Department of Public Health, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands.
BMC Pediatr. 2013 Apr 23;13:63. doi: 10.1186/1471-2431-13-63.
Body mass index (BMI) is a common indirect method to assess weight status among children. There is evidence that BMI data alone can underestimate overweight-related health risk and that waist circumference (WC) should also be measured. In this study we investigated the agreement between BMI and WC and BMI and the waist-height ratio (WHtR) when used to identify overweight among children.
This cross-sectional population-based study uses baseline data from 5-year-olds (n = 7703) collected by healthcare professionals for the 'Be active, eat right' study.
According to age-specific and sex-specific cut-off points for BMI (IOTF, 2000) and WC (Fredriks et al., 2005), the prevalence of overweight (obesity included) was 7.0% and 7.1% among boys, and 11.6% and 10.1% among girls, respectively. For the WHtR the 90th percentile was used as the cut-off point. Among boys, observed proportion of agreement between BMI and WC classification was 0.95, Cohen's kappa 0.58 (95% CI; 0.53-0.63), and proportions of positive and negative agreement were 0.61 and 0.97, respectively. Observed proportion of agreement between BMI and WHtR classification was 0.92, Cohen's kappa 0.46 (95% CI; 0.41-0.51), and proportions of positive and negative agreement were 0.51 and 0.95. Children identified as overweight according to WC were relatively tall, and children classified as overweight according to the WHtR only were relatively short (comparable results for girls).
There is moderate agreement between BMI and measures of WC on the presence of overweight among 5-year-olds. If BMI data and cut-offs continue to be used, then part of the group of children identified as overweight according to WC and the WHtR will be omitted. Follow-up of the children classified as overweight according to BMI only, WC only, and WHtR only, will give indications whether WC should be measured in addition to BMI or whether WC should only be measured in certain subgroups (e.g. relatively tall or short children) to identify and monitor overweight in children. This may improve early identification and prevention of overweight and overweight-related health problems in children.
体重指数（BMI）是一种常用的间接方法，用于评估儿童的体重状况。有证据表明，BMI 数据本身可能低估了与超重相关的健康风险，因此还应测量腰围（WC）。在这项研究中，我们研究了 BMI 与 WC 以及 BMI 与腰高比（WHtR）在识别儿童超重方面的一致性。
这是一项基于人群的横断面研究，使用了由医疗保健专业人员为“积极运动，合理饮食”研究收集的 5 岁儿童（n=7703）的基线数据。
根据 BMI（IOTF，2000）和 WC（Fredriks 等人，2005）的年龄和性别特异性切点，男孩超重（包括肥胖）的患病率为 7.0%和 7.1%，女孩分别为 11.6%和 10.1%。对于 WHtR，使用第 90 百分位数作为切点。在男孩中，BMI 与 WC 分类之间的观察一致性比例为 0.95，Cohen's kappa 为 0.58（95%CI：0.53-0.63），阳性和阴性一致性的比例分别为 0.61 和 0.97。BMI 与 WHtR 分类之间的观察一致性比例为 0.92，Cohen's kappa 为 0.46（95%CI：0.41-0.51），阳性和阴性一致性的比例分别为 0.51 和 0.95。根据 WC 确定为超重的儿童相对较高，而仅根据 WHtR 确定为超重的儿童相对较矮（女孩有类似的结果）。
在 5 岁儿童中，BMI 与 WC 等指标之间对超重的存在具有中等程度的一致性。如果继续使用 BMI 数据和切点，那么根据 WC 和 WHtR 确定为超重的部分儿童将被遗漏。对仅根据 BMI、WC 或 WHtR 分类为超重的儿童进行随访，将表明是否应除 BMI 外还应测量 WC，或者是否仅应在某些亚组（例如相对较高或较矮的儿童）中测量 WC，以识别和监测儿童超重。这可能会改善儿童超重和超重相关健康问题的早期识别和预防。
