基于生物电阻抗法测量的体脂肪量对儿童青少年血脂异常的预测价值:适宜体脂切点的研究  

Predictive value of bioelectrical impedance analysis-measured body fat to abnormal lipid profiles in children and adolescents:the optimal cut-off values of body fat

作　　者：程红[1] 李海波 侯冬青[1] 高爱钰 朱忠信 郁兆仓 王宏健 赵小元[1] 肖培 黄贵民 米杰 Cheng Hong;Li Haibo;Hou Dongqing;Gao Aiyu;Zhu Zhongxin;Yu Zhaocang;Wang Hongjian;Zhao Xiaoyuan;Xiao Pei;Huang Guimin;Mi Jie(Department of Epidemiology,Capital Institute of Pediatrics,Beijing 100020,China;Graduate School of Peking Union Medical College,Peking Union Medical College,Beijing 100730,China;Beijing Dongcheng Primary and Secondary School Health Center,Beijing 100009,China;Beijing Miyun Primary and Secondary School Health Center,Beijing 101500,China;Beijing Tongzhou Primary and Secondary School Health Center,Beijing 201100,China;Beijing Fangshan Primary and Secondary School Health Center,Beijing 102400,China;Department of Non-Communicable Disease Management,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China)

机构地区：[1]首都儿科研究所流行病学研究室,北京100020 [2]北京协和医学院研究生院,北京100730 [3]东城区中小学卫生保健所,北京100009 [4]密云区中小学卫生保健所,北京101500 [5]通州区中小学卫生保健所,北京201100 [6]房山区中小学卫生保健所,北京102400 [7]国家儿童医学中心儿童慢病管理中心,首都医科大学附属北京儿童医院,北京100045

出　　处：《中华实用儿科临床杂志》2021年第1期36-41,共6页Chinese Journal of Applied Clinical Pediatrics

基　　金：国家自然科学基金(81973110);国家重点研发计划(2016YFC0900600,2016YFC0900602,2016YFC1300101)。

摘　　要：目的探讨儿童青少年中基于生物电阻抗法(BIA)测量的体脂肪量对各项血脂异常的预测价值,初步提出适宜的体脂切点。方法于2017年11月至2018年1月,采用分层整群抽样的方法在北京市东城、房山、密云及通州区选取30所学校(包括8所小学,21所中学和1所12年制学校)内6~16岁中小学在校学生作为研究对象。进行问卷调查和体格检测,通过BIA法测量体脂肪量,计算体质量指数(BMI)、体脂肪指数(FMI)和体脂肪率(FMP),并检测血清各项血脂水平。结果14309名儿童的年龄为(11.0±3.3)岁,男童占49.9%。在男女童中分别以FMI和FMP通过偏度-中位数-变异系数法(LMS法)拟合的百分位数值(P60~P95)逐个作为切点,选择对血脂异常预测敏感度、特异度、预测值和曲线下面积(AUC)均相对较好的P75值作为体脂过多切点参考值。男童FMI在P75以上者占人数的28%,控制男童FMI在P75以下,可能防止8%~57%的各项血脂异常;女童FMI在P75以上的约占26%,将FMI控制在此切点值以下,可能防止8%~42%的各项血脂异常。FMP观察到与FMI类似的结果。在男童中基于FMI和FMP的P75切点在预测各血脂异常[低密度脂蛋白胆固醇(HDL-C)除外]的特异度和AUC高于BMI(AUC:52.4%~69.6%比50.2%~67.1%,P<0.05),而在女童中差异均无统计学意义(P>0.05)。此外,当FMI或FMP超过P90时,对各血脂异常的特异度近似达到90%。结论基于FMI和FMP的体脂过多、肥胖诊断切点值能够更加真实地反映儿童体成分状况,对儿童血脂异常的识别具有较高的特异度和综合预测价值,可进一步在今后儿童肥胖和相关慢性疾病防治工作中推广应用。Objective To assess the predictive values of bioelectrical impedance analysis(BIA)-measured body fat indices to abnormal lipid profiles,and to preliminary propose optimal cut-off values of body fat in children and adolescents.Methods Children and adolescents,aged 6-16 years,were selected from 30 schools(8 primary schools,21 middle schools and one 12-year education school)in Dongcheng,Tongzhou,Fangshan and Miyun districts of Beijing by adopting a stratified cluster sampling method from November 2017 to January 2018.Questionnaire survey,body mass index(BMI),body fat mass index(FMI),fat mass percentage(FMP)and four lipid profiles were conducted.Results A total of 14309 participants,aged(11.0±3.3)years,were enrolled in the analysis,with 49.9%boys.In boys and girls,the percentile values(P60-P95)fitted by FMI and FMP with K-median-coefficient of variation(LMS)method were taken as the cutting points,and P75 values were selected as the cut-off points of excessive body fat for their better sensitivity,specificity,predictive value and area under curve(AUC)for identification of abnormal lipid profiles.Boys with FMI above P75 accounted for 28%of the total population,and controlling boys with FMI below P75 could prevent dyslipidemia of 8%-57%.FMI in girl population occupied about 26%of the above,and controlling FMI in girl population below this cut-off point may prevent dyslipidemia from 8%-42%.FMP observed similar results to FMI.Assessed by FMI or FMP with P75 cut-off values,adiposity performed better than BMI for recognizing abnormal lipid profiles in boys(AUC:52.4%-69.6%vs.50.2%-67.1%,P<0.05)rather than in girls(P>0.05).In addition,when FMI or FMP beyond P90,the specificity of each abnormal lipid profiles was around 90%.Conclusions The recommend cut-off points for body fat may be to assess children′s adiposity,and can be applied in preventive activities.

关 键 词：儿童 体脂肪指数 体脂肪率 血脂 

分 类 号：R723.14[医药卫生—儿科]