Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
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Usefulness of the Waist Circumference-to-Height Ratio in Screening for Obesity in Korean Children and Adolescents

한국 소아청소년 비만에서 허리둘레-신장비의 유용성

  • Gil, Joo-Hyun (Department of Pediatrics, Medicine, Ewha Womans University School of Medicine) ;
  • Lee, Mi-Na (Department of Pediatrics, Medicine, Ewha Womans University School of Medicine) ;
  • Lee, Hye-Ah (Department of Preventive, Medicine, Ewha Womans University School of Medicine) ;
  • Park, Hye-Sook (Department of Preventive, Medicine, Ewha Womans University School of Medicine) ;
  • Seo, Jeong-Wan (Department of Pediatrics, Medicine, Ewha Womans University School of Medicine)
  • 길주현 (이화여자대학교 의학전문대학원 소아과학교실) ;
  • 이미나 (이화여자대학교 의학전문대학원 소아과학교실) ;
  • 이혜아 (이화여자대학교 의학전문대학원 예방의학교실) ;
  • 박혜숙 (이화여자대학교 의학전문대학원 예방의학교실) ;
  • 서정완 (이화여자대학교 의학전문대학원 소아과학교실)
  • Received : 2010.08.13
  • Accepted : 2010.09.03
  • Published : 2010.09.30
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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.

목 적: 2005년 소아청소년 신체 계측조사의 원자료를 분석하여, 비만을 진단하기 위한 WHTR 최적 절단값을 구하고, 허리둘레와 BMI 기준과 비교하여, 성별, 연령별 참고치를 필요로 하지 않는 간편한 단일지표로서 WHTR의 유용성을 알아보고자 하였다. 방 법: 2005년 소아청소년 신체 계측조사 자료에서 신장, BMI, 허리둘레를 사용하였고 이를 통해 WHTR 값을 구하여 분석하였다. WHTR이 연령에 구애받지 않고 적용이 가능한 범위를 선정하기 위해 2~5세, 6~18세의 연령군으로 나누어 연령과의 상관성을 분석하였다. 6~18세의 소아청소년에서, ROC분석을 시행하여 비만 진단 지표로서 WHTR, 허리둘레의 정확도를 비교하였고, BMI로 정의한 과체중과 비만을 진단하기 위한 WHTR의 최적 절단값을 구하였다. 통계 분석은 SAS, STATA 통계프로그램을 이용하였다. 결 과: 1. WHTR은 연령과 유의한 음의 상관관계를 나타냈다(p~0.0001). 특히, 6~18세 연령군에서 2~5세 연령군에 비해 연령에 따른 WHTR의 변화의 폭이 작았고, 연령과의 상관성이 더 약하였다(남아 r=.0.16 vs .0.53, 여아 r=.0.14 vs .0.56). WHTR은 6~18세에서 허리둘레에 비해 연령과의 상관성이 더 약하였다(남아 r=.0.16 vs 0.66, 여아 r=.0.14 vs 0.65). 2. BMI로 정의한 비만과 과체중군을 진단하는 데 있어서 WHTR의 AUC가 허리둘레의 AUC에 비해 유의하게 더 컸고, 정확도가 더 좋았다(p<0.0001). 3. 연령에 구애받지 않는 WHTR의 최적 절단값을 구하기 위하여 6~18세의 연령군에서 ROC 분석을 시행하였다. 비만군(BMI 95 백분위수 이상)에 해당하는 최적 절단값은 남아 0.51, 여아 0.49, 과체중 및 비만군(BMI 85 백분위수이상)에 해당하는 최적 절단값은 남아 0.48, 여아 0.47이었다. BMI 백분위수와 무관하게 아시아 성인 비만의 기준인 BMI 25 kg/$m^2$ 이상을 적용하였을 때, 최적 절단 값은 남아 0.49, 여아 0.48이었다. 모든 값은 AUC 0.9 이상으로 매우 정확한 지표였다. 4. 비만군을 진단하는데 있어서 WHTR 최적 절단값과 허리둘레${\geq}$90백분위수를 비교했을 때, WHTR의 민감도가 더 좋았다. 결 론: 본 연구에서는 6~18세 소아청소년에서 성별, 연령별 참고치를 찾을 필요가 없으며, 연령에 따른 상관성이 약하여 허리둘레보다 민감하고, 비만을 조기에 선별할 수 있는 실용적 기준으로 WHTR (남아 0.51, 여아 0.49)을 제시하였다. WHTR은 일반인도 쉽게 사용 할 수 있어, 비만을 조기에 선별하고 중재하는데 유용할 수 있다.

Keywords

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