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中国循证儿科杂志

中国循证儿科杂志 ›› 2023, Vol. 18 ›› Issue (5): 334-340.DOI: 10.3969/j.issn.1673-5501.2023.05.002

• 论著 • 上一篇    下一篇

南京地区3~16岁儿童青少年颈围的参照标准值及其 评估腹型肥胖准确性的横断面调查

师亚楠，燕武，曹梦瑶，彭璐婷，赵明，王莉，刘倩琦，李晓南   

  1. 南京医科大学附属儿童医院儿童保健科南京，210008
  • 收稿日期:2023-08-25 修回日期:2023-10-02 出版日期:2023-10-25 发布日期:2023-10-25
  • 通讯作者: 李晓南

The reference standard values of neck circumference and its accuracy in predicting abdominal obesity among children and adolescents aged 3-16 years in Nanjing: A cross-sectional study

SHI Yanan, YAN Wu, CAO Mengyao, PENG Luting, ZHAO Ming, WANG Li, LIU Qianqi, LI Xiaonan   

  1. Department of Child Health Care, Children's Hospital of Nanjing Medical University, Nanjing 210008，China
  • Received:2023-08-25 Revised:2023-10-02 Online:2023-10-25 Published:2023-10-25
  • Contact: LI Xiaonan, email: xiaonan6189@163.com

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摘要： 背景：颈围是近年来新引入的体格测量指标，但我国尚无建立儿童青少年颈围的参照标准值及生长曲线的研究。 目的：建立3~16岁儿童青少年颈围的参考值范围并探讨颈围评价腹型肥胖的截断值，为儿童青少年体格评估的临床应用提供新的指标和参考依据。 设计：横断面调查。 方法：纳入2021年7月至2022年9月在南京医科大学附属儿童医院儿童保健门诊健康体检的3~16岁儿童及青少年。排除患有可能影响颈围、生长发育的疾病或四肢残疾、姿势异常、畸形的患儿。自制质控标准和操作手册，由3名测量人员严格按照操作手册完成颈围、身高、体重、腰围和体成分测量，并任意抽取10%的样本重复验证，验证前后的符合率应≥99%。对数据的录入、整理实行双人双轨录入和逻辑检查。按性别和年龄建立3~16岁儿童青少年颈围的标准参考值，采用LMS方法构建生长曲线。将6~16岁男童和6~9岁女童腰围身高比（WHtR）>0.48、 10~16岁女童WHtR>0.46定义为腹型肥胖。分析颈围和其他体格测量指标以及腹型肥胖的相关性，以受试者工作特征（ROC）曲线的AUC分析颈围判断腹型肥胖的准确性。 主要结局指标：3~16岁儿童青少年的颈围参照标准值和6~16岁儿童青少年颈围评估腹型肥胖的截断值。 结果：18 371名3~16岁儿童青少年进入本文分析，男童10 701名（58.2%），女童7 670名；腹型肥胖儿童5 407名（29.4%）。除体脂质量外，男童颈围、年龄、身高、体重、BMI、腰围、WHtR、骨骼肌、骨骼肌百分比（PSM）均显著高于女童，体脂百分比（PBF）低于女童，差异均有统计学意义（P均＜0.05）。①3~16岁男童和女童的颈围随着年龄增长而增长，且每个相同年龄段男童颈围始终大于女童。男童和女童平均年增长幅度分别为0.85 cm和0.65 cm，7~8岁年增长幅度相近，7岁前和8岁后男童年增长幅度均大于女童，12岁后更加明显。②男女童颈围与腹型肥胖（r男=0.614，r女=0.541）、BMI（r男=0.824，r女=0.800）、腰围（r男=0.827，r女=0.801）、WHtR（r男=0.729，r女=0.683 ）及PBF（r男=0.669，r女=0.679）均呈显著正相关，与PSM（r男=-0.497，r女=-0.470 ）呈负相关。③6~16岁男童颈围评估腹型肥胖的最佳截断值为27.15~37.05 cm，女童颈围评估腹型肥胖的最佳截断值为26.25~30.50 cm，均位于各性别年龄组的P75；各年龄阶段男童和女童颈围评估腹型肥胖的AUC分别为≥0.83和＞0.79。 结论：3~16岁儿童青少年不同年龄段男童颈围皆大于女童，且均随年龄增加而增长；6~16岁男童和女童颈围评估腹型肥胖的截断值分别为27.15~37.05 cm和26.25~30.50 cm，AUC分别≥0.83和＞0.79，准确性较高。

关键词: 颈围, 腰围, 儿童, 青少年, 腹型肥胖, 参照标准值

Abstract: Background：Neck circumference is a new anthropometric measurement parameter in recent years. However, there is no published study on the reference standard values and the growth charts of neck circumference for children and adolescents in China. Objective：To establish the reference standard values of neck circumference of children and adolescents aged 3-16 years and then to explore the cut-off values of neck circumference in predicting abdominal obesity in children and adolescents so as to provide a new index and reference for the clinical application of physical assessment in children and adolescents. Design：A cross-sectional study. Methods：The subjects were children and adolescents aged 3-16 years who underwent physical examination in the Children's Health Clinic of the Children's Hospital Affiliated to Nanjing Medical University from July 2021 to September 2022. Children with diseases that may affect neck circumference, growth and development, or limb disability, abnormal posture, or deformity were excluded. The neck circumference, height, weight, waist circumference and body composition were measured by 3 surveyors strictly according to the operating manual which was made by ourselves. Ten percent of samples were randomly selected for repeated verification, and the coincidence rate before and after verification should be ≥99%. Double track entry and logical check were carried out for data entry and arrangement. The neck circumference reference standard values of children and adolescents aged 3-16 years were established according to gender and age groups, and the growth charts were constructed by Lambda-median-sigma (LMS) method. Abdominal obesity was defined as waist-to-height ratio (WHtR) >0.48 in boys aged 6-16 years and girls aged 6-9 years, and WHtR >0.46 in girls aged 10-16 years. The association of neck circumference with other physical measures and abdominal obesity was analyzed. The area under the receiver operating characteristic (ROC) curve was used to analyze the accuracy of neck circumference reference in predicting abdominal obesity. Main outcome measures：The reference standard values of neck circumference for children and adolescents aged 3-16 years and the cut-off values of neck circumference for assessing abdominal obesity for children and adolescents aged 6-16 years. Results：A total of 18 371 children and adolescents aged 3-16 years were included in the analysis, including 10 701 boys (58.2%) and 7 670 girls. There were 5 407 (29.4%) children with abdominal obesity. In addition to body fat mass, neck circumference, age, height, weight, BMI, waist circumference, WHtR, skeletal muscle and skeletal muscle percentage (PSM) of boys were significantly greater than those of girls, body fat percentage (PBF) of girls was greater than that of boys, and the differences were statistically significant (all P<0.05). The neck circumference of boys and girls aged 3-16 years increased with age, and the neck circumference of boys was always greater than that of girls at each age. The average growth rate was 0.85 cm/year for boys and 0.65 cm/year for girls, which was similar for boys and girls aged 7 to 8 years. The annual growth rate of boys was greater than that of girls before the age of 7 and after the age of 8, and it was more obvious after the age of 12. For boys and girls, neck circumference was positively correlated with abdominal obesity (r male=0.614, r female=0.541), BMI (r male=0.824, r female= 0.800), waist circumference (r male=0.827, r female=0.801), WHtR (r male=0.729, r female=0.683) and PBF (r male=0.669, r female=0.679), and was negatively correlated with PSM (r male=-0.497, r female=-0.470). The optimal cut-off values of neck circumference for assessing abdominal obesity were 27.15-37.05 cm for boys and 26.25-30.50 cm for girls aged 6-16 years, both of which were located in the P75 of all gender and age groups. The area under the curve(AUC) of neck circumference in assessing abdominal obesity were ≥0.83 in boys and ＞0.79 in girls of all ages. Conclusions：The neck circumference of boys was greater than that of girls in all age groups and it increased with age from 3 to 16 years old. The optimal cut-off values of neck circumference for assessing abdominal obesity were 27.15-37.05 cm for boys and 26.25-30.50 cm for girls aged 6-16 years, and the AUC was≥0.83 in boys and ＞0.79 in girls of all ages, with high accuracy.

Key words: neck circumference, Waist circumference, Children, Adolescents, Abdominal obesity, Reference standard values