不同类型肥胖与心血管疾病危险因素关联的比较  

Odds ratio on cardiovascular risk factors of obesity defined by waist and body mass index

作　　者：杜松明[1] 李艳平[2] 房红芸[2] 胡小琪[2] 杨晓光[2] 马冠生[2] 胡永华[1] 

机构地区：[1]北京大学医学部公共卫生学院流行病与卫生统计学系,100191 [2]中国疾病预防控制中心营养与食品安全所

出　　处：《中华流行病学杂志》2010年第6期626-632,共7页Chinese Journal of Epidemiology

基　　金：卫生部专项基金、科技部重大专项基金（2001DEA30035,2003DIA6N008）[全国31个省级（不含香港、澳门特别行政区及台湾）工作队和132个调查点项目工作队的4700余名调查队员参与本项调查;感谢联合国儿童基金会、世界卫生组织、联合利华食品（中国）有限公司、达能营养中心（中国）在研究中给予的支持]

摘　　要：目的比较不同类型肥胖与心血管疾病（CVD）危险因素的关联，为预防和控制心血管疾病提供科学依据。方法利用“2002年中国居民营养与健康状况调查”资料，按照《中国成人超重和肥胖症预防控制指南》中判定肥胖的界值点[体重指数（BMI）：24kg／m^2和28kg／m^2；腰围：男性85cm和95cm，女性80cm和90cm]判定肥胖类型，比较不同类型肥胖人群与罹患CVD危险因素的关联；用logistic回归和多元线性回归分析BMI和腰围与CVD危险因素的关系。结果与体重和腰围均在正常范围的人群（OR=1）相比，正常体重并高腰围Ⅰ（男性85～95cm，女性80～90cm）的人群、超重但腰围正常的人群罹患CVD危险因素的风险为1～2倍，超重并高腰围Ⅰ、肥胖但腰围正常的人群为2～3倍，超重并高腰围Ⅱ（男性≥95cm，女性≥90cm）、肥胖并高腰围Ⅰ或Ⅱ（男性≥85cm，女性≥80cm）的人群为≥3倍；同一腰围组中，随着BMI增加罹患CVD危险因素的风险也呈逐渐增加趋势；BMI和腰围同时解释CVD危险因素变异的1．7％～9．4％，大于BMI或腰围单独解释的比例（1．5％～9．0％）；BMI对于收缩压的标化回归系数为0．129，略大于腰围（0．123），腰围对甘油三酯、总胆固醇和高密度脂蛋白胆固醇标化回归系数的绝对值大于BMI。结论BMI和腰围与CVD危险因素独立相关，建议评估疾病危险时同时使用BMI和腰围两项指标。Objective To compare the odds ratio of waist circumference （WC） and/or body mass index（BMI） on cardiovascular risk factors. Methods Data on a cross-sectional study involving 41 087 adults （19 567 male, 21 520 female） from the 2002 China National Nutrition and Health Survey were examined. According to the obesity definition of the Chinese Working Group on Obesity for Children （WGOC） （BMI, 24 and 28 kg/m^2; WC, male 85 cm, female 80 cm ）, the study population were divided into 9 groups. The prevalence and odds ratio （OR） of cardiovascular disease （CVD） risk factors were compared among these 9 groups. Variation and standard β were indexes being used to compare the likelihood of BMI and/or WC on CVD risk factors. Results Within each of the BMI categories, with few exceptions, indices levels on CVD risk factors were significantly increased （decreased for HDL-C levels） with the increase of WC, and vice versa. After adjusting the effects of age, sex, income, education, sedentary activity and dietary factors, the ORs of hypertension in adults with higher WC within each of the BMI categories were higher than adults with lower WC, and the ORs of hypertension in adults with higher BMI within each of the WC categories were higher than adults with lower BMI. Similar trends were found for high fast plasma glucose （FPG） and dyslipidemia. The variation in CVD risk factors explained only by WC and BMI were quite similar, but slightly larger when combined WC with BMI. Standard β was higher on BMI when predicting systolic BP and was higher on WC when predicting TG, TC and HDL-C. Conclusion BMI and WC were independently associated with the risk factors on CVD.To combine the BMI and WC, the results could accurately evaluate the risk of CVD, thus to provide substantive evidence that the WGOC cutoff points for the WC might help in identifying those population under increased risk.

关 键 词：肥胖 中心型肥胖 心血管疾病危险因素 多元回归模型 

分 类 号：R54[医药卫生—心血管疾病] R589.2[医药卫生—内科学]