不同人体测量指标评价学龄前儿童肥胖的比较

Comparison of Different Anthropometric Indicators in Evaluating Obesity Among Preschool Children

目的旨在建立武汉市学龄前儿童体脂率百分位数参考值及参考曲线,并分析不同人体测量指标与体成分的相关性,评价其在筛查学龄前儿童肥胖中的可靠性。方法采用横断面研究设计,通过整群随机抽样的方法于2021~2023年选取武汉市江汉区及汉阳区2710名3~5岁学龄前儿童进行调查,应用康娃WS-RT-2U体检仪及皮尺测量其身高、体重、腰围(WC)和臀围,同时计算身体质量指数(BMI)、腰围身高比(WHtR)和腰围臀围比(WHR);采用InBody 230体成分仪通过生物电阻抗法测量其体脂率(PBF)、脂肪质量及去脂肪质量。利用广义可加模型(GAMLSS)对儿童体脂率数据进行拟合,构建武汉市学龄前儿童体脂率的百分位数参考值;通过计算脂肪质量指数(FMI)及去脂肪体质量指数(FFMI),对BMI构成进行分解;以建立的PBF P95为肥胖标准参考值,使用受试者工作特征(ROC)曲线来评估BMI、WC、WHtR及WHR在肥胖筛查中的效果。结果在学龄前期,男女童体脂率随年龄增长逐渐下降,且男童下降幅度大于女童。同性别年龄不同体重状态儿童BMI的差异主要由FMI贡献(56%~82%),且BMI越大FMI贡献比例越高。ROC曲线分析显示,BMI的曲线下面积(AUC)接近1.0(男童=0.942;女童=0.937),显著大于WC、WHtR及WHR的AUC值(P<0.05)。结论本研究构建了武汉市学龄前儿童体脂率百分位参考值及生长曲线,并发现BMI是学龄前儿童肥胖筛查最佳评价指标,可为本地区学龄前儿童的生长发育评价和肥胖的识别提供参考依据。

Objective To establish percentile reference values and reference curves for body fat percentage in preschool children in Wuhan.To analyze the correlation between different body measurement indicators and body composition,and to evaluate their reliability in screening obesity in preschool children.Methods A total of 2710 preschoolers aged 3 to 5 years in Jianghan and Hanyang District of Wuhan were selected and investigated by cluster random sampling method between 2021 and 2023.Their body height,weight,waist circumference(WC),and hip circumference were measured according to standard procedure.Body mass index(BMI),waist-to-hip ratio(WHR),and waist-to-height ratio(WHtR)were calculated.Body composition indexes,such as fat mass and fat-free mass,were measured by bioelectrical impedance analysis(BIA)using InBody 230 body composition instrument.The Generalized Additive Model for Location,Scale and Shape(GAMLSS)was used to construct the percentile curve of PBF of preschool children in Wuhan.The BMI composition was analyzed by computing the fat mass index(FMI)and the fat-free body mass index(FFMI).The receiver operating characteristic(ROC)curve was used to evaluate the effectiveness of BMI,WC,WHtR,and WHR in obesity screening,using the established PBF P_(95)as the reference value for obesity.Results The PBF of preschool children gradually decreased with age,and the decline of boys was greater than that of girls.FMI contributed to main differences(56%—82%)in BMI in children of same age and gender with varying weight status and its contribution increased with increasing BMI.ROC curve analysis showed that the area under the curve(AUC)of BMI was close to 1.0(boys=0.942;girls=0.937),which was significantly larger than the AUC values of WC,WHtR,and WHR(P<0.05).ConclusionThe percentile reference value and growth curve of PBF of preschool children in Wuhan are constructed.BMI is the best evaluation index for obesity screening of preschool children.It can provide a reference for the growth and development evaluation as well as obesity screening among preschool children in this region.