小儿肥胖相关非酒精性脂肪性肝病：腰围身高比是最佳的人体测量学预测指标。
Pediatric obesity-related non-alcoholic fatty liver disease: waist-to-height ratio best anthropometrical predictor.
机构信息
Department of the Woman, the Child, of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy.
Department of Internal Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.
出版信息
Pediatr Res. 2021 Jul;90(1):166-170. doi: 10.1038/s41390-020-01192-w. Epub 2020 Oct 10.
BACKGROUND
Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disorder in pediatric obesity. Our study aims to identify a predictive anthropometrical measure for NAFLD in obese children.
METHODS
We retrospectively enrolled children and adolescents with obesity. Physical, biochemical, and ultrasound assessments were available. ROC curve tests were performed to identify the best predictor of NAFLD among waist-to-height ratio (WHR), BMI z-score, and triponderal mass index (TMI, an anthropometric index recently associated with increased adiposity in children). Subsequently, a cut-off value was identified.
RESULTS
In total, 1900 children and adolescents (1011 with NAFLD) were included. WHR (AUC 0.62, 95% CI 0.59-0.64) was the best predictor of NAFLD compared to BMI z-score (AUC 0.58, 95% CI 0.55-0.60) and TMI (AUC 0.58, 95% CI 0.55-0.61). WHR ≥ 0.53 in boys and 0.63 in girls displayed the best sensitivity and specificity for NAFLD presence. In addition, children with high WHR showed a significantly higher risk of NAFLD (boys: OR 2.43, 95% CI 1.61-3.68, p < 0.0001; girls: OR 1.92, 95% CI 1.58-2.34, p < 0.0001) and elevated ALT (OR 5.71, 95% CI 2.09-15.56, p = 0.0007; girls: OR 2.16, 95% CI 1.70-2.74, p < 0.0001) independent of covariates.
CONCLUSIONS
WHR might represent a good anthropometric tool to candidate children and adolescents to NAFLD screening. WHR cut-off differs according to sex, being lower in boys than girls.
IMPACT
Waist-to-height ratio is a better predictor of non-alcoholic fatty liver disease risk compared to other anthropometric measures in obese children and adolescents. The predictive cut-off of waist-to-height ratio differs between boys and girls, being lower in boys than girls. The use of waist-to-height ratio measurement and its cut-off in clinical practice might help clinician in identifying obese children and adolescents at risk of non-alcoholic fatty liver disease.
背景
非酒精性脂肪性肝病（NAFLD）是小儿肥胖症中最常见的慢性肝脏疾病。我们的研究旨在确定一种预测肥胖儿童 NAFLD 的人体测量指标。
方法
我们回顾性纳入肥胖儿童和青少年患者。可获得体格、生化和超声评估数据。ROC 曲线检验用于识别腰高比（WHR）、BMI z 评分和三皮德指数（TMI，一种与儿童肥胖相关的新的人体测量指数）中预测 NAFLD 的最佳指标。随后确定了截断值。
结果
共纳入 1900 名儿童和青少年（1011 名患有 NAFLD）。与 BMI z 评分（AUC 0.58，95%CI 0.55-0.60）和 TMI（AUC 0.58，95%CI 0.55-0.61）相比，WHR（AUC 0.62，95%CI 0.59-0.64）是预测 NAFLD 的最佳指标。男孩中 WHR≥0.53，女孩中 WHR≥0.63 显示出对 NAFLD 存在的最佳敏感性和特异性。此外，高 WHR 的儿童患 NAFLD 的风险显著增加（男孩：OR 2.43，95%CI 1.61-3.68，p<0.0001；女孩：OR 1.92，95%CI 1.58-2.34，p<0.0001）和 ALT 升高（OR 5.71，95%CI 2.09-15.56，p=0.0007；女孩：OR 2.16，95%CI 1.70-2.74，p<0.0001），独立于协变量。
结论
WHR 可能是一种候选儿童和青少年 NAFLD 筛查的良好人体测量工具。WHR 截断值因性别而异，男孩低于女孩。
影响
与肥胖儿童和青少年中的其他人体测量指标相比，腰高比（WHR）是预测非酒精性脂肪性肝病风险的更好指标。男孩的 WHR 预测截断值低于女孩。在临床实践中使用 WHR 测量及其截断值可能有助于临床医生识别患非酒精性脂肪性肝病风险的肥胖儿童和青少年。
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