Friedl Karl E
Telemedicine and Advanced Technology Research Center, US Army Medical Research and Materiel Command, Fort Detrick, Maryland 21702-5012, USA.
J Diabetes Sci Technol. 2009 Jul 1;3(4):761-9. doi: 10.1177/193229680900300424.
Adult gains in body weight, excess adiposity, and intra-abdominal fat have each been associated with risk for type 2 diabetes mellitus (T2DM), forming the basis for preventive medicine guidelines and actuarial predictions using practical indices of weight (e.g., body mass index [BMI]) and waist circumference (WC). As obesity-related disease spreads beyond affluent western countries, application of WC thresholds to other populations has highlighted issues of their generalizability. For example, U.S. national health goals based on BMI < 25 kg/m(2) and WC < 89 cm (women) and <102 cm (men) differ considerably with a recent law in Japan mandating intervention for older adults with WC exceeding 90 cm (women) and 85 cm (men). The U.S. military has also faced issues of generalizability of WC-based adiposity standards that are fair and achievable. Data from many studies indicate that WC is a reliable biomarker for T2DM risk, suggesting that, for adult men and women, action thresholds should be more stringent than current U.S. guidelines, and it would not be harmful to set worldwide targets somewhere below 90 cm for men and women, regardless of weight status. Medical technology has provided many great insights into disease, including modern imaging technologies that have differentiated fat depots that have the greatest influence on T2DM, but ultimately, an inexpensive measuring tape provides the most useful and cost-effective preventive measure for T2DM today. At some point in the future, a Star Trek-like abdominal body fat "tricorder" noninvasive assessment of tissue composition may provide an advantage over abdominal girth.
成年人的体重增加、肥胖过度和腹部脂肪堆积均与2型糖尿病（T2DM）风险相关，这构成了预防医学指南以及使用体重实用指标（如体重指数[BMI]）和腰围（WC）进行精算预测的基础。随着肥胖相关疾病在富裕的西方国家之外蔓延，将WC阈值应用于其他人群凸显了其普遍性的问题。例如，美国基于BMI<25kg/m²以及WC<89cm（女性）和<102cm（男性）的国家健康目标，与日本最近一项法律有很大差异，该法律规定对WC超过90cm（女性）和85cm（男性）的老年人进行干预。美国军方也面临基于WC的肥胖标准普遍性的问题，这些标准要公平且可实现。许多研究的数据表明，WC是T2DM风险的可靠生物标志物，这表明，对于成年男性和女性，行动阈值应比美国现行指南更为严格，而且无论体重状况如何，将全球目标设定在男性和女性均低于90cm的某个数值不会有坏处。医学技术为疾病提供了许多深刻见解，包括现代成像技术，这些技术区分了对T2DM影响最大的脂肪储存部位，但最终，一条廉价的卷尺为当今的T2DM提供了最有用且最具成本效益的预防措施。在未来的某个时候，类似《星际迷航》中那样的腹部体脂“三录仪”对组织成分进行无创评估可能会比腹围更具优势。
