Foucan Lydia, Hanley Jim, Deloumeaux Jacqueline, Suissa Samy
Département d'Information Médicale et de Santé Publique, French West Indies, CHU de Pointe-à-Pitre, Guadeloupe.
J Clin Epidemiol. 2002 Oct;55(10):990-6. doi: 10.1016/s0895-4356(02)00430-4.
Hypertension, dyslipidemia and type 2 diabetes, important cardiovascular risk factors, are strongly linked to obesity. Body mass index (BMI) and waist circumference (WC) are measures of obesity that can be useful in identifying individuals with these risk factors. We assessed which of the two measures is more informative at the population level. The study population included 5,149 consecutive women aged 18 to 74 recruited in an Health Center of Guadeloupe (FWI) in 1999. The areas under the ROC curves of BMI and WC and their 95% CI were computed and compared. Logistic regression analysis of BMI and WC and the areas under the ROC curves in two separate age groups (18-39 years and 40-74 years) showed that age modifies the discriminant ability of these parameters in identifying the CVD risk factors. Sensitivity equalled specificity at levels between 52-70% for BMI and 55-80% for WC. ROC areas for identifying each risk factors by BMI varied from 0.52 to 0.84 and by WC from 0.55 to 0.88. For the identifying of women with at least one CVD risk factor, in the whole population, the areas under the curves for BMI and WC (respectively, 0.71; 95% CI: 0.69-0.73 and 0.76; 95% CI: 0.74-0.78) were both significantly greater than 0.5. The difference between these correlated areas was 0.04, 95% CI [-0.05, -0.03]. The lowest values of the areas were noted in detecting women with dyslipidemia and the highest in detecting those with type 2 diabetes. Waist circumference, a practical tool that had a higher discriminant ability than BMI in identifying presence or absence of all these risk factors, appears as the best screening tool in this population.
高血压、血脂异常和2型糖尿病是重要的心血管危险因素，与肥胖密切相关。体重指数（BMI）和腰围（WC）是肥胖的衡量指标，可用于识别具有这些危险因素的个体。我们评估了这两种指标在人群层面上哪一种提供的信息更多。研究人群包括1999年在瓜德罗普岛（法属西印度群岛）的一个健康中心招募的5149名年龄在18至74岁之间的连续女性。计算并比较了BMI和WC的ROC曲线下面积及其95%置信区间。对BMI和WC以及两个不同年龄组（18 - 39岁和40 - 74岁）的ROC曲线下面积进行逻辑回归分析表明，年龄会改变这些参数在识别心血管疾病危险因素方面的判别能力。BMI的敏感性和特异性在52% - 70%之间相等，WC在55% - 80%之间相等。通过BMI识别每种危险因素的ROC面积在0.52至0.84之间，通过WC在0.55至0.88之间。对于识别至少有一种心血管疾病危险因素的女性，在整个人口中，BMI和WC的曲线下面积（分别为0.71；95%置信区间：0.69 - 0.73和0.76；95%置信区间：0.74 - 0.78）均显著大于0.5。这些相关面积之间的差异为0.04，95%置信区间为[-0.05, -0.03]。在检测血脂异常女性时，面积值最低，在检测2型糖尿病女性时最高。腰围作为一种实用工具，在识别这些危险因素的存在与否方面比BMI具有更高的判别能力，似乎是该人群中最佳的筛查工具。
