腰围、腰臀比、腰高比和体重指数作为糖耐量受损指标及2型糖尿病危险因素的比较评估。
A comparative evaluation of waist circumference, waist-to-hip ratio, waist-to-height ratio and body mass index as indicators of impaired glucose tolerance and as risk factors for type-2 diabetes mellitus.
作者信息
Łopatyński Jerzy, Mardarowicz Grazyna, Szcześniak Grzegorz
机构信息
Primary Health Care Department of Family Medicine Department Medical University of Lublin.
出版信息
Ann Univ Mariae Curie Sklodowska Med. 2003;58(1):413-9.
UNLABELLED
A number of anthropometric indices is used for evaluation of fat tissue accumulation. It is known, that together with increase of obesity increases prevalence of impaired glucose tolerance (IGT) and diabetes mellitus type 2 (DM 2). The aim of this study was to determine, which of following indices: body mass index (BMI), waist to hip ratio (WHR), waist to height ratio (WHtR) and waist circumference (WC) is the most suitable for the assessment of glucose tolerance disturbances' risk in clinical practice.
MATERIAL AND METHODS
The research involved an examination of 1965 people aged > or = 35 years selected from the Lublin town population. Their body mass, height, waist and hip circumferences were measured. Fasting glicaemia and glucose concentration level in the 120th minute after 75 g glucose oral load were determined in full vein blood. DM 2 and IGT were diagnosed according to the 1985 WHO criteria. The evaluation of receiver operating characteristics (ROC) and Pearson's correlation test were used for statistical analysis.
RESULTS
The increase of all the studied indices was correlated with the increase of glicaemia, especially after an oral glucose load. The weakest correlation was shown by WHR. WC showed the strongest correlation with fasting glicaemia (except for men, where closer relationship with BMI was observed). Glicaemia after the load was stronger correlated with BMI and WHtR. A comparison of indices made by the analysis of ROC proved that all of them are characterised by a similar relation with the studied diseases. The indices in question showed significantly weaker relation with IGT than with DM 2. WHtR proved to have the highest diagnostic value in the IGT risk assessment IGT and WC in the assessment of DM 2. Interval estimation demonstrated a presence of statistically significant differences between WHR and other indices in the ROC distribution for DM2. The best cut-off points suggested higher DM 2 risk we found were: BMI - 29,2 kg/m2, WC - 97 cm, WHtR - O,62, WHR - 0,91 for women and 27,9 kg/m2, WC - 99 cm, WHtR - O,57, WHR - 0,97 for men.
CONCLUSIONS
All the studied indices have a similar value for DM 2 risk assessment. Waist circumference (WC) is especially noteworthy for the family doctor's practice both because of its high diagnostic precision and exceptional simplicity of its determination. The cut-off points of the studied indices should be differentiated according to sex.
未标注
一些人体测量指标用于评估脂肪组织堆积情况。众所周知,随着肥胖率的上升,糖耐量受损(IGT)和2型糖尿病(DM 2)的患病率也会增加。本研究的目的是确定以下指标中哪一个:体重指数(BMI)、腰臀比(WHR)、腰高比(WHtR)和腰围(WC)在临床实践中最适合评估糖耐量紊乱的风险。
材料与方法
该研究对从卢布林市人口中选取的1965名年龄≥35岁的人进行了检查。测量了他们的体重、身高、腰围和臀围。测定全静脉血中空腹血糖和口服75克葡萄糖后第120分钟的血糖浓度水平。根据1985年世界卫生组织标准诊断DM 2和IGT。采用受试者工作特征(ROC)评估和Pearson相关检验进行统计分析。
结果
所有研究指标的增加都与血糖升高相关,尤其是口服葡萄糖负荷后。WHR的相关性最弱。WC与空腹血糖的相关性最强(男性除外,男性中观察到与BMI的关系更密切)。负荷后血糖与BMI和WHtR的相关性更强。通过ROC分析对指标进行比较证明,它们与所研究疾病的关系相似。所讨论的指标与IGT的关系明显弱于与DM 2的关系。WHtR在IGT风险评估中具有最高的诊断价值,WC在DM 2评估中具有最高诊断价值。区间估计表明,在DM2的ROC分布中,WHR与其他指标之间存在统计学显著差异。我们发现的提示DM 2风险较高的最佳切点为:女性BMI - 29.2 kg/m²,WC - 97 cm, WHtR - 0.62, WHR - 0.91;男性BMI - 27.9 kg/m²,WC - 99 cm, WHtR - 0.57, WHR - 0.97。
结论
所有研究指标在DM 2风险评估中具有相似的价值。腰围(WC)因其高诊断精度和测定异常简单,在家庭医生的实践中尤其值得关注。所研究指标的切点应根据性别进行区分。