Beyond Body Mass Index: Advantages of Abdominal Measurements for Recognizing Cardiometabolic Disorders.
Beyond Body Mass Index: Advantages of Abdominal Measurements for Recognizing Cardiometabolic Disorders.
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DOI：
10.1016/j.amjmed.2015.08.010
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发表时间：
2016-01
期刊：
影响因子：
--
通讯作者：
Bullard KM
中科院分区：
文献类型：
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作者：
Kahn HS;Bullard KM
基于矢状腹径（SAD;也称为“腹高”）或腰围而不是体重的人体测量学可能会增强对心脏代谢疾病的临床识别。体重指数（BMI，体重/身高2）与SAD/身高比（SADHtR）或腰围/身高比（WHtR）的直接比较以前没有在全国代表性人群中进行过测试。在2011-2012年美国国家健康和营养检查调查中，未诊断为糖尿病的非妊娠成人（年龄20-64岁; n = 3071）提供了常规人体测量和仰卧位SAD（通过滑动梁卡尺）。人口加权logistic模型估计了每个人体测量指标与5种心脏代谢疾病的相关程度：血糖异常（糖化血红蛋白≥5.7%）、高非HDL c（非高密度脂蛋白[HDL]胆固醇≥4.14 mmol/L，或服用抗高血压药物），高血压（收缩压≥140 mm Hg或舒张压≥90 mm Hg，或服用降压药物），高ALT（丙氨酸转氨酶≥p75 [第75百分位数，性别特异性]）和HyperGGT（γ-谷氨酰转移酶≥p75 [性别特异性]）。在对每个指标进行缩放后，当识别除精神障碍外的每种疾病时，SADHtR的调整后比值比（aOR）往往最高，BMI最低。当SADHtR与BMI同时进入模型时，BMI的aOR不再直接识别任何疾病，而SADHtR识别高非HDL c患者的aOR为2.78（95%置信区间[CI]，1.71-4.51），高血压aOR 2.51（95% CI，1.22-5.15），ALT升高aOR 2.89（95% CI，1.56-5.37），GGT升高aOR 5.43（95% CI，3.01-9.79）。WHtR在代谢异常、高非HDL c和高GGT方面成功地与BMI竞争。SADHtR和WHtR的c-统计量在鉴别高非HDLc和高GGT方面高于BMI（P <0.001）。在非老年人中，SADHtR或WHtR比BMI更能识别心脏代谢疾病。
The clinical recognition of cardiometabolic disorders might be enhanced by anthropometry based on the sagittal abdominal diameter (SAD; also called “abdominal height”) or waist circumference rather than on weight. Direct comparisons of body mass index (BMI, weight/height2) with SAD/height ratio (SADHtR) or waist circumference/height ratio (WHtR) have not previously been tested in nationally representative populations. Nonpregnant adults without diagnosed diabetes (ages 20–64 years; n = 3071) provided conventional anthropometry and supine SAD (by sliding-beam caliper) in the 2011–2012 US National Health and Nutrition Examination Survey. Population-weighted, logistic models estimated how strongly each anthropometric indicator was associated with 5 cardiometabolic disorders: Dysglycemia (glycated hemoglobin ≥5.7%), HyperNonHDLc (non-high-density-lipoprotein [HDL] cholesterol ≥4.14 mmol/L, or taking anticholesteremic medications), Hypertension (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg, or taking antihypertensive medications), HyperALT (alanine transaminase ≥p75 [75th percentile, sex-specific]), and HyperGGT (gamma-glutamyltransferase ≥p75 [sex-specific]). After scaling each indicator, adjusted odds ratios (aORs) tended to be highest for SADHtR and lowest for BMI when identifying each disorder except dysglycemia. When SADHtR entered models simultaneously with BMI, the aORs for BMI no longer directly identified any condition, whereas SADHtR identified persons with HyperNonHDLc by aOR 2.78 (95% confidence interval [CI], 1.71–4.51), Hypertension by aOR 2.51 (95% CI, 1.22–5.15), HyperALT by aOR 2.89 (95% CI, 1.56–5.37), and HyperGGT by aOR 5.43 (95% CI, 3.01–9.79). WHtR competed successfully against BMI with regard to Dysglycemia, Hyper-NonHDLc, and HyperGGT. c-Statistics of SADHtR and WHtR were higher than those of BMI (P <.001) for identifying HyperNonHDLc and HyperGGT. Among nonelderly adults, SADHtR or WHtR recognized cardiometabolic disorders better than did the BMI.