Asayama K, Dobashi K, Hayashibe H, Kodera K, Uchida N, Nakane T, Araki T, Nakazawa S
Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
Int J Obes Relat Metab Disord. 2002 Feb;26(2):208-13. doi: 10.1038/sj.ijo.0801865.
To determine whether the direct measure of visceral adipose tissue (VAT) by computed tomography (CT) is a superior diagnostic criterion to the anthropometric surrogates and more classical criteria of obesity.
Cross-sectional, clinical study. Obese boys were classified according to the occurrence of abnormal values in either serum triglyceride, alanine aminotransferase or insulin level. A threshold value of each criterion for such metabolic derangement was calculated, using the analysis of receiver operating characteristic (ROC) curve.
Seventy-five consecutive outpatient Japanese obese boys, ranging in age from 6 to 14 y, were studied.
Anthropometric indices measured were height, body weight, waist girth, hip girth, triceps and subscapular skinfold thicknesses. Classical criteria for obesity used were percentage overweight (POW), body mass index (BMI) and percentage body fat. Waist girth, sagittal diameter by CT and waist-hip ratio (WHR) were evaluated as anthropometric surrogates for VAT. The areas of total abdominal fat (TAF), VAT and subcutaneous adipose tissue (SAT) were measured by CT at the level of the umbilicus. Clinical blood biochemistry was analyzed in fasting blood samples of obese boys.
Thirty-three boys were classified into a no-complication group, and 42 into a complication group. TAF, VAT and SAT areas were closely associated with age, body size and degree of overweight and adiposity, while VAT/SAT was not. VAT area, sagittal diameter, TAF area and waist girth were closely correlated with alanine aminotransferase, insulin, TG and HDL-C. VAT/SAT, BMI, SAT area, WHR, percentage body fat and POW were less closely associated with these biochemical indices. The descending order of the values of area under the curve for the ROC curves were as follows: VAT>sagittal diameter>TAF>VAT/SAT>waist girth>BMI>WHR>percentage body fat>POW. Both VAT area and VAT/SAT gave >80% of sensitivity and specificity. Among the anthropometric indices studied, the sagittal diameter was the best surrogate of visceral fat measure. The sensitivity and specificity for the rest of the anthropometric indices were in an unsatisfactory range. The threshold values for VAT area, VAT/SAT and sagittal diameter were 58.0 cm(2), 0.276 and 19.2 cm, respectively.
The threshold values for VAT area, VAT/SAT and sagittal diameter for detecting biochemical complication in Japanese obese boys were lower than the respective values reported in adults. These values can be used for classifying the obese boys into two types: those with medical problem and those without.
确定通过计算机断层扫描（CT）直接测量内脏脂肪组织（VAT）是否是比人体测量替代指标和更经典的肥胖标准更优越的诊断标准。
横断面临床研究。肥胖男孩根据血清甘油三酯、丙氨酸转氨酶或胰岛素水平是否出现异常值进行分类。使用受试者操作特征（ROC）曲线分析计算每个标准对于此类代谢紊乱的阈值。
对75名连续门诊的日本肥胖男孩进行了研究，年龄在6至14岁之间。
测量的人体测量指标包括身高、体重、腰围、臀围、肱三头肌和肩胛下皮褶厚度。使用的肥胖经典标准为超重百分比（POW）、体重指数（BMI）和体脂百分比。腰围、CT矢状径和腰臀比（WHR）作为VAT的人体测量替代指标进行评估。在脐水平通过CT测量腹部总脂肪（TAF）、VAT和皮下脂肪组织（SAT）的面积。对肥胖男孩的空腹血样进行临床血液生化分析。
33名男孩被分类为无并发症组，42名被分类为并发症组。TAF、VAT和SAT面积与年龄、体型以及超重和肥胖程度密切相关，而VAT/SAT则不然。VAT面积、矢状径、TAF面积和腰围与丙氨酸转氨酶、胰岛素、甘油三酯和高密度脂蛋白胆固醇密切相关。VAT/SAT、BMI、SAT面积、WHR、体脂百分比和POW与这些生化指标的相关性较低。ROC曲线下面积值的降序如下：VAT>矢状径>TAF>VAT/SAT>腰围>BMI>WHR>体脂百分比>POW。VAT面积和VAT/SAT的敏感性和特异性均>80%。在所研究的人体测量指标中，矢状径是内脏脂肪测量的最佳替代指标。其余人体测量指标的敏感性和特异性处于不令人满意的范围。VAT面积、VAT/SAT和矢状径的阈值分别为58.0 cm²、0.276和19.2 cm。
日本肥胖男孩中检测生化并发症的VAT面积、VAT/SAT和矢状径的阈值低于成人报告的相应值。这些值可用于将肥胖男孩分为两类：有医学问题的和没有医学问题的。
