人类学学报 ›› 2021, Vol. 40 ›› Issue (02): 328-345.doi: 10.16359/j.cnki.cn11-1963/q.2020.0042
• 综述 • 上一篇
收稿日期:
2018-06-27
修回日期:
2019-09-04
出版日期:
2021-04-15
发布日期:
2020-09-28
作者简介:
席焕久(1945-),男,硕士,教授,辽宁绥中人,主要从事生物人类学研究。E-mail: 基金资助:
XI Huanjiu(), LI Wenhui, LIU Yingying
Received:
2018-06-27
Revised:
2019-09-04
Online:
2021-04-15
Published:
2020-09-28
摘要:
本文通过查阅文献,对体质测量在评估超重、肥胖和预测健康风险中的应用进行了回顾性调查、总结和分析,并对体质量指数、体脂肪指数和内脏脂肪指数等测量指标的优势和局限性进行了分析和讨论。由于预测结果受多种因素的影响,因而预测评价时应根据不同地域的不同的研究对象和不同的预测风险,选用不同的测量指标和不同的测量工具。为同行们今后应用提供参考,对防治与肥胖相关疾病具有重要意义。
中图分类号:
席焕久, 李文慧, 刘莹莹. 体质测量在超重和肥胖研究中的应用[J]. 人类学学报, 2021, 40(02): 328-345.
XI Huanjiu, LI Wenhui, LIU Yingying. Application of anthropometry in study of overweight and obesity[J]. Acta Anthropologica Sinica, 2021, 40(02): 328-345.
时间/Time | 国家或地区/Country or Area | 年龄/Years | 超重/Overweigh | 肥胖/Obesity |
---|---|---|---|---|
2013 | 全球/All the World | 18+ | n=12.5亿 | n=6.5亿 |
<5 | n>4100万 | n>4100万 | ||
5-19 | n>340万 | n>340万 | ||
2000-2016 | 非洲/Africa | <5 | 增近50% | |
亚洲/Asia | ? | 近1/2 | 近1/2 | |
1975-2016 | 全球/All the World | 5-19 | 4%-18% | |
2017 | 中国大陆/Mainland China | ? | Male 10.8%; Female 14.8% | |
20< | Male 23%; Female 14% | Male 23%; Female 14% |
表1 超重与肥胖趋势
Tab.1 Trends of overweight and obesity
时间/Time | 国家或地区/Country or Area | 年龄/Years | 超重/Overweigh | 肥胖/Obesity |
---|---|---|---|---|
2013 | 全球/All the World | 18+ | n=12.5亿 | n=6.5亿 |
<5 | n>4100万 | n>4100万 | ||
5-19 | n>340万 | n>340万 | ||
2000-2016 | 非洲/Africa | <5 | 增近50% | |
亚洲/Asia | ? | 近1/2 | 近1/2 | |
1975-2016 | 全球/All the World | 5-19 | 4%-18% | |
2017 | 中国大陆/Mainland China | ? | Male 10.8%; Female 14.8% | |
20< | Male 23%; Female 14% | Male 23%; Female 14% |
作者/Author | 样本男/Male | 样本女/ Female | 年龄/Years | 测定方法一致性偏差/Deviation | 主要发现/Evaluation |
---|---|---|---|---|---|
Robinson et al | 22 | 26 | 30-50 | BAP 女5.0% 男6.0% | 低估了体脂率 |
Thirel et al | 58 | 61 | 12-16 | 3.4% | 过高估体脂率 |
Bergman et al | 1733 | 20-50 | DXA-BAI 相关r=0.95 | 适当、准确 | |
Segheto et al | 331 | 395 | 20-59 | BAP女5.0%, 男5.4% | 高估体脂率 |
Carpio-Rivera | 106 | 93 | 18.9±26 | BAP女7.2%, 男2.9% | 女低估, 男高估 |
Cerqueira et al | - | 102 | 60.3±9.8 | 3.2% | 高估 |
Esco et al | - | 30(女运动员) | 20.0±1.3 | 5.8% | 高估 |
Chang et al | 483 | 471 | 55-96 | 5.1% | 高估 |
Lemacks et al | - | 187(绝经后超重/肥胖) | 55.8±3.3 | 相关系数r=0.39 | 高估,与DXA一致性差 |
Vinknes et al | 5193 | 47-72 | — | 低体脂率者高估(男),高估超重、肥胖体脂率 | |
Robinson et al | 903 | 21.4±3.3 | BAP男9.5%,女3.2%,总6.4% | 总BAI过高估,对超重者高估,肥胖者低估(男女) | |
Geliebter et al | - | 19 (超重、肥胖术前无糖尿病) | 32.6±7.7 | BAP 2.2% | 低估 |
Bernhard et al | 240(超重肥胖) | 44.1±11.1 | 组内相关0.74, 95%可信间隔0.68-0.79 | 二法相近 | |
Ezeukwu et al | - | 30(肥胖) | 22.8±3.3 | BAP 15.0% | 低估 |
David et al | 1151 | 18-110 | 体脂率男偏高3.9%,女偏低2.5% | 男高估,女低估 |
表2 BAI参数比较
Tab.2 BAI parameter comparison
作者/Author | 样本男/Male | 样本女/ Female | 年龄/Years | 测定方法一致性偏差/Deviation | 主要发现/Evaluation |
---|---|---|---|---|---|
Robinson et al | 22 | 26 | 30-50 | BAP 女5.0% 男6.0% | 低估了体脂率 |
Thirel et al | 58 | 61 | 12-16 | 3.4% | 过高估体脂率 |
Bergman et al | 1733 | 20-50 | DXA-BAI 相关r=0.95 | 适当、准确 | |
Segheto et al | 331 | 395 | 20-59 | BAP女5.0%, 男5.4% | 高估体脂率 |
Carpio-Rivera | 106 | 93 | 18.9±26 | BAP女7.2%, 男2.9% | 女低估, 男高估 |
Cerqueira et al | - | 102 | 60.3±9.8 | 3.2% | 高估 |
Esco et al | - | 30(女运动员) | 20.0±1.3 | 5.8% | 高估 |
Chang et al | 483 | 471 | 55-96 | 5.1% | 高估 |
Lemacks et al | - | 187(绝经后超重/肥胖) | 55.8±3.3 | 相关系数r=0.39 | 高估,与DXA一致性差 |
Vinknes et al | 5193 | 47-72 | — | 低体脂率者高估(男),高估超重、肥胖体脂率 | |
Robinson et al | 903 | 21.4±3.3 | BAP男9.5%,女3.2%,总6.4% | 总BAI过高估,对超重者高估,肥胖者低估(男女) | |
Geliebter et al | - | 19 (超重、肥胖术前无糖尿病) | 32.6±7.7 | BAP 2.2% | 低估 |
Bernhard et al | 240(超重肥胖) | 44.1±11.1 | 组内相关0.74, 95%可信间隔0.68-0.79 | 二法相近 | |
Ezeukwu et al | - | 30(肥胖) | 22.8±3.3 | BAP 15.0% | 低估 |
David et al | 1151 | 18-110 | 体脂率男偏高3.9%,女偏低2.5% | 男高估,女低估 |
文献/Reference | 相关系数/r | 说明/Note |
---|---|---|
Moliner-Urdiales et al (39) | 0.78 | 8050/2259*追踪个体 |
Angel et al (8) | 0.64 | 地中海白人 |
Lemacks et al (54) | 0.90 | 美绝经后白人 |
Allan et al(52) | 0.90 | 临床重度肥胖妇女 |
Robinson et al[ | 0.885 | - - |
Regi et al (3) | 0.698 | - - |
Seghetow et al(51) | 0.86 | 评价DS |
表3 BAI与BMI的相关关系
Tab.3 Correlation between BAI and BMI
文献/Reference | 相关系数/r | 说明/Note |
---|---|---|
Moliner-Urdiales et al (39) | 0.78 | 8050/2259*追踪个体 |
Angel et al (8) | 0.64 | 地中海白人 |
Lemacks et al (54) | 0.90 | 美绝经后白人 |
Allan et al(52) | 0.90 | 临床重度肥胖妇女 |
Robinson et al[ | 0.885 | - - |
Regi et al (3) | 0.698 | - - |
Seghetow et al(51) | 0.86 | 评价DS |
BAI | BMI | 文献/Reference |
---|---|---|
0.68/0.81 | 0.80/0.84 | [23] |
0.86 | 0.74 | [40] |
0.74 | 0.64 | [4] |
0.75 | 0.78 | [52] |
0.42 | 0.65 | [54] |
0.51 | 0.78 | [30] |
0.66/0.58 | 0.83/0.71 | [31] |
0.70/0.79 | 0.79/0.86 | [56] 皮褶厚度 法 |
0.65 | 0.72 | [57] |
表4 BAI(体脂率)与BMI(体脂率)对比
Tab.4 Comparison of the correlation between BAI and body fat percent, and the correlation between BMI and body fat percent
BAI | BMI | 文献/Reference |
---|---|---|
0.68/0.81 | 0.80/0.84 | [23] |
0.86 | 0.74 | [40] |
0.74 | 0.64 | [4] |
0.75 | 0.78 | [52] |
0.42 | 0.65 | [54] |
0.51 | 0.78 | [30] |
0.66/0.58 | 0.83/0.71 | [31] |
0.70/0.79 | 0.79/0.86 | [56] 皮褶厚度 法 |
0.65 | 0.72 | [57] |
体脂率测定方法/Method | r | r2 | SEE |
---|---|---|---|
生物电阻抗/BIA | 0.87**/0.90** | 0.76/0.80 | 2.22/2.01 |
空气置换/ADP | 0.73**/0.81** | 0.53/0.65 | 3.99/3.45 |
双能X线吸收/DXA | 0.42/0.65** | 0.17/0.42 | 8.18/6.86 |
表5 BAI/BMI与生物电阻抗、空气置换、双能X线吸收法的相关关系
Tab.5 Correlation between BAI/BMI and BIA, ADP, DXA
体脂率测定方法/Method | r | r2 | SEE |
---|---|---|---|
生物电阻抗/BIA | 0.87**/0.90** | 0.76/0.80 | 2.22/2.01 |
空气置换/ADP | 0.73**/0.81** | 0.53/0.65 | 3.99/3.45 |
双能X线吸收/DXA | 0.42/0.65** | 0.17/0.42 | 8.18/6.86 |
腰臀比/WHR | 腰围身高比/WHtR | 腰围/Waist circumference | 体脂率 | |
---|---|---|---|---|
BMI | -0.065 | 0.624** | 0.488** | 0.368** |
BAI | -0.303** | 0.684** | 0.428** | 0.579** |
腰臀比/WHR | 0.632** | -0.300** | ||
腰围身高比/WHtR | 0.920** | 0.296** |
表6 体质测量指标间相关性比较
Tab.6 Comparison of correlation between anthropometry indexes
腰臀比/WHR | 腰围身高比/WHtR | 腰围/Waist circumference | 体脂率 | |
---|---|---|---|---|
BMI | -0.065 | 0.624** | 0.488** | 0.368** |
BAI | -0.303** | 0.684** | 0.428** | 0.579** |
腰臀比/WHR | 0.632** | -0.300** | ||
腰围身高比/WHtR | 0.920** | 0.296** |
方法/Method | 内容/Item | 部位/Position | 准确度/Accuracy | 精确度/Precise | 特点/Features |
---|---|---|---|---|---|
BMI | 脂肪和骨骼肌 | 全身 | 较差 | 较差 | 简便,价廉,无放射性,可用于筛查,但不能区分肌重与脂肪重,评价儿童和运动员有局限性 |
BAI | 脂肪和骨骼肌 | 全身 | 差 | 较差 | 不需要测体重,适于人口筛查 |
VAI | 脂肪 | 局部 | 良 | 一般 | 简便,是评价内脏脂肪分布、功能有价值的指标,适于代谢综合征等风险评估 |
腰围/Waist circumference | 脂肪 | 局部 | 一般 | 一般 | 简便,好于臀围,是中心性肥胖关键指标,但不能区分内脏与皮下脂肪 |
腰臀比/WHR | 脂肪 | 局部 | 一般 | 一般 | 简便,是评价健康尺度,筛查与体重相关疾病的工具 |
皮褶厚度/Skinfold thickness | 脂肪和骨骼肌 | 局部或全身 | 差 | 差 | 简便,廉价,反映脂肪组织分布特征,但重复性差,需要用DXA等校准 |
CT | 骨骼,脂肪和骨骼肌 | 局部或全身 | 很好 | 很好 | 探测细节好,但价高,放射性强 |
MRI | 脂肪和骨骼肌 (骨骼) | 局部或全身 | 很好 | 很好 | 探测细节较好,无放射性 但价高 |
DXA | 骨骼,脂肪和骨骼肌 | 局部或全身 | 很好 (骨,脂肪)或较好(骨骼肌) | 很好 (骨,脂肪)或较好(骨骼肌) | 放射性弱,适用人群广,操作简单, 但无探测细节(如骨松质和骨密质,肌间脂肪组织等)的功能 |
ADP | 通过测量体积研究体成分 | 全身 | 较好 | 较好 | 设备价高,不便携带,但从婴儿到老人,运动员,高身材(2m以上),肥胖者(>159kg)皆适用, 可靠性、顺应性佳 |
BIA | 脂肪和水(有的可测骨和骨骼肌) | 全身(有的可测局部) | 较好(脂肪和水)或不确定 (骨和骨骼肌) | 较好(脂肪和水)或不确定 (骨和骨骼肌) | 简便,价廉,无放射性,但影响测量结果的因素较多 |
定量超声/Quantitative ultrasonic | 骨含量和强度 (有的可测脂肪和骨骼肌) | 局部 | 较好(骨)或不确定 (脂肪和骨骼肌) | 较好(骨)或不确定 (脂肪和骨骼肌) | 简便,价廉,无放射性,但缺乏标准程序,结果受主观影响较大 |
生化检测/Biochemical examination | 骨的变化或骨骼肌含量 | 全身 | 好或不确定 | 好或不确定 | 无放射性,需取血或尿样 |
表7 人体组成成分活体测量方法比较与分析
Tab.7 Comparison and analysis of anthropometry in human vivo for body composition
方法/Method | 内容/Item | 部位/Position | 准确度/Accuracy | 精确度/Precise | 特点/Features |
---|---|---|---|---|---|
BMI | 脂肪和骨骼肌 | 全身 | 较差 | 较差 | 简便,价廉,无放射性,可用于筛查,但不能区分肌重与脂肪重,评价儿童和运动员有局限性 |
BAI | 脂肪和骨骼肌 | 全身 | 差 | 较差 | 不需要测体重,适于人口筛查 |
VAI | 脂肪 | 局部 | 良 | 一般 | 简便,是评价内脏脂肪分布、功能有价值的指标,适于代谢综合征等风险评估 |
腰围/Waist circumference | 脂肪 | 局部 | 一般 | 一般 | 简便,好于臀围,是中心性肥胖关键指标,但不能区分内脏与皮下脂肪 |
腰臀比/WHR | 脂肪 | 局部 | 一般 | 一般 | 简便,是评价健康尺度,筛查与体重相关疾病的工具 |
皮褶厚度/Skinfold thickness | 脂肪和骨骼肌 | 局部或全身 | 差 | 差 | 简便,廉价,反映脂肪组织分布特征,但重复性差,需要用DXA等校准 |
CT | 骨骼,脂肪和骨骼肌 | 局部或全身 | 很好 | 很好 | 探测细节好,但价高,放射性强 |
MRI | 脂肪和骨骼肌 (骨骼) | 局部或全身 | 很好 | 很好 | 探测细节较好,无放射性 但价高 |
DXA | 骨骼,脂肪和骨骼肌 | 局部或全身 | 很好 (骨,脂肪)或较好(骨骼肌) | 很好 (骨,脂肪)或较好(骨骼肌) | 放射性弱,适用人群广,操作简单, 但无探测细节(如骨松质和骨密质,肌间脂肪组织等)的功能 |
ADP | 通过测量体积研究体成分 | 全身 | 较好 | 较好 | 设备价高,不便携带,但从婴儿到老人,运动员,高身材(2m以上),肥胖者(>159kg)皆适用, 可靠性、顺应性佳 |
BIA | 脂肪和水(有的可测骨和骨骼肌) | 全身(有的可测局部) | 较好(脂肪和水)或不确定 (骨和骨骼肌) | 较好(脂肪和水)或不确定 (骨和骨骼肌) | 简便,价廉,无放射性,但影响测量结果的因素较多 |
定量超声/Quantitative ultrasonic | 骨含量和强度 (有的可测脂肪和骨骼肌) | 局部 | 较好(骨)或不确定 (脂肪和骨骼肌) | 较好(骨)或不确定 (脂肪和骨骼肌) | 简便,价廉,无放射性,但缺乏标准程序,结果受主观影响较大 |
生化检测/Biochemical examination | 骨的变化或骨骼肌含量 | 全身 | 好或不确定 | 好或不确定 | 无放射性,需取血或尿样 |
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