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

Predictive values of body mass index and waist circumference to risk factors of related diseases in Chinese adult population

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年以后的调查资料入选 ,共计 2 0～ 70岁以上成人 2 39972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 2 1个省市、自治区和台湾。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切点 2 4为中国成人超重的界限 ,特异度达 90 %的BMI切点 2 8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 2 4以下 ,可能防止人群中 45 %～ 5 0 %的危险因素聚集。对BMI在2 8及以上者用药物控制到此切点以下 ,可能防止 15 %～ 17%的危险因素聚集 ,从而降?

Objective For prevention of obesity in Chinese population, it is necessary to define the optimal range of healthy weight and the appropriate cut-off points of body mass index (BMI) and waist circumference for Chinese adults. The Working Group on Obesity in China (WGOC) under the support of International Life Sciences Institute Focal point in China organized a meta-analysis on the relation between BMI, waist circumference and risk factors of related chronic diseases. Methods All together 13 population studies met the criteria for enrollment, with data of 239 972 adults (20-70 year) surveyed in the 1990s. Data on waist circumference was available for 111 411 persons and data on serum lipids and glucose were available for more than 80 000. The study populations located in 21 provinces, municipalities and autonomous regions in China's Mainland as well as in Taiwan. Each enrolled study group provided data according to a common protocol and uniform format. The center for data management in the Department of Epidemiology,Fu Wai Hospital was responsible for statistical analysis. Results The prevalence of hypertension, diabetes,dyslipidemia and clustering of risk factors all increased with increasing levels of BMI or waist circumference. BMI at 24 with best sensitivity and specificity for identification of the risk factors, was recommended as the cut-off point for overweight since and BMI at 28 which might identify the risk factors with specificity around 90% to be recommended as the cut-off point for obesity. Waist circumference beyond 85 cm for men and beyond 80 cm for women were recommended as the cut-off points for central obesity. Conclusions Analysis of population attributable risk percent illustrated that reducing BMI to normal range (<24) could prevent 45%-50% clustering of risk factors. Treatment of obese persons ( BMI≥28) with drugs could prevent 15%-17% clustering of risk factors. Control the waist circumference under 85 cm for men and under 80 cm for women, could prevent 47%- 58% clustering of risk factors. According to these results of meta-analysis, the classification of overweight and obesity for Chinese adults was recommended.