PLOS ONE：WC与BMI联用能更好的评估CMD和CVD风险

心血管疾病（CVD）是影响中国人健康最普遍的疾病，可以预料的是心脏代谢紊乱（CMD）和CVD一起将成为更加严重的公共健康负担。肥胖作为心脏代谢最重要的危险因素，在过去20年期间，中国人肥胖的发病率一路飙升。为了更新中国成年人肥胖的发病率，评估在中国成年人，单独和联合使用腰围（WC）和体重指数（BMI）指标增量识别CMD和CVA风险的临床效果，来自中国国家糖尿病和代谢紊乱研究组的贾伟平教授等人进行了一项研究（Impact of Waist Circumference and Body Mass Index on Risk of Cardiometabolic Disorder and Cardiovascular Disease in Chinese Adults: A National Diabetes and Metabolic Disorders Survey）,该研究认为WC与BMI联用能更好的评估CMD和CVD风险。该研究结果发表在2013年3月8日的美国《PLOS ONE》上，该杂志影响因子为4.092。
该研究是在2007年到2008年期间进行的一项全国代表性样本调查，分析了包括46024例年龄大于20岁的参与者。考虑到中国指南制定联合委员会（JCDCG）和中国肥胖工作组（WGOC）推荐的切点，根据参与者在均数周围0.5-SD增量，分成4个WC组和4个BMI组，以及16个WC和BMI的交叉联合组。
该研究结果表明，根据JCDCG和WGOC标准，中国成年人中分别有27.1%、31.4%和12.2%为中心性肥胖、超重和肥胖。校正潜在混杂因素后，WC每增加一个SD，发生糖尿病或糖尿病和血脂异常的危险分别是BMI每增加一个SD的1.7倍和2.2倍；与WC相比，BMI对高血压或高血压+血脂代谢异常的影响更大，每增加一个标准差，风险分别增加2.3倍和1.7倍。WC与BMI指标联用与CMD风险强相关，例如，联合与单独最高数值WC和BMI指标对患有糖尿病、高血压、血脂异常的校正OR（95%CI）分别为2.19（1.96-2.44）vs1.88(1.67-2,12)和1.12（0.99-1.26）；5.70（5.24-6.19）vs1.51(1.39–1.65) 和1.69 (1.57–1.82); 3.73 (3.42–4.07) vs 2.16 (1.98–2.35) 和1.33 (1.25–1.40)。即使CMD的影响被控制后，WC和BMI指标的联合更有可能识别低WC和低BMI个体的CVD风险。
该研究发现，中心性肥胖、超重和肥胖在中国成年人中流行。WC和BMI联合测量比单独指数更好的识别CMD和CVD风险。

 与心血管疾病相关的拓展阅读：

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• 面相老的人患心血管疾病风险高
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• FDA警告 伐尼克兰或有致心血管疾病风险
• JAMA：每日补充多种维生素未能降低心血管疾病风险
• 中文版2012ESC心血管疾病预防指南
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Impact of Waist Circumference and Body Mass Index on Risk of Cardiometabolic Disorder and Cardiovascular Disease in Chinese Adults: A National Diabetes and Metabolic Disorders Survey
Background
We updated the prevalence of obesity and evaluated the clinical utility of separate and combined waist circumference (WC) or body mass index (BMI) category increments in identifying cardiometabolic disorder (CMD) and cardiovascular disease (CVD) risk in Chinese adults.
Methods and Findings
46,024 participants aged ≥20 years, a nationally representative sample surveyed in 2007–2008, were included in this analysis. Taking the cutoffs recommended by the Chinese Joint Committee for Developing Chinese Guidelines (JCDCG) and the Working Group on Obesity in China (WGOC) into account, the participants were divided into four WC and four BMI groups in 0.5-SD increments around the mean, and 16 cross-tabulated combination groups of WC and BMI. 27.1%, 31.4%, and 12.2% of Chinese adults are centrally obese, overweight, or obese according to JCDCG and WGOC criteria. After adjustment for confounders, after a 1-SD increment, WC is associated with a 1.7-fold or 2.2-fold greater risk of having DM or DM plus dyslipidemia than BMI, while BMI was associated with a 2.3-fold or 1.7-fold higher hypertension or hypertension plus dyslipidemia risk than WC. The combination of WC and BMI categories had stronger association with CMD risk, i.e., the adjusted ORs (95% CI) of having DM, hypertension, and dyslipidemia for the combined and separate highest WC and BMI categories were 2.19 (1.96–2.44) vs 1.88 (1.67–2.12) and 1.12 (0.99–1.26); 5.70 (5.24–6.19) vs 1.51 (1.39–1.65) and 1.69 (1.57–1.82); and 3.73 (3.42–4.07) vs 2.16 (1.98–2.35) and 1.33 (1.25–1.40), respectively. The combination of WC and BMI categories was more likely to identify individuals with lower WC and lower BMI at CVD risk, even after the effects of CMD were controlled (all P<0.05).
Conclusion
Central obesity, overweight, and obesity are epidemic in Chinese adults. The combination of WC and BMI measures is superior to the separate indices in identifying CMD and CVD risk.