Department of Internal Medicine, Endocrinology, Erasmus Medical Center, Rotterdam, The Netherlands.
Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
Eur J Endocrinol. 2019 Aug;181(2):173-183. doi: 10.1530/EJE-19-0181.
Craniopharyngioma patients often have poor metabolic profiles due to hypothalamic-pituitary damage. Previously, using BMI as obesity marker, the occurrence of the metabolic syndrome in these patients was estimated at 46%. Our aim was to determine if dual X-ray absorptiometry (DXA) scan in evaluation of obesity and metabolic syndrome would be superior.
Retrospective study of craniopharyngioma patients for whom DXA scan results were available.
BMI, fat percentage and fat mass index were used to evaluate obesity and as components for obesity in metabolic syndrome.
Ninety-five craniopharyngioma patients were included (51% female, 49% childhood-onset disease). Metabolic syndrome occurred in 34-53 (45-51%) subjects (depending on the definition of obesity, although all definitions occurred in higher frequency than in the general population). Metabolic syndrome frequency was higher if obesity was defined by fat percentage (52 vs 42%) or fat mass index (51 vs 43%) compared to BMI. Misclassification appeared in 9% (fat percentage vs BMI) and 7% (fat mass index vs BMI) for metabolic syndrome and 29 and 13% for obesity itself, respectively. For metabolic syndrome, almost perfect agreement was found for BMI compared with fat percentage or fat mass index. For obesity, agreement was fair to moderate (BMI vs fat percentage).
Using BMI to evaluate obesity underestimates the true prevalence of metabolic syndrome in patients with craniopharyngioma. Furthermore, fat percentage contributes to a better evaluation of obesity than BMI. The contribution of DXA scan might be limited for identification of the metabolic syndrome.
颅咽管瘤患者由于下丘脑-垂体损伤，常伴有代谢异常。既往研究使用 BMI 作为肥胖标志物，此类患者代谢综合征的发生率约为 46%。本研究旨在探讨双能 X 线吸收法（DXA）评估肥胖和代谢综合征的价值是否优于 BMI。
回顾性分析颅咽管瘤患者的临床资料，患者均行 DXA 检查。
使用 BMI、体脂百分比和体脂质量指数评估肥胖，并作为代谢综合征的组成部分。
共纳入 95 例颅咽管瘤患者（女性占 51%，发病年龄＜18 岁者占 49%）。根据不同的肥胖定义，代谢综合征发生率为 45%-51%（BMI 定义时发生率最低，为 43%）。与 BMI 相比，使用体脂百分比（52%比 42%）或体脂质量指数（51%比 43%）定义肥胖时，代谢综合征的发生率更高。代谢综合征和肥胖本身的误诊率分别为 9%（体脂百分比与 BMI 相比）和 7%（体脂质量指数与 BMI 相比），29%和 13%的患者肥胖诊断被高估。对于代谢综合征，BMI 与体脂百分比或体脂质量指数的一致性极好；对于肥胖，BMI 与体脂百分比的一致性为中等至良好。
使用 BMI 评估肥胖会低估颅咽管瘤患者代谢综合征的真实发生率。与 BMI 相比，体脂百分比更有助于评估肥胖。DXA 扫描对于代谢综合征的诊断价值可能有限。
