Endocr Pract. 2016 Oct;22(10):1170-1176. doi: 10.4158/EP161291.OR. Epub 2016 Jun 13.
The accumulation of abdominal fat is associated with cardiometabolic abnormalities. Waist circumference (WC) measurements allow an indirect evaluation of abdominal adiposity. However, controversy exists over which WC reference values are the most suitable for identifying the pediatric population at risk. The aim of the study was to evaluate the ability of various WC indices to identify abdominal obesity as diagnostic tools for predicting cardiometabolic risk in Mexican children and adolescents.
Anthropometric measurements were performed and biochemical profiles determined in a crosssectional study that included 366 children and adolescents. Four parameters were used to evaluate abdominal obesity in our study group: (1) WC >90th percentile, according to the Fernández reference in a Mexican-American population measured by the National Center for Health Statistics (NCHS) technique; (2) WC >90th percentile, according to the Klünder reference in a Mexican population (measured by the World Health Organization [WHO] technique); (3) waist-to-height ratio (WHtR) >0.5 according to WHO; and (4) WHtR >0.5 according to NCHS. The ability of each of the indices to discriminate cardiometabolic abnormalities (fasting plasma glucose, dyslipidemia, and hypertension) was assessed.
WHtR >0.5 according to WHO or NCHS references showed greater sensitivity to detect metabolic abnormalities compared to percentile reference parameters (74.3 to 100% vs. 59.0 to 88.9%; P<.05). However, the percentiles displayed more specificity to identify these alterations (46.2 to 62.2 vs. 21.3 to 46.9; P<.05). Area under the curve analysis showed that WHtR >0.5 can more readily detect hypertriglyceridemia (0.642), hypoalphalipoproteinemia (0.700), and a combination of two or more metabolic abnormalities (0.661), whereas WC >90th percentile, according to Klünder, better detected hyperglycemia (0.555).
WHtR >0.5 is a sensitive measure to identify pediatric patients with cardiometabolic alterations, despite its low specificity, and is a useful diagnostic tool to detect populations at risk. Based on the results of this study, we recommend preferential use of the Klünder waist circumference references over the Fernández method in Mexican pediatric populations.
AUC = area under the curve BMI = body mass index HDL = high-density lipoprotein IDF = International Diabetes Federation LDL = low-density lipoprotein MS = metabolic syndrome NCHS = National Center for Health Statistics ROC = receiver operating characteristic WC = waist circumference WHO = World Health Organization WHtR = waist-to-height ratio.
腹部脂肪堆积与心脏代谢异常有关。腰围（WC）测量可间接评估腹部肥胖。然而，对于哪种 WC 参考值最适合识别存在风险的儿科人群，目前仍存在争议。本研究旨在评估各种 WC 指数作为诊断工具，以识别腹部肥胖并预测墨西哥儿童和青少年的心脏代谢风险的能力。
在一项横断面研究中对 366 名儿童和青少年进行了人体测量和生化指标检测。我们的研究组使用了 4 个参数来评估腹部肥胖：（1）根据 Fernández 参考值，在墨西哥裔美国人中，用美国国家卫生统计中心（NCHS）技术测量的 WC>第 90 百分位数；（2）根据 Klünder 参考值，在墨西哥人中，用世界卫生组织（WHO）技术测量的 WC>第 90 百分位数；（3）根据 WHO，腰高比（WHtR）>0.5；（4）根据 NCHS，WHtR>0.5。评估了每个指数区分心脏代谢异常（空腹血糖、血脂异常和高血压）的能力。
与百分位参考参数相比，WHtR>WHO 或 NCHS 参考值的敏感性更高，可检测到代谢异常（74.3%至 100%比 59.0%至 88.9%；P<.05）。然而，百分位数对识别这些改变的特异性更高（46.2%至 62.2%比 21.3%至 46.9%；P<.05）。曲线下面积分析显示，WHtR>0.5 更易于检测高甘油三酯血症（0.642）、低高密度脂蛋白血症（0.700）和两种或更多代谢异常的组合（0.661），而根据 Klünder，WC>90 百分位更好地检测到高血糖（0.555）。
尽管 WHtR>0.5 的特异性较低，但它是一种敏感的测量方法，可用于识别存在心脏代谢改变的儿科患者，是一种有用的诊断工具，可用于检测存在风险的人群。基于这项研究的结果，我们建议在墨西哥儿科人群中优先使用 Klünder 腰围参考值而不是 Fernández 方法。
