Comparative evaluation of neck circumference, body mass index, and waist circumference for detecting abnormal glucose and lipid metabolism in community-dwelling older adults
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摘要:
目的 探讨颈围（NC）、体重指数（BMI）及腰围（WC）预测社区老年人糖代谢异常和血脂异常的效能，并分析性别差异，为社区健康老龄化策略提供依据。 方法 回顾性整理上海市闵行区申鑫社区卫生服务中心2024年4—5月2 449例≥60岁老年人体检资料（男性1 061例，女性1 388例），记录身高、体质量、NC、WC及空腹血糖和血脂指标，计算BMI。按性别分层，采用MedCalc 21.0绘制ROC曲线，比较NC、BMI、WC对糖代谢异常与血脂异常的AUC及确定最佳切点，并行Z检验。 结果 男性体质量、NC、WC均高于女性（P＜0.01），不同性别BMI比较差异无统计学意义（P＞0.05）。NC预测女性糖代谢异常的最佳界值为35 cm；男性、女性NC预测血脂异常的最佳界值分别为37 cm与34 cm。女性BMI、NC、WC预测糖代谢异常时，三项指标间差异无统计学意义。男性BMI、NC、WC预测血脂异常时差异无统计学意义；女性NC、WC预测血脂异常时差异无统计学意义。 结论 NC对于60岁社区老年人血脂异常以及女性糖代谢异常具有较高的预测价值；BMI、NC、WC在评价血脂异常时效能接近。建议将NC纳入常规社区体检，以利于糖脂代谢异常的早期识别与干预。 Abstract:Objective To assess the ability of neck circumference (NC), body mass index (BMI), and waist circumference (WC) to predict abnormal glucose and lipid metabolism in community-dwelling older adults and to examine sex-specific differences. Methods Data from 2 449 elderly individuals (≥60 years; 1 061 males, 1 388 females) undergoing physical examinations at the Shanghai Minhang Shenxin Community Health Service Center (April to May 2024) were retrospectively analyzed. Height, weight, NC, WC, fasting glucose, and lipid profiles were recorded. BMI was calculated. Using MedCalc 21.0, receiver operating characteristic (ROC) curves were generated by gender to compare the area under the curve (AUC) for NC, BMI, and WC, determine optimal cut-offs, and perform Z-tests. Results Men had significantly higher weight, NC, and WC than women (P < 0.01), while BMI did not differ significantly between the genders (P>0.05). The optimal NC cut-off for predicting abnormal glucose metabolism in women was 35 cm; for dyslipidemia, it was 37 cm in men and 34 cm in women. In women, no significant differences were observed among BMI, NC, and WC in predicting abnormal glucose metabolism. In men, BMI, NC, and WC showed comparable predictive efficacy for dyslipidemia; in women, NC and WC performed similarly. Conclusion NC has a comparatively better predictive value for dyslipidemia in community-dwelling adults aged ≥60 years and for dysglycemia in older women. BMI, NC, and WC showed similar performance in predicting dyslipidemia. Routine inclusion of NC in community health examinations may aid early detection and intervention for abnormal glucose and lipid metabolism. -
Key words:
- Community-dwelling elderly /
- Neck circumference /
- Body mass index /
- Waist circumference /
- Dysglycaemia /
- Dyslipidaemia
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图 1 BMI、颈围NC、腰围WC评价男性组糖代谢异常的ROC曲线
Figure 1. ROC curves of BMI, NC, and WC for identifying dysglycemia in men
图 2 BMI、颈围NC、腰围WC评价女性组糖代谢异常的ROC曲线
Figure 2. ROC curves of BMI, NC, and WC for identifying dysglycemia in women
图 3 BMI、颈围NC、腰围WC评价男性组血脂异常ROC曲线
Figure 3. ROC curves of BMI, NC, and WC for identifying dyslipidemia in men
图 4 BMI、颈围NC、腰围WC评价女性组血脂异常ROC曲线
Figure 4. ROC curves of BMI, NC, and WC for identifying dyslipidemia in women
表 1 不同性别老年人身体测量指标及糖、脂代谢异常检出率比较
Table 1. Comparison of anthropometric indices and detection rates of dysglycemia and dyslipidemia among older adults by sex
性别 例数 体质量(x±s，kg) 颈围(x±s，cm) BMI(x±s) 腰围(x±s，cm) 糖代谢异常[例(%)] 血脂异常[例(%)] 男性 1 061 69.55±17.98 37.59±3.30 24.93±6.53 87.04±28.01 251(23.7) 989(93.2) 女性 1 388 59.60±18.00 34.00±3.22 24.83±7.03 81.84±8.68 299(21.5) 1 290(92.9) 统计量 13.554a 27.045a 0.348a 6.510a 1.545b 0.070b P值 ＜0.001 ＜0.001 0.728 ＜0.001 0.215 0.791 注：a为t值，b为χ2值。 
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表 2 BMI、颈围NC、腰围WC预测糖代谢异常的效能
Table 2. Predictive performance of BMI, NC, and WC for dysglycem
性别 指标 界值 AUC(95% CI) P值 灵敏度(%) 特异度(%) 男性 BMI 23.45 0.531(0.500~0.561) 0.136 71.31 35.68 NC(cm) 37 0.535(0.504~0.565) 0.093 51.39 54.81 WC(cm) 87 0.566(0.535~0.596) 0.001 51.00 59.88 女性 BMI 26.95 0.559(0.532~0.585) 0.002 31.44 77.59 NC(cm) 35 0.585(0.558~0.611) ＜0.001 37.46 77.96 WC(cm) 87 0.590(0.564~0.616) ＜0.001 35.12 78.03
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表 3 体质指数BMI、颈围NC、腰围WC预测血脂异常的效能
Table 3. Predictive performance of BMI, NC, and WC for dyslipidem
性别 指标 界值 AUC(95% CI) P值 灵敏度(%) 特异度(%) 男性 BMI 24.26 0.652(0.623~0.681) ＜0.001 47.32 79.17 NC(cm) 37 0.670(0.640~0.698) ＜0.001 55.31 73.61 WC(cm) 88 0.640(0.610~0.669) ＜0.001 64.41 56.94 女性 BMI 23.50 0.553(0.527~0.580) 0.071 38.14 74.49 NC(cm) 34 0.589(0.563~0.615) 0.001 62.56 53.06 WC(cm) 81 0.580(0.553~0.606) 0.006 51.67 63.27
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