中国成年人代谢异常相关的体质指数和腰围切点研究

The cut-off points of body mass index and waist circumference for predicting metabolic risk factors in Chinese adults

目的研究中国成年人BMI和腰围与各项代谢危险因素之间的相关性,确定超重肥胖的适宜BMI和腰围切点。方法中国慢性病前瞻性研究于2004-2008年进行基线调查,并于2013-2014年随机抽取了5%的研究对象进行第2次重复调查。本研究剔除体格指标或代谢危险因素变量缺失或极端值、自报患有恶性肿瘤者,基线纳入501201人,第2次重复调查纳入19201人。比较不同BMI和腰围下代谢危险因素异常率,通过受试者工作特征(ROC)曲线分析,确定预测高血压、糖尿病、血脂异常和危险因素聚集的适宜BMI和腰围切点。结果随BMI或腰围的增加,高血压、糖尿病、血脂异常和危险因素聚集患病率均呈现上升的趋势。依据正确指数最大的原则选取BMI超重切点和腰围切点,男性和女性BMI超重切点均接近24.0 kg/m^2,男性腰围切点接近85 cm,女性腰围切点约为80~85 cm。男性和女性中,检出各项代谢危险因素特异度达到90%的BMI切点范围为27.0~28.9 kg/m^2,多数接近28.0 kg/m^2,以28.0 kg/m^2作为肥胖切点。结论本研究在更新开展的大样本调查中进一步验证了中国肥胖问题工作组2002年推荐的超重和肥胖标准,超重和肥胖的BMI切点分别为24.0和28.0 kg/m^2;中心性肥胖的腰围适宜切点男性为85 cm,女性为80~85 cm。

Objective To assess the association of BMI and waist circumference(WC)with metabolic risk factors,and confirm the appropriate cut-off points of BMI and WC among Chinese adults.Methods After excluding participants with missing or extreme measurement values,as well as individuals with self-reported histories of cancer,a total of 501201 adults in baseline and 19201 adults in the second re-survey from the China Kadoorie Biobank were included.The associations of BMI and WC with metabolic risk factors were estimated.Receiver operating characteristic(ROC)analyses were conducted to assess the appropriate cut-off values of BMI and WC to predict the risk of hypertension,diabetes,dyslipidemia and clustering of risk factors.Results The prevalence of hypertension,diabetes,dyslipidemia and clustering of risk factors all presented ascending trends with the increasing levels of BMI or WC.Defined as the points on the ROC curve where Youden's index reached the highest,the appropriate overweight cut-off points of BMI were around 24.0 kg/m2 both in men and women,and the points of WC were around 85 cm in men and 80 to 85 cm in women.With specificity 90%for identification of risk factors,the appropriate obese cut-off points of BMI were around 28.0 kg/m^2 both in men and women,with the range of 27.0 to 28.9 kg/m^2.Conclusions The cut-off points for overweight and obesity recommended by Coorperative Meta-analysis Group of China Obesity Task Force was verified in the large sample survey conducted more recently.The cut-off points of BMI were 24.0 and 28.0 kg/m2 for overweight and obesity,and the cut-off point of WC was 85 cm in men and 80 to 85 cm in women for central obesity.