Ouyang Xiaojun, Lou Qinlin, Gu Liubao, Ko Gary T, Mo Yongzhen, Wu Haidi, Bian Rongwen
Diabetes Care and Research Center, Jiangsu Province Institute of Geriatrics, 30 Luojia Road, Nanjing, 210024 China ; Department of Endocrinology and Metabolism, Jiangsu Province Institute of Geriatrics, 30 Luojia Road, Nanjing, 210024 China.
Department of Medicine and Therapeutics, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China.
Diabetol Metab Syndr. 2015 Apr 24;7:37. doi: 10.1186/s13098-015-0032-5. eCollection 2015.
There remains controversy regarding which of the anthropometric indicators best defines obesity. In this study, we compared the efficacy of using body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) in the diagnosis of obesity and assessed their associations with diabetes, hypertension, and dyslipidemia in an urban working population in China.
Anthropometric measurements, blood pressure, plasma lipids, fasting and 2-hour plasma glucose (PG) levels by a 75 gram oral glucose tolerance test (OGTT) were obtained from 2603 working Chinese who had no history of cardiovascular diseases or diabetes. Cardio-metabolic risk factors including high blood pressure, dyslipidemia, and glucose intolerance were evaluated. The diagnoses of overweight and obesity were based on the WHO definitions with BMI for general obesity and WC and WHR for central obesity.
Based on BMI, WC and WHR, there were 31.3%, 16.6%, 35.2% of the studied subjects, respectively, being overweight and 2.0%, 5.6%, 9.2% being obese. Among women but not men, more overweight and obese subjects were diagnosed using WHR and WC. The number of cardio-metabolic risks was higher by WC criterion than BMI and WHR in the whole group (p <0.05) and female subjects (p <0.01). Comparing the three anthropometric indexes predicting hypertension, hyperglycemia, dyslipidemia and multiple cardio-metabolic risks, for women, it was WC having the largest areas under ROC curves (0.759, 0.746, 0.701 and 0.773 respectively); while in men, it was WC for hypertension, WHR for hyperglycemia, BMI for dyslipidemia and WC for multiple cardio-metabolic risks (areas under ROC curves were 0.658, 0.686, 0.618 and 0.695 respectively).
Among Chinese working population, the need of lower cutoff values to define overweight and obesity were observed. Central obesity indicator (WC) is the preferred measure to predict the presence of cardio-metabolic risk in Chinese female subjects.
关于哪种人体测量指标能最佳定义肥胖仍存在争议。在本研究中，我们比较了使用体重指数（BMI）、腰围（WC）和腰臀比（WHR）诊断肥胖的效果，并评估了它们与中国城市在职人群中糖尿病、高血压和血脂异常的关联。
对2603名无心血管疾病或糖尿病病史的在职中国人群进行人体测量、血压、血脂、空腹及75克口服葡萄糖耐量试验（OGTT）后2小时的血浆葡萄糖（PG）水平检测。评估包括高血压、血脂异常和葡萄糖不耐受在内的心血管代谢危险因素。超重和肥胖的诊断基于世界卫生组织的定义，一般肥胖采用BMI，中心性肥胖采用WC和WHR。
根据BMI、WC和WHR，分别有31.3%、16.6%、35.2%的研究对象超重，2.0%、5.6%、9.2%的研究对象肥胖。在女性而非男性中，使用WHR和WC诊断出的超重和肥胖对象更多。在整个组（p<0.05）和女性对象（p<0.01）中，按照WC标准诊断出的心血管代谢风险数量高于BMI和WHR。比较预测高血压、高血糖、血脂异常和多种心血管代谢风险的三种人体测量指标，对于女性，WC的ROC曲线下面积最大（分别为0.759、0.746、0.701和0.773）；而对于男性，高血压采用WC，高血糖采用WHR，血脂异常采用BMI，多种心血管代谢风险采用WC（ROC曲线下面积分别为0.658、0.686、0.618和0.695）。
在中国在职人群中，发现需要更低的临界值来定义超重和肥胖。中心性肥胖指标（WC）是预测中国女性心血管代谢风险存在的首选指标。
