Kahn Henry S, Bullard Kai McKeever
Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
PLoS One. 2017 Mar 1;12(3):e0172245. doi: 10.1371/journal.pone.0172245. eCollection 2017.
BACKGROUND/OBJECTIVES: The supine sagittal abdominal diameter (SAD) and standing waist circumference (WC) describe abdominal size. The SAD/height ratio (SADHtR) or WC/height ratio (WHtR) may better identify cardiometabolic disorders than BMI (weight/height2), but population-based distributions of SADHtR and WHtR are not widely available. Abdominal adiposity may differ by sociodemographic characteristics.
SUBJECTS/METHODS: Anthropometry, including SAD by sliding-beam caliper, was performed on 9894 non-pregnant adults ≥20 years in the US National Health and Nutrition Examination Surveys of 2011-2014. Applying survey design factors and sampling weights, we estimated nationally representative SADHtR and WHtR distributions by sex, age, educational attainment, and four ancestral groups.
The median (10th percentile, 90th percentile) for men's SADHtR was 0.130 (0.103, 0.165) and WHtR 0.569 (0.467, 0.690). For women, median SADHtR was 0.132 (0.102, 0.175) and WHtR 0.586 (0.473, 0.738). Medians for SADHtR and WHtR increased steadily through age 79. The median BMI, however, reached maximum values at ages 40-49 (men) or 60-69 (women) and then declined. Low educational attainment, adjusted for age and ancestry, was associated with elevated SADHtR more strongly than elevated BMI. While non-Hispanic Asians had substantially lower BMI compared to all other ancestral groups (adjusted for sex, age and education), their relative reductions in SADHtR and WHtR, were less marked.
These cross-sectional data are consistent with monotonically increasing abdominal adipose tissue through the years of adulthood but decreasing mass in non-abdominal regions beyond middle age. They suggest also that visceral adipose tissue, estimated by SADHtR, expands differentially in association with low socioeconomic position. Insofar as Asians have lower BMIs than other populations, employing abdominal indicators may attenuate the adiposity differences reported between ancestral groups. Documenting the distribution and sociodemographic features of SADHtR and WHtR supports the clinical and epidemiologic adoption of these adiposity indicators.
背景/目的：仰卧位腹部矢状径（SAD）和站立位腰围（WC）描述腹部大小。SAD与身高之比（SADHtR）或WC与身高之比（WHtR）可能比体重指数（BMI，体重/身高²）能更好地识别心脏代谢紊乱，但基于人群的SADHtR和WHtR分布情况尚未广泛可得。腹部肥胖程度可能因社会人口学特征而异。
对象/方法：在美国2011 - 2014年国家健康与营养检查调查中，对9894名年龄≥20岁的非妊娠成年人进行了人体测量，包括使用游标卡尺测量SAD。应用调查设计因素和抽样权重，我们按性别、年龄、教育程度和四个祖先群体估算了具有全国代表性的SADHtR和WHtR分布情况。
男性SADHtR的中位数（第10百分位数，第90百分位数）为0.130（0.103，0.165），WHtR为0.569（0.467，0.690）。女性SADHtR中位数为0.132（0.102，0.175），WHtR为0.586（0.473，0.738）。SADHtR和WHtR的中位数在79岁之前稳步上升。然而，BMI中位数在40 - 49岁（男性）或60 - 69岁（女性）达到最大值，然后下降。在调整年龄和祖先因素后，低教育程度与SADHtR升高的关联比与BMI升高的关联更强。虽然非西班牙裔亚洲人的BMI与所有其他祖先群体相比显著更低（已根据性别、年龄和教育程度进行调整），但他们的SADHtR和WHtR的相对降低幅度较小。
这些横断面数据与成年期腹部脂肪组织持续增加但中年以后非腹部区域脂肪量减少一致。这些数据还表明，通过SADHtR估算的内脏脂肪组织与低社会经济地位相关的差异扩张情况。鉴于亚洲人的BMI低于其他人群，采用腹部指标可能会减弱不同祖先群体间报告的肥胖差异。记录SADHtR和WHtR的分布及社会人口学特征支持了这些肥胖指标在临床和流行病学中的应用。
