Article(id=1220689487240282728, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1220689483859677846, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2025.19.022, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=review-article, receivedDate=1723478400000, receivedDateStr=2024-08-13, revisedDate=1757347200000, revisedDateStr=2025-09-09, acceptedDate=null, acceptedDateStr=null, onlineDate=1768964653072, onlineDateStr=2026-01-21, pubDate=1760025600000, pubDateStr=2025-10-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1768964653072, onlineIssueDateStr=2026-01-21, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1768964653072, creator=13701087609, updateTime=1768964653072, updator=13701087609, issue=Issue{id=1220689483859677846, tenantId=1146029695717560320, journalId=1220038315760373764, year='2025', volume='39', issue='19', pageStart='3201', pageEnd='3376', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1768964652266, creator=13701087609, updateTime=1768965013333, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1220690998338961744, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1220689483859677846, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1220690998338961745, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1220689483859677846, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=3348, endPage=3353, ext={EN=ArticleExt(id=1220689487517106801, articleId=1220689487240282728, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Research progress on clinical application of weight⁃adjusted⁃waist index, columnId=1220689485315101342, journalTitle=Chinese Nursing Research, columnName=Review Articles, runingTitle=null, highlight=null, articleAbstract=

This review summarized the proposal and calculation method of the weight⁃adjusted⁃waist index(WWI),its correlation with various diseases,differences from other body measurement tools,as well as its advantages and limitations.It aimed to provide a reference for clinical healthcare professionals to identify obesity more simply and conveniently,and to study the weight⁃adjusted⁃waist index and its associated diseases.

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JI Hong, E⁃mail: honghongji⁃
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对体重调整腰围指数(WWI)的提出与计算方法、与多种疾病的关系、与其他身体测量工具的差异及其优势、局限性进行综述,为临床医护人员更简单、便捷地识别肥胖及开展与体重调整腰围指数相关疾病的研究提供一定的参考。

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季红,E⁃mail:honghongji⁃
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边令梓,护士,硕士研究生在读

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体重调整腰围指数临床应用的研究进展
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边令梓 1 , 相裕华 2 , 李红 1 , 贾国安 2 , 姚晨丝雨 3 , 季红 3
护理研究 | 科研综述 2025,39(19): 3348-3353
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护理研究 | 科研综述 2025, 39(19): 3348-3353
体重调整腰围指数临床应用的研究进展
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边令梓1, 相裕华2, 李红1, 贾国安2, 姚晨丝雨3, 季红3
作者信息
  • 1.山东第二医科大学,山东 261053
  • 2.山东第一医科大学
  • 3.山东第一医科大学第一附属医院
  • 边令梓,护士,硕士研究生在读

通讯作者:

季红,E⁃mail:honghongji⁃
Research progress on clinical application of weight⁃adjusted⁃waist index
Lingzi BIAN1, Yuhua XIANG2, Hong LI1, Guo'an JIA2, Chensiyu YAO3, Hong JI3
Affiliations
  • 1.Shandong Second Medical University, Shandong 261053 China
  • 2.Shandong First Medical University
  • 3.The First Affiliated Hospital of Shandong First Medical University
出版时间: 2025-10-10 doi: 10.12102/j.issn.1009-6493.2025.19.022
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对体重调整腰围指数(WWI)的提出与计算方法、与多种疾病的关系、与其他身体测量工具的差异及其优势、局限性进行综述,为临床医护人员更简单、便捷地识别肥胖及开展与体重调整腰围指数相关疾病的研究提供一定的参考。

体重调整腰围指数  /  超重  /  肥胖  /  人体测量  /  护理  /  综述

This review summarized the proposal and calculation method of the weight⁃adjusted⁃waist index(WWI),its correlation with various diseases,differences from other body measurement tools,as well as its advantages and limitations.It aimed to provide a reference for clinical healthcare professionals to identify obesity more simply and conveniently,and to study the weight⁃adjusted⁃waist index and its associated diseases.

weight⁃adjusted⁃waist index  /  overweight  /  obesity  /  anthropometry  /  nursing  /  review
边令梓, 相裕华, 李红, 贾国安, 姚晨丝雨, 季红. 体重调整腰围指数临床应用的研究进展. 护理研究, 2025 , 39 (19) : 3348 -3353 . DOI: 10.12102/j.issn.1009-6493.2025.19.022
Lingzi BIAN, Yuhua XIANG, Hong LI, Guo'an JIA, Chensiyu YAO, Hong JI. Research progress on clinical application of weight⁃adjusted⁃waist index[J]. Chinese Nursing Research, 2025 , 39 (19) : 3348 -3353 . DOI: 10.12102/j.issn.1009-6493.2025.19.022
随着经济的快速发展,我国人民的生活方式发生了很大变化,肥胖的患病率也呈快速上升趋势[1]。研究显示,我国超重和肥胖的人数在全球国家中排名位居前列[2],肥胖已成为严重的公共卫生问题。肥胖不仅仅是身体脂肪的蓄积,往往还会增高糖尿病[3]、高血压[4]、乳腺癌[5]等一系列疾病的发生率,影响健康的同时也给社会医疗体系带来了巨大的负担。目前,国内外研究者常使用体质指数(BMI)、腰围(WC)、腰高比(WHtR)、内脏脂肪指数(visceral fat index,VFI)、脂质积累指数(lipid accumulation product,LAP)等指标评估超重和肥胖,不同的指标侧重点各不相同。体质指数是临床研究中定义超重和肥胖最常用的指数,但其无法反映身体脂肪的分布情况,也无法区分不同个体脂肪与肌肉的比例,这可能会导致“肥胖悖论”的发生[6]。腰围是评估人体中心性肥胖的有效指标,腰高比在腰围的基础上解释了身高差异,但二者均不能有效区分皮下脂肪和内脏脂肪[78]。内脏脂肪指数和脂质积累指数是国外学者针对西方人群开发和验证的内脏肥胖指数,由于基因、环境、生活习惯等差异,我国人更容易出现内脏肥胖,这一差异可能造成不严谨的评估结果[9]。体重调整腰围指数(weight⁃adjusted⁃waist index,WWI)是基于亚洲人群数据开发的一种人体测量指数,与肥胖相关的疾病发病率和死亡率相关性更加密切且具有预测价值[10]。现综述体重调整腰围指数在临床中的应用进展以及价值,以期为临床医护人员更简单、便捷地识别肥胖,应用体重调整腰围指数提供参考。
体重调整腰围指数是一个反映中心性肥胖的人体测量指数,由韩国学者Park等[10]于2018年针对约100万名韩国成年人的相关研究后提出。Park等[10]参照体质指数最初的推导方式,基于相同的概念,提出可以将对数转换后的腰围和体重进行最小二乘回归,实现腰围针对体重的标准化,经推导后最终公式呈现为腰围除以体重的平方根,计算简单且易于理解。体重调整腰围指数与身高呈负相关,弥补了腰围不能区分不同身高对同一腰围测量数值影响的缺陷,且与体质指数的相关性较弱,可以缓解与体质指数相关的“肥胖悖论”。目前,体重调整腰围指数已被国外学者发现与多种疾病有关,国内相关研究相对较少。
高脂肪量、低肌肉量和低骨量等身体成分的不健康状态是影响健康的关键问题。研究表明,体重调整腰围指数与脂肪量呈正相关,与肌肉质量、骨量呈负相关[1113],表明体重调整腰围指数可以帮助识别身体成分的不利结果。Wang等[14]通过对约7 000名美国青少年的横断面研究发现,体重调整腰围指数与青少年总骨密度(BMD)之间存在显著的负相关关系;Zhang等[1516]研究表明,体重调整腰围指数与成年人的总骨密度之间也存在负相关关系。过去的研究常使用国际公认的体质指数和腰围作为肥胖识别参数,且认为体质指数、腰围与总骨密度之间存在正相关关系,即肥胖和超重是骨质疏松的保护性因素[1718]。然而,随着研究方法的改进,越来越多的学者提出与之相反的观点。詹群璋等[19]研究发现,肥胖是骨质疏松症的危险因素,但未发现骨质疏松症与肥胖的反向关联。一项基于1 979名美国老年人的调查发现,体重调整腰围指数与骨质疏松症之间存在显著的正相关关系,支持肥胖是骨质疏松症的危险因素这一观点[20]。由此可见,肥胖与骨骼健康的关系并未统一,这一争论的来源可能与肥胖的评估指标有关。越来越多的专家认为,体质指数和腰围等传统肥胖指标可能不足以准确衡量肥胖,且易受年龄、性别和种族差异的影响[21],而体重调整腰围指数有望成为评估肥胖的有效指标。
Park等[10]研究指出,对于心血管疾病的发病率和死亡率,体重调整腰围指数具有卓越的预测能力,后续的研究[2223]也支持了这一观点。研究表明,体重调整腰围指数升高与中老年人的高血压发生风险存在很强的相关性[2426],提示体重调整腰围指数可在早期阶段识别中老年人群的高血压发生风险。He等[27]研究不同人体测量指标在糖尿病和糖尿病前期病人中与心血管疾病风险的关系,结果显示,体重调整腰围指数与心血管疾病风险之间存在非线性关联,且体重调整腰围指数<11.155时与心血管疾病风险呈正相关,体重调整腰围指数≥11.155时与心血管疾病风险的关系较弱。Qin等[28]研究发现,当体重调整腰围指数<11.11时与腹主动脉钙化风险存在正相关关系,强调一定范围内的高体重调整腰围指数水平与较高心血管风险相关,与He等[27]研究结果一致。Ye等[29]研究指出,高体重调整腰围指数与脑卒中的高患病率有关,强调了体重调整腰围指数在预防和管理脑卒中的重要性。Xiong等[30]对比不同体质指数高血压病人体重调整腰围指数与肱踝脉搏波速度的关系,发现二者在任何体质指数组别的高血压病人中均存在正相关关系,其中在体质指数水平较低组中关系最为显著,且血压在其中起到中介作用。由此可见,体重调整腰围指数升高会对心血管健康产生多种负面影响。
目前,体重调整腰围指数被证实与糖尿病发病及糖尿病肾病相关。Yu等[31]对我国东北农村地区3县的26个村进行了中位时间为4.66年的随访,发现2型糖尿病的发病率随着体重调整腰围指数水平的升高而增加,且这种相关性不受性别、年龄、体质指数或心血管等危险因素特征的影响。Zheng等[32]研究结果与之相似,但更进一步指出这一相关性在60岁以下人群和非高血压人群中更为强烈。Sun等[33]研究也指出,体重调整腰围指数水平每增加1个单位,患2型糖尿病的风险就高出1.96倍。研究证明,较高的体重调整腰围指数与糖尿病肾病有关,可以作为预测糖尿病肾病的人体测量指标,但未来还需要更多的前瞻性研究进一步验证[3435]
肥胖会增加非酒精性脂肪肝病(NAFLD)的发病风险,及早识别肥胖,尤其是中心性肥胖有利于早期干预,降低非酒精性脂肪肝病风险、减少相关不良结局的发生。Shen等[36]使用瞬时弹性成像技术量化肝脏脂肪沉积与纤维化,发现体重调整腰围指数与肝脏脂肪沉积之间呈正相关,并指出当体重调整腰围指数>10.75时关联相对更强。后续的研究结果与之相似[3738],更加证实了这一发现,Hu等[37]强调40岁以下的白人男性风险更高,故应该受到重点关注。
研究表明,体重调整腰围指数与高尿酸血症、肾结石、慢性肾脏病、白蛋白尿等肾脏病有关。Ding等[39]研究指出,体重调整腰围指数与高尿酸血症之间存在非线性正相关关系,但这种正相关关系在不饮酒者中未观察到,其原因可能与不饮酒人群嘌呤的摄入较少有关。Zhao等[40]研究证明,体重调整腰围指数与高血压病人并发高尿酸血症风险呈正相关。研究指出,体重调整腰围指数值升高与肾结石风险增加有关[4143]。Chen等[43]为了更好地控制协变量偏差,应用倾向评分匹配法研究体重调整腰围指数与肾结石之间的关联,其结果具有更高的可信度。除上述疾病外,还有研究指出,体重调整腰围指数与慢性肾脏病、尿白蛋白都存在正相关关系[4445],这表明体重调整腰围指数在肾脏健康的多个方面都具有重要意义,提示应该引起高风险人群的重视。
肥胖不仅会引起心血管疾病、身体代谢异常等身体健康问题,还有可能对心理状态产生不良影响,严重时可能导致焦虑、抑郁的发生[46]。与普通人群相比,超重和肥胖人群有更高的异常情绪风险,肥胖个体患终身抑郁的可能性高达55%[47]。体重调整腰围指数作为新的肥胖评估指标,其与心理健康的关系受到许多研究者的关注。研究证明,体重调整腰围指数与抑郁风险呈正相关且相关关系稳定[4850],提示体重调整腰围指数在预防抑郁症状和改善抑郁病人预后方面具有潜在作用。Li等[50]研究了体重调整腰围指数与抑郁症的关系并进行了中介分析,结果显示,膳食炎症指数(DII)、全身免疫炎症指数(SII)和久坐不动均介导了体重调整腰围指数与抑郁症之间的关联,进一步为肥胖的预防和控制拓宽了思路。Guo等[51]对9 500名参与者进行横断面分析,发现高体重调整腰围指数与自杀意念增加和自杀意念水平升高相关。由此可见,体重调整腰围指数与心理健康存在密切联系,肥胖或肥胖与其他疾病共存的人群可能面临更大的健康挑战,这种情况可能会导致或加剧病人精神压力,严重时则会产生自杀意念。因此,有必要将体重调整腰围指数纳入心理健康风险评估,以更准确地识别风险,制定精准干预措施,预防不良结局。
近年来,有关肥胖与认知功能关系的报道越来越多,但结论存在一定争议,原因可能与学者在研究时过度依赖体质指数作为衡量肥胖的指标有关[52]。因此,体重调整腰围指数作为新的肥胖测量指标,其与认知功能的关系逐渐受到广泛关注。Zhou等[5354]研究均采用阿尔茨海默病登记中心单词学习分数测试(CERAD W⁃L)、动物流畅性测试(AFT)和数字符号替换测试(DSST)3种测试方法对认知进行评估,均得出体重调整腰围指数与认知功能不良之间存在非线性关系,即体重调整腰围指数越大,认知功能不良的风险越大。但不同的是,Zhou等[53]认为体重调整腰围指数与DSST所指示的低认知功能之间存在不显著的非线性关联,而Li等[54]研究认为这种关系是显著的,且在体重调整腰围指数>12.21时更为明显。Huang等[55]仅使用阿尔茨海默病登记中心单词学习分数测试1种方法评估认知功能,发现体重调整腰围指数与认知功能不良之间的非线性关系在脑卒中病人这一特定人群中更加强烈。研究发现,体重调整腰围指数与痴呆呈正相关,且这一关联在有午睡习惯的人群中更强[53]。由此可知,体重调整腰围指数与认知功能紧密相关,日后可将体重调整腰围指数作为识别老年人认知功能下降的有效方法,以帮助临床工作者识别认知高危人群,尽早开展相关干预措施提供参考。
肥胖与生殖健康的关系受到越来越多的关注,超重或肥胖等代谢异常可能对两性生殖功能造成多种不良影响。Wen等[56]通过对3 526名18~45岁女性的横断面调查证实了较高体重调整腰围指数的个体发生不孕症的可能性更高。Sun等[57]研究支持了这一观点,且更进一步提出抑郁症在二者的关系中起到潜在中介作用。Cao等[58]研究体重调整腰围指数和勃起功能障碍之间的关联,发现与最低体重调整腰围指数组相比,高体重调整腰围指数组男性出现勃起功能障碍的可能性明显增加。Wu等[59]与Liu等[60]分别对6~19岁的青少年以及>20岁的成年男性展开调查,发现体重调整腰围指数与总睾酮水平之间存在负相关关系,其中青春期晚期发生睾酮水平降低风险更大。体重调整腰围指数的升高会增加女性不孕、男性勃起功能障碍、睾酮缺乏症的风险,未来可以根据体重调整腰围指数制定肥胖的控制方案。
肥胖是导致过早死亡的主要危险因素之一,体重调整腰围指数对心血管疾病死亡率的预测有较高准确性,其与全因死亡率的相关性也逐渐受到关注。Cai等[61]以我国城市社区居民为对象进行了长达10年的前瞻性队列研究,发现体重调整腰围指数与全因死亡率增加显著相关,最高体重调整腰围指数类别的全因死亡率是最低体重调整腰围指数类别的2.66倍,但这一相关性在年龄≥75岁人群中并不显著,原因可能是老年人与年轻人之间体脂分布差异有关。Cao等[62]对美国的非亚裔人群展开调查,指出体重调整腰围指数与全因死亡率之间存在U形相关性,表明体重调整腰围指数越接近于极低值或极高值时死亡风险较高。2项研究结论不尽相同,其原因可能与研究人群不同有关,体重调整腰围指数与全因死亡率的关系还需更多研究证实。
除上述疾病外,还有不同研究表明体重调整腰围指数与多种疾病相关。Yu等[63]研究指出,较高的体重调整腰围指数与哮喘患病率增加和首次哮喘发病年龄较大有关,体重调整腰围指数每增加1个单位,哮喘发病延迟3.89年。Han等[64]研究结果显示,哮喘持续时间与体重调整腰围指数呈正相关,但与体质指数呈负相关,即较长的哮喘持续时间可能会导致体重减轻,但会增加腹部肥胖的风险。Shi等[65]研究在12~25岁的人群中观察到体重调整腰围指数越高,近视的发生率和严重程度越低,高体重调整腰围指数可能是近视的保护因素。研究指出,6~17岁青少年体重调整腰围指数越高发生发育不良的风险越大[66]。还有研究分别调查了体重调整腰围指数与急迫性尿失禁[67]、牙周炎[68]、类风湿性关节炎和骨关节炎[69]的关系,结果表明,体重调整腰围指数与这些疾病之间均存在不同程度的正相关关系。体重调整腰围指数被证明与多种疾病相关,但许多疾病的相关研究较少,受研究类型的限制大多未能解释其因果关系,故未来仍需更多前瞻性调查进行更深入研究,探讨不同维度的影响机制。
国内外学者将体重调整腰围指数与其他身体测量工具进行了对比及相关性分析。Kim等[70]使用双能X射线吸收测定法测量身体成分,对比体质指数、腰围、腰高比和体重调整腰围指数作为肌肉减少性肥胖预测指标的能力,结果显示,体重调整腰围指数在男性肌肉减少性肥胖预测方面能力更佳。Fang等[23]研究验证了美国成年人体重调整腰围指数与心血管疾病之间的关联,发现体重调整腰围指数对心血管疾病的识别性能优于体质指数、腰围和腰高比,并指出体重调整腰围指数不仅适用于东亚人群,还普遍适用于其他人群。Ye等[29]采用受试者工作特征(ROC)曲线评价体重调整腰围指数、体质指数和内脏肥胖指数(VAI)对脑卒中的预测能力,结果显示体重调整腰围指数有更好的预测能力,综合考虑计算的简单性和预测能力,认为体重调整腰围指数可以作为临床检测使用的新工具。Hafezi等[71]使用机器学习方法构建伊朗人群2型糖尿病发病率的预测模型,指出体质指数是2型糖尿病发病率的最佳预测因子,而体重调整腰围指数未被纳入预测因子。
体重调整腰围指数作为一种人体测量指数在临床应用方面具有一定优势。首先,体重调整腰围指数的评估指标为客观指标且计算简便,仅需测量身高与腰围即可得出,无需特殊仪器设备或实验室检查[10];其次,体重调整腰围指数削弱了与体质指数的关联,可以评估中心性肥胖的严重程度,消除体重的影响[29];最后,体重调整腰围指数在评估身体成分和预测疾病风险方面具有良好的性能[29,35,70],有望成为优于腰围、体质指数等传统身体测量指标的新指标。体重调整腰围指数虽已被诸多学者运用于疾病的相关性研究,仍存在一些不足:体重调整腰围指数的提出者Park并未给出明确的肥胖判断标准,在临床使用时无法快速判断被测量者是否属于超重或肥胖,后续研究中也未有学者针对此问题进行改进;其次,体重调整腰围指数在不同研究中预测的诊断界值各不相同,这导致了各研究结果间缺乏可比性;最后,体重调整腰围指数作为一种新的人体测量指数,其相关研究仍处在初步阶段,未来仍需大量前瞻性研究与临床试验验证其与不同疾病之间的因果关系。
体重调整腰围指数是一种可以反映中心性肥胖的人体测量指标,在与多种疾病的相关性研究中展现出良好的预测能力,日后可能成为更全面、更准确的肥胖衡量标准。目前,虽然国外对体重调整腰围指数的研究较多,涉及多种疾病;国内研究相对少,但整体来说,对于体重调整腰围指数的探索仍处在初步阶段。本研究对体重调整腰围指数以及其在临床上的应用进行阐述,以期为后续肥胖及与肥胖有关疾病的研究提供依据。
  • 山东省研究型医院协会科研项目(2022004)
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2025年第39卷第19期
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doi: 10.12102/j.issn.1009-6493.2025.19.022
  • 接收时间:2024-08-13
  • 首发时间:2026-01-21
  • 出版时间:2025-10-10
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  • 收稿日期:2024-08-13
  • 修回日期:2025-09-09
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山东省研究型医院协会科研项目(2022004)
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    1.山东第二医科大学,山东 261053
    2.山东第一医科大学
    3.山东第一医科大学第一附属医院

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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