中国三省成年居民肥胖指标与高血压和血脂异常的关系

Association of obesity indexes with hypertension and dyslipidemia in Chinese adults

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),P<0.001],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),P<0.001]。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。

Objective To explore the association of obesity indicators with hypertension and dyslipidemia in adults.Methods The study used anthropometric data of 1022 adults aged 18-69 years in Liaoning,Henan and Hunan Provinces in 2012 to describe the overweight and obesity rate of body mass index (BMI),waist circumference (WC),waist to height ratio (WHtR),waist hip ratio (WHR)and body fat percentage (BF%).The ability of indicators to predict the risk of hypertension and dyslipidemia was evaluated by receiver operating characteristic (ROC)curve analysis.Results In comparison of anthropometric measurements,male WC was significantly higher than female,thigh circumference (ThC)was no gender differences and thigh height ratio (THtR)lower in men .than in women.The obesity index was used to determine the overweight and obesity rate of Chinese adults:WHtR >WHR >BMI >BF%>WC was 58.7%,50.4%,49.1%,35.7% and 35.3%,respectively.The obesity rate of BMI was 13.2%,significantly lower than other indicators.The ROC curve illustrated area under curve(AUC)of WHtR was the largest in predicting the risk of hypertension,and the cutoff values were 0.53 and 0.56 in male and female.AUC of WHR were the largest with hypercholesterolemia as dependent variables in male and female and as the only significant indicator in men.The value of BMI,WC,WHtR,WHR and BF% to predict the risk of hypertriglyceridemia was similar.ThC and THtR had a better prognosis value than BMI, WC,WHtR and other common indicators in low high-density lipoprotein cholesterolemia, especially in male residents.The cut-off values of ThC were 52.50 and 55.40,and the cut-off values of THtR were 0.31 and 0.35 in male and female.Conclusion Men are more likely to hoard fat in the abdomen,female fat easily in the thigh accumulation. WHtR is the best index in predicting the risk of hypertension.The association between obesity indexes and different clinical classification of dyslipidemia are not the same :WHR shows the best effect in predicting the risk of hypercholesterolemia,BMI,WC,WHtR, WHR and BF% have the same value in predicting the risk of hypertriglyceridemia,ThC and THtR are better than BMI,WC,WHtR and other common indicators in predicting the risk of low high-density lipoprotein cholesterolemia,especially in male residents.