兒童及青少年肥胖評估工具 黃秀玫張碧真 * Cole & Rolland-Cachera, body mass index, BMI Mei et al., 2002 BMI. body mass index, BMI BMI

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1 78 兒童及青少年肥胖評估工具 黃秀玫張碧真 * 身體組成的測量可以觀察身體的相關生長與疾病的狀態, 臨床與研究上常運用各種測量方式以定 義兒童及青少年肥胖 本文主要回顧實地測量方 式, 探討各種工具的運用與信 效度, 並以臺 灣實施現況加以討論, 以期在未來可以正確地評 估兒童及青少年肥胖 測量身體組成的方式包括 實驗室檢查法與實地測量法, 其中實地測量法包 括重高指標與脂肪分佈的測量, 而實地測量方式 可以定義軀幹型肥胖與中央型肥胖, 並且可以測 量身體脂肪量 目前這些方法的使用有他們的缺 點, 所以在未來各國應該訂定符合各自的定義標 準, 而且醫療健康專業人員應該更深入了解各種 評估工具的適用性, 以便在未來可以更精確的評 估兒童及青少年肥胖, 以達到防治的目標 兒童 青少年 肥胖 重高指標 脂肪分佈 %10.3% 2007 Cole & Rolland-Cachera, 2002 field method laboratory procedures weight-for-height indexes Cole & Rolland-Cachera, 2002body mass index, BMI Mei et al., 2002 BMI body mass index, BMI 2 BMI BMI Centers for Disease Control and Prevention CDC International Obesity Task Force IOTF Cole & Rolland-Cachera, 2002 CDC IOTF 2000CDC BMI 5 85 at risk for overweight 95 Ogden et al., 2002 IOTF 6 18 BMI 18 BMI 25 kg/m 2 30kg/ m 2 IOTF IOTF Cole, Bellizzi, Flegal, & Dietz, 2000 IOTF CDC IOTF IOTF *

2 % 48.3% CDC 91.4% 67.9% Zimmerman, Gübeli, Püntener, & Molinari, 2004 IOTF 46% 72% 95 88% Reilly, Dorosty, Emmett, & The ALSPAC Study Team, 2000 BMI Mei et al., 2002 r = -.21 Schroeder & Martorell, 1999 BMI 10 BMI Widhalm, Schönegger, Huemer, & Auterith, 2001 BMI weight-length index, WLI 50 = < 0.90 DuRant & Linder, 1981WLI WLI 14.14% 12.83% BMI 7.87%4.21% BMI WLI 1.2 OR = 2.7 OR = 5.83 BMI WLI OR = 3.75 OR = 5.04 Ng & Lai, 2004 DuRant Linder 1981 WLI 3 50 BMI WLI WLI BMI WLI Ng & Lai, 2004 Fat Distribution skinfold 2/3 van Loan, 1996 skinfold caliper 1 millimeter 3 van Loan, % 30% ROC ROC 1 Sardinha, Going, Teixeira, & Lohman, 1999 van Loan, 1996 circumference waist-to-hip ratio, WHR van Loan, 1996 waist-to-height ratio, WHtR Ashwell & Hsieh, 2005

3 80 WHR Sung et al., 2007 WHtR 0.5 Ashwell & Hsieh, 2005 WHtR WHtR WHtR Weili et al., 2007 Sung et al., 2007 p <.05 p <.05WHR Semiz, Özgören, & Sabir, 2007 ROC WHtR WHtR Weili et al., 2007 BMI WHR WHtR WHtR r =.60 Hara, Saito, Iwata, Okada, & Harada, 2002 OR = 7, p <.001 WHtR OR = 8.16, p <.001 Maffeis, Banazato, & Talamini, 2008 WHtR WHtR Maffeis et al., 2008 BMI IOTF BMI IOTF 7.8% IOTF Yoo, Lee, Kim, & Sung, 2007 BMI BMI BMI WLI BMI BMI WLI WHR WHR WHtR WHtR WHtR 0.5 WHtR Maffeis et al., 2008 WHtR WHtR

4 81 WHtR WHtR S128 S S85 S93 Ashwell, M., & Hsieh, S. D. (2005). Six reasons why the waistto-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. International Journal of Food Sciences and Nutrition, 56(5), Cole, T. J., Bellizzi, M. C., Flegal, K. M., & Dietz, W. H. (2000). Establishing a standard definition for child overweight and obesity worldwide: International survey. British Medical Journal, 320(7244), Cole, T. J., & Rolland-Cachera, M. F. (2002). Measurement and definition. In W. Burniat, T. J. Cole, I. Lissau, & E. Poskitt (Eds.), Child and adolescent obesity: Cause and consequences, prevention and management (1st ed., pp. 1 22). New York: Cambridge University Press. DuRant, R. H., & Linder, C. W. (1981). An evaluation of five indexes of relative body weight for use with children. Journal of the American Dietetic Association, 78(1), Hara, M., Saito, E., Iwata, F., Okada, T., & Harada, K. (2002). Waist-to-height ratio is the best predictor of cardiovascular disease risk factors in Japanese schoolchildren. Journal of Atherosclerosis and Thrombosis, 9(3), Maffeis, C., Banzato, C., & Talamini, G. (2008). Waist-to-height ratio a useful index to identify high metabolic risk in overweight children. Journal of Pediatrics, 152(2), Mei, Z., Grummer-Strawn, L. M., Pietrobelli, A., Goulding, A., Goran, M. I., & Dietz, W. H. (2002).Validity of body mass index compared with other body-composition screening indexes for the assessment of body fatness in children and adolescents. American Journal of Clinical Nutrition, 75(5), Ng, K. C., & Lai, S. W. (2004). Application of anthropometric indices in childhood obesity. Southern Medical Association, 97(6), Ogden, C. L., Kuczmarski, R. J., Flegal, K. M., Mei, Z., Guo, S., Wei, R, et al. (2002). Centers for Disease Control and Prevention 2000 growth charts for the United States: Improvements to the 1977 national center for health statistics version. Pediatrics, 109(1), Reilly, J. J., Dorosty, Emmett, P. M., &The ALSPAC Study Team. (2000). Identification of the obese child: Adequacy of the body mass index for clinical practice and epidemiology. International Journal of Obesity, 24(12), Sardinha, L. B., Going, S. B., Teixeira, P. J., & Lohman, T. G. (1999). Receiver operating characteristic analysis of body mass index, triceps skinfold thickness and arm girth for obesity screening in children and adolescents. American Journal of Clinical Nutrition, 70(6), Schroeder, D. G., & Martorell, R. (1999). Fatness and body mass index from birth to young adulthood in a rural Guatemalan population. American Journal of Clinical Nutrition, 70(1), 137s 144s. Semiz, S., Özgören, E., & Sabir, N. (2007). Comparison of ultrasonographic and anthropometric methods to assess body fat in childhood obesity. International Journal of Obesity, 31(1), Sung, R. Y., Yu, C. C., Choi, K. C., McManus, A., Li, A. M., Xu, S. L., et al. (2007). Waist circumference and body mass index in Chinese children: Cutoff values for predicting cardiovascular risk factors. International Journal of Obesity, 31(3),

5 82 van Loan, M. D. (1996). Skinfolds, circumferences, and bioimpedance. In R. Chernoff (Ed.), Obesity assessment: Tools, methods, interpretations (5th ed., pp ). New York: Chapman & Hall. Weili, Y., He, B., Yao, H., Dai, J., Cui, J., Ge, D, et al. (2007). Waist-to-height ratio is an accurate and easier index for evaluating obesity in children and adolescents. Obesity Research, 15(3), Widhalm, K., Schönegger, K., Huemer, C., & Auterith, A. (2001). Does the BMI reflect body fat in obese children and adolescents? A study using the TOBEC method. International Journal of Obesity, 25(2), Yoo, S., Lee, S. Y., Kim, K. N., & Sung, E. (2006). Obesity in Korean pre-adolescent school children: Comparison of various anthropometric measurements based on bioelectrical impedance analysis. International Journal of Obesity, 30(7), Zimmermann, M. B., Gübeli, C., Pünterner, C., & Molinari, L. (2004). Detection of overweight and obesity in a national sample of 6-12-y-old Swiss children: Accuracy and validity of reference values for body mass index from the USA centers for disease control and prevention and the international obesity task force. American Journal of Clinical Nutrition, 79(5), in Children and Adolescents Hsiu-Mei Huang Pi-Chen Chang * Abstract: Measuring body composition allows medical professionals to assess body growth and the status of various diseases. Various measurement methods are available to clinical and research to define obesity in children and adolescents. The aims of this paper were to exam the application, reliability, and validity of these methods and their current use in Taiwan in order to help ensure that obesity in children and adolescents is being assessed accurately and consistently. Measurement approaches may be categorized into laboratory and field methods. Field methods include weight-for-height indexes and fat distribution, which define total and central obesity and assess body fat level. These methods present limitations in use and have yet to be standardized in application. Healthcare professionals must better understand these methods to assess obesity in children and adolescents in order to recommend and implement appropriate prevention regimens. Key Words: children, adolescent, obesity, weight-for-height indexes, fat distribution. RN, MSN, Adjunct Instructor, School of Nursing, Chang Gung University; *RN, PhD, Associate Professor, College of Nursing, Taipei Medical University. Received: August 15, 2008 Revised: September 25, 2008 Accepted: March 22, 2009 Address correspondence to: Pi-Chen Chang, No. 250, Wusing St., Sinyi District, Taipei 11031, Taiwan, ROC. Tel: +886 (2) ext. 6322; pichen@tmu.edu.tw