Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, PR China.
Department of Commissioning, South Western Sydney Primary Health Network, Campbelltown, Australia.
Int J Obes (Lond). 2020 Apr;44(4):886-894. doi: 10.1038/s41366-019-0416-y. Epub 2019 Jul 22.
To investigate the performance of weight/height in discriminating obesity-related cardio-metabolic risks, and compare their performance with BMI in Chinese and American children.
57,201 Chinese children aged 7-18 and 10,441 American children aged 12-18 with complete record of sex, age, height, weight, and waist circumference were included. Analyses and comparisons of BMI, weight/height, and weight/height were predominantly discussed, while BMI z score, converted by BMI based on 2007 WHO growth standard, was set as the reference. Log-binomial regression models and areas under receiver-operating characteristic curves were used to examine their abilities on identifying cardio-metabolic risks, including elevated blood pressure, impaired fasting glucose, and dyslipidemia. Misclassification rates of each index were calculated.
Weight/height is relatively stable during childhood in both populations. Odds ratio of weight/height in discriminating cardio-metabolic risks ranged from 1.09 (95% CI: 1.04, 1.14) to 1.23 (95% CI: 1.22, 1.25) and 1.06 (95% CI: 1.04, 1.08,) to 1.17 (95% CI: 1.15, 1.20) in Chinese and American participants, respectively. When 85th and 95th percentiles were set as thresholds for each sex, weight/height showed similar accuracy to BMI percentiles, and were more precise than BMI z scores. Misclassification rates of weight/height ranged from 19.1% (95% CI: 18.8%, 19.5%) to 34.7% (95% CI: 34.0%, 35.4%) compared to BMI z score, which ranged from 26.3% (95% CI: 26.0%, 26.7%) to 36.8% (95% CI: 36.0%, 37.5%) in Chinese participants. Results were similar in American participants. Combined use of weight/height and waist-to-height ratio did not change the classification accuracy.
Tri-ponderal mass index (TMI) performed superior to BMI z scores and similar to BMI percentiles in Chinese and American participants. TMI is stable in adolescents, and could be a more efficient indicator for screening obesity-related cardio-metabolic risks in routine health screening compared with BMI.
探讨体重/身高在鉴别肥胖相关心血管代谢风险方面的表现，并比较其在中、美儿童中的表现。
共纳入 57201 名中国 7-18 岁和 10441 名美国 12-18 岁儿童的完整性别、年龄、身高、体重和腰围记录。主要讨论了 BMI、体重/身高和体重/身高的分析和比较，同时将基于 2007 年世卫组织生长标准的 BMI 转换后的 BMI z 分数作为参考。使用对数二项式回归模型和受试者工作特征曲线下面积来检测它们在识别心血管代谢风险方面的能力，包括血压升高、空腹血糖受损和血脂异常。计算每个指数的错误分类率。
在两个人群中，体重/身高在儿童期相对稳定。体重/身高鉴别心血管代谢风险的比值比范围分别为 1.09（95%CI：1.04，1.14）至 1.23（95%CI：1.22，1.25）和 1.06（95%CI：1.04，1.08）至 1.17（95%CI：1.15，1.20）在中国和美国参与者中。当 85 百分位和 95 百分位分别设定为每个性别时，体重/身高与 BMI 百分位的准确性相似，且比 BMI z 分数更准确。体重/身高的错误分类率范围为 19.1%（95%CI：18.8%，19.5%）至 34.7%（95%CI：34.0%，35.4%），而 BMI z 分数的错误分类率范围为 26.3%（95%CI：26.0%，26.7%）至 36.8%（95%CI：36.0%，37.5%）在中国参与者中。美国参与者的结果相似。体重/身高和腰高比的联合使用并未改变分类准确性。
三指针质量指数（TMI）在中、美参与者中的表现优于 BMI z 分数，与 BMI 百分位相似。TMI 在青少年中稳定，与 BMI 相比，在常规健康筛查中筛查肥胖相关心血管代谢风险可能是一种更有效的指标。
