Lerum Ø, Aadland E, Andersen L B, Anderssen S A, Resaland G K
Faculty of Teacher Education and Sports, Sogn og Fjordane University College, Sogndal, Norway.
Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.
Scand J Med Sci Sports. 2017 Aug;27(8):865-872. doi: 10.1111/sms.12826. Epub 2017 Jan 16.
Agreement between and classification accuracy of six different noninvasive composite scores and a cardiovascular disease (CVD) risk factor score were investigated in 911 (466 boys and 445 girls) 10-year-old Norwegian children. A CVD risk factor score (triglyceride, total cholesterol/HDL ratio, homeostasis model assessment of insulin resistance, systolic blood pressure (SBP), waist-to-height ratio (WHtR), and cardiorespiratory fitness) and six noninvasive risk scores (fitness+three different measurements of fatness (body mass index (BMI), WHtR, and skinfolds), with and without inclusion of SBP) were calculated (mean z-score by gender). Agreement was assessed using Bland-Altman plots. The ability of noninvasive scores to correctly classify children with clustered CVD risk was examined by receiver operating characteristic (ROC) analysis and Cohen's kappa coefficient (κ). For both sexes, the noninvasive scores without SBP showed excellent AUC values (AUC=0.93-0.94, 95% CI=0.88-0.98) and moderate kappa values (κ=0.49-0.64) and had limits of agreement of 0.0±0.78-0.89 (arbitrary unit). Inclusion of SBP increased AUC values (AUC=0.96-0.97, 95% CI=0.94-0.99), kappa values (κ=0.58-0.69), and reduced limits of agreement (0.0±0.68-0.76). Noninvasive scores that include fitness and fatness provide acceptable agreement and classification accuracy, allowing for widespread early identification of children that might be at risk for developing CVD later in life. SBP should be included in the noninvasive score to improve classification accuracy if possible.
在911名（466名男孩和445名女孩）10岁的挪威儿童中，研究了六种不同的非侵入性综合评分与心血管疾病（CVD）风险因素评分之间的一致性及分类准确性。计算了一个CVD风险因素评分（甘油三酯、总胆固醇/高密度脂蛋白比率、胰岛素抵抗的稳态模型评估、收缩压（SBP）、腰高比（WHtR）和心肺适能）以及六个非侵入性风险评分（适能+三种不同的肥胖测量指标（体重指数（BMI）、WHtR和皮褶厚度），包括和不包括SBP）（按性别计算平均z分数）。使用Bland-Altman图评估一致性。通过受试者操作特征（ROC）分析和科恩kappa系数（κ）检验非侵入性评分正确分类具有聚集性CVD风险儿童的能力。对于男女两性，不包括SBP的非侵入性评分显示出优异的AUC值（AUC=0.93 - 0.94，95%CI=0.88 - 0.98）和中等的kappa值（κ=0.49 - 0.64），一致性界限为0.0±0.78 - 0.89（任意单位）。纳入SBP会增加AUC值（AUC=0.96 - 0.97，95%CI=0.94 - 0.99）、kappa值（κ=0.58 - 0.69），并降低一致性界限（0.0±0.68 - 0.76）。包括适能和肥胖指标的非侵入性评分提供了可接受的一致性和分类准确性，有助于广泛早期识别可能在生命后期有患CVD风险的儿童。如果可能，应将SBP纳入非侵入性评分以提高分类准确性。
