Waist circumference reference values for screening cardiovascular risk factors in Chinese children and adolescents aged 7-18 years

目的 根据儿童不同腰围水平罹患心血管疾病的危险,研究中同学龄儿童青少年腰围的适宜界值点.方法 利用受试者工作特征曲线(ROC)法分析从全国汇总的65 898名7～18岁学龄儿童青少年腰围及其相关代谢指征数据,探索预测心血管疾病的腰围最佳界值点.结果 儿童青少年腰围值小于第75百分位数(P75)时,收缩压、舒张压、血糖、总胆固醇、甘油三酯和低密度脂蛋白胆固醇水平以及血压升高率、血糖升高率、血脂异常率随腰围变化趋势不明显,当腰围大于P75后,上述指标逐渐增加,从P90开始,增加趋势明显,高密度脂蛋白胆固醇的变化趋势相反.ROC曲线结果表明,预测血压增加的腰围最佳界值点为P75;预测至少两项心血管疾病危险因素聚集的最佳界值点为P90.与腰围低于P75,的儿童青少年相比,在腰围处于P75～P90者中至少聚集两项心血管疾病危险因素的比例增加了1倍,腰围大于P90者中该比例则增加了5倍.按体重指数分类标准分层后,儿童青少年血压升高率仍然随腰围增加而显著增加.结论 建议将中国儿童青少年腰围的年龄别性别P7,和P90作为儿童青少年心血管病危险开始增加和明显增加的界值点.Objective To explore the optimal threshold values of waist circumference (WC) in detecting the risk on cardiovascular (CV) among the Chinese children and adolescents. Methods Association of WC and CV risk factors were studied among 65 898 children and adolescents aged 7-18 years whose data were pooled from nine studies carried out in China. Receive-operating characteristic analysis (ROC) and logistic regression were employed to derive optimal age- and sex-specific waist circumference references for predicting the CV risk factors. Results A slight increasing trend of CV risk factors was observed starting from the 75th percentile of waist circumference in the study population, while a remarkable increasing trend occurred from the 90th percentile. The optimal waist circumference thresholds for predicting high blood pressures were at the 75th percentile for both boys and girls, and at the 90th percentiles it could detect at least two of the above three CV risk factors. In comparison with children whose waist circumference was below the 75th percentile, the odds ratio of two CV risk factors doubled among children with waist circumference between 75th and 90th percentile, and increased by 6 times among children with waist circumference above the 90th percentile. The trend of high blood pressure increasing remained significant with waist circumference after having been stratified by BMI category. Conclusion The 75th and the 90th percentile of WC appeared to be the optimal cut-off points for predicting an increased and a substantially increased risk of CV factors in Chinese children and adolescents.卫生部专项基金; 科技部重大专项项目; 北京市科技计划重点项目; 乌鲁木齐市科学技术计划项目; 重庆市卫生局课题; 国家体育总局群体招标项目中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)06609-6153