Choi Dong-Hyun, Hur Yang-Im, Kang Jae-Heon, Kim Kyoungwoo, Cho Young Gyu, Hong Soo-Min, Cho Eun Byul
Department of Family Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul 100032, Korea.
Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul 100032, Korea.
Nutrients. 2017 Mar 10;9(3):256. doi: 10.3390/nu9030256.
The aims of this study were to assess the diagnostic value of the weight-to-height ratio (WHtR) for the detection of obesity and metabolic syndrome (MS) in Korean children and adolescents, and to determine the advantages of WHtR as a population-based screening tool in comparison with other obesity indicators, such as body mass index (BMI) and waist circumference (WC). We performed a cross-sectional analysis of data from 3057 children and adolescents (1625 boys, 1332 girls) aged 10-19 years who were included in the fifth Korean National Health and Nutrition Examination Survey (KNHANES, 2010-2012) up to the second year of the sixth KNHANES (2013-2014). Receiver operation characteristic (ROC) curves were generated to determine the optimal cutoff value and accuracy of WHtR for predicting individual obesity indicators or more than two non-WC components of MS. The area under the ROC curve (AUC) is a measure of the diagnostic power of a test. A perfect test will have an AUC of 1.0, and an AUC equal to 0.5 means that the test performs no better than chance. The optimal WHtR cutoff for the evaluation of general obesity and central obesity was 0.50 in boys and 0.47-0.48 in girls, and the AUC was 0.9. Regarding the assessment of each MS risk factor, the optimal WHtR cutoff was 0.43-0.50 in boys and 0.43-0.49 in girls, and these cutoffs were statistically significant only for the detection of high triglyceride and low High-density lipoprotein (HDL) cholesterol levels. When a pairwise comparison of the AUCs was conducted between WHtR and BMI/WC percentiles to quantify the differences in power for MS screening, the WHtR AUC values (boys, 0.691; girls, 0.684) were higher than those of other indices; however, these differences were not statistically significant (boys, = 0.467; girls, = 0.51). The WHtR cutoff value was 0.44 (sensitivity, 67.7%; specificity, 64.6%) for boys and 0.43 (sensitivity, 66.4%; specificity, 66.9%) for girls. There was no significant difference between the diagnostic power of WHtR and that of BMI/WC when screening for MS. Although the use of WHtR was not superior, WHtR is still useful as a screening tool for metabolic problems related to obesity because of its convenience.
本研究的目的是评估身高体重比（WHtR）在检测韩国儿童和青少年肥胖及代谢综合征（MS）方面的诊断价值，并确定与其他肥胖指标（如体重指数（BMI）和腰围（WC））相比，WHtR作为基于人群的筛查工具的优势。我们对3057名10 - 19岁的儿童和青少年（1625名男孩，1332名女孩）的数据进行了横断面分析，这些数据来自韩国第五次全国健康与营养检查调查（KNHANES，2010 - 2012年）直至第六次KNHANES的第二年（2013 - 2014年）。绘制受试者操作特征（ROC）曲线以确定WHtR预测个体肥胖指标或MS的两个以上非WC成分的最佳临界值和准确性。ROC曲线下面积（AUC）是测试诊断能力的一种度量。完美的测试AUC为1.0，AUC等于0.5意味着测试的表现不比随机猜测好。评估一般肥胖和中心性肥胖的最佳WHtR临界值在男孩中为0.50，在女孩中为0.47 - 0.48，AUC为0.9。关于每个MS风险因素的评估，最佳WHtR临界值在男孩中为0.43 - 0.50，在女孩中为0.43 - 0.49，这些临界值仅在检测高甘油三酯和低高密度脂蛋白（HDL）胆固醇水平时具有统计学意义。当在WHtR与BMI/WC百分位数之间进行AUC的成对比较以量化MS筛查能力的差异时，WHtR的AUC值（男孩为0.691；女孩为0.684）高于其他指标；然而，这些差异无统计学意义（男孩， = 0.691；女孩， = 0.684）。男孩的WHtR临界值为0.44（敏感性为67.7%；特异性为64.6%），女孩为0.43（敏感性为66.4%；特异性为66.9%）。在筛查MS时，WHtR和BMI/WC的诊断能力没有显著差异。虽然WHtR的使用并不更具优势，但由于其便利性，WHtR作为与肥胖相关的代谢问题的筛查工具仍然有用。
