한국 소아청소년 비만에서 허리둘레-신장비의 유용성 = Usefulness of the Waist Circumference-to-Height Ratio in Screening for Obesity in Korean Children and Adolescents

다국어 초록 (Multilingual Abstract)

Purpose: To evaluate the feasibility and usefulness of the waist circumference-to-height ratio (WHTR) in screening for obesity in Korean children and adolescents. Methods: Data, including body mass index (BMI), waist circumference (WC), and height, were obtained from the national growth surveys for children and adolescents in 2005. The WHTR was calculated dividing WC by height in subjects 2~18 years of age. Overweight and obese were defined by BMI percentiles for age and gender. The receiver operating characteristic (ROC) analysis was performed to find out the optimal cutoff values of WHTR that matched BMI-determined overweight and obesity using the STATA program. The area under the curve (AUC), a measure of diagnostic power, of WHTR was compared to WC. The influence of age on WHTR was analyzed by the SAS program. Results: The WHTR significantly decreased with age, and had less correlation with age in the 6~18-year-old age group than the 2~5-year-old age group. Furthermore, the WHTR also had less correlation with age than WC in the 6~18-year-old age group. The AUC of WHTR in identifying overweight and obesity was significantly higher than the AUC of WC in the 6~18-year-old age group. The optimal cutoff values were 0.51 in boys and 0.49 in girls for obesity, and 0.48 in boys and 0.47 in girls for overweight, with all having the AUC>0.9. The optimal cutoff values of WHTR had a higher sensitivity for diagnosing obesity than WC${\geq}$90th percentiles. Conclusion: The WHTR is an easy, accurate, and less age-dependent index with high applicability in screening for obesity in children and adolescents.

참고문헌 (Reference)

1 변정수, "허리둘레/키 비의 비만지표로서의 유용성" 대한가정의학회 25 (25): 307-313, 2004

2 박미정, "한국 소아청소년의 신장, 체중, 체질량 지수, 허리둘레의 변화추이; 1998, 2001, 2005년 한국국민건강영양조사 분석" 대한소아내분비학회 12 (12): 142-149, 2007

3 오경원, "한국 소아청소년의 비만 유병률 추이: 1997년과 2005년 비교" 대한소아과학회 51 (51): 950-955, 2008

4 조기영, "소아청소년 비만에서 생활습관과 대사증후군의 연관성" 대한소아소화기영양학회 11 (11): 150-159, 2008

5 서정완, "소아청소년 비만" 대한소아과학회 52 (52): 1311-1320, 2009

6 염혜원, "소아 비만에서 대사증후군의 고찰" 대한소아소화기영양학회 7 (7): 228-238, 2004

7 김종훈, "소아 비만 환아에서 체지방 측정법간의 연관성" 대한소아과학회 47 (47): 485-490, 2004

8 Hsieh SD, "Waist-to-height ratio, a simple and practical index for assessing central fat distribution and metabolic risk in Japanese men and women" 27 : 610-616, 2003

9 Weili Y, "Waist-to-height ratio is an accurate and easier index for evaluating obesity in children and adolescents" 15 : 748-752, 2007

10 Sung RY, "Waist circumference and waist-to-height ratio of Hong Kong Chinese children" 80 : 324-, 2008

11 Park SH, "Waist circumference and waist-to-height ratio as predictors of cardiovascular disease risk in Korean adults" 73 : 1643-1650, 2009

12 Savva SC, "Waist circumference and waist-to-height ratio are better predictors of cardiovascular disease risk factors in children than body mass index" 243 : 1453-1458, 2000

13 Stephen RD, "The utility of body mass index as a measure of body fatness in children and adolescents; differences by race and gender" 99 : 804-807, 1997

14 Guo SS, "The predictive value of childhood body mass index values for overweight at age 35 y" 59 : 810-819, 1994

15 Lee DH, "The committee for public health statistics, the committee for nutrition. 1998 Korean national growth charts"

16 Inoue S, "The Asia-Pacific Perspective: Redefining Obesity and its Treatment. The International Diabetes Institute"

17 Ashwell M, "The Ashwell Shape Chart-a public health approach to the metabolic risks of obesity" 22 : S213-, 1998

18 Ashwell M, "Six reasons why the waist- to-height ratio is a rapid and effective global indicator for health risks of obesity and how its use could simplify the international public health message on obesity" 56 : 303-307, 2005

19 Maynard LM, "Siervogel RM. Childhood body composition in relation to body mass index" 107 : 344-350, 2001

20 Li C, "Recent trends in waist circumference and waist-height ratio among US children and adolescents" 118 : 1390-1398, 2006

21 Ashwell M, "Ratio of waist circumference to height may be better indicator of need for weight management" 312 : 377-, 1996

22 Maffeis C, "Provera S, Tatò L. Waist circumference and cardiovascular risk factors in prepubertal children" 9 : 179-187, 2001

23 Greiner M, "Principles and practical application of the receiver-operating characteristic analysis for diagnostic tests" 45 : 23-41, 2000

24 Lin WY, "Optimal cut-off values for obesity: using simple anthropometric indices to predict cardiovascular risk factors in Taiwan" 26 : 1232-1238, 2002

25 Quak SH, "Obesity Working Group. Obesity in children and adolescents" 47 : 254-259, 2008

26 Viggiano D, "O.Si.M.E. Study Group. Screening of metabolic syndrome in obese children: a primary care concern" 49 : 329-334, 2009

27 Johnson ST, "Metabolic risk varies according to waist circumference measurement site in overweight boys and girls" 156 : 247-252, 2010

28 "Korea Center for Disease Control and Prevention, The Korean Pediatric Society, The Committee for the Development of Growth Standard for Korean Children and Adolescents"

29 Hsieh SD, "Health risks among Japanese men with moderate body mass index" 24 : 358-362, 2000

30 Barlow SE, "Expert Committee. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report" 120 : S164-192, 2007

31 Taylor RW, "Evaluation of waist circumference, waist-to-hip ratio, and the conicity index as screening tools for high trunk fat mass, as measured by dual-energy X-ray absorptiometry, in children aged 3∼19 y" 72 : 490-495, 2000

32 Fluss R, "Estimation of the Youden Index and its associated cutoff point" 47 : 458-472, 2005

33 Hsieh SD, "Do people with similar waist circumference share similar health risks irrespective of height?" 188 : 55-60, 1999

34 Wang J, "Comparisons of waist circumferences measured at 4 sites" 77 : 379-384, 2003

35 Daniels SR, "Association of body fat distribution and cardiovascular risk factors in children and adolescents" 99 : 541-545, 1999

36 Revenga-Frauca J, "Abdominal fat and metabolic risk in obese children and adolescents" 65 : 415-420, 2009

37 McCarthy HD, "A study of central fatness using waist-to-height ratios in UK children and adolescents over two decades supports the simple message - ‘keep your waist circumference to less than half your height’" 30 : 988-992, 2006

38 Kahn HS, "A population based comparison of BMI percentiles and waist-to height ratio for identifying cardiovascular risk in youth" 146 : 482-488, 2005

39 문진수, "2007 한국 소아 청소년 성장도표 : 개발 과정과 전망" 대한소아과학회 51 (51): 1-25, 2008

40 Hara M, "-to-height ratio is the best predictor of cardiovascular disease risk factors in Japanese school children" 9 : 127-132, 2002