2023年杭州市6~18岁儿童青少年肥胖筛查工具的比较和应用  

Comparison and application of obesity screening indicators in children and adolescents aged 6-18 years in Hangzhou in 2023

作　　者：赵丽娟 朱冰 徐虹[1] 张文辉[1] 郝莉[1] 张旭慧[1] 张玉婷 吴尚熹 Zhao Lijuan;Zhu Bing;Xu Hong;Zhang Wenhui;Hao Li;Zhang Xuhui;Zhang Yuting;Wu Shangxi(Hangzhou Center for Disease Control and Prevention(Hangzhou Sanitary Supervision Institute),Hangzhou 310021,China;Zhejiang Provincial Center for Disease Control and Prevention,Hangzhou 310057,China)

机构地区：[1]杭州市疾病预防控制中心(杭州市卫生监督所),杭州310021 [2]浙江省疾病预防控制中心,杭州310057

出　　处：《卫生研究》2024年第5期746-754,共9页Journal of Hygiene Research

基　　金：杭州市卫生科技计划项目(No.A20220246)。

摘　　要：目的 建立儿童青少年分性别分年龄的全身体脂率百分位数参考值及参考曲线,并评价不同人体测量指标在筛查儿童青少年肥胖中的可靠性,探寻有效性和实用性较高的儿童肥胖大规模筛查工具及其理想临界值。方法 以2023年杭州市中小学生为研究对象,采用分层随机整群抽样方法选取小学、初中和高中各2所5983名6~18岁儿童青少年进行调查,测量体重、身高、腰围和臀围,采用生物电阻抗体成分分析仪测量儿童全身体脂含量。采用广义可加模型建立儿童体脂率百分位数参考曲线,使用受试者工作特征曲线评估各人体测量指标在将儿童青少年正确分类为肥胖方面的表现。结果 女生体脂率随着年龄增加呈逐年增高趋势,而男生体脂率呈现先增高后减低的趋势。脂肪质量是导致同年龄性别下体质指数差异的主要因素,且体质指数较高的儿童青少年中脂肪质量的贡献更大。体质指数在男生和女生中均有最大的曲线下面积,最佳截断值分别为26.82和24.52,曲线下面积值分别为0.988和0.992。腰围身高比的变异度小且曲线下面积值同样较大(男生为0.980,女生为0.970),可以同时满足儿童青少年大规模筛查中肥胖评价的准确性和实用性要求。结论 本研究建立了基于生物电阻抗方法的杭州市6~18岁儿童青少年体脂率的百分位数参考值及参考曲线,并发现腰围身高比是变异度低,简单、有效且实用的儿童肥胖筛查工具,可为本地区6~18岁儿童的生长发育评价和肥胖的识别提供参考依据。OBJECTIVE To determine the percentile reference values and reference curves of total body fat percentage in children and adolescents by sex and age,and to evaluate the reliability of different anthropometric indicators in screening for obesity in children and adolescents in order to explore the validity and practicality of a large-scale screening tool for childhood obesity and its desirable thresholds.METHODS A total of 5983 children and adolescents aged 6-18 years from six primary and secondary schools were selected by stratified randomised cluster sampling in Hangzhou City in 2023,and their weight,height,waist and hip circumferences were measured,and the children's total body fat content was measured using the bioelectrical resistance-antibody composition analyser.A generalised additive model(GAMLSS) was used to construct a percentile reference curve for children's body fat percentage,and the performance of each anthropometric measure in correctly classifying children and adolescents as obese was assessed using receiver operating characteristic(ROC) curves.RESULTS Over the period 6-18 years,body fat percentage in girls tended to increase with age from year to year,whereas in boys it tended to increase and then decrease.Fat mass index was the main factor contributing to the difference in BMI at the same age and sex(the optimal cutoff values were 26.82 and 24.52,with AUC values of 0.988 and 0.992,respectively),and the contribution of fat mass index was greater in those with a higher BMI.BMI,which had the largest area under the curve for both boys and girls,was the best indicator for assessing obesity in children and adolescents;the waist-to-height ratio(WHtR),with small variability and equally large area under curve values(0.980 for boys and 0.970 for girls),could simultaneously meet the requirements of accuracy and practicality for obesity assessment in mass screening of children and adolescents.CONCLUSION This study establish the percentile reference value and reference curve of body fat percentage of children

关 键 词：肥胖 体脂肪 儿童青少年 腰围身高比 体成分分析 

分 类 号：R151[医药卫生—营养与食品卫生学] R153[医药卫生—公共卫生与预防医学]