青岛市6~12岁儿童腰围、腰围身高比及 中心性肥胖分布现状研究

Research on Current Distribution Status of Waist Circumference, Waist-to-Height Ratio, and Central Obesity among Children Aged 6 - 12 Years in Qingdao

摘要: 目的：探讨青岛市6~12岁儿童腰围(waist circumference, WC)、腰围身高比(waist-to-height ratio, WHtR)水平及中心性肥胖的分布现状，并评估WC与WHtR在识别中心性肥胖中的一致性。方法：采用随机整群抽样方法，于2023年10月至2024年6月选取青岛市6所小学中6~12岁的2993名儿童作为研究对象，进行身高、体重和腰围的测量，分析腰围、腰围身高比水平及中心性肥胖流行现状以及不同体型儿童腰围、腰围身高比水平。根据诊断中心性肥胖的WC切点(同年龄同性别腰围的P₉₀)和WHtR超标界值(6~15岁男童WHtR > 0.48，6~9岁女童WHtR > 0.48，10~15岁女性WHtR > 0.46)，比较预测中心性肥胖的一致性。结果：随年龄增长，儿童WC均值呈上升趋势，且各年龄段男童WC均高于女童(P < 0.05)。WHtR均值随年龄变化不明显，各年龄段男童WHtR均高于女童(P < 0.05)。根据WC切点7~12岁儿童中心性肥胖检出率男童为29.56% (95% CI: 27.12%~32.00%)，女童为23.17% (95% CI: 20.79%~25.55%)；WHtR超标比例男孩为35.50% (95% CI: 32.92%~38.08%)，女孩为18.89% (95% CI: 16.66%~21.12%)，男童显著高于女童(P < 0.001)。BMI正常儿童中存在一定比例的高腰围和WHtR超标儿童。WHtR筛查中心性肥胖与WC诊断结果一致性良好(Kappa = 0.826, P < 0.001)，灵敏度和特异度分别为0.948和0.945。结论：青岛市6~12岁男童WC和WHtR水平普遍较女童高。与2010年山东省数据相比，各年龄组男女童的WC均有增加，儿童中心性肥胖问题日趋严重。在7~12岁儿童中，WC和WHtR对预测中心性肥胖的效能相当，具有良好的一致性。在儿童肥胖筛查工作中，应结合BMI、WC、WHtR等多维度指标综合判读，以提高中心性肥胖儿童的识别率，为肥胖儿童的风险分层和个体化干预提供科学依据。

Abstract: Objective: To investigate the distribution of waist circumference (WC), waist-to-height ratio (WHtR), and central obesity among 6~12-year-old children in urban areas of Qingdao, and to evaluate the consistency of WC and WHtR in identifying central obesity. Methods: A random cluster sampling method was used to select 2993 children aged 6~12 years from 6 primary schools in urban Qingdao from October 2023 to June 2024. Their height, weight, and WC were measured. The prevalence of central obesity and the levels of WC and WHtR among children of different body types were analyzed. The WC cut-off points for diagnosing central obesity (P90 of WC for the same age and gender) and the WHtR threshold values (WHtR > 0.48 for boys aged 6~15, WHtR > 0.48 for girls aged 6~9, and WHtR > 0.46 for girls aged 10~15) were used to compare the consistency in predicting central obesity. Results: The mean WC showed an increasing trend with age, and boys had significantly higher WC than girls across all age groups (P < 0.05). The mean WHtR did not show a significant trend with age, but boys had significantly higher WHtR than girls in all age groups (P < 0.05). Based on WC cut-off points, the detection rate of central obesity among boys aged 7~12 was 29.56% (95% CI: 27.12%~32.00%), and among girls was 23.17% (95% CI: 20.79%~25.55%). The proportion of children exceeding the WHtR threshold was 35.50% in boys (95% CI: 32.92%~38.08%) and 18.89% in girls (95% CI: 16.66%~21.12%), and this was significantly greater in boys than in girls (P < 0.001). A certain proportion of children with normal BMI had elevated WC or exceeded WHtR thresholds. WHtR demonstrated high agreement with WC in screening for central obesity (Kappa = 0.826, P < 0.001), with a sensitivity of 0.948 and a specificity of 0.945. Conclusion: The levels of WC and WHtR are generally higher in boys than in girls aged 6~12 years in Qingdao. Compared to data from Shandong Province in 2010, WC has increased in both boys and girls across all age groups, indicating a growing problem of central obesity in children. For children aged 7~12, WC and WHtR perform similarly and show good consistency in predicting central obesity. In childhood obesity screening, a comprehensive interpretation using multi-dimensional indicators such as BMI, WC, and WHtR is recommended to improve the identification rate of central obesity and provide a scientific basis for risk stratification and individualized intervention for obese children.