基于不同体块指数筛查标准的2011年北京市儿童青少年超重和肥胖检出率比较研究

目的 描述2011年北京市7~18岁儿童青少年超重和肥胖的检出率，并比较基于不同BMI筛查标准的检出率的差异。方法 研究对象为2011年北京市中小学体检的7~18岁学龄儿童青少年。采用BMI作为评价超重和肥胖的指标。超重和肥胖筛查分别采用4种不同的国内（CN2010和WGOC）和国际（IOTF和WHO2007）标准。不同BMI筛查标准之间超重、肥胖检出率比较采用McNemar检验。结果 ①92 212名男女生BMI在P50、P85和P95上均显著高于全国水平(2009年“中国0~18岁儿童青少年体块指数的生长曲线”)，男女生在对应百分位曲线上无交叉现象，男生BMI水平高于女生。②基于CN2010和WGOC标准，男生肥胖检出率分别为17.8%和18.2%，女生检出率分别为10.8%和10.9%；基于IOTF和WHO2007标准，男生肥胖检出率分别为12.9%和21.0%，女生检出率分别为6.0%和8.6%。③基于CN2010和WGOC标准，男生超重（含肥胖）检出率两标准间差异无统计学意义，均为36.0%，各年龄组差异亦不明显，但女生检出率CN2010标准高于WGOC标准（28.1％ vs 24.1%），在7~15岁组差异较为明显，但在16~18岁组差异较小；与国际标准相比，基于国内标准的男生超重（含肥胖）检出率略高于IOTF标准，但却明显低于WHO2007标准，女生检出率超重（含肥胖）明显高于IOTF标准，但与WHO2007标准较为接近。④与基于WGOC标准的2004年北京市7~18岁儿童青少年超重和肥胖检出率相比，2011年超重和肥胖检出率显著增长，男女肥胖检出率分别增长5.8%和3.8%，超重（含肥胖）检出率分别增长9.3%和7.6%。结论 2011年北京市7~18岁学生中有1/3处于超重或肥胖状态。国内标准与国际标准存在明显差异，在反映中国儿童的超重肥胖流行状况时建议采用国内标准，而理想的国内标准应实现2～18岁的统一，并与成人接轨。

Updated prevalence of overweight and obesity among children and adolescents in Beijing in 2011 based on different BMI cutoffs

Objective To describe the prevalence of overweight and obesity among children and adolescents aged 7-18 years in Beijing in 2011 and compare the differences in the prevalence based on different BMI cutoffs. Methods A total of 92 212 children and adolescents aged 7-18 years in Beijing in 2011 were included in this study. Overweight and obesity were defined as the cutoffs of BMI of two Chinese norms (CN2010 and WGOC) and two international criteria (IOTF and WHO2007). The differences of the prevalence of overweight and obesity based on different standards were compared using McNemar test. Results ①The growth level of BMI in P50, P85 and P95 in Beijing children and adolescents was higher than that of national BMI reference, no crosses occurred in the corresponding percentiles between both sexes and the level of BMI was always higher in boys than girls.②Based on the CN2010 and WGOC, the prevalence of obesity was 17.8% and 18.2% for boys and 10.8% and 10.9% for girls, respectively. Based on the IOTF and WHO2007, the prevalence of obesity was 12.9% and 21.0% for boys and 6.0% and 8.6% for girls, respectively. ③Using the CN2010 and WGOC, the prevalence of overweight (including obesity) were both 36.0% for boys, but the prevalence based the CN2010 (28.3%) was higher than 24.1% based on the WGOC for girls. In contrast, the prevalence of overweight (including obesity) for boys based on these Chinese norms was higher than that based on the IOTF but lower than based on the WHO2007; the prevalence for girls was higher than that based on the IOTF but close to that based on the WHO2007. ④Compared with the prevalence in 2004 based on WGOC, the prevalence of overweight and obesity among children aged 7-18 years in 2011 increased sharply, with 5.8% and 3.8% of increased rates of prevalence of obesity for boys and girls and 9.3% and 7.6% of increased rates of prevalence of overweight (including obesity). Conclusion About one third of children and adolescents aged 7-18 years were at overweight or obesity in Beijing in 2011. Significant differences in prevalence were observed between Chinese BMI norms and international criteria, Chinese BMI cutoffs were recommended to truly describe epidemiological status of overweight and obesity among children and adolescents in Beijing. Further, the ideal Chinese norm should achieve the unity of the screening criteria at age of 2 to 18 years and the consistency with adult standards at age of 18 years.