体重指数与体脂率指标评价肥胖:基于诊断试验的比较研究

发布时间：2018-06-07 09:46

本文选题：体重指数 + 体脂率　；参考：《中国运动医学杂志》2017年03期

【摘要】：目的:通过诊断试验评价体重指数(BMI)诊断肥胖的价值,并比较BMI与体脂率两种指标对肥胖相关疾病高血压、动脉硬化的预测价值,为肥胖的评价研究及指标应用的适应性提供参考。方法:采用分层整群方法,以3149名江苏省社区自然人群作为研究对象进行回顾性研究,同时测量BMI和体脂率。体脂率采用WHO和ASBP(美国减肥专科医学会)两种标准评价,筛查高血压和动脉硬化作为相关疾病。以体脂率定义的肥胖为效标,采用诊断试验的受试者工作特征(ROC)曲线评估BMI的诊断价值,并分析和比较BMI与体脂率两种指标对肥胖相关疾病的预测价值。结果:(1)BMI对肥胖(以体脂率定义)的诊断价值:女性的ROC曲线下面积为0.949(WHO标准)、0.906(ASBP标准),高于男性的0.864(WHO、ASBP两标准相同);不同年龄组中,20~39岁青年人群的曲线下面积最高;上述非参数检验P0.01。(2)根据ROC曲线,与原切点相比,BMI调整切点为男26 kg/m~2、女25 kg/m~2(体脂率WHO标准)或男26 kg/m~2、女23 kg/m~2(体脂率ASBP标准),预测肥胖的特异度从90%~99%下降到76%~87%,但灵敏度从17%~43%大幅度增加到78%~89%,总体精确程度大幅增加;调整切点后,肥胖检出率的一致性检验Kappa系数男性从0.475提高到0.537,女性从0.115提高到0.655。当体脂率为WHO标准时,BMI预测肥胖的灵敏度、特异度均比ASBP标准更高。(3)BMI预测高血压、动脉硬化的ROC曲线下面积分别为男性0.688(95%CI:0.656~0.720)、0.613(95%CI:0.586~0.642),女性0.745(95%CI:0.708~0.782)、0.692(95%CI:0.659~0.726);体脂率预测高血压、动脉硬化的ROC曲线下面积分别为男性0.687(95%CI:0.655~0.718)、0.635(95%CI:0.608~0.663),女性0.723(95%CI:0.681~0.764)、0.683(95%CI:0.648~0.718);上述P0.01。(4)男性体脂率对动脉硬化的预测价值(曲线下面积)高于BMI(u=2.05,P0.05),女性无差异(u=0.75,P0.05);男、女体脂率和BMI对高血压的预测价值均无差异(u=0.92、1.26,P0.05)。结论:(1)大样本研究时,BMI对肥胖(体脂率评价)有较高的诊断价值,尤其是女性、青年人群;BMI指标具备可替代性,但需要考虑切点的调整。(2)BMI和体脂率两种指标均可有效地预测人群高血压、动脉硬化风险,在女性和青年人中应用价值更大。(3)参照中国肥胖问题工作组的BMI标准,体脂率WHO标准比ASBP标准更适合中国人群评价肥胖。
[Abstract]:Objective: to evaluate the diagnostic value of body mass index (BMI) in the diagnosis of obesity, and to compare the predictive value of BMI and body fat rate in hypertension and arteriosclerosis associated with obesity. To provide a reference for the evaluation of obesity and the adaptability of the application of indicators. Methods: using stratified cluster method, 3149 community natural population in Jiangsu province were studied retrospectively, and BMI and body fat rate were measured at the same time. Body fat rates were assessed by WHO and ASBP, screening hypertension and arteriosclerosis as related diseases. Based on the obesity defined by body fat rate, the diagnostic value of BMI was evaluated by using the operating characteristics of the subjects in the diagnostic test, and the predictive value of BMI and body fat rate in obesity related diseases was analyzed and compared. Results the diagnostic value of ROC for obesity (defined by body fat rate) was: the area under the ROC curve of women was 0.949(WHO standard 0.906, which was higher than that of men, and the area under the curve was the highest in young people aged 2039 years in different age groups. The above non-parametric test P0.01.2) according to the ROC curve, Compared with the original point, the BMI adjusted cut point was 26 kg / m ~ 2 for men, 25 kg / m ~ 2 for women, or 26 kg / m ~ (-2) for men and 23 kg / m ~ (2) for women. The specificity of predicting obesity was decreased from 90 ~ 99% to 7687%, but the sensitivity increased significantly from 17 ~ 43% to 78 ~ 8 ~ 89, and the overall accuracy was greatly increased. After adjusting the cut point, the Kappa coefficient of obesity detection rate was increased from 0.475 to 0.537 for males and from 0.115 to 0.655 for females. When the body fat rate is the standard of WHO, the sensitivity of predicting obesity is higher and the specificity is higher than that of ASBP. The area under the ROC curve of arteriosclerosis is 0.68895 CI: 0.668895 CI: 0.61395CI: 0.5860.642N, and female 0.74595CIW 0.7080.7880.782t 0.69295 CI: 0.659266.The body fat rate predicts hypertension. The areas under the ROC curve of arteriosclerosis were 0.687 / 95CI0.655 / 0.718 / 0.63595 CI0.6080.663 for males and 0.72395CI0.6810.764C / 0.68395CI0.648: 0.71818 for women respectively. The predicted value of body fat rate for arteriosclerosis (area under the curve) was higher (area under the curve) than that of BMIUU 52.0P0.05 for women. There was no difference in body fat rate between men and women and the predicted value of BMI for hypertension. There was no difference in body fat rate between male and female and the predicted value of BMI in hypertension. Conclusion the BMI of large sample study has high diagnostic value for obesity (body fat rate evaluation), especially in women and young people. However, the adjustment of cutting point should be taken into account. Both BMI and body fat rate can effectively predict the risk of hypertension and arteriosclerosis in the population. It is of greater value in women and young people.) the BMI standard of the China working Group on Obesity is taken into account. Body fat rate WHO standard is more suitable for Chinese population to evaluate obesity than ASBP standard.
【作者单位】：上海体育学院运动科学学院;江苏省体育科学研究所;
【基金】：上海市人类运动能力开发与保障重点实验室项目(编号11DZ2261100) 2014年国家体育总局科教司科研项目(编号:2014B050)共同资助
【分类号】：R589.2

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