不同代谢健康超重/肥胖标准的比较

Comparison of criteria for metabolically healthy overweight/obesity in Shanghai Changfeng study

目的在上海长风社区45岁以上人群中比较不同代谢健康超重/肥胖(metabolically healthy overweight/obesity,MHO/O)标准,提出较为合理且适合我国人群的工作标准。方法在上海长风社区45岁以上3301例(男性1521例,女性1780例)超重/肥胖受试者中,根据目前7个不同的MHO/O标准,评估MHO/O检出率及检出率随体重指数(BMI)的变化趋势,并比较不同标准MHO/O的临床生化指标的差异。评估标准根据是否包含腰围、稳态模型法评估的胰岛素抵抗指数(HOMA-IR)≥2.5指标分为美国国家胆固醇教育计划成人治疗组Ⅲ(ATP-Ⅲ)标准(包括腰围)、ATP-Ⅲ标准(不包括腰围)、改良的代谢相关性脂肪肝病(MAFLD)标准,根据三类标准中代谢组分异常的数量(<1即含有0条,<2即含有0~1条,依次类推)进一步分为:ATP-Ⅲ(包括腰围)<1、ATP-Ⅲ(包括腰围)<2、ATP-Ⅲ(包括腰围)<3、ATP-Ⅲ(不包括腰围)<1、ATP-Ⅲ(不包括腰围)<2、改良的MAFLD标准<1、改良的MAFLD标准<2,共7个。结果ATP-Ⅲ(包括腰围)<1、ATP-Ⅲ(包括腰围)<2、ATP-Ⅲ(包括腰围)<3、ATP-Ⅲ(不包括腰围)<1、ATP-Ⅲ(不包括腰围)<2、改良的MAFLD标准<1、改良的MAFLD标准<2的MHO/O检出率分别为2.85%、15.48%、39.87%、8.00%、33.66%、2.33%、12.24%。MHO/O检出率随BMI的升高而降低,当BMI≥28 kg/m^(2)时,ATP-Ⅲ(包括腰围)<1和改良的MAFLD标准<1标准的MHO/O检出率为均0。结论不含改良的MAFLD标准中异常组分的标准是较为合理的MHO/O判定标准。

Objective To establish a more suitable and practicable criterion of metabolically healthy overweight/obesity(MHO/O)in Chinese,a comparison study on different criteria of MHO/O was conducted in subjects aged over 45-year-old in Shanghai Changfeng Community.Method A total of 3301 overweight/obese subjects over 45 years old(men 1521,women 1789)in Shanghai Changfeng Community was included in the study.According to the inclusion or exclusion of waist circumference(WC),homeostasis model assessment of insulin resistance(HOMA-IR)≥2.5,and numbers of abnormal metabolic components,the MHO/O criteria were divided into 7 types:Adult Treatment PanelⅢ(ATP-Ⅲ)(with WC)<1 component,ATP-Ⅲ(with WC)<2 components,ATP-Ⅲ(with WC)<3 components,ATP-Ⅲ(without WC)<1 component,ATP-Ⅲ(without WC)<2 components,adjusted metabolic associated fatty liver disease(MAFLD)criteria<1 component,and adjusted MAFLD criteria<2 components.The prevalence of MHO/O and its relationship with the changes of body mass index(BMI),and the differences of the characteristics of MHO/O among the 7 types of metabolic health standards were compared.Result The prevalence of MHO/O according to the ATP-Ⅲ(with WC)<1,ATP-Ⅲ(with WC)<2,ATP-Ⅲ(with WC)<3,ATP-Ⅲ(without WC)<1,ATP-Ⅲ(without WC)<2,adjusted MAFLD criteria<1,and adjusted MAFLD criteria<2 was 2.85%,15.48%,39.87%,8.00%,33.66%,2.33%,12.24%,respectively.The prevalence of MHO/O decreased as BMI increased.When BMI≥28 kg/m^(2),the prevalence of MHO/O by ATP-Ⅲ(with WC)<1 and adjusted MAFLD criteria<1 dropped to 0.Conclusion The adjusted MAFLD criterion without abnormal metabolic components is the most practicable definition of MHO/O.