Petroff D, Kromeyer-Hauschild K, Wiegand S, l'Allemand-Jander D, Binder G, Schwab K-O, Stachow R, Kiess W, Hammer E, Sturm S, Holl R W, Blüher S
1] Clinical Trial Centre Leipzig, University of Leipzig, Leipzig, Germany [2] Leipzig University Medical Center, IFB Adiposity Diseases, Leipzig, Germany.
Institute of Human Genetics, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany.
Int J Obes (Lond). 2015 Jan;39(1):52-60. doi: 10.1038/ijo.2014.170. Epub 2014 Sep 12.
Weight status in children and adolescents is commonly defined using age- and gender-corrected standard deviation scores for body mass index (BMI-SDS, also called z-scores). Values are not reliable for the extremely obese however. Moreover, paediatricians and parents may have difficulties understanding z-scores, and while percentiles are easier to gauge, the very obese have values above the 99th percentile, making distinction difficult. The notion of excess body weight (EBW) is increasingly applied in adult patients, mainly in the context of bariatric surgery. However, a clear definition is not available to date for the paediatric population.
A simple definition of EBW for children and adolescents is introduced, with median weight as a function of height, age and gender (characterized by an asterisk): EBW (%) = 100x(weight-median weight*)/median weight*. EBW is compared with BMI-SDS and waist-to-height ratio (WHtR). Using two data sources (APV registry and German Health Interview and Examination Survey for Children and Adolescents (KiGGS)) including more than 14,000 children, the relationships between these anthropometric and various metabolic parameters are analysed for a group of overweight/obese children who have sought obesity therapy (APV), for the general paediatric population and for the subset of overweight/obese children from the general population (KiGGS).
The three anthropometric parameters are strongly correlated, with the linear correlation coefficients exceeding 0.8 in the general population and 0.75 in those seeking obesity therapy. Moreover, their relationship to metabolic parameters is quite similar regarding correlations and area under the curve from receiver operating characteristic analyses.
EBW has similar predictive value for metabolic or cardiovascular comorbidities compared with BMI and WHtR. As it is reliable at the extreme end of the obesity spectrum, easily communicable and simple to use in daily practice, it would make a very useful addition to existing tools for working with obese children and adolescents. Its usefulness in assessing weight change needs to be studied however.
儿童和青少年的体重状况通常使用年龄和性别校正后的体重指数标准差分数（BMI-SDS，也称为z分数）来定义。然而，这些数值对于极度肥胖者来说并不可靠。此外，儿科医生和家长可能难以理解z分数，虽然百分位数更容易衡量，但极度肥胖者的数值高于第99百分位数，这使得区分变得困难。超重体重（EBW）的概念越来越多地应用于成年患者，主要是在减肥手术的背景下。然而，迄今为止，儿科人群尚无明确的定义。
引入了一种针对儿童和青少年的EBW简单定义，其中中位数体重是身高、年龄和性别的函数（用星号表示）：EBW（%）=100×（体重-中位数体重*）/中位数体重*。将EBW与BMI-SDS和腰高比（WHtR）进行比较。使用两个数据源（APV登记处和德国儿童和青少年健康访谈与检查调查（KiGGS）），其中包括超过14000名儿童，分析了一组寻求肥胖治疗的超重/肥胖儿童（APV）、一般儿科人群以及一般人群中超重/肥胖儿童子集（KiGGS）的这些人体测量参数与各种代谢参数之间的关系。
这三个人体测量参数高度相关，在一般人群中线性相关系数超过0.8，在寻求肥胖治疗的人群中超过0.75。此外，就相关性和受试者工作特征分析的曲线下面积而言，它们与代谢参数的关系非常相似。
与BMI和WHtR相比，EBW对代谢或心血管合并症具有相似的预测价值。由于它在肥胖谱的极端情况下可靠、易于交流且在日常实践中易于使用，因此将是现有用于处理肥胖儿童和青少年的工具的非常有用的补充。然而，其在评估体重变化方面的有用性有待研究。
