A Comparison of Fat and Lean Body Mass Index to BMI for the Identification of Metabolic Syndrome in Children and Adolescents
A Comparison of Fat and Lean Body Mass Index to BMI for the Identification of Metabolic Syndrome in Children and Adolescents
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DOI：
10.1210/jc.2014-1684
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发表时间：
2014-09-01
影响因子：
5.8
通讯作者：
Zemel, Babette S.
中科院分区：
文献类型：
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作者：
Weber, David R.;Leonard, Mary B.;Zemel, Babette S.
背景：使用体重指数 (BMI) 评估儿科人群心脏代谢疾病的风险可能会因无法区分脂肪和瘦体重而受到限制。 目的：本研究的目的是确定使用脂肪 (FMI) 和瘦体重指数 (LBMI) 定义肥胖的生物学标准，并比较 FMI 和 LBMI 与 BMI 识别是否存在代谢综合征 (MetSyn) 的能力。营养检查调查1999-2006年数据。参与者：共有3004名12-20岁的参与者，具有双能X射线吸收测定身体成分和空腹实验室数据。主要结果指标：根据FMI和LBMI状态调整MetSyn的比值比，并测量识别MetSyn的曲线下面积。结果：接受者操作特征曲线分析确定 FMI 的第 80 个百分位和 LBMI 的第 74 个百分位作为识别 MetSyn 的最佳切点。 FMI 曲线下面积没有差异 [0.867； MetSyn 辨别的 95% 置信区间 (CI) 0.838-0.891] 与 BMI（0.868；95% CI 0.837-0.894）Z 分数。单独的多变量回归模型确定，BMI-Z 识别 MetSyn 的比值比为 6.2 (95% CI 3.3-11.5)，FMI-Z 为 6.4 (95% CI 3.7-11.1)，LBMI-Z 为 4.6 (95% CI 3.0-7.1)。包含 FMI-Z 和 LBMI-Z 的模型显示，较高的 LBMI-Z 与低高密度脂蛋白（1.5；95% CI 1.2-1.9）、高血压（1.8；95% CI 1.1-2.9）和胰岛素抵抗（1.8；95% CI 1.4-2.5）的几率较高相关，与 FMI-Z 无关。结论：FMI 和 LBMI-Z 的使用在儿科人群中识别 MetSyn 方面，LBMI 并没有改进 BMI。出乎意料的是，较高的 LBMI 与独立于 FMI 的多种心脏代谢危险因素的发生率较高相关。 FMI 和 LBMI 的使用可以对身体部位和疾病之间的关系进行独立评估，并值得未来的研究。
Context: The use of body mass index (BMI) to assess risk for cardiometabolic disease in the pediatric population may be limited by a failure to differentiate between fat and lean body mass.Objectives: The objectives of the study were to identify biologically based criteria for the definition of obesity using fat (FMI) and lean body mass index (LBMI) and to compare the ability of FMI and LBMI to BMI to identify the presence of metabolic syndrome (MetSyn).Design: This was a cross-sectional study using National Health and Nutrition Examination Survey 1999-2006 data.Participants: A total of 3004 participants aged 12-20 years with dual-energy X-ray absorptiometry body composition and fasting laboratory data participated in the study.Main Outcome Measures: Adjusted odds ratios for MetSyn according to FMI and LBMI status and area under the curve for the identification of MetSyn were measured.Results: Receiver-operating characteristic curve analyses identified the 80th percentile for FMI and the 74th percentile for LBMI as the optimal cut points for the identification of MetSyn. There was no difference in the area under the curve for FMI [0.867; 95% confidence interval (CI) 0.838-0.891] vs BMI (0.868; 95% CI 0.837-0.894) Z-scores for MetSyn discrimination. Separate multivariate regression models identified odds ratios for the identification of MetSyn of 6.2 (95% CI 3.3-11.5) for BMI-Z, 6.4 (95% CI 3.7-11.1) for FMI-Z, and 4.6 (95% CI 3.0-7.1) for LBMI-Z. Models containing both FMI-Z and LBMI-Z revealed that greater LBMI-Z was associated with greater odds of low high-density lipoprotein (1.5; 95% CI 1.2-1.9), high blood pressure (1.8; 95% CI 1.1-2.9), and insulin resistance (1.8; 95% CI 1.4-2.5), independent of FMI-Z.Conclusions: The use of FMI and LBMI does not improve upon BMI for the identification of MetSyn in the pediatric population. Unexpectedly, higher LBMI was associated with greater odds of multiple cardiometabolic risk factors independent of FMI. The use of FMI and LBMI allow for the independent evaluation of relationships between body compartments and disease and warrants future research.