有最佳的敏感性和特异性。结论反映中国成人多重心血管危险因素聚集的男性最佳腰围切割点为85cm、女性为80cm。     

Does the relationship between waist circumference,morbidity and mortality depend on measurement protocol for waist circumference?

There is currently no consensus regarding the optimal protocol for measurement of waist circumference (WC), and no scientific rationale is provided for any of the WC protocols recommended by leading health authorities. A panel of experts conducted a systematic review of 120 studies (236 samples) to determine whether measurement protocol influenced the relationship of WC with morbidity of cardiovascular disease (CVD) and diabetes and with mortality from all causes and from CVD. Statistically significant associations with WC were reported for 65% (152) of the samples across all outcomes combined. Common WC protocols performed measurement at the minimal waist (33%), midpoint (26%) and umbilicus (27%). Non-significant associations were reported for 27% (64) of the samples. Most of these protocols measured WC at the midpoint (36%), umbilicus (28%) or minimal waist (25%). Significant associations were observed for 17 of the remaining 20 samples, but these were not significant when adjustment was made for covariates. For these samples, the most common WC protocols were the midpoint (35%) and umbilicus (30%). Similar patterns of association between the outcomes and all WC protocols were observed across sample size, sex, age, race and ethnicity. Our findings suggest that WC measurement protocol has no substantial influence on the association between WC, all-cause and CVD mortality, CVD and diabetes.     

中国成人代谢综合征腰围切点的研究

目的　根据中国成人较近期的调查数据 ,分析代谢综合征中腰围的适宜切点。方法　利用国家“九五”科技攻关课题 1998年在 15组人群进行心血管病危险因素调查 13732例 35～ 5 9岁成人的数据库 ,分析男性和女性不同腰围水平和代谢综合征其他成分聚集的关系 ,并寻找检出两个及以上危险成分假阳性和假阴性率均较低的腰围切点 ,作为成人腰围切点的建议。据此计算各性别年龄组代谢综合征的患病率 ,以及成分组合特点。结果　随腰围增大 ,代谢综合征成分聚集的OR值显著增高 ,以男性腰围≥ 85cm ,女性腰围≥ 80cm ,ROC曲线距离最短。以此为腰围切点中年男性人群代谢综合征患病率为 19 3% ,女性为 13 9% ,其中以腰围超标 ,血压升高和高甘油三酯三项的组合为最多。结论　建议男性腰围≥ 85cm ,女性腰围≥ 80cm ,收缩压≥ 130mmHg(1mmHg =0 133kPa)和 (或 )舒张压≥ 85mmHg ,血清甘油三酯≥ 1 6 9mmol/L ,高密度脂蛋白胆固醇 <1 0 3mmol/L ,空腹血糖≥ 6 1mmol/L ,5项中具备 3项及以上作为中国成人代谢综合征的临床检出标准。以上初步结果需要在有全国代表性的样本中进一步验证。     

Association of change in waist circumference and dyslipidaemia risk: The rural Chinese cohort study

Objective

To investigate the association of change in waist circumference (WC) and incidence of dyslipidaemia in a cohort study of a rural Chinese population.

Methods

Change in WC (ΔWC) was defined as the value at follow‐up minus the corresponding value at baseline. Risk of dyslipidaemia associated with ΔWC was assessed by odds ratios and 95% confidence intervals in a logistic regression model, and the odds ratios were transformed to relative risks (RRs).

Results

Among 7691 participants without dyslipidaemia at baseline, 3213 (41.78%) showed dyslipidaemia at 6 year follow‐up. Risk of dyslipidaemia was decreased for participants with the first quartile of ΔWC and normal baseline WC (adjusted RR [aRR] = 0.79 [95% confidence interval: 0.64‐0.98]) and was increased with the fourth quartile of ΔWC and male gender, age 18 to 30 years, age 31 to 50 years, or normal baseline WC (aRR = 1.55 [1.19‐2.03], 2.40 [1.16‐4.95], 1.32 [1.06‐1.64], and 1.66 [1.35‐2.04], respectively). The risk of dyslipidaemia increased with change in WC from normal at baseline to abnormal at follow‐up for both genders (aRR = 1.88 [1.39‐2.55] for men and 1.60 [1.30‐1.97] for women) and decreased with abnormal baseline WC changed to normal WC for women (aRR = 0.61 [0.45‐0.83]).

Conclusions

Dynamic change in waist circumference was closely related to the incidence of dyslipidaemia in a rural Chinese population. Waist circumference reduction could decrease dyslipidaemia risk, whereas WC increase may increase the risk. Interventions to control or reduce WC to within the normal range are important for early prevention of dyslipidaemia.     

Large waist circumference and risk of hypertension

OBJECTIVE: To examine the relationship between 24 h ambulatory blood pressure monitoring and three commonest anthropometric measurements for obesity--body mass index (BMI), waist-to-hip ratio (WHR) and waist circumference (W). DESIGN: Cross-sectional survey among outpatients at the Obesity Research Center. SUBJECTS AND METHODS: Four-hundred and sixty-one overweight or obese subjects, non-diabetic, otherwise healthy, aged 20-70 y, of either sex, were consecutively recruited. All subjects underwent 24 h ambulatory blood pressure monitoring. The population study was separated in normotensive and hypertensive males and females and the possible risk factors for hypertension (W, WHR, BMI and age) were subdivided into different classes of values. RESULTS: Logistic regression shows that W is the most important anthropometric factor associated with the hypertensive risk. Among males with W> or =102 cm the odds ratio (OR) for hypertension is three times that of males with W<94 cm using casual BP measure (OR 3.04), nearly four times higher using 24 h BP mean (OR 3.97), and even five times higher using day-time BP mean (OR 5.19). Females with W> or =88 cm have a risk for hypertension twice that of females with W<80 cm, whatever BP measurement was take (casual, 24 h or day-time). Males with WHR> or =0.96 and females with WHR> or =0.86 show significant OR for hypertension only by 24 h BP measurement and by day-time BP measurement. BMI seems to have no significant relationship to hypertensive risk. Age shows a significant relationship to hypertensive risk only considering males aged > or =55 y and females aged > or =50 y. CONCLUSION: The waist circumference seems to have a strong association with the risk of hypertension, principally by the ambulatory BP monitoring, when compared with casual BP measurement.     

我国维吾尔族成人代谢综合征腰围适宜切点研究

目的研究我国维吾尔族成人代谢综合征（MS）诊断中腰围的适宜切点。方法以乌鲁木齐市和喀什地区2526例25-90岁维吾尔族成人为研究对象，以国际糖尿病联盟（IDF）MS全球共识诊断标准为基础，分析维吾尔族男女不同腰围水平与MS其他组分聚集的关系，检出至少两个组分存在时假阳性率和假阴性率均较低的腰围界限，作为诊断维吾尔族成人MS腰围切点，并以此计算不同年龄组MS的检出率及成分组合特点。结果随腰围增大，MS组分聚集的OR值显著增高。在我们所划分的切点中，当男性腰围≥93cm、女性腰围≥89cm时，ROC曲线距离最短。以此腰围切点计算维吾尔族成人的MS检出率，男性为26．0％，女性为27．7％。结论建议维吾尔族以男性腰围≥93cm、女性腰围≥89cm为切点，结合IDF诊断标准中其他组分定义，作为维吾尔族成人MS的临床检出标准。以上结果有待在更大样本量的维吾尔族人群中进一步验证。     

腰围身高比值与2型糖尿病心血管病危险因素的关系

目的探讨腰围身高比值（WHtR）用于2型糖尿病（T2DM）评估腹型肥胖及其与心血管病危险因素的关系。方法新诊断T2DM患者4ll例，测血压、血糖、血脂、身高、体重、腰围（WC）、臀围，计算BMI、WHtR及腰臀比（WHR），分析WHtR、BMI、WC及WHR与身高的关系，各肥胖指数与血压、血脂的关系。结果（1）WHtR与血压、TG及HDL-C的相关程度均大于与BMI、WC、wHR的相关程度。WHtR与高血压、高TG及低HDL-C均显著相关。结论WHtR升高与血压、血脂关系密切，可作为评估腹型肥胖及预测T2DM心血管疾病危险因素指标之一。     

Evaluation of metabolic syndrome risk in Korean premenopausal women: not waist circumference but visceral fat

BACKGROUND: In clinical practice, using the patient's waist circumference (WC) to evaluate visceral obesity may underestimate disorders with a metabolic origin. This study examined whether or not the WC derived from the cut-off point of the visceral fat area (VFA) can reflect the features of metabolic syndrome (MetS) in premenopausal women. METHODS AND RESULTS: Computed tomography-scanned VFA, MetS components and the concentrations of high-sensitivity C-reactive protein (CRP) and adiponectin were measured in a total of 349 premenopausal women. The VFA at the L1 and the L4 sites was a significant index (p<0.001) of incremental MetS risk. Receiver-operating characteristic curve analysis showed that 75 cm2 of VFA at L4 and 87.5 cm2 at L1 were the optimal thresholds for discrimination of MetS risk. Significant differences in all MetS components, as well as CRP (p<0.05) and adiponectin levels (p<0.005), were observed when subjects were subdivided by the L4 VFA cut-off point (<75/>or=75 cm2), whereas there was a significant difference only in the triglycerides level in the groups divided by WC (WC<88/>or=88 cm). Moreover, subjects with a lower WC-higher VFA showed a similar pattern in MetS components and lower adiponectin than those with a higher WC-higher VFA. CONCLUSIONS: This study clarified that VFA rather than WC is a major determinant of MetS risk in premenopausal women.     

Hypoadiponectinaemia enhances waist circumference as a predictor of glucose intolerance and clustering of risk factors in Chinese men

AimThis study aimed to confirm the hypothesis that adiponectin levels can enhance the discriminative value of waist circumference (WC) in predicting impaired glycaemic status and clustering of risk factors.MethodsWe used receiver operating characteristic (ROC) curve analysis to define the optimal cut-off value of adiponectin to predict diabetes in Chinese men with no relevant past medical history. This value was combined with WC to increase its discriminative power in ascertaining impaired glycaemic status and various cardiovascular risk factors.ResultsIn 360 men (mean ± S.D.; age: 41.3 ± 9.2 years), the mean ± S.D. adiponectin level was 5.2 ± 2.7 μg/mL. Based on oral glucose tolerance tests (OGTTs), 84 men (23.3%) had undiagnosed diabetes, 52 (14.4%) had impaired glucose tolerance (IGT) and 224 (62.3%) had normal glucose tolerance. On ROC analysis, 5.7 μg/mL was the optimal cut-off value of adiponectin in this population to predict diabetes. Compared with subjects who had normal WC (defined as less than 90 cm) and high adiponectin levels (≥ 5.7 μg/mL), the likelihood ratio of diabetes was 2.54 in those with central obesity and hypoadiponectinaemia.ConclusionThe combined use of low adiponectin levels and large WC measures has greater discriminative power than using either index alone to identify subjects at particular risk of glucose intolerance and clustering of risk factors.     

Influence of age on the relation between waist circumference and cardiometabolic risk markers

Background and aimsTo determine whether the relation between waist circumference (WC) and cardiometabolic risk markers is attenuated with advancing age.Methods and resultsThe study population consisted of 5222 adults from the 1999 to 2004 U.S. National Health and Nutrition Examination Survey, a nationally representative cross-sectional study. Study variables were assessed in a clinical exam. Subjects were grouped into low, moderate, and high sex-specific WC tertiles. The cardiometabolic risk markers examined consisted of insulin resistance (HOMA method), high C-reactive protein, hypertension, and high LDL-cholesterol. Logistic regression was used to determine and compare the association between WC categories with high-risk cardiometabolic risk marker values within young (20–39 years), middle-aged (40–59 years), and older (60+ year) adults. With few exceptions, within each of the three age categories, individuals with a moderate and high WC were significantly more likely to have elevated cardiometabolic risk markers than individuals with a low WC. There was a significant interaction between age and WC indicating that the relation between WC with insulin resistance, high CRP, and hypertension was attenuated in older adults. For example, the odds ratio for hypertension in those with a high relative to low WC was 11.07 (95% CI: 6.13–20.00) in young adults, 3.67 (2.47–5.46) in middle-aged adults, and 2.68 (2.00–3.59) in older adults. Similar observations were made for BMI to those reported for WC.ConclusionsA high WC was associated with elevated cardiometabolic risk markers irrespective of age. However, the association between WC and cardiometabolic risk markers was greatly attenuated with advancing age.     

The relationship of waist circumference to blood pressure: the Olivetti Heart Study

BACKGROUND: The association between overweight, high blood pressure (BP), and insulin resistance is well established, but the role of body fat distribution in this association has yet to be fully elucidated. The aim of this study was to investigate the role of central adiposity in the association between overweight, high BP, and insulin resistance. METHODS: A total of 1,079 men participated in the follow-up of the Olivetti Heart Study from 1994 to 1995. The present analysis includes 768 men, after the exclusion of 184 participants on pharmacological treatment for hypertension. In 65 men fasting blood glucose was >7 mmol/L; in 48, age was below or above 2 standard deviations from the mean of the population; and in 14 the data set was incomplete. Anthropometric indices of adiposity, metabolic variables (including fasting serum insulin and homeostasis model assessment [HOMA] index of insulin sensitivity), and BP were measured. RESULTS: In univariate analysis, waist circumference was the anthropometric index that best correlated with BP (P < .001). In multiple regression analysis, waist circumference remained the strongest independent predictor of BP after adjustment for confounders. Significant increase of systolic (P value for trend analysis < .001) and diastolic (P < .001) pressure, heart rate (P = .003), fasting and postload serum insulin (P < .001), and HOMA index of insulin sensitivity (P < .001) were observed across age-adjusted quintiles of waist circumference. Greater degrees of central adiposity were associated with higher prevalence of elevated BP values and insulin resistance (P value < .001, chi2 for linear trend). CONCLUSIONS: In middle-aged men, a central distribution of body fat is associated with increased BP, independently of body mass index and insulin resistance, thus suggesting a key role of central adiposity in the full expression of the "metabolic syndrome."     

The relationship between body mass index and waist circumference: implications for estimates of the population prevalence of overweight

OBJECTIVE: Body mass index (BMI) based on self-reported height and weight is a systematically biased, but acceptable measure of adiposity and is commonly used in population surveys. Recent studies indicate that abdominal obesity is more strongly associated with obesity-related health problems than is adiposity measured by BMI. The purpose of this study was to determine the relationships of both measured and self-reported BMI with measured waist circumference in a randomly selected sample of Australian adults. DESIGN: Cross-sectional survey with self-reported and laboratory-based measures of adiposity. SUBJECTS: 1140 randomly-selected Australian adults aged 18-78 y resident in the city of Adelaide, South Australia. MEASUREMENTS: Data on self-reported and measured height and weight as well as measured waist circumference were drawn from the Pilot Survey of the Fitness of Australians database. The proportion of men and women with acceptable BMI (BMI/=94 cm for men and >/=80 cm for women) was determined. Differences in the prevalence of overweight based on BMI alone or BMI and waist circumference were also determined. RESULTS: Compared with the prevalence based on self-reported BMI alone, the prevalence of overweight among men based on self-reported BMI and waist circumference combined was 2.4%, 5.3%, 19.1% and 7.5% greater for men aged 18-39 y, 40-59 y, 60-78 y and for all men, respectively. Among women, compared with the prevalence based on self-reported BMI alone, the prevalence of overweight based on the combined measures was 9.9%, 24.0%, 33.3% and 20.6% greater for women aged 18-39 y, 40-59 y, 60-78 y and for all women, respectively. CONCLUSIONS: If waist circumference is used as the criterion, then the prevalence of overweight among Australian adults, and probably other Caucasian populations, may be significantly greater than indicated by surveys relying on self-reported height and weight. The development of valid self-reported measures of waist circumference for use in population surveys may allow more accurate epidemiological monitoring of overweight and obesity.     

Visceral adipose tissue,but not waist circumference is a better measure of metabolic risk in Singaporean Chinese and Indian men

Objectives:

Visceral adipose tissue (VAT) is an independent risk factor in cardiometabolic diseases and is commonly measured by computed tomography (CT). It is measured clinically by waist circumference (WC). The L4/5 intervertebral space VAT (L4/5 VAT) is traditionally used to represent total VAT volume. We set out to determine (1) the level of intervertebral space on CT that best approximates the total VAT volume; (2) compare the association between WC and VAT in Singaporean Chinese and Indian; and (3) examine the correlation between VAT and cardiometabolic risk factors.

Subjects:

A total of 60 Chinese and 60 Asian Indian men older than 60 years were recruited. Their medical history was taken and anthropometry was measured. Fasting glucose, insulin, lipids, adipokines and inflammatory markers were measured. Insulin resistance was evaluated by homeostasis model assessment-insulin resistance. VAT was determined by CT. Total VAT volume was calculated in 22 patients from VAT areas at seven intervertebral levels. The optimal VAT area most representative of total VAT volume was determined and used for all patients to approximate total VAT volume.

Results:

The VAT area at L2/3 intervertebral space (L2/3 VAT) correlated almost perfectly with VAT volume (R²=0.974 and 0.946 for Chinese and Indians, respectively). Subjects from the two races had similar height, weight, body mass index (BMI), WC and L2/3 VAT but more Indian men had hypertension, hyperlipidemia and type 2 diabetes mellitus. WC was correlated with the L2/3 VAT area in both Chinese (r=0.484, P<0.001) and Indian subjects (r=0.366, P=0.004) without racial difference (P=0.2 for interaction term). L2/3 VAT also correlated better with cardiometabolic risk factors, adipokines and C-reactive protein than WC, BMI or L4/5 VAT.

Conclusion:

The L2-L3 intervertebral space was the best anatomic level for a single-slice CT cross-sectional area measurement of VAT to approximate total body visceral adipose volume in this population of Chinese and Asian Indian men older than 60 years. L2/3 VAT was better correlated with multiple cardiovascular risk factors, adipokines and inflammatory marker than either L4/5 VAT, WC or BMI.     

腰围与心率变异性相关性分析

目的探讨腰围对心率变异性（HRV）的影响。方法193例研究对象按腰围分为正常与异常两组。检测HRV、BMI、腰围、腰臀比、脂肪含量、脂肪比例、FPG、TC、TG、HDL-C、LDL-C、血尿酸等指标。结果腰围异常组除LF/HF外HRV各指标均低于正常组（P〈0.01）;协方差分析校正年龄、性别、吸烟、腰围、SBP、DBP、FPG、TC、TG、HDL-C、LDL-C、血尿酸后HRV所有指标差异均有统计学意义（P〈0.01）。结论腰围可影响HRV,腰围异常时HRV降低。