Evaluación de la obesidad mediante IMC y razón cintura-talla en una comunidad de Pedro Juan Caballero, Paraguay: estudio transversal
Palabras clave:
obesidad, índice de masa corporal, índice cintura-talla
Resumen
Introducción: el índice de masa corporal (IMC) ha sido siempre el criterio de oro para diagnosticar la obesidad. Sin embargo, el problema con este parámetro es que ocurre un subdiagnóstico y pérdida de oportunidad en lo que refiere a la detección oportuna y tratamiento. El índice cintura/talla (ICT ≥0,5) ha sido propuesto como complementario del cribado de obesidad.
Objetivo: comparar la frecuencia de obesidad según IMC con respecto al criterio ampliado (IMC + ICT) y analizar la carga de comorbilidades en los grupos de obesos, reclasificados y no obesos.
Metodología: se aplicó un estudio transversal en 103 adultos de ambos sexos. Se clasificaron en: Grupo A, obeso por IMC ≥30 kg/m²; Grupo B, re-clasificado obeso por IMC 25-29,9 kg/m² + ICT ≥0,5; Grupo C, no obeso por ambos criterios. Se evaluó concordancia con kappa de Cohen y prueba de McNemar. Las comorbilidades estudiadas fueron hipertensión arterial, diabetes mellitus 2 y dislipidemia.
Resultados: la frecuencia de obesidad fue 19,4% (20/103) por IMC, 49,5% (51/103) por criterio ampliado y 31 sujetos (30,1%) fueron re-clasificados. La concordancia fue moderada: κ= 0,39 (IC 95% 0,21-0,57), χ²=29,03, p <0,001. La proporción con ≥1 comorbilidad fue: grupo A 3,.0%, Grupo B 51,6% y Grupo C 30,8%.
Conclusión: el criterio combinado aumenta la detección de obesidad e identifica un grupo de sobrepeso con ICT elevado (30,1%) que concentra la mayor carga de dislipemia y diabetes. El ICT permite detectar obesidad oculta de alto riesgo cardiometabólico no identificada por IMC.
Citas
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2.Shaikh SR, Beck MA, Alwarawrah Y, MacIver NJ. Emerging mechanisms of obesity-associated immune dysfunction. Nat Rev Endocrinol [Internet]. 2024 [cited 2025 Jun 3];20(3):136–48. Available from: https://pubmed.ncbi.nlm.nih.gov/38129700/
3.Ochoa Nieto AR, Espinosa Espinosa H, Prieto Fuenmayor C. Fenotipos de la obesidad en adultos y su relevancia clínica. Revisión narrativa. Salud Uninorte [Internet]. 2024 [citado 10 Feb 2025];40(3):1067–82. Disponible en: http://www.scielo.org.co/pdf/sun/v40n3/2011-7531-sun-40-03-1067.pdf
4.Vásquez-Romero LEM, Zuzunaga-Montoya FE, Loayza-Castro JA, Vigil-Ventura E, Ramos W, Vera-Ponce VJ. Prevalence of obesity according to body mass index, waist circumference, and waist-to-height ratio in Peru: A systematic review and meta-analysis. Obes Pillars [Internet]. 2025 [cited 2025 Jun 3];13:100166. Available from: https://pubmed.ncbi.nlm.nih.gov/40028617/
5.Busetto L, Dicker D, Frühbeck G, Halford JCG, Sbraccia P, Yumuk V, Goossens GH. A new framework for the diagnosis, staging and management of obesity in adults. Nat Med [Internet]. 2024 [cited 2025 Jun 3];30(9):2395–9. Available from: http://dx.doi.org/10.1038/s41591-024-03095-3
6.Rubino F, Cummings DE, Eckel RH, Cohen RV, Wilding JPH, Brown WA, et al. Definition and diagnostic criteria of clinical obesity. Lancet Diabetes Endocrinol [Internet]. 2025 [cited 2025 Jun 3];13(3):221–62. Available from: https://pubmed.ncbi.nlm.nih.gov/39824205/
7.Ministerio de Salud Pública y Bienestar Social, Dirección de Vigilancia de Enfermedades No Transmisibles. Segunda encuesta nacional sobre factores de riesgo de enfermedades no transmisibles [Internet]. Asunción: Dirección de Vigilancia de Enfermedades No Transmisibles; 2023. [citado 10 Feb 2025]. Disponible en: https://www.ine.gov.py/Publicaciones/Biblioteca/documento/223/ENFR 2022.pdf
8. Lobstein T, Powis J, Thompson R, Jackson-Leach R, compiled. World obesity atlas 2025: Overweight, obesity and non-communicable diseases. [Internet]. London: World Obesity Federation; 2025. [cited 2025 Jun 3]. Disponible en: https://data.worldobesity.org/publications/world-obesity-atlas-2025-v7.pdf
9.WHO. BMI-for-age girls 2 to 5. WHO growth Ref. 2007;1–7. Available from: https://cdn.who.int/media/docs/default-source/child-growth/child-growth-standards/indicators/body-mass-index-for-age/bmi-girls-2-5-percentiles.pdf?sfvrsn=db2f9ba8_12
10.Organization WH. BMI-for-age boys 2 to 5. World Heal Organ [Internet]. 2007;7:1. Available from: https://www.who.int/docs/default-source/child-growth/child-growth-standards/indicators/body-mass-index-for-age/bmi-boys-2-5-zscores.pdf
11.World Health Organization. BMI-for-age Boys: 5 to 19 years (z-scores).[Planilla datos estadistico] WHO; 2007. [Internet]. [cited 2025 Jun 3]. Available from: https://cdn.who.int/media/docs/default-source/child-growth/growth-reference-5-19-years/bmi-for-age-(5-19-years)/bmifa-boys-z-5-19-labels.pdf?sfvrsn=5775aced_4
12.Bergese PS. BMI-for-age GIRLS 5 to 19. [Internet]. WHO Growth Ref. 2007;2007. [cited 2025 Jun 3]. Available from: https://cdn.who.int/media/docs/default-source/child-growth/growth-reference-5-19-years/bmi-for-age-%285-19-years%29/cht-bmifa-girls-perc-5-19years.pdf
13.Parente EB, Mutter S, Harjutsalo V, Ahola AJ, Forsblom C, Groop PH. Waist-height ratio and waist are the best estimators of visceral fat in type 1 diabetes. Sci Rep [Internet]. 2020 [cited 2025 Jun 3];10(1):18575. Available from: https://pubmed.ncbi.nlm.nih.gov/33122731/
14.Feng Q, Bešević J, Conroy M, Omiyale W, Woodward M, Lacey B, Allen N. Waist-to-height ratio and body fat percentage as risk factors for ischemic cardiovascular disease: a prospective cohort study from UK Biobank. Am J Clin Nutr [Internet]. 2024 [cited 2025 Jun 3];119(6):1386–96. Disponible en: https://pubmed.ncbi.nlm.nih.gov/38839194/
15.Gudzune KA, Perreault L, Apovian CM, Aroda VR, Aronne LJ, Fitch A, et al. Screening, diagnosis, evaluation, and staging of obesity in adults: standards of care in overweight and obesity—2026. Diabetes Obes Cardiometab CARE [Internet]. 2026 [cited 2026 Jul 30];1(4):536–71. Available from: https://diabetesjournals.org/docm-care/article/1/4/536/170058/Screening-Diagnosis-Evaluation-and-Staging-of
16.Gamboa-Delgado EM, Domínguez-Urrego CL, Quintero-Lesmes DC. Waist-to-height ratio and its relation with cardiometabolic risk factors in children from Bucaramanga, Colombia. Nutr Hosp [Internet]. 2017 [cited 2025 Feb 10];34(6):1338–44. Available from: https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0212-16112017000900013
17.Lobstein T, Thompson R, Jackson-Leach R, Spreckley S, Powis J, compiled. World obesity atlas 2026: Childhood Obesity. [Internet]. 2nd ed. London: World Obesity Federation; 2026. [cited 2026 May 20]. Available from: https://s3-eu-west-1.amazonaws.com/wof-files/WOF_Obesity_Atlas_2026.pdf
18.Ashwell M, Gibson S. A proposal for a primary screening tool: `Keep your waist circumference to less than half your height’. BMC Med [Internet]. 2014 [cited 2025 Jun 3];12(1):207. Available from: https://link.springer.com/article/10.1186/s12916-014-0207-1
19.Srinivasan SR, Wang R, Chen W, Wei ChY, Xu J, Berenson GS. Utility of waist-to-height ratio in detecting central obesity and related adverse cardiovascular risk profile among normal weight younger adults (from the bogalusa heart study). Am J Cardiol [Internet]. 2009 [cited 2025 Jun 3];104(5):721–4. Available from: https://pubmed.ncbi.nlm.nih.gov/19699351 Subscription required
20.Campos-Nonato I, Galván-Valencia Ó, Hernández-Barrera L, Oviedo-Solís C, Barquera S. Prevalencia de obesidad y factores de riesgo asociados en adultos mexicanos: resultados de la Ensanut 2022. Salud Publica Mex [Internet]. 2023 [citado 10 Feb 2025];65:s238–47. Disponible en: https://www.saludpublica.mx/index.php/spm/article/view/14809
21.López-Sobaler AM, Aparicio A, Aranceta-Bartrina J, Gil Á, González-Gross M, Serra-Majem L, et al. Overweight and General and Abdominal Obesity in a Representative Sample of Spanish Adults: Findings from the ANIBES Study. Biomed Res Int [Internet]. 2016 [cited 2025 Jun 3];2016:8341487. Available from: https://pubmed.ncbi.nlm.nih.gov/27382572/
