Tompuri Tuomo Tapani, Jääskeläinen Jarmo, Lindi Virpi, Laaksonen David Elliot, Eloranta Aino-Maija, Viitasalo Anna, Laitinen Tomi, Lakka Timo Antero
Department of Clinical Physiology and Nuclear Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland.
Institute of Biomedicine/Physiology, School of Medicine, University of Eastern Finland, Kuopio, Finland.
Front Endocrinol (Lausanne). 2019 Jun 26;10:410. doi: 10.3389/fendo.2019.00410. eCollection 2019.
Adiposity induces the clustering of cardiometabolic risk factors, and pediatric adiposity is a better indicator for adulthood cardiometabolic diseases than pediatric metabolic syndrome. However, the observed prevalence of pediatric adiposity depends on the methods and cut-points used. Therefore, we aimed to define diagnostic criteria for adiposity which enable more valid identification of prepubertal children at increased cardiometabolic risk. The participants were 470 prepubertal children (249 boys) aged 6-8 years. The measures of adiposity included body mass index-standard deviation score (BMI-SDS), waist-to-height ratio (WHtR) and body fat percentage (BF%) assessed by bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DXA). Criteria for adiposity were determined by increased cardiometabolic risk. Cardiometabolic risk factors which correlated with BF% assessed by DXA in the upper but not lower half of BF% (serum insulin and plasma high-density lipoprotein cholesterol, triglycerides, gamma-glutamyl transferase, high-sensitivity C-reactive protein and uric acid) were included in the cardiometabolic risk score (CMS). We computed receiver operating characteristics curves for the measures of adiposity using the ≥90th percentile of CMS as a measure of increased cardiometabolic risk, and local regression curves were graphed to demonstrate the associations of the measures of adiposity with CMS. In girls, WHtR of 0.445 (area under curve 0.778, its 95% confidence interval 0.65-0.91, sensitivity and specificity 0.73) and BF% of 19.5% assessed by BIA (0.801, 0.70-0.90, 0.73) were the best overall criteria for increased cardiometabolic risk. In boys, BMI-SDS of 0.48 (0.833, 0.75-0.92, 0.76) was the best overall criterion for increased cardiometabolic risk. While local regression curves in girls showed that WHtR of 0.445 corresponds well to a point where CMS began to increase, in boys local regression curves suggest that CMS began to increase even at a lower level of BMI-SDS than 0.48. Moreover, the diagnostic ability of the measures of adiposity to exclude increased cardiometabolic risk was poorer than the ability to detect it. In general, the measures of adiposity have sufficient diagnostic accuracy to be utilized as the screening tool for increased cardiometabolic risk. The observed cut-points for adiposity were lower than the traditional cut-points for adiposity.
肥胖会引发心血管代谢危险因素的聚集，而且儿童肥胖比儿童代谢综合征更能预示成年期心血管代谢疾病。然而，所观察到的儿童肥胖患病率取决于所使用的方法和切点。因此，我们旨在确定肥胖的诊断标准，以便更有效地识别心血管代谢风险增加的青春期前儿童。研究对象为470名6至8岁的青春期前儿童（249名男孩）。肥胖测量指标包括体重指数标准差评分（BMI-SDS）、腰高比（WHtR）以及通过生物电阻抗分析（BIA）和双能X线吸收法（DXA）评估的体脂百分比（BF%）。肥胖标准根据心血管代谢风险增加来确定。将与通过DXA评估的BF%上半部分而非下半部分相关的心血管代谢危险因素（血清胰岛素、血浆高密度脂蛋白胆固醇、甘油三酯、γ-谷氨酰转移酶、高敏C反应蛋白和尿酸）纳入心血管代谢风险评分（CMS）。我们以CMS的第90百分位数作为心血管代谢风险增加的指标，计算肥胖测量指标的受试者工作特征曲线，并绘制局部回归曲线以展示肥胖测量指标与CMS之间的关联。在女孩中，如果采用BIA评估，腰高比为0.445（曲线下面积为0.778，其95%置信区间为0.65至0.91，灵敏度和特异度为0.73）以及体脂百分比为19.5%（0.801，0.70至0.90，0.73）是心血管代谢风险增加的最佳总体标准。在男孩中，BMI-SDS为0.48（0.833，0.75至0.92，0.76）是心血管代谢风险增加情况的最佳总体标准。虽然女孩的局部回归曲线显示腰高比为0.445与CMS开始上升的点对应良好，但在男孩中，局部回归曲线表明，即使BMI-SDS低于0.48，CMS也已开始上升。此外，肥胖测量指标排除心血管代谢风险增加情况的诊断能力低于检测该情况的能力。总体而言，肥胖测量指标具有足够的诊断准确性，可作为心血管代谢风险增加的筛查工具。所观察到的肥胖切点低于传统的肥胖切点。
