Weber David R, Leonard Mary B, Shults Justine, Zemel Babette S
Department of Pediatrics (D.R.W., M.B.L., J.S., B.S.Z.), The Children's Hospital of Philadelphia, and Perelman School of Medicine (M.B.L., J.S., B.S.Z.), University of Pennsylvania, Philadelphia, Pennsylvania 19104.
J Clin Endocrinol Metab. 2014 Sep;99(9):3208-16. doi: 10.1210/jc.2014-1684. Epub 2014 Jun 13.
The use of body mass index (BMI) to assess risk for cardiometabolic disease in the pediatric population may be limited by a failure to differentiate between fat and lean body mass.
The objectives of the study were to identify biologically based criteria for the definition of obesity using fat (FMI) and lean body mass index (LBMI) and to compare the ability of FMI and LBMI to BMI to identify the presence of metabolic syndrome (MetSyn).
This was a cross-sectional study using National Health and Nutrition Examination Survey 1999-2006 data.
A total of 3004 participants aged 12-20 years with dual-energy X-ray absorptiometry body composition and fasting laboratory data participated in the study.
Adjusted odds ratios for MetSyn according to FMI and LBMI status and area under the curve for the identification of MetSyn were measured.
Receiver-operating characteristic curve analyses identified the 80th percentile for FMI and the 74th percentile for LBMI as the optimal cut points for the identification of MetSyn. There was no difference in the area under the curve for FMI [0.867; 95% confidence interval (CI) 0.838-0.891] vs BMI (0.868; 95% CI 0.837-0.894) Z-scores for MetSyn discrimination. Separate multivariate regression models identified odds ratios for the identification of MetSyn of 6.2 (95% CI 3.3-11.5) for BMI-Z, 6.4 (95% CI 3.7-11.1) for FMI-Z, and 4.6 (95% CI 3.0-7.1) for LBMI-Z. Models containing both FMI-Z and LBMI-Z revealed that greater LBMI-Z was associated with greater odds of low high-density lipoprotein (1.5; 95% CI 1.2-1.9), high blood pressure (1.8; 95% CI 1.1-2.9), and insulin resistance (1.8; 95% CI 1.4-2.5), independent of FMI-Z.
The use of FMI and LBMI does not improve upon BMI for the identification of MetSyn in the pediatric population. Unexpectedly, higher LBMI was associated with greater odds of multiple cardiometabolic risk factors independent of FMI. The use of FMI and LBMI allow for the independent evaluation of relationships between body compartments and disease and warrants future research.
在儿科人群中，使用体重指数（BMI）评估心血管代谢疾病风险可能因无法区分脂肪量和瘦体重而受到限制。
本研究的目的是确定基于生物学的肥胖定义标准，使用脂肪量指数（FMI）和瘦体重指数（LBMI），并比较FMI、LBMI与BMI识别代谢综合征（MetSyn）的能力。
这是一项横断面研究，使用1999 - 2006年国家健康和营养检查调查数据。
共有3004名年龄在12 - 20岁的参与者，他们有双能X线吸收法测量的身体成分数据和空腹实验室数据，参与了本研究。
测量根据FMI和LBMI状态调整后的MetSyn比值比以及识别MetSyn的曲线下面积。
受试者工作特征曲线分析确定FMI的第80百分位数和LBMI的第74百分位数为识别MetSyn的最佳切点。FMI识别MetSyn的曲线下面积[0.867；95%置信区间（CI）0.838 - 0.891]与BMI（0.868；95% CI 0.837 - 0.894）的Z评分在识别MetSyn方面没有差异。单独的多变量回归模型确定，BMI - Z识别MetSyn的比值比为6.2（95% CI 3.3 - 11.5），FMI - Z为6.4（95% CI 3.7 - 11.1），LBMI - Z为4.6（95% CI 3.0 - 7.1）。同时包含FMI - Z和LBMI - Z的模型显示，较高的LBMI - Z与较低高密度脂蛋白（1.5；95% CI 1.2 - 1.9）、高血压（1.8；95% CI 1.1 - 2.9）和胰岛素抵抗（1.8；95% CI 1.4 - 2.5）的较高比值比相关，独立于FMI - Z。
在儿科人群中，使用FMI和LBMI在识别MetSyn方面并不优于BMI。出乎意料的是，较高的LBMI与多种心血管代谢风险因素的较高比值比相关，独立于FMI。使用FMI和LBMI能够独立评估身体各部分与疾病之间的关系，值得未来进一步研究。
