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Article(id=1325501832327476068, tenantId=1146029695717560320, journalId=1256213402557890569, issueId=1325501647736156411, articleNumber=null, orderNo=null, doi=10.16835/j.cnki.1000-9817.2025067, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1733068800000, receivedDateStr=2024-12-02, revisedDate=1736352000000, revisedDateStr=2025-01-09, acceptedDate=null, acceptedDateStr=null, onlineDate=1793953863459, onlineDateStr=2026-11-06, pubDate=1742832000000, pubDateStr=2025-03-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793953863459, onlineIssueDateStr=2026-11-06, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793953863459, creator=13701087609, updateTime=1793953863459, updator=13701087609, issue=Issue{id=1325501647736156411, tenantId=1146029695717560320, journalId=1256213402557890569, year='2025', volume='46', issue='3', pageStart='305', pageEnd='456', issueExtLink='null', onlineDate='null', pubDate='1742832000000', pubDateStr='2025-03-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793953819450, creator='13701087609', updateTime=1793953819450, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=421, endPage=425, ext={EN=ArticleExt(id=1325501834844058470, articleId=1325501832327476068, tenantId=1146029695717560320, journalId=1256213402557890569, language=EN, title=Performance of body mass index, waist circumference and waist-to-height ratio in screening true obesity in children, columnId=1325500884406379444, journalTitle=Chinese Journal of School Health, columnName=Disease Control, runingTitle=null, highlight=null, articleAbstract=
Objective

To evaluate the accuracy of body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR) in screening true obesity among children, so as to provide a scientific basis for precise screening and early prevention and control of childhood obesity.

Methods

A total of 1 322 children aged 10-15 years old were surveyed by the Huantai Children Cardiovascular Health Cohort in 2021. Fat mass percentage (FMP) and fat mass index (FMI) were measured by bioelectrical impedance analysis, with FMP or FMI values at or above the age- and sex-specific 70th percentiles as the criteria for defining true obesity. BMI, WC and WHtR were used to define general obesity and central obesity. The accuracy of these measures in screening for true obesity was evaluated by calculating the missed diagnosis rate, misdiagnosis rate, area under the curve(AUC) for receiver operating characteristic and Kappa coefficient.

Results

Boys had higher BMI [(21.79±4.56) kg/m2], WC [(76.41±12.53) cm] and WHtR (0.47±0.07) than girls [(20.83±4.13) kg/m2, (70.69±10.06) cm, (0.45±0.06)] (t=4.02, 9.19, 6.63), while boys had lower FMP [(18.29±8.35)%] and FMI [(4.35±2.79) kg/m2] than girls [(24.87±6.51)%, (5.44±2.53) kg/m2] (t=-16.10, -7.42) (P < 0.01). Using FMP as a reference standard, the diagnosis error rates of screening for true obesity based on BMI, WC and WHtR were 12.24%, 2.11% and 2.11%, respectively; the diagnosis error rates were 10.88%, 27.28% and 24.33%; the AUC values were 0.88, 0.85 and 0.87; the Kappa coefficients were 0.67, 0.48 and 0.52. Using FMI as a reference standard, rates of BMI, WC and WHtR screening for true obesity were 14.20%, 1.23% and 2.78%; the diagnosis error rates were 4.81%, 20.84% and 18.14%; the AUC values were 0.90, 0.89 and 0.90; the Kappa coefficients were 0.81, 0.64 and 0.67.

Conclusions

BMI has a higher diagnosis error rate in screening for true obesity in children, while WC and WHtR have higher diagnosis error rates. It is recommended to promote body fat assessment in clinical practice, so as to achieve more accurate prevention and control of chronic diseases.

, authors=Qihuan FANG1, Yuedong WANG1, Min ZHAO2, Lili YANG*, 1, Bo XI*, 1, authorsList=Qihuan FANG, Yuedong WANG, Min ZHAO, Lili YANG, Bo XI, authorCompany=null, correspAuthors=Lili YANG, Bo XI, authorNote=null, correspAuthorsNote=null, copyrightStatement=Copyright ©2025 Chinese Journal of School Health. All rights reserved., copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1325501837394195303, articleId=1325501832327476068, tenantId=1146029695717560320, journalId=1256213402557890569, language=CN, title=体质量指数与腰围和腰围身高比筛查儿童真实肥胖效果, columnId=1325500884628677558, journalTitle=中国学校卫生, columnName=疾病控制, runingTitle=null, highlight=null, articleAbstract=
目的

评价体质量指数(BMI)、腰围(WC)和腰围身高比(WHtR)筛查儿童真实肥胖的准确性，旨在为儿童肥胖精准筛查和早期防控提供科学依据。

方法

数据来自“桓台儿童心血管健康随访队列”2021年调查的1 322名10~15岁儿童。采用生物电阻抗法测量体脂肪率(FMP)和脂肪质量指数(FMI)，以FMP或FMI大于等于相应性别和年龄别的第70百分位数为真实肥胖的判定标准。分别采用BMI、WC和WHtR定义一般性肥胖与中心性肥胖，并通过计算漏诊率、误诊率、受试者工作特征曲线下面积(AUC)和Kappa系数等指标，评价其筛查儿童真实肥胖的效果。

结果

男生BMI[(21.79±4.56)kg/m2]、WC[(76.41±12.53)cm]和WHtR(0.47±0.07)均高于女生[(20.83±4.13)kg/m2，(70.69±10.06)cm，(0.45±0.06)](t值分别为4.02, 9.19, 6.63)，男生FMP[(18.29±8.35)%]和FMI[(4.35±2.79)kg/m2]均低于女生[(24.87±6.51)%，(5.44±2.53)kg/m2](t值分别为-16.10，-7.42)(P值均 < 0.01)。以FMP为参考标准，BMI、WC和WHtR筛查真实肥胖的漏诊率分别为12.24%，2.11%，2.11%；误诊率分别为10.88%，27.28%，24.33%；AUC分别为0.88，0.85，0.87；Kappa系数分别为0.67，0.48，0.52。以FMI为参考标准，BMI、WC和WHtR筛查真实肥胖的漏诊率分别为14.20%，1.23%，2.78%；误诊率分别为4.81%，20.84%，18.14%；AUC分别为0.90，0.89，0.90；Kappa系数分别为0.81，0.64，0.67。

结论

BMI在筛查儿童真实肥胖时漏诊率较高，而WC和WHtR的误诊率较高。应在临床实践中推广体脂水平检测，以实现更精准的慢性病预防与控制。

, authors=方棨桓1, 王悦栋1, 赵敏2, 杨丽丽*, 1, 席波*, 1, authorsList=方棨桓, 王悦栋, 赵敏, 杨丽丽, 席波, authorCompany=null, correspAuthors=杨丽丽, 席波, authorNote=

方棨桓(1997-)，男，浙江杭州人，在读硕士，主要研究方向为儿童心血管流行病学

, correspAuthorsNote=
杨丽丽，E-mail:
席波，E-mail:
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Comparison of physical measurement and body composition testing data among children of different genders(x±s)

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性别人数体重/kg身高/cmBMI/(kg·m-2)WC/cmWHtRFMP/%FMI/(kg·m-2)
男69757.92±16.30161.92±11.8821.79±4.5676.41±12.530.47±0.0718.29±8.354.35±2.79
女62552.16±13.12157.47±8.1820.83±4.1370.69±10.060.45±0.0624.87±6.515.44±2.53
t值7.118.004.029.196.63-16.10-7.42
P值< 0.01< 0.01< 0.01< 0.01< 0.01< 0.01< 0.01
), ArticleFig(id=1325501860441895829, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325501832327476068, language=CN, label=表1, caption=

不同性别儿童体格测量和体成分检测数据比较(x±s)

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性别人数体重/kg身高/cmBMI/(kg·m-2)WC/cmWHtRFMP/%FMI/(kg·m-2)
男69757.92±16.30161.92±11.8821.79±4.5676.41±12.530.47±0.0718.29±8.354.35±2.79
女62552.16±13.12157.47±8.1820.83±4.1370.69±10.060.45±0.0624.87±6.515.44±2.53
t值7.118.004.029.196.63-16.10-7.42
P值< 0.01< 0.01< 0.01< 0.01< 0.01< 0.01< 0.01
), ArticleFig(id=1325501860857131926, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325501832327476068, language=EN, label=Tab.2, caption=

Confusion matrix for screening true obesity among children of different genders by BMI, WC and WHtR under FMP

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性别选项BMIWCWHtR
正常a一般性肥胖正常中心性肥胖正常中心性肥胖
男正常47391388176407157
真实肥胖2011321314129
女正常49427401120414107
真实肥胖99531011103
总体正常967118789296821264
真实肥胖2920852325232
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FMP参考标准下BMI、WC、WHtR筛查不同性别儿童真实肥胖混淆矩阵

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性别选项BMIWCWHtR
正常a一般性肥胖正常中心性肥胖正常中心性肥胖
男正常47391388176407157
真实肥胖2011321314129
女正常49427401120414107
真实肥胖99531011103
总体正常967118789296821264
真实肥胖2920852325232
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Confusion matrix for screening true obesity among children of different genders by BMI, WC and WHtR under FMI

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性别选项BMIWCWHtR
正常a一般性肥胖正常中心性肥胖正常中心性肥胖
男正常47147388130405113
真实肥胖2215721776173
女正常47914027841268
真实肥胖2412121433142
总体正常95048790208817181
真实肥胖4627843209315
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FMI参考标准下BMI、WC、WHtR筛查不同性别儿童真实肥胖混淆矩阵

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性别选项BMIWCWHtR
正常a一般性肥胖正常中心性肥胖正常中心性肥胖
男正常47147388130405113
真实肥胖2215721776173
女正常47914027841268
真实肥胖2412121433142
总体正常95048790208817181
真实肥胖4627843209315
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Accuracy of BMI, WC and WHtR in screening true obesity among children of different genders under FMP(n=1 322)

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性别指标漏诊率/%误诊率/%阳性预测值/%阴性预测值/%AUC值(95%CI)Kappa系数
男BMI(一般性肥胖)15.0416.1355.3995.940.84(0.81~0.88)0.57
WC(中心性肥胖)1.5031.2142.6799.490.84(0.82~0.86)0.45
WHtR(中心性肥胖)3.0127.8445.1099.030.85(0.82~0.87)0.48
女BMI(一般性肥胖)8.655.1877.8798.210.93(0.90~0.96)0.80
WC(中心性肥胖)2.8823.0345.7099.260.87(0.85~0.90)*0.51
WHtR(中心性肥胖)0.9620.5449.0599.760.89(0.87~0.91)*0.56
), ArticleFig(id=1325501862140588955, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325501832327476068, language=CN, label=表4, caption=

FMP参考标准下BMI、WC和WHtR筛查不同性别儿童真实肥胖的效果(n=1 322)

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性别指标漏诊率/%误诊率/%阳性预测值/%阴性预测值/%AUC值(95%CI)Kappa系数
男BMI(一般性肥胖)15.0416.1355.3995.940.84(0.81~0.88)0.57
WC(中心性肥胖)1.5031.2142.6799.490.84(0.82~0.86)0.45
WHtR(中心性肥胖)3.0127.8445.1099.030.85(0.82~0.87)0.48
女BMI(一般性肥胖)8.655.1877.8798.210.93(0.90~0.96)0.80
WC(中心性肥胖)2.8823.0345.7099.260.87(0.85~0.90)*0.51
WHtR(中心性肥胖)0.9620.5449.0599.760.89(0.87~0.91)*0.56
), ArticleFig(id=1325501862480327580, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325501832327476068, language=EN, label=Tab.5, caption=

Accuracy of BMI, WC and WHtR in screening true obesity among children of different genders under FMI(n=1 322)

, figureFileSmall=null, figureFileBig=null, tableContent=
性别指标漏诊率/%误诊率/%阳性预测值/%阴性预测值/%AUC值(95%CI)Kappa系数
男BMI(一般性肥胖)12.299.0776.9695.540.89(0.87~0.92)0.75
WC(中心性肥胖)1.1225.1057.6599.490.87(0.85~0.89)0.60
WHtR(中心性肥胖)3.3521.8160.4998.540.87(0.85~0.90)0.63
女BMI(一般性肥胖)16.550.2199.1895.230.92(0.89~0.95)0.88
WC(中心性肥胖)1.3816.2564.7199.500.91(0.89~0.93)0.70
WHtR(中心性肥胖)2.0714.1767.6299.280.92(0.90~0.94)0.72
), ArticleFig(id=1325501862895563677, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325501832327476068, language=CN, label=表5, caption=

FMI参考标准下BMI、WC和WHtR筛查不同性别儿童真实肥胖的效果(n=1 322)

, figureFileSmall=null, figureFileBig=null, tableContent=
性别指标漏诊率/%误诊率/%阳性预测值/%阴性预测值/%AUC值(95%CI)Kappa系数
男BMI(一般性肥胖)12.299.0776.9695.540.89(0.87~0.92)0.75
WC(中心性肥胖)1.1225.1057.6599.490.87(0.85~0.89)0.60
WHtR(中心性肥胖)3.3521.8160.4998.540.87(0.85~0.90)0.63
女BMI(一般性肥胖)16.550.2199.1895.230.92(0.89~0.95)0.88
WC(中心性肥胖)1.3816.2564.7199.500.91(0.89~0.93)0.70
WHtR(中心性肥胖)2.0714.1767.6299.280.92(0.90~0.94)0.72
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体质量指数与腰围和腰围身高比筛查儿童真实肥胖效果
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方棨桓 1 , 王悦栋 1 , 赵敏 2 , 杨丽丽 *, 1 , 席波 *, 1
中国学校卫生 | 疾病控制 2025,46(3): 421-425
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中国学校卫生 |疾病控制 2025 , 46 (3) : 421 -425
体质量指数与腰围和腰围身高比筛查儿童真实肥胖效果
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方棨桓1, 王悦栋1, 赵敏2, 杨丽丽*, 1 , 席波*, 1
作者信息
  • 1山东大学齐鲁医学院公共卫生学院流行病学系/山东大学儿童心血管研究中心, 济南 250012
  • 2山东大学齐鲁医学院公共卫生学院营养与食品卫生学系
通讯作者:
杨丽丽，E-mail:
席波，E-mail:
作者简介:

方棨桓(1997-)，男，浙江杭州人，在读硕士，主要研究方向为儿童心血管流行病学

Performance of body mass index, waist circumference and waist-to-height ratio in screening true obesity in children
Qihuan FANG1, Yuedong WANG1, Min ZHAO2, Lili YANG*, 1 , Bo XI*, 1
Affiliations
  • 1Department of Epidemiology, School of Public Health, Cheeloo College of Medicine/Children Cardiovascular Research Center, Shandong University, Jinan(250012), Shandong Province, China
出版时间: 2025-03-25 doi: 10.16835/j.cnki.1000-9817.2025067
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摘要
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目的

评价体质量指数(BMI)、腰围(WC)和腰围身高比(WHtR)筛查儿童真实肥胖的准确性，旨在为儿童肥胖精准筛查和早期防控提供科学依据。

方法

数据来自“桓台儿童心血管健康随访队列”2021年调查的1 322名10~15岁儿童。采用生物电阻抗法测量体脂肪率(FMP)和脂肪质量指数(FMI)，以FMP或FMI大于等于相应性别和年龄别的第70百分位数为真实肥胖的判定标准。分别采用BMI、WC和WHtR定义一般性肥胖与中心性肥胖，并通过计算漏诊率、误诊率、受试者工作特征曲线下面积(AUC)和Kappa系数等指标，评价其筛查儿童真实肥胖的效果。

结果

男生BMI[(21.79±4.56)kg/m2]、WC[(76.41±12.53)cm]和WHtR(0.47±0.07)均高于女生[(20.83±4.13)kg/m2，(70.69±10.06)cm，(0.45±0.06)](t值分别为4.02, 9.19, 6.63)，男生FMP[(18.29±8.35)%]和FMI[(4.35±2.79)kg/m2]均低于女生[(24.87±6.51)%，(5.44±2.53)kg/m2](t值分别为-16.10，-7.42)(P值均 < 0.01)。以FMP为参考标准，BMI、WC和WHtR筛查真实肥胖的漏诊率分别为12.24%，2.11%，2.11%；误诊率分别为10.88%，27.28%，24.33%；AUC分别为0.88，0.85，0.87；Kappa系数分别为0.67，0.48，0.52。以FMI为参考标准，BMI、WC和WHtR筛查真实肥胖的漏诊率分别为14.20%，1.23%，2.78%；误诊率分别为4.81%，20.84%，18.14%；AUC分别为0.90，0.89，0.90；Kappa系数分别为0.81，0.64，0.67。

结论

BMI在筛查儿童真实肥胖时漏诊率较高，而WC和WHtR的误诊率较高。应在临床实践中推广体脂水平检测，以实现更精准的慢性病预防与控制。

人体质量指数  /  腰围  /  肥胖症  /  曲线下面积  /  儿童
Objective

To evaluate the accuracy of body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR) in screening true obesity among children, so as to provide a scientific basis for precise screening and early prevention and control of childhood obesity.

Methods

A total of 1 322 children aged 10-15 years old were surveyed by the Huantai Children Cardiovascular Health Cohort in 2021. Fat mass percentage (FMP) and fat mass index (FMI) were measured by bioelectrical impedance analysis, with FMP or FMI values at or above the age- and sex-specific 70th percentiles as the criteria for defining true obesity. BMI, WC and WHtR were used to define general obesity and central obesity. The accuracy of these measures in screening for true obesity was evaluated by calculating the missed diagnosis rate, misdiagnosis rate, area under the curve(AUC) for receiver operating characteristic and Kappa coefficient.

Results

Boys had higher BMI [(21.79±4.56) kg/m2], WC [(76.41±12.53) cm] and WHtR (0.47±0.07) than girls [(20.83±4.13) kg/m2, (70.69±10.06) cm, (0.45±0.06)] (t=4.02, 9.19, 6.63), while boys had lower FMP [(18.29±8.35)%] and FMI [(4.35±2.79) kg/m2] than girls [(24.87±6.51)%, (5.44±2.53) kg/m2] (t=-16.10, -7.42) (P < 0.01). Using FMP as a reference standard, the diagnosis error rates of screening for true obesity based on BMI, WC and WHtR were 12.24%, 2.11% and 2.11%, respectively; the diagnosis error rates were 10.88%, 27.28% and 24.33%; the AUC values were 0.88, 0.85 and 0.87; the Kappa coefficients were 0.67, 0.48 and 0.52. Using FMI as a reference standard, rates of BMI, WC and WHtR screening for true obesity were 14.20%, 1.23% and 2.78%; the diagnosis error rates were 4.81%, 20.84% and 18.14%; the AUC values were 0.90, 0.89 and 0.90; the Kappa coefficients were 0.81, 0.64 and 0.67.

Conclusions

BMI has a higher diagnosis error rate in screening for true obesity in children, while WC and WHtR have higher diagnosis error rates. It is recommended to promote body fat assessment in clinical practice, so as to achieve more accurate prevention and control of chronic diseases.

Body mass index  /  Waist circumference  /  Obesity  /  Area under curve  /  Child
方棨桓, 王悦栋, 赵敏, 杨丽丽, 席波. 体质量指数与腰围和腰围身高比筛查儿童真实肥胖效果. 中国学校卫生, 2025 , 46 (3) : 421 -425 . DOI: 10.16835/j.cnki.1000-9817.2025067
Qihuan FANG, Yuedong WANG, Min ZHAO, Lili YANG, Bo XI. Performance of body mass index, waist circumference and waist-to-height ratio in screening true obesity in children[J]. Chinese Journal of School Health, 2025 , 46 (3) : 421 -425 . DOI: 10.16835/j.cnki.1000-9817.2025067
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超重肥胖已成为威胁我国儿童健康的重要公共卫生问题。1985—2019年，我国儿童超重肥胖检出率由1.2%上升至23.4%[1]。儿童超重肥胖不仅会引起血压升高、血脂异常和血糖偏高等代谢异常，还会损害心脏、血管和肾脏等器官[2]。此外，儿童超重肥胖会增加成年期患心血管疾病等慢性病和死亡的风险[3]。肥胖是指体内脂肪积聚过多的一种慢性病危险因素[4]。体质量指数(body mass index, BMI)是目前常用的一般性肥胖评价指标，但在预测疾病风险时观察到了“肥胖悖论”现象[5-6]；肥胖悖论是指在某些疾病(如心血管病)患者群体中，肥胖个体的生存率反而高于正常体重个体的现象，可能与BMI难以区分脂肪与瘦体重有关[7]。有学者建议将腰围(waist circumference, WC)和腰围身高比(waist-to-height ratio, WHtR)作为BMI的重要补充，用于评价中心性肥胖[7-8]。然而，其仍难以准确反映体内脂肪含量，且更易受测量位置和操作人员的影响。因此，需要更进一步阐明哪一指标能够更有效地筛查和评估儿童真实肥胖[9]。
人体成分分析仪，如生物电阻抗法(bioelectrical impedance analysis, BIA)，可有效评估人体脂肪含量和比例，从而更准确地判断个体的真实肥胖情况。本研究将利用BIA测量的体脂肪率(fat mass percentage, FMP)和脂肪质量指数(fat mass index, FMI)定义真实肥胖，并分别采用BMI、WC和WHtR定义一般性肥胖和中心性肥胖，评价BMI、WC和WHtR筛查儿童真实肥胖的效果，旨在为儿童肥胖精准筛查和早期防控提供科学依据。
1　对象与方法
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1.1　对象
研究人群源于“桓台儿童心血管健康随访队列”，该队列采用方便整群抽样方法，于2017年在桓台县某小学方便选取一至五年级1 515名6~11岁的健康儿童作为研究对象进行基线调查，包括问卷调查、体格测量和超声检查等。该队列每2年随访1次，目前已完成3次随访。其中第2次随访(2021年10—12月)新增了体成分测量。因此，本研究基于2021年的调查数据，共收集1 353名儿童的信息。排除体格测量和体成分测量等主要指标缺失的个体后，最终纳入1 322名儿童。其中男生697名，女生625名；年龄10~15岁，平均年龄(12.19±1.52)岁。研究方案已通过山东大学公共卫生学院伦理学委员会审批(批号：20160308)，所有儿童及其家长均签署了知情同意书。
1.2　调查方法
1.2.1　体格测量
使用HGM-300型超声身高体重仪(中国河南盛苑实业有限公司)测量儿童身高、体重，分别精确到0.1 cm和0.1 kg。测量时，要求研究对象身着轻薄衣物并脱鞋帽，直立目视前方。连续测量2次，取平均值，并计算BMI，BMI =体重(kg)/[身高(m)]2。WC测量使用标准的非弹性软尺，于研究对象脐上1 cm处紧贴腹部环绕一周，于呼气末读数，精确到0.1 cm。WHtR=WC/身高。每位研究对象由2名测量人员独立完成，取平均值用于分析。
1.2.2　体成分测量
使用人体成分分析仪X-SCAN PLUS Ⅱ(韩国杰文)。测量时，研究对象脱去外套和鞋袜，挽起裤脚，衣着轻便，站在仪器踏板中央，脚掌完全接触金属电极，双手握住手柄，手掌覆盖金属电极，大拇指放在手柄按钮上，同时双臂与身体呈30°角，避免接触身体。研究对象大拇指按下手柄按钮开始测量，测量全程保持安静并维持上述姿势。测量结束后，数据自动传输到电脑端，测量值精确至小数点后2位。可直接获得脂肪质量(fat mass, FM)，进一步计算FMP和FMI，FMP=FM(kg)/体重(kg)×100%；FMI=FM(kg)/[身高(m)]2。
1.3　肥胖定义
一般性肥胖采用《学龄儿童青少年超重与肥胖筛查》(WS/T 586—2018)[10]定义，即BMI≥性别和年龄别肥胖对应的BMI百分位数。根据中国儿童WC百分位数界值[11]，将中心性肥胖定义为WC≥性别和年龄别的第90百分位数。WHtR定义中心性肥胖的界值为：男生WHtR≥0.48，女生WHtR≥0.46 [12]。参考2020年拟合的中国6~16岁儿童FMP和FMI分位数，将FMP或FMI ≥相应性别和年龄别的第70百分位数定义为真实肥胖[13]。
1.4　质量控制
调研前，所有参加调研的人员均接受统一的操作规范培训，考核合格后方可参加调研；所有测量仪器在使用前均进行测试和校正。调研全程设有质控人员，确保调研现场安静有序。调研结束后，采用EpiData 3.0软件进行双人双录入，并完成一致性检验，对于不一致情况及时查看原始问卷予以修正。
1.5　统计学分析
利用R 4.1.3软件完成统计学分析。采用Q-Q图对连续型变量进行正态性检验，若符合正态分布，采用(x±s)表示，组间比较使用独立样本t检验；若不符合正态分布，采用M(P25，P75)描述，组间比较使用Wilcoxon秩和检验。分类变量采用频数和率描述，组间比较使用χ2检验。分别以FMP和FMI定义真实肥胖，计算BMI、WC和WHtR筛查真实肥胖的漏诊率、误诊率、阳性预测值、阴性预测值、受试者工作特征曲线下面积(area under the curve，AUC)及其95%置信区间和Kappa系数。采用Delong非参数法比较AUC大小，并用AUC和Kappa系数比较男女生3种指标筛查真实肥胖的准确性。双侧检验水准α=0.05。
2　结果
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2.1　研究对象基本特征
男生身高、体重、BMI、WC和WHtR水平均高于女生，而FMP和FMI水平低于女生，差异均有统计学意义(P值均 < 0.01)。见表1。男生一般性肥胖率(29.27%，204/697)、WC定义中心性肥胖率(44.05%，307/697)和WHtR定义中心性肥胖率(41.03%, 286/697)均高于女生(19.52%，122/625；35.36%，221/625；33.60%，210/625)(χ2值分别为16.33，10.00，7.45，P值均 < 0.01)，但男生FMP定义和FMI定义的真实肥胖率(19.08%，133/697；25.68%，179/697)与女生(16.64%，104/625；23.20%，145/625)相比，差异均无统计学意义(χ2值分别为1.17，0.97，P值均>0.05)。
2.2　BMI、WC和WHtR筛查儿童真实肥胖的效果评价
以FMP和以FMI为参考标准，BMI、WC和WHtR筛查真实肥胖的混淆矩阵如表2~3所示。进一步计算可得，以FMP为参考标准，BMI筛查真实肥胖的漏诊率为12.24%，误诊率为10.88%，阳性预测值为63.80%，阴性预测值为97.09%，AUC(95%CI)为0.88(0.86~0.91)，Kappa系数为0.67；WC筛查真实肥胖的漏诊率为2.11%，误诊率为27.28%，阳性预测值为43.94%，阴性预测值为99.37%，AUC(95%CI)为0.85(0.84~0.87)，Kappa系数为0.48；WHtR筛查真实肥胖的漏诊率为2.11%，误诊率为24.33%，阳性预测值为46.77%，阴性预测值为99.39%，AUC(95%CI)为0.87(0.85~0.88)，Kappa系数为0.52。经Delong检验，仅WC筛查真实肥胖的AUC略低于BMI。由表4可见，按照性别分层后，女生BMI、WC和WHtR筛查真实肥胖的AUC和Kappa系数均高于男生。
以FMI为参考标准，BMI筛查真实肥胖的漏诊率为14.20%，误诊率为4.81%，阳性预测值为85.28%，阴性预测值为95.38%，AUC(95%CI)为0.90(0.88~0.92)，Kappa系数为0.81；WC筛查真实肥胖的漏诊率为1.23%，误诊率为20.84%，阳性预测值为60.61%，阴性预测值为99.50%，AUC(95%CI)为0.89(0.88~0.90)，Kappa系数为0.64；WHtR筛查真实肥胖的漏诊率为2.78%，误诊率为18.14%，阳性预测值为63.51%，阴性预测值为98.91%，AUC(95%CI)为0.90(0.88~0.91)，Kappa系数为0.67。Delong检验显示，BMI、WC和WHtR筛查真实肥胖的AUC差异均无统计学意义(P值均>0.05)。由表5可见，女生BMI、WC和WHtR筛查真实肥胖的AUC和Kappa系数仍均高于男生。
3　讨论
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本研究结果显示，BMI、WC和WHtR在筛查儿童真实肥胖时均表现出较高的阴性预测值和AUC值，但阳性预测值和Kappa系数相对较低。其中，分别基于FMP和FMI参考标准下，用BMI筛查肥胖会漏诊12.24%和14.20%真实肥胖儿童，而用WC和WHtR则会分别误诊27.28%，24.33%和20.84%，18.14%正常儿童。因此，建议在临床实践中推广体脂水平检测，这将有助于儿童肥胖和相关慢性病的精准防控。此外，在女生中3种指标筛查真实肥胖的准确性均高于男生。
由于BMI具有高效、简便且成本较低的优势，被广泛应用于一般性肥胖的评估和筛查。然而，由于BMI无法区分脂肪和瘦体重，其在筛查真实肥胖时的准确性仍存在一定争议[7, 14]。2015年一项Meta分析研究发现，以FMP为参考标准，BMI筛查真实肥胖的特异度较高(93%，95%CI=88%~96%)，但灵敏度较低(73%，95%CI=67%~79%)，即BMI作为筛查工具可能会漏诊约1/4的真实肥胖儿童[15]。2022年，美国一项针对5~18岁儿童的研究发现，在年龄别BMI≥95百分位数的男生和年龄别BMI≥85百分位数的女生中，BMI与FMI密切相关，但在BMI水平较低的儿童中，BMI水平与体脂水平之间差异较大[16]。以上研究证据支持本研究结果，揭示了BMI作为真实肥胖筛查指标的局限性。有研究表明，BMI漏诊的真实肥胖儿童出现心血管代谢异常的风险显著增加[17]。
WC和WHtR是常用于识别中心性肥胖的指标。巴西一项纳入了788名4~9岁儿童的研究发现，WC和WHtR筛查双能X射线吸收法定义的体脂过多的AUC值和灵敏度较高，但特异度较低，与本研究结果一致[18]。提示WC和WHtR筛查肥胖会误诊部分正常儿童，可能对儿童及其家庭造成额外的心理负担。本研究还发现WHtR筛查真实肥胖与WC效果相当，验证了其作为WC替代指标的可行性[19]。同样，本课题组前期研究显示WC和WHtR筛查儿童颈动脉内中膜厚度增加和左心室肥厚的效果相似[20-21]。
此外，本研究发现BMI、WC和WHtR筛查女生真实肥胖的效果优于男生，可能是性别差异导致的体成分变化。在青春期阶段，随着年龄的增长，男生的瘦体重增加明显，而女生则表现为脂肪增加为主[22]。有研究表明，女生BMI与FMI的相关性强于男生[23]，7~10岁男生BMI与FMI的关联强于14~16岁男生[24]。
本研究存在以下局限：第一，研究仅采用BIA法测量体脂水平，未使用X射线吸收法 [25]。已有证据表明BIA与DXA之间具有较高的相关性[26]，并且BIA操作简单、经济且安全，适用于大规模儿童体脂监测和筛查。第二，研究样本来源于山东省某县部分儿童，研究结果外推需谨慎。第三，目前国内尚无统一的儿童体脂定义真实肥胖界值。
基金
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  • 国家自然科学基金项目(81673195, 82173538)；国家资助博士后研究人员计划项目(GZC20231438)；山东省博士后创新人才支持计划项目(SDBX2023003)
文献
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2025年第46卷第3期
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doi: 10.16835/j.cnki.1000-9817.2025067
  • 接收时间：2024-12-02
  • 首发时间：2026-11-06
  • 出版时间：2025-03-25
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  • 收稿日期：2024-12-02
  • 修回日期：2025-01-09
基金
国家自然科学基金项目(81673195, 82173538)；国家资助博士后研究人员计划项目(GZC20231438)；山东省博士后创新人才支持计划项目(SDBX2023003)
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    1山东大学齐鲁医学院公共卫生学院流行病学系/山东大学儿童心血管研究中心, 济南 250012
    2山东大学齐鲁医学院公共卫生学院营养与食品卫生学系

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席波，E-mail:
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
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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