儿童肥胖在全球的高度流行构成了一个重大的全球公共卫生挑战。世界卫生组织最近估计，全世界约18%的5-19岁儿童和青少年(约3.4亿人)受到超重或肥胖的影响。该项研究旨在评估基于英国的预测模型在非英国环境下估算儿童和青少年的无脂肪质量(和间接脂肪质量)的性能。

该模型在非英国儿童和青少年人群中显示出良好的预测能力，在所有国家提供了75%的gr2值，在19个国家中的11个提供了90%的gr2值，并对观测值和预测值具有良好的校准，R2、校准斜率和大范围校准的汇集值(95%置信区间)分别为88.7%(85.9% ~ 91.4%)、0.98(0.97 ~ 1.00)和0.01(−0.02 ~ 0.04)。模型表现在男孩和女孩、年龄、种族和国家收入群体之间没有显著差异。

基于英国的预测模型基于现成的测量方法，在一系列非英国设置中提供了儿童无脂肪质量的预测，因此也提供了脂肪质量的预测，这解释了观察到的无脂肪质量的很大一部分变异性，并表现出良好的校准性能，特别是在对每个人群的截距进行重新校准后。该模型在4-15岁健康儿童和青少年的中低收入和高收入人群中均具有良好的可泛化性。

Abstract

Objective: To evaluate the performance of a UK based prediction model for estimating fat-free mass (and indirectly fat mass) in children and adolescents in non-UK settings.

Design: Individual participant data meta-analysis.

Setting: 19 countries.

Participants: 5693 children and adolescents (49.7% boys) aged 4 to 15 years with complete data on the predictors included in the UK based model (weight, height, age, sex, and ethnicity) and on the independently assessed outcome measure (fat-free mass determined by deuterium dilution assessment).

Main outcome measures: The outcome of the UK based prediction model was natural log transformed fat-free mass (lnFFM). Predictive performance statistics of R2, calibration slope, calibration-in-the-large, and root mean square error were assessed in each of the 19 countries and then pooled through random effects meta-analysis. Calibration plots were also derived for each country, including flexible calibration curves.

Results: The model showed good predictive ability in non-UK populations of children and adolescents, providing R2 values of >75% in all countries and >90% in 11 of the 19 countries, and with good calibration (ie, agreement) of observed and predicted values. Root mean square error values (on fat-free mass scale) were <4 kg in 17 of the 19 settings. Pooled values (95% confidence intervals) of R2, calibration slope, and calibration-in-the-large were 88.7% (85.9% to 91.4%), 0.98 (0.97 to 1.00), and 0.01 (-0.02 to 0.04), respectively. Heterogeneity was evident in the R2 and calibration-in-the-large values across settings, but not in the calibration slope. Model performance did not vary markedly between boys and girls, age, ethnicity, and national income groups. To further improve the accuracy of the predictions, the model equation was recalibrated for the intercept in each setting so that country specific equations are available for future use.

Conclusion: The UK based prediction model, which is based on readily available measures, provides predictions of childhood fat-free mass, and hence fat mass, in a range of non-UK settings that explain a large proportion of the variability in observed fat-free mass, and exhibit good calibration performance, especially after recalibration of the intercept for each population. The model demonstrates good generalisability in both low-middle income and high income populations of healthy children and adolescents aged 4-15 years.

文章连接：

https://www.bmj.com/content/bmj/378/bmj-2022-071185.full.pdf

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