比較身體質量指數及腰圍預測台灣中老年人糖尿病風險之能力

A Comparison of the Abilities of Body Mass Index and Waist Circumference to Predict the Risk of Diabetes in Mid- and Old-age Taiwanese

10.6288/TJPH2013-32-01-10

王琴惠(Chin-Hui Wang)；蔡仲弘(Alan C. Tsai)

身體質量指數 ； 腰圍 ； 糖尿病 ； 中老年人 ； BMI ； waist circumference ； diabetes ； older Taiwanese

台灣公共衛生雜誌

32卷1期（2013 / 02 / 01）

76 - 84

繁體中文

目標：比較台灣中老年人身體質量指紋（BMI）及腰圍與糖尿病的關聯，及其預測罹患糖尿病風險的能力。方法：分析「台灣地區中老年身心社會生活健康狀況長期追蹤調查」2003及2007年4987位≥50歲個案的資料。以邏輯斯迴歸分析BMI和腰圍與糖尿病風險的橫斷關聯，及預測2007年新罹患糖尿病的風險。又以受試者工作特徵（Receive r Operating Characteristics, ROC）曲線計算兩指標的預測切點。結果：兩指標都與糖尿病的風險呈顯著關聯，且都具預測未來罹患糖尿病的功能，但是腰圍比BMI關聯強，預測力也較強。腰圍每增加1cm，男性增加6%風險（p=0.001）；女性增加4%（p=0.005）。而兩指標判定糖尿病風險的切點因年齡及性別而異，從50-64歲到≥75歲，男性由BMI 24.52 kg/m^2 減到21.82 kg/m^2；女性由24.27 kg/m^2減到22.88 kg/m^2；而腰圍男性由84.5cm增至的89.5 cm；女性由82.5 cm增至91.5 cm。結論：BMI和腰圍皆具預測中老年人罹患糖尿病的能力，但腰圍預測力較強。而兩指標預測罹患糖尿病風險的切結則因性別、年齡而不同。此結果與現行台灣中老年人糖尿病風險的建議切點有所不同。國人的理想切點值應考量性別及年齡的差別。

Objectives: To evaluate the association of Body Mass Index (BMI) and waist circumference (WC) with the risk for diabetes, and to examine the ability of these measures to predict new cases of diabetes in ≥50-year old Taiwanese. Methods: We utilized the 2003 and 2007 ”Survey of Health and Living Status of the Elderly in Taiwan” datasets. We analyzed the cross-sectional associations in 4987 subjects (≥50 years old) and the ability of BMI and WC to predict new cases of diabetes in these subjects four years later. We also analyzed the cutoffs with Receiver Operating Characteristics (ROC). Results: Both indicators were associated with a risk for diabetes but WC showed a stronger association. Both indicators significantly predicted the risk for new diabetes, but WC was a stronger predictor. For each 1 cm increment in WC. there was a 6% increase in the risk for new diabetes in men (p=0.001) and a 4% increase in women (p=0.005). The cutoffs for the risk of new onset diabetes differed by age and gender. The BMI cutoff was reduced from 24.52 to 21.82 kg/m^2 for men and 24.27 to 22.88 kg/m^2 for women, whereas the WC cutoff was increased from 84.5 to 89.5 cm for men and 82.5 to 91.5 cm for women. Conclusions: Both BMI and WC were significantly associated with the risk for diabetes or the risk for new diabetes, but the association was stronger with WC for both. The predicted cutoffs for diabetes varied according to age and gender and were different from the current Bureau of Health Promotion recommendations.

1. Bureau of Health Promotion, Department of Health, Executive Yuan, R.O.C. (Taiwan). 1989 survey of the elderly in Taiwan. Available at: http://www.bhp.doh.gov.tw/BHPNet/Web/HealthTopic/Topic.aspx?id=200712270002. Accessed June 28, 2012.
2. 行政院衛生署：民國99年死因統計結果分析。http://www.doh.gov.tw/CHT2006/DM/DM2_2.aspx?now_fod_list_o=11962&class_no=440&level_no=4。引用2012/06/07。Department of Health, Executive Yuan, R.O.C. (Taiwan). The analysis of cause of death statistics in 2010. Available at: http://www.doh.gov.tw/CHT2006/DM/DM2_2.aspx?now_fod_list_o=11962&class_no=440&level_no=4. Accessed June 7, 2012. [In Chinese]
3. 行政院衛生署國民健康局：民國92年中老年身心社會生活狀態長期追蹤調查問卷。http://www.bhp.doh.gov.tw/BHPNet/Web/HealthTopic/Topic.aspx?id=200712270002。引用2012/06/28。Bureau of Health Promotion, Department of Health, Executive Yuan, R.O.C. (Taiwan). 2003 Survey of Health and Living Status of the Older in Taiwan (SHLSET). Available at: http://www.bhp.doh.gov.tw/BHPNet/Web/HealthTopic/Topic.aspx?id=200712270002. Accessed June 28, 2012. [In Chinese]
4. Beaufrere, B.,Morio, B.(2000).Fat and protein redistribution with aging: metabolic considerations.Eur J Clin Nutr,54(Suppl 3),S48-53.
5. Cheong, K.C.,Yusoff, A.F.,Ghazali, S.M.(2013).Optimal BMI cut-off values for predicting diabetes, hypertension and hypercholesterolaemia in a multi-ethnic population.Public Health Nutr,16,453-9.
6. Gallagher, D.,Visser, M.,Sepulveda, D.,Pierson, R.N.,Harris, T.,Heymsfield, S.B.(1996).How useful is body mass index for comparison of body fatness across age, sex, and ethnic groups?.Am J Epidemiol,143,228-39.
7. Goldman, N.,Lin, I.F.,Weinstein, M.,Lin, Y.H.(2003).Evaluating the quality of self-reports of hypertension and diabetes.J Clin Epidemiol,56,148-54.
8. Huxley, R.,James, W.P.,Barzi, F.(2008).Ethnic comparisons of the cross-sectional relationships between measures of body size with diabetes and hypertension.Obes Rev,9(Suppl 1),53-61.
9. Iannuzzi-Sucich, M.,Prestwood, K.M.,Kenny, A.M.(2002).Prevalence of sarcopenia and predictors of skeletal muscle mass in healthy, older men and women.J Gerontol A Biol Sci Med Sci,57,M772-7.
10. Kim, C.(2012).Does menopause increase diabetes risk? Strategies for diabetes prevention in midlife women.Women's Health,8,155-67.
11. Kim, C.H.,Kim, H.K.,Kim, E.H.,Bae, S.J.,Park, J.Y.(2012).Impact of body mass index on the predictive ability of body fat distribution for Type 2 diabetes risk in Koreans.Diabet Med,29,1395-8.
12. Klein, S.,Allison, D.B.,Heymsfield, S.B.(2007).Waist circumference and cardiometabolic risk: a consensus statement from Shaping America's Health: association for Weight Management and Obesity Prevention: NAASO, The Obesity Society: the American Society for Nutrition: and the American Diabetes Association.Am J Clin Nutr,85(5),1197-202.
13. Meisinger, C.,Doring, A.,Thorand, B.,Heier, M.,Lowel, H.(2006).Body fat distribution and risk of type 2 diabetes in the general population: are there differences between men and women? The MONICA/KORA Augsburg cohort study.Am J Clin Nutr,84,483-9.
14. Mishra, G.,Carrigan, G.,Brown, W.,Barnett, A.,Dobson, A.(2007).Short-term weight change and the incidence of diabetes in midlife.Diabetes Care,30,1418-24.
15. Qiao, Q.,Nyamdorj, R.(2010).Is the association of type II diabetes with waist circumference or waist-to-hip ratio stronger than that with body mass index?.Eur J Clin Nutr,64,30-4.
16. Soriguer, F.,Morcillo, S.,Hernando, V.(2009).Type 2 diabetes mellitus and other cardiovascular risk factors are no more common during menopause.Menopause,16,817-21.
17. Tsai, A.C.,Chang, T.L.(2012).Quality issues of self-report of hypertension: analysis of a population representative sample of older adults in Taiwan.Arch Gerontol Geriatric,55,338-42.
18. Tseng, C.H.,Chong, C.K.,Chan, T.T.(2010).Optimal anthropometric factor cutoffs for hyperglycemia, hypertension and dyslipidemia for the Taiwanese population.Atherosclerosis,210,585-9.
19. Vazquez, G.,Duval, S.,Jacobs, D.R., Jr.,Silventoinen, K.(2007).Comparison of body mass index, waist circumference, and waist/hip ratio in predicting incident diabetes: a meta-analysis.Epidemiol Rev,29,115-28.
20. Wang, Y.,Rimm, E.B.,Stampfer, M.J.,Willett, W.C.,Hu, F.B.(2005).Comparison of abdominal adiposity and overall obesity in predicting risk of type 2 diabetes among men.Am J Clin Nutr,81,555-63.
21. Wannamethee, S.G.,Papacosta, O.,Whincup, P.H.(2010).Assessing prediction of diabetes in older adults using different adiposity measures: a 7 year prospective study in 6,923 older men and women.Diabetologia,53,890-8.

1. 洪彰岑、林麗鳳、林育如、甘能斌(2017)。合併有氧及阻力的循環訓練對老年人功能性體適能、運動自我效能與人際關係互動之成效探討。運動生理暨體能學報，25，9-22。