Antropometrik Ölçümler ve Vücut Kompozisyonu
Özet
Obezitenin sağlık üzerindeki etkileri hakkındaki mevcut bilgilerimizin çoğu, ağırlık ve boy hakkındaki verilerden elde edilmektedir. Bu değişkenlerin toplanması kolay ve ucuz olduğundan ve öz bildirimle bile oldukça doğru bir şekilde değerlendirilebildiğinden, epidemiyolojik çalışmalarda merkezi bir rol oynamaya devam etmektedirler. Erken beslenme durumunu potansiyel olarak yansıtan boy ve diğer boyutlardan şimdiye kadar yapılandan daha fazla yararlanılabilir. Obeziteyi değerlendirmek için ağırlık ve boy kombinasyonları arasında beden kütle indeksi (ağırlık/boy2), alternatif indeksler kadar genel vücut yağı ile güçlü bir şekilde ilişkilidir ve çalışmalar arasında kıyaslanabilirliğin önemli avantajını sağlar.
Ağırlık ve boy temelli obezite indekslerinin yaygın olarak kullanılmasına rağmen, vücut yağ yüzdesini temsil etmedeki hataları, boy ve ağırlığın doğru bir şekilde ölçülmediği için değil, aynı boydaki kişiler arasında yağsız vücut kütlesi önemli ölçüde değişebildiği için önemlidir. Beden kütle indeksinin geçerliliği, herkeste olmasa da bazı yaşlı kişiler tarafından önemli ölçüde yağsız kütle kaybı nedeniyle yaşa göre önemli ölçüde değişiklik gösterebilir. Epidemiyolojik uygulamalar için ağırlık ve boy kombinasyonlarının geçerliliği, yaş ve cinsiyete göre heterojen çalışma popülasyonları kullanıldığından geçmişte muhtemelen olduğundan daha iyidir. Öte yandan vücut yağ yüzdesini değerlendirme kriteri olarak beden kütle indeksinin kullanılması uygun olmayabilir çünkü bu indeks mutlak kütleyi (göreceli kütlenin aksine) yansıtır. Beden kütle indeksi, genç ve orta yaşlı yetişkinlerde boy için ayarlanmış mutlak yağ kütlesinin bir ölçüsü olarak mükemmel bir geçerliliğe sahip görünmektedir. Kan basıncı, HDL kolesterol ve açlık kan şekeri gibi şişmanlığın fizyolojik göstergelerinin kullanılması, şişmanlığı ölçmek için çeşitli yöntemlerin göreli geçerliliğini ve ayrıca şişmanlığı ifade etmenin çeşitli yollarının biyolojik ilişkisini daha fazla değerlendirmek için yararlı olabilir.
Şişmanlığın bir ölçüsü olarak obezite indeksleri ile ilişkili hatalar, obezitenin sağlık üzerindeki etkilerinin epidemiyolojik çalışmalarda hafife alındığı anlamına gelmektedir. Bu eksik tahmin, Bölüm 12'de tartışıldığı gibi ölçüm hatası için istatistiksel düzeltmelerle veya gelecekteki çalışmalarda vücut yağ yüzdesini ölçmek için geliştirilmiş yöntemler kullanılarak ele alınabilir. Alternatif yaklaşımlar arasında biyoelektriksel impedans, epidemiyolojik olarak yaygın olarak kullanılmaya yetecek kadar basit ve ucuz tek yöntem gibi görünmektedir. Bununla birlikte, bu yöntemin, ağırlık ve boy ölçümlerinden bağımsız olarak vücut şişmanlığı hakkında yararlı bilgiler eklediği görülmemektedir. Vücut yağ dağılımı üzerine yapılan araştırmaların, pek çok hastalığın patofizyolojisine ilişkin anlayışımızı geliştirmesi muhtemeldir. BT ve MRI gibi görüntüleme tekniklerindeki son gelişmeler, yağın dağılımını ve konumlarını daha doğru bir şekilde ölçmeye yardımcı olabilir. Bununla birlikte, bu yöntemlerin büyük epidemiyolojik çalışmalarda geleneksel antropometrik ölçümlerin yerini alması olası değildir. Hem toplam şişmanlığı hem de belirli yerlerdeki şişmanlığı yansıttıkları için, günümüzde yaygın olarak kullanılan oranların gerçekte neyi ölçüldüğünü tanımlamak için ek çalışmalara ihtiyaç vardır.
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