Gamliel Adir, Ziv-Baran Tomer, Siegel Robert M, Fogelman Yacov, Dubnov-Raz Gal
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Prev Med. 2015 Dec;81:174-9. doi: 10.1016/j.ypmed.2015.08.017. Epub 2015 Sep 5.
There are relatively low rates of screening for overweight and obesity among children and adolescents in primary care. A simplified method for such screening is needed. The study objective was to examine if weight-for-age percentiles are sufficiently sensitive in identifying overweight and obesity in children and adolescents. We used data from two distinct sources: four consecutive cycles of the National Health and Nutrition Examination Surveys (NHANES) from the years 2005 to 2012, using participants aged 2-17.9 years for whom data on age, sex, weight, and height were available (n=12,884), and primary care clinic measurements (n=15,152). Primary outcomes were the threshold values of weight-for-age percentiles which best discriminated between normal weight, overweight, and obesity status. Receiver operating characteristic analyses demonstrated that weight-for-age percentiles well discriminated between normal weight and overweight and between non-obese and obese individuals (area under curve=0.956 and 0.977, respectively, both p<0.001). Following Classification and Regression Trees analysis, the 90th and 75th weight-for-age percentiles were chosen as appropriate cutoffs for obesity and overweight, respectively. These cutoffs had high sensitivity and negative predictive value in identifying obese participants (94.3% and 98.6%, respectively, for the 90th percentile) and in identifying overweight participants (93.2% and 95.9%, respectively, for the 75th percentile). The sensitivities and specificities were nearly identical across race and sex, and in the validation data from NHANES 2011 to 2012 and primary care. We conclude that weight-for-age percentiles can discriminate between normal weight, overweight and obese children, and adolescents. The 75th and 90th weight-for-age percentiles correspond well with the BMI cutoffs for pediatric overweight and obesity, respectively.
在初级保健中，儿童和青少年超重及肥胖的筛查率相对较低。因此需要一种简化的筛查方法。本研究的目的是检验年龄别体重百分位数在识别儿童和青少年超重及肥胖方面是否足够敏感。我们使用了两个不同来源的数据：2005年至2012年连续四个周期的美国国家健康与营养检查调查（NHANES），选取年龄在2至17.9岁且有年龄、性别、体重和身高数据的参与者（n = 12,884），以及初级保健诊所的测量数据（n = 15,152）。主要结局是年龄别体重百分位数的阈值，该阈值能最佳地区分正常体重、超重和肥胖状态。受试者工作特征分析表明，年龄别体重百分位数能很好地区分正常体重与超重以及非肥胖与肥胖个体（曲线下面积分别为0.956和0.977，p均<0.001）。经过分类与回归树分析，分别选择第90和第75年龄别体重百分位数作为肥胖和超重的合适切点。这些切点在识别肥胖参与者（第90百分位数分别为94.3%和98.6%）和超重参与者（第75百分位数分别为93.2%和95.9%）方面具有较高的敏感性和阴性预测值。在不同种族和性别间，以及在2011年至2012年NHANES和初级保健的验证数据中，敏感性和特异性几乎相同。我们得出结论，年龄别体重百分位数能够区分正常体重、超重和肥胖的儿童及青少年。第75和第90年龄别体重百分位数分别与儿童超重和肥胖的BMI切点非常吻合。
