Davidson Arthur J, McCormick Emily V, Dickinson L Miriam, Haemer Matthew A, Knierim Shanna D, Hambidge Simon J
Denver Public Health, Denver Health, Denver, Colo; Department of Biostatistics and Informatics, University of Colorado, Aurora, Colo; Department of Family Medicine, University of Colorado, Aurora, Colo.
Denver Public Health, Denver Health, Denver, Colo.
Acad Pediatr. 2014 Nov-Dec;14(6):632-8. doi: 10.1016/j.acap.2014.06.007. Epub 2014 Oct 30.
To determine the utility of repeated patient-level body mass index (BMI) measurements among higher-risk patients seen at safety-net clinics as a community-level monitoring tool for overweight and obesity population trends.
Data from a network of urban, federally qualified community health centers with computerized tracking of BMI at sequential outpatient visits were analyzed. We performed a longitudinal observational study over 8 years (2005-2012) with children stratified by weight status groups on the basis of BMI. Changes in BMI z-scores were used to estimate population trends among children 2 to 11 years old, with at least 2 visits (at least 1 year apart), for whom weight and height were measured.
Among children (n = 33,542), the rate of overweight was 16% and rate of obesity was 18% at their last visit. Children were followed for an average of 3.24 ± 1.76 years to measure trends and change in weight status from earlier to later childhood. Children who were obese at first visit had increased odds (adjusted odds ratio 27.8, 95% confidence interval 25.6-30.2) of being obese by last visit. Mean change in BMI z-score per person-year of observation was 0.10 ± 0.38, with a differing rate of change based on weight status category at last visit (not overweight = 0.06 ± 0.39; overweight = 0.17 ± 0.34; obese = 0.19 ± 0.36). Change in BMI z-score per person-year decreased for 40% of obese children; however, their weight status group remained unchanged.
Childhood obesity prevalence was high, with substantial progression to overweight and obesity from first to last visit. Clinically derived BMI z-score per person-year measures can effectively show population trends not observed using standard weight status categories.
确定在安全网诊所就诊的高危患者中重复进行个体层面的体重指数（BMI）测量作为超重和肥胖人群趋势的社区层面监测工具的效用。
分析来自城市联邦合格社区卫生中心网络的数据，这些中心在连续门诊就诊时对BMI进行计算机化跟踪。我们进行了一项为期8年（2005 - 2012年）的纵向观察研究，根据BMI将儿童按体重状况分组。BMI z评分的变化用于估计2至11岁儿童（至少有2次就诊，间隔至少1年）的人群趋势，这些儿童的体重和身高均已测量。
在儿童（n = 33,542）中，末次就诊时超重率为16%，肥胖率为18%。儿童平均随访3.24 ± 1.76年以测量从儿童早期到晚期体重状况的趋势和变化。首次就诊时肥胖的儿童末次就诊时肥胖的几率增加（调整后的优势比为27.8，95%置信区间为25.6 - 30.2）。每人每年观察的BMI z评分平均变化为0.10 ± 0.38，根据末次就诊时的体重状况类别变化率不同（非超重 = 0.06 ± 0.39；超重 = 0.17 ± 0.34；肥胖 = 0.19 ± 0.36）。40%的肥胖儿童每人每年的BMI z评分变化有所下降；然而，他们的体重状况组保持不变。
儿童肥胖患病率很高，从首次就诊到末次就诊有大量进展为超重和肥胖。临床上得出的每人每年的BMI z评分测量可以有效显示使用标准体重状况类别未观察到的人群趋势。
