Han T S, van Leer E M, Seidell J C, Lean M E
Department of Human Nutrition, University of Glasgow, Royal Infirmary, UK.
Obes Res. 1996 Nov;4(6):533-47. doi: 10.1002/j.1550-8528.1996.tb00267.x.
To evaluate the receiver operating characteristics (ROC) to determine the cutoffs of waist circumference as a potential population directed screening tool for hypercholesterolaemia (> or = 6.5 mmol/L), low high density lipoprotein cholesterol (< 0.9 mmol/L), and hypertension (treated and/or systolic > or = 160 and/or diastolic blood pressure > or = 95 mmHg), in 2183 men and 2698 women aged 20 to 59 years selected at random from Dutch civil registries.
Height, weight, body mass index (BMI), waist circumference, total plasma cholesterol and high density lipoprotein cholesterol concentrations, and blood pressure.
ROC curves showed that sensitivity equalled specificity at waist circumferences between 93-95 cm in men and 81-84 cm in women for identifying individual risk factors, and 92 cm in men and 81 cm in women for identifying those with at least one risk factor. Sensitivity and specificity were equal at levels between 61% to 69% for identifying individual risk factors, with positive predictions (56.8% in men and 37.8% in women) within 2% of those using previously defined 'Action Level 1' of waist circumference 94 cm in men and 80 cm in women (58.8% in men and 37.4% in women). Risk prediction by anthropometric methods was relatively low: ROC areas for identifying each risk factor by waist varied from 55% to 60%, and reached about 65% for identifying at least one risk factor. Height accounted for less than 0.3% of variance in waist circumference. Using BMI at 25 kg/m2 gave similar prediction to waist, but its combination with waist did not improve predictive values.
Measurement of waist circumference 'Action Level 1' at 94 cm (37 inches) in men and 80 cm (32 inches) in women could be adopted as a simpler valid alternative to BMI for health promotion, to alert those at risk of cardiovascular disease, and as a guide to risk avoidance by self-weight management.
为评估接受者操作特征（ROC），以确定腰围作为高胆固醇血症（≥6.5 mmol/L）、低高密度脂蛋白胆固醇（<0.9 mmol/L）和高血压（已治疗和/或收缩压≥160和/或舒张压≥95 mmHg）的潜在人群定向筛查工具的临界值，从荷兰民事登记处随机选取了2183名年龄在20至59岁之间的男性和2698名女性。
身高、体重、体重指数（BMI）、腰围、总血浆胆固醇和高密度脂蛋白胆固醇浓度以及血压。
ROC曲线显示，对于识别个体危险因素，男性腰围在93 - 95 cm之间、女性腰围在81 - 84 cm之间时，敏感性等于特异性；对于识别至少有一种危险因素的人群，男性腰围为92 cm、女性腰围为81 cm时，敏感性和特异性相等。识别个体危险因素时，敏感性和特异性在61%至69%之间相等，阳性预测值（男性为56.8%，女性为37.8%）与使用先前定义的男性腰围94 cm和女性腰围80 cm的“行动水平1”时的预测值（男性为58.8%，女性为37.4%）相差在2%以内。通过人体测量方法进行的风险预测相对较低：通过腰围识别每个危险因素的ROC面积在55%至60%之间，识别至少一种危险因素时达到约65%。身高在腰围变异中所占比例不到0.3%。使用BMI为25 kg/m²时与腰围的预测相似，但将其与腰围结合并未提高预测价值。
男性腰围“行动水平1”设定为94 cm（37英寸）、女性腰围设定为80 cm（3尺2寸），可作为一种比BMI更简单有效的健康促进替代方法，用于警示心血管疾病风险人群，并作为通过自我体重管理避免风险的指南。
