Performance of body mass index, waist circumference and waist-to-height ratio in screening true obesity in children
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摘要:
目的 评价体质量指数(BMI)、腰围(WC)和腰围身高比(WHtR)筛查儿童真实肥胖的准确性，旨在为儿童肥胖精准筛查和早期防控提供科学依据。 方法 数据来自“桓台儿童心血管健康随访队列”2021年调查的1 322名10~15岁儿童。采用生物电阻抗法测量体脂肪率(FMP)和脂肪质量指数(FMI)，以FMP或FMI大于等于相应性别和年龄别的第70百分位数为真实肥胖的判定标准。分别采用BMI、WC和WHtR定义一般性肥胖与中心性肥胖，并通过计算漏诊率、误诊率、受试者工作特征曲线下面积(AUC)和Kappa系数等指标，评价其筛查儿童真实肥胖的效果。 结果 男生BMI[(21.79±4.56)kg/m2]、WC[(76.41±12.53)cm]和WHtR(0.47±0.07)均高于女生[(20.83±4.13)kg/m2，(70.69±10.06)cm，(0.45±0.06)](t值分别为4.02, 9.19, 6.63)，男生FMP[(18.29±8.35)%]和FMI[(4.35±2.79)kg/m2]均低于女生[(24.87±6.51)%，(5.44±2.53)kg/m2](t值分别为-16.10，-7.42)(P值均 < 0.01)。以FMP为参考标准，BMI、WC和WHtR筛查真实肥胖的漏诊率分别为12.24%，2.11%，2.11%；误诊率分别为10.88%，27.28%，24.33%；AUC分别为0.88，0.85，0.87；Kappa系数分别为0.67，0.48，0.52。以FMI为参考标准，BMI、WC和WHtR筛查真实肥胖的漏诊率分别为14.20%，1.23%，2.78%；误诊率分别为4.81%，20.84%，18.14%；AUC分别为0.90，0.89，0.90；Kappa系数分别为0.81，0.64，0.67。 结论 BMI在筛查儿童真实肥胖时漏诊率较高，而WC和WHtR的误诊率较高。应在临床实践中推广体脂水平检测，以实现更精准的慢性病预防与控制。 Abstract:Objective To evaluate the accuracy of body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR) in screening true obesity among children, so as to provide a scientific basis for precise screening and early prevention and control of childhood obesity. Methods A total of 1 322 children aged 10-15 years old were surveyed by the Huantai Children Cardiovascular Health Cohort in 2021. Fat mass percentage (FMP) and fat mass index (FMI) were measured by bioelectrical impedance analysis, with FMP or FMI values at or above the age- and sex-specific 70th percentiles as the criteria for defining true obesity. BMI, WC and WHtR were used to define general obesity and central obesity. The accuracy of these measures in screening for true obesity was evaluated by calculating the missed diagnosis rate, misdiagnosis rate, area under the curve(AUC) for receiver operating characteristic and Kappa coefficient. Results Boys had higher BMI [(21.79±4.56) kg/m2], WC [(76.41±12.53) cm] and WHtR (0.47±0.07) than girls [(20.83±4.13) kg/m2, (70.69±10.06) cm, (0.45±0.06)] (t=4.02, 9.19, 6.63), while boys had lower FMP [(18.29±8.35)%] and FMI [(4.35±2.79) kg/m2] than girls [(24.87±6.51)%, (5.44±2.53) kg/m2] (t=-16.10, -7.42) (P < 0.01). Using FMP as a reference standard, the diagnosis error rates of screening for true obesity based on BMI, WC and WHtR were 12.24%, 2.11% and 2.11%, respectively; the diagnosis error rates were 10.88%, 27.28% and 24.33%; the AUC values were 0.88, 0.85 and 0.87; the Kappa coefficients were 0.67, 0.48 and 0.52. Using FMI as a reference standard, rates of BMI, WC and WHtR screening for true obesity were 14.20%, 1.23% and 2.78%; the diagnosis error rates were 4.81%, 20.84% and 18.14%; the AUC values were 0.90, 0.89 and 0.90; the Kappa coefficients were 0.81, 0.64 and 0.67. Conclusions BMI has a higher diagnosis error rate in screening for true obesity in children, while WC and WHtR have higher diagnosis error rates. It is recommended to promote body fat assessment in clinical practice, so as to achieve more accurate prevention and control of chronic diseases. -
Key words:
- Body mass index /
- Waist circumference /
- Obesity /
- Area under curve /
- Child
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表 1 不同性别儿童体格测量和体成分检测数据比较(x±s)
Table 1. Comparison of physical measurement and body composition testing data among children of different genders(x±s)
性别 人数 体重/kg 身高/cm BMI/(kg·m-2) WC/cm WHtR FMP/% FMI/(kg·m-2) 男 697 57.92±16.30 161.92±11.88 21.79±4.56 76.41±12.53 0.47±0.07 18.29±8.35 4.35±2.79 女 625 52.16±13.12 157.47±8.18 20.83±4.13 70.69±10.06 0.45±0.06 24.87±6.51 5.44±2.53 t值 7.11 8.00 4.02 9.19 6.63 -16.10 -7.42 P值 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 
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表 2 FMP参考标准下BMI、WC、WHtR筛查不同性别儿童真实肥胖混淆矩阵
Table 2. Confusion matrix for screening true obesity among children of different genders by BMI, WC and WHtR under FMP
性别 选项 BMI WC WHtR 正常a 一般性肥胖 正常 中心性肥胖 正常 中心性肥胖 男 正常 473 91 388 176 407 157 真实肥胖 20 113 2 131 4 129 女 正常 494 27 401 120 414 107 真实肥胖 9 95 3 101 1 103 总体 正常 967 118 789 296 821 264 真实肥胖 29 208 5 232 5 232 注： a包括超重儿童。
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表 3 FMI参考标准下BMI、WC、WHtR筛查不同性别儿童真实肥胖混淆矩阵
Table 3. Confusion matrix for screening true obesity among children of different genders by BMI, WC and WHtR under FMI
性别 选项 BMI WC WHtR 正常a 一般性肥胖 正常 中心性肥胖 正常 中心性肥胖 男 正常 471 47 388 130 405 113 真实肥胖 22 157 2 177 6 173 女 正常 479 1 402 78 412 68 真实肥胖 24 121 2 143 3 142 总体 正常 950 48 790 208 817 181 真实肥胖 46 278 4 320 9 315 注： a包括超重儿童。
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表 4 FMP参考标准下BMI、WC和WHtR筛查不同性别儿童真实肥胖的效果(n=1 322)
Table 4. Accuracy of BMI, WC and WHtR in screening true obesity among children of different genders under FMP(n=1 322)
性别 指标 漏诊率/% 误诊率/% 阳性预测值/% 阴性预测值/% AUC值(95%CI) Kappa系数 男 BMI(一般性肥胖) 15.04 16.13 55.39 95.94 0.84(0.81~0.88) 0.57 WC(中心性肥胖) 1.50 31.21 42.67 99.49 0.84(0.82~0.86) 0.45 WHtR(中心性肥胖) 3.01 27.84 45.10 99.03 0.85(0.82~0.87) 0.48 女 BMI(一般性肥胖) 8.65 5.18 77.87 98.21 0.93(0.90~0.96) 0.80 WC(中心性肥胖) 2.88 23.03 45.70 99.26 0.87(0.85~0.90)* 0.51 WHtR(中心性肥胖) 0.96 20.54 49.05 99.76 0.89(0.87~0.91)* 0.56 注： *与BMI(一般性肥胖)组相比，P < 0.05。
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表 5 FMI参考标准下BMI、WC和WHtR筛查不同性别儿童真实肥胖的效果(n=1 322)
Table 5. Accuracy of BMI, WC and WHtR in screening true obesity among children of different genders under FMI(n=1 322)
性别 指标 漏诊率/% 误诊率/% 阳性预测值/% 阴性预测值/% AUC值(95%CI) Kappa系数 男 BMI(一般性肥胖) 12.29 9.07 76.96 95.54 0.89(0.87~0.92) 0.75 WC(中心性肥胖) 1.12 25.10 57.65 99.49 0.87(0.85~0.89) 0.60 WHtR(中心性肥胖) 3.35 21.81 60.49 98.54 0.87(0.85~0.90) 0.63 女 BMI(一般性肥胖) 16.55 0.21 99.18 95.23 0.92(0.89~0.95) 0.88 WC(中心性肥胖) 1.38 16.25 64.71 99.50 0.91(0.89~0.93) 0.70 WHtR(中心性肥胖) 2.07 14.17 67.62 99.28 0.92(0.90~0.94) 0.72
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