体重指数、腰围和腰臀比预测高血压、高血糖的实用价值及其建议值探讨

王文绢; 王克安; 李天麟; 向红丁; 马林茂; 富振英; 陈君石; 刘尊永; 白锦; 冯晋光; 金书香; 李彦琴; 秦汝莉; 陈泓

Abstract

王文绢,王克安,李天麟,向红丁,马林茂,富振英,陈君石,刘尊永,白锦,冯晋光,金书香,李彦琴,秦汝莉,陈泓.体重指数、腰围和腰臀比预测高血压、高血糖的实用价值及其建议值探讨[J].Chinese journal of Epidemiology,2002,23(1):16-19

体重指数、腰围和腰臀比预测高血压、高血糖的实用价值及其建议值探讨

A discussion on utility and purposed value of obesity and abdomen obesity when body mass index, waist circamference,waist to hip ratio used as indexes predicting hypertension and hyper-blood glucose

Received:August 29, 2001

DOI：

KeyWord: 超重肥胖腹部,肥胖诊断指标诊断界值

English Key Word: Overweight Obesity Abdominal visceral obesity Diagnostic index Diagnostic cut-off point

FundProject:卫生部科学研究基金资助项目 ( 94 1 0 78)

Author Name	Affiliation
WANG Wenjuan	中国预防医学科学院慢性病与健康促进办公室
WANG Kean	中国预防医学科学院慢性病与健康促进办公室
LI Tianlin	中国预防医学科学院慢性病与健康促进办公室
XIANG Hongding	中国医学科学院协和医院
MA Linmao	中国预防医学科学院慢性病与健康促进办公室
FU Zhenying	中国预防医学科学院慢性病与健康促进办公室
CHEN Junshi	中国预防医学科学院慢性病与健康促进办公室
LIU Zunyong	中国预防医学科学院慢性病与健康促进办公室
BAI Jin	中国预防医学科学院慢性病与健康促进办公室
FENG Jinguan	Chinese Academy of Preventive Medicine, Beijing 100050, China
JIN Shuxiang	中国预防医学科学院慢性病与健康促进办公室
LI Yanqin	中国预防医学科学院慢性病与健康促进办公室
QIN Ruli	中国预防医学科学院慢性病与健康促进办公室
CHEN Hong	中国预防医学科学院慢性病与健康促进办公室

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Abstract:

目的探讨体重指数(BMI)、腰围(WC)、腰臀比(WHR)对于预测高血压、高血糖患病的实用价值及其诊断建议值,为确定我国肥胖和腹部肥胖的诊断指标及其界值提供科学依据。方法利用1995～1997年全国糖尿病(DM)流行病学调查资料进行分析,方法包括偏相关分析、logistic多因素回归分析、交互作用分析,计算BMI、WC、WHR在不同截点暴露对高血压、高血糖和二者聚集的相对危险度(RR)、暴露组归因危险百分比(ARP)和人群归因危险百分比(PARP)。结果①BMI、WC与血压和血糖的相关性比WHR好;②logistic调整了年龄、性别、职业性体力活动强度、休闲活动强度、文化程度和DM家族史后,BMI、WC、WHR是患高血压、高血糖以及二者聚集重要的预测因子,三者的相对重要性以BMI>WC>WHR;③BMI、WC、WHR三者之间对于高血压和高血糖患病有相加交互作用,尤其以BMI与WC的交互作用普遍存在,其纯归因交互作用百分比〔AP(AB)〕在5.95%～29.34%之间;④BMI≥23、≥24、≥25时,RR在2.5左右,从流行病学角度看,RR值处于暴露因子与疾病关联的中高度有害范围,其ARP在0.580～0.626之间,PARP在0.259～0.425之间;⑤男性 WC≥85cm、女性 WC ≥80 cm 和男性 WC≥90 cm、女性 WC ≥80 cm 时 , RR 分别在2.06～ 3.08之间 , 此时腹部肥胖对高血压、高血糖和二者聚集的 RR 值分别处于中、高度有害;ARP 分别在0.515～ 0.676之间, PARP分别在0.241～ 0.431之间。结论　从暴露对疾病危害的程度, 人们对超重和肥胖的可接受性, 我国开展肥胖防治处于初期阶段及从公共卫生人群预防的角度综合考虑, 在 BMI、WC、WHR 中, 预测我国高血压和高血糖的实用价值以 BMI 和 WC 为好, 建议以BMI为肥胖指标, BMI≥24 诊断为超重和肥胖;以WC为腹部肥胖指标, 男性 WC≥85 cm, 女性 WC≥80 cm 为诊断界值。

English Abstract:

Objective Discussion on utility and purposed value of obesity and abdomen obesity when body mass index(BMI), waist circumference(WC), waist to hip ratio(WHR) used as indexes predicting hypertension, hyper-blood glucose, and both clusters, to provide scientific basis for the decision on the indexes and their cut-off points of obesity and abdomen obesity in Chinese people. Methods Using the data of diabetes mellitus(DM) from epidemiological studies carried out in 11 provinces/autonomous regions/municipalities of China from July 1995 to June 1997. Partial relative analysis, logistic multi-factors regression analysis, interaction analysis were used. Relative risk (RR), attributable risk proportion (ARP) and population attributable risk proportion(PARP) of hypertension, hyper-blood glucose, and the both cluster as BMI, WC, WHR with the different cut off points were analysed. Results 1) The correlations between BMI, WC and blood pressure, blood glucose were better than the WHR. 2) After adjusted by age, sex, occupation leisure physical activity, education degree and the family history of DM, the Results suggested that BMI,WC,WHR were important predictive factors, with relative importance as BMI WCWHR. 3) There were augment interactions on BMI, WC and WHR with hypertension, hyper-blood glucose, with the interaction of BMI and WC in particular. Their pure attributableinteraction proportion were from 5.95% to 29.34%. 4) The values of RR were about 2.5 when BMI≥23,≥24 and ≥25, suggesting the relationship with exposure factors and diseases were with medium and high maleficent extent. Their ARP were from 0.580 to 0.623 with PARP from 0.259 to 0.425. The values of RR were from 2.06 to 3.08 as WC≥85 cm in males,WC≥80 cm in females while WC≥90 cm in males,WC≥80 cm in females, which suggested that the relationship with exposure factors and diseases were in medium and high maleficent extent. Their ARP were from 0.515 to 0.676 while PARP from 0.241 to 0.431.ConclusionsSince the maleficent extent of exposure factors to diseases, the acceptability for overweight and obesity in population, and the prevention and care for overweight and obesity were just in the introduction stage in China. The utility value of predicted hypertension, hyper-blood glucose in BMI and WC seemed to be better then in WHR. We suggested that BMI used as the obesity index, with the diagnostic cut-off point BMI≥24. WC as the abdomen obesity index. The diagnostic cut-off points are suggested to be WC≥85 cm in males,and WC≥80 cm in females.

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