BMI in Pediatrics
Content
149
´Ñª¹ÕÁÇÅ¡ÒÂ㹡ØÁÒÃàǪÈÒʵÃ
(Body Mass Index in Pediatrics)
´Ã. ¹¾. »ÃÐʧ¤ à·Õ¹ºØ MD, FRCPedT, BS, MCN (Nutrition), FICN (Nutrition), PhD (Nutrition),
Cert. Specialist, Clinical Nutrition and Metabolism.
˹ÇÂâÀª¹ÈÒʵà ÀÒ¤ÇÔªÒ¡ØÁÒÃàǪÈÒʵà ¤³Ðá¾·ÂÈÒʵà ÁËÒÇÔ·ÂÒÅÑÂàªÕ§ãËÁ àªÕ§ãËÁ 50200.
Email: [email protected]
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¡ÒÃÇÑ´´Ñª¹ÕÁÇÅ¡Ò (body mass index BMI) ໹ÇÔ¸Õ§ÒÂæÇÔ¸Õ˹Ö觷ÕèÊÒÁÒö¹ÓÁÒãªã¹
¡ÒûÃÐàÁÔ¹ÀÒÇзҧâÀª¹Ò¡Òâͧà´ç¡áÅÐÇÑÂÃعâ´Â੾ÒÐÍÂÒ§ÂÔè§ÀÒÇÐâÀª¹Ò¡ÒÃà¡Ô¹áÅÐâä
Íǹ »¨¨ØºÑ¹âäÍǹã¹à´ç¡áÅÐÇÑÂÃع¡ÓÅѧàÃÔèÁ໹»ËÒ·ÕèÊÓ¤ÑÊÓËÃѺ»ÃÐà·Èä·Â âäÍǹ¨ÐÁÕ
¼Å¡ÃзºµÍÃкºàÁ·ÒâºÅÔ«ÁÖ ¢Í§ÃÒ§¡ÒÂહ ¡Òù͹ËÅѺ ¹Í¹¡Ã¹ ËÂØ´ËÒÂã¨à»¹ÃÐÂÐæã¹
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¤ÇÃ) ÃдѺä¢Áѹã¹àÅ×Í´¼Ô´»Ã¡µÔ àºÒËÇÒ¹áÅлǴ¢Í ໹µ¹ ¹Í¡¨Ò¡¹Ñé¹ÂѧÁռšÃзºµÍ ¤ÇÒÁ
ÊÙ§ ÃÙ»ÃÒ§ ¤ÇÒÁÊǧÒÁ ¤ÇÒÁËÅÍàËÅÒ ¤ÇÒÁ¡Ñ§ÇÅ ¤ÇÒÁäÁÁÑè¹ã¨ã¹µÑÇàͧáÅÐàÁ×èÍàµÔºâµà»¹
¼Ùã˨ÐÁÕ¤ÇÒÁÊÙ§¹Í¡ÇÒ·Õè¤ÇèÐ໹ ¡ÒûÃÐàÁÔ¹ÀÒÇÐâÀª¹Ò¡ÒâͧâäÍǹÁÕËÅÒÂÇÔ¸Õહ
¡ÒÃÇÑ´ÊÑ´ÊǹµÒ§æ¢Í§ÃÒ§¡Ò (anthropometric measurements) ·Ñ駷ҧµÃ§áÅзҧÍÍÁ ¡ÒÃÇÑ´
¤ÇÒÁ˹Òá¹¹¢Í§ÃÒ§¡ÒÂâ´Â¡ÒêÑ觹éÓ˹ѡ㵹éÓ (body density measurement using under
water weighing method) ¡ÒÃÇÑ´»ÃÔÁÒ³â»á·Êà«ÕÂÁ·Ñ§é ËÁ´ã¹ÃÒ§¡Ò (total body potassium-40
measurement), Dual energy x-ray absorptiometry (DEXA), bioelectrical impedance (BEI)
measurement, ¡ÒÃ㪠deuterium oxide dilution technic áÅÐÍ×è¹æ ໹µ¹ ÇÔ¸Õ¡ÒÃàËÅÒ¹ÕéÊÔé¹
à»Å×ͧ¤Òãª¨Ò ÂÊÙ§áÅкҧÇÔ¸äÕ ÁàËÁÒÐÊÁ·Õ¨è йÓÁÒãªã¹à´ç¡ ¨Ö§·Óã˼¤Ù ¹ËѹÁÒʹ㨡ÒÃÇÑ´´Ñª¹Õ
ÁÇÅ¡Ò¡ѹÁÒ¡¢Öé¹ Hammer LD (1991) 1 ¨Ö§ä´¾ÔÁ¾¡ÃÒ¿´Ñª¹ÕÁÇÅ¡Ò¢ͧà´ç¡·Ñé§à¾ÈªÒÂáÅÐ
ËÔ§ÍÒÂØ 1-19 »¢Öé¹ãª ·ÓãËàÃÒÊÒÁÒö·Ó¹Ò¤ÇÒÁÍǹáÅмÍÁ¢Í§à´ç¡ã¹Í¹Ò¤µä´2, 3 à¹×èͧ¨Ò¡
¤Ò´Ñª¹ÕÁÇÅ¡Ò¢ͧà´ç¡¨Ð໹仵ÒÁàʹ¡ÃÒ¿¢Í§à»ÍÃૹµä·ÅËÃ×Í·ÕèàÃÕ¡ÇÒ tracking4, 5 ¨Ò¡¡ÒÃ
ÈÖ¡ÉҢͧ ´Ã. ¹¾. »ÃÐʧ¤ à·Õ¹ºØ6 â´Â¡ÒõԴµÒÁ¤Ò´Ñª¹ÕÁÇÅ¡Ò¢ͧà´ç¡ááà¡Ô´à»¹àÇÅÒ¹Ò¹
15 »¾ºÇÒ 19% ¢Í§à´ç¡·ÕèÍǹ㹢Ǻ»áá¨Ð¡ÅÒÂ໹à´ç¡ÍǹàÁ×èÍÍÒÂØ 6-7 » áÅÐ 24% ¢Í§
à´ç¡·ÕèÍǹ㹢Ǻ»áá¨ÐÍǹàÁ×èÍÍÒÂØ 15 » áÅÐ 57% ¢Í§à´ç¡·ÕèÍǹã¹ÇÑÂÍÒÂØ 6-7 » (ÍÒÂØÇÔ¡ÄµÔ critical age) ¨ÐÍǹàÁ×èÍ໹à´ç¡ÇÑÂÃعÍÒÂØ 15 » ¹Í¡¨Ò¡¹Ñ鹧ҹÇԨѵҧæÂѧ¾ºÇÒ 15%-80%
¢Í§à´ç¡Íǹ¨Ð¡ÅÒÂ໹¼ÙãË·ÕèÍǹ5, 7, 8
ÇÒÃÊÒÃâÀª¹ºÓºÑ´ ¾.È. 2547 »·Õè 15 ©ºÑº·Õè 3 Thai Journal of Parenteral and Enteral Nutrition 2004;15(3)
150
¡ÒäӹǹËҤҴѪ¹ÕÁÇÅ¡ÒÂ
¤Ò´Ñª¹ÕÁÇÅ¡ÒÂËÃ×Í body mass index (BMI) ÍÒ¨¤Ó¹Ç¹â´Â㪹éÓ˹ѡ·ÕèÁÕ˹ÇÂ໹
¡ÔâÅ¡ÃÑÁáÅФÇÒÁÊÙ§·ÕÁè ËÕ ¹ÇÂ໹àÁµÃ ËÃ×Í ¹éÓ˹ѡ·ÕÁè ËÕ ¹ÇÂ໹»Í¹´áÅФÇÒÁÊÙ§·ÕÁè ËÕ ¹ÇÂ໹¹ÔÇé
´Ñ§¹Õé
´Ñª¹ÕÁÇÅ¡Ò (BMI ¡¡/Á2)
=
¹éÓ˹ѡ (¡¡)
¤ÇÒÁÊÙ§ (àÁµÃ) ¡¡ÓÅѧÊͧ
ËÃ×Í
´Ñª¹ÕÁÇÅ¡Ò (BMI »Í¹´/¹ÔéÇ2) =
703 x ¹éÓ˹ѡ (»Í¹´)
¤ÇÒÁÊÙ§ (¹ÔéÇ) ¡¡ÓÅѧÊͧ
áµâ´Â·ÑèÇ仹ÔÂÁãªË¹Ç¢ͧ´Ñª¹ÕÁÇÅ¡ÒÂ໹ ¡¡/Á2 ¡ÒÃÇÑ´´Ñª¹ÕÁÇÅ¡ÒÂ໹ÇÔ¸Õ˹Ö觷Õè
´Õ·ÊÕè ´Ø ã¹»¨¨Øº¹Ñ 㹡ÒûÃÐàÁÔ¹ÀÒÇÐâÀª¹Ò¡Òâͧ»ÃЪҡÃâ´Â੾ÒÐÍÂÒ§ÂÔ§è ÀÒÇйéÓ˹ѡà¡Ô¹
áÅÐâäÍǹ à¹×Íè §¨Ò¡àÊÕ¤Òãª¨Ò Â¹ÍÂáÅÐÂѧãªä´§Ò ÂÊÓËÃѺºØ¤¤Å·ÑÇè ä»
¡ÃÒ¿´Ñª¹ÕÁÇÅ¡Ò¢ͧ CDC Body mass index for age (BMI-for-age)
ã¹» ¾È. 2543 (¤È. 2000) ͧ¤¡Ã Center for Disease Control (CDC) ¢Í§»ÃÐà·È
ÊËÃÑ°ÍàÁÃÔ¡Ò9 ä´¾ÔÁ¾¡ÃÒ¿¢Í§¡ÒÃà¨ÃÔàµÔºâµ¢Í§à´ç¡áÅÐÇÑÂÃع¢Öé¹ â´Â¹Ó¡ÃÒ¿Íѹà¡Ò¢Í§
National Center for Health and Statistics (NCHS) ·Õ¾è ÁÔ ¾ã¹» ¾È. 2520 (¤È. 1977) ÁÒ·º·Ç¹
ãËÁáÅÐä´¾ÔÁ¾¡ÃÒ¿´Ñª¹ÕÁÇÅ¡ÒµÒÁÍÒÂØáÅÐà¾È (BMI-for-age and gender) ¢Í§·Ñé§à¾ÈªÒÂ
áÅÐËÔ§¢Öé¹ãª´Ñ§ÃÙ»·Õè 1 áÅÐ 2 㹡ÒûÃÐàÁÔ¹ÀÒÇÐâÀª¹Ò¡Òâͧà´ç¡¹Ñé¹ CDC á¹Ð¹ÓãË㪡ÃÒ¿
BMI-for-age á·¹·Õè¡ÃÒ¿ weight-for-height ÊÓËÃѺà´ç¡·Ø¡¤¹·ÕèÍÒÂØ 2-20 » ¡ÃÒ¿¢Í§¡ÒÃà¨ÃÔ
àµÔºâµ (growth chart) ¢Í§à´ç¡áÅÐÇÑÂÃعÍѹãËÁ¢Í§ CDC 2000 ¹ÕéÁÕ¢ÍᵡµÒ§¨Ò¡¡ÃÒ¿Íѹà¡Ò
¢Í§¢Í§» ¾È. 2520 (¤È. 1977) ¤×Í
1. ¢ÍÁÙÅ·Õèãªà¾×èÍÊÃÒ§¡ÃÒ¿ÍѹãËÁ໹¢ÍÁÙÅ·Õè໹µÑÇá·¹¢Í§»ÃЪҡÃà´ç¡·ÕèÍÒÂØááà¡Ô´
¶Ö§ 36 à´×͹áÅÐà´ç¡ÍÒÂØ 2-20 »
2. ÁÕ¡ÒûÃѺ»Ãاàʹ¡ÃÒ¿ (smooth curve) ãË´Õ¢Öé¹
3. ÁÕ¡ÃÒ¿ BMI-for-age ÊÓËÃѺà´ç¡ÍÒÂØ 2-20 »·Ñé§à¾ÈªÒÂáÅÐËÔ§
4. ÁÕàʹ¡ÃÒ¿·Õè 85th percentile µÒÁÍÒÂØáÅÐà¾Èà¾×èÍãªÊÓËÃѺ»ÃÐàÁÔ¹ÀÒÇйéÓ˹ѡà¡Ô¹
(risk of overweight) â´ÂãÊäÇ·Ñé§ã¹¡ÃÒ¿¢Í§ BMI-for-age áÅÐ weight-for height ¹Í¡¨Ò¡¹Ñé¹Âѧ
à¾ÔèÁàʹ¡ÃÒ¿¢Í§à»ÍÃૹµä·Å·Õè 3rd áÅÐ 97th à¢Òä»´ÇÂ
ÇÒÃÊÒÃâÀª¹ºÓºÑ´ ¾.È. 2547 »·Õè 15 ©ºÑº·Õè 3 Thai Journal of Parenteral and Enteral Nutrition 2004;15(3)
151
ÃÙ»·Õè 1. ¡ÃÒ¿áÊ´§¤Ò´Ñª¹ÕÁÇÅ¡ÒµÒÁÍÒÂآͧà´ç¡ªÒÂÍÒÂØ 2-20 » (CDC 2000, USA)
ÇÒÃÊÒÃâÀª¹ºÓºÑ´ ¾.È. 2547 »·Õè 15 ©ºÑº·Õè 3 Thai Journal of Parenteral and Enteral Nutrition 2004;15(3)
152
ÃÙ»·Õè 2. ¡ÃÒ¿áÊ´§¤Ò´Ñª¹ÕÁÇÅ¡ÒµÒÁÍÒÂآͧà´ç¡ËÔ§ÍÒÂØ 2-20 » (CDC 2000, USA)
ÇÒÃÊÒÃâÀª¹ºÓºÑ´ ¾.È. 2547 »·Õè 15 ©ºÑº·Õè 3 Thai Journal of Parenteral and Enteral Nutrition 2004;15(3)
153
´Ñª¹ÕÁÇÅ¡ÒÂ: à´ç¡ vs ¼ãÙ Ë
»ÃÔÁÒ³ä¢Áѹã¹à´ç¡¨Ðà»ÅÕè¹á»Å§ä»µÒÁà¾È ÍÒÂØ à¼Ò¾Ñ¹¸ØáÅСÒÃà¨ÃÔàµÔºâµ·Ò§à¾È
(sexual maturation) ´Ñ§¹Ñ鹤ҴѪ¹ÕÁÇÅ¡Ò¢ͧà´ç¡¨Ö§¢Ö鹡Ѻà¾È ÍÒÂØ à¼Ò¾Ñ¹¸ØáÅСÒÃà¨ÃÔàµÔºâµ
·Ò§à¾È´Ç 㹡ÒûÃÐàÁÔ¹ÀÒÇÐâÀª¹Ò¡Òâͧà´ç¡áÅÐÇÑÂÃعÍÒÂØ 2-20 » ͧ¤¡Ã Center for
Disease Control (CDC) ¢Í§»ÃÐà·ÈÊËÃÑ°ÍàÁÃÔ¡Ò9 ä´¡Ó˹´¤ÒÍÒ§ÍÔ§äǴѧµÒÃÒ§·Õè 1
µÒÃÒ§·Õè 1. ÀÒÇÐâÀª¹Ò¡Òâͧà´ç¡ÍÒÂØ 2-20 »µÒÁ¤Òà»ÍÃૹµä·Å¢Í§ BMI-for-age (CDC 2000) 9
ÀÒÇзҧâÀª¹Ò¡ÒÃ
BMI-for-age
Underweight
<5th Percentile
At risk of overweight
85th to <95th Percentile
Overweight
>=95th Percentile
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µÒ§æ·ÓãËʶҺѹ National Heart, Lung and Blood á˧ÊËÃÑ°ÍàÁÃÔ¡Ò10 ÊÒÁÒö¡Ó˹´¤ÒÍÒ§
ÍÔ§¢Í§´Ñª¹ÕÁÇÅ¡ÒÂÊÓËÃѺ¼ãÙ ËäÇ´§Ñ µÒÃÒ§·Õè 2 áµÊÓËÃѺ¤¹àÍà«Õ¹ѹé ͧ¤¡ÒÃ͹ÒÁÑÂâÅ¡11 ä´
¡Ó˹´¤Ò´Ñª¹ÕÁÇÅ¡ÒÂÍÒ§ÍÔ§ÊÓËÃѺ¤¹»Ã¡µÔà·Ò¡Ñº 18.5-22.9 ¡¡/Á2 ´Ñ§µÒÃÒ§·Õè 3
µÒÃÒ§·Õè 2. ÀÒÇзҧâÀª¹Ò¡ÒõÒÁ¤Ò´Ñª¹ÕÁÇÅ¡Ò¢ͧ¼ÙãË·ÕèÍÒÂØ 20 »ËÃ×ÍÁÒ¡¡ÇÒ (ÊËÃÑ°ÍàÁÃÔ¡Ò)10
ÀÒÇÐâÀª¹Ò¡ÒÃ
´Ñª¹ÕÁÇÅ¡Ò (¡¡/Á2)
¼ÍÁ
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»Ã¡µÔ
18.5-24.9
¹éÓ˹ѡà¡Ô¹
25.0-29.9
Íǹ
30.0 ËÃ×ÍÁÒ¡¡ÇÒ
µÒÃÒ§·Õè 3. ÀÒÇзҧâÀª¹Ò¡ÒõÒÁ¤Ò´Ñª¹ÕÁÇÅ¡Ò¢ͧ¤¹àÍà«Õ·ÕèÍÒÂØ 20 »ËÃ×ÍÁÒ¡¡ÇÒ11
ÀÒÇÐâÀª¹Ò¡ÒÃ
´Ñª¹ÕÁÇÅ¡Ò (¡¡/Á2)
¼ÍÁÁÒ¡ (Grade III)
<16.0
¼ÍÁ»Ò¹¡ÅÒ§ (Grade II)
16.9-16.0
¼ÍÁàÅ硹Í (Grade I)
18.4-17.0
¼ÍÁ
<18.5
»Ã¡µÔ
18.5-22.9
¹éÓ˹ѡà¡Ô¹/Íǹ
>=23.0
ÍǹàÅ硹Í (At risk)
23.0-24.9
Íǹ»Ò¹¡ÅÒ§ (Obese grade 1)
25.0-29.9
ÍǹÁÒ¡ (Obese grade 2)
>30.0
ÇÒÃÊÒÃâÀª¹ºÓºÑ´ ¾.È. 2547 »·Õè 15 ©ºÑº·Õè 3 Thai Journal of Parenteral and Enteral Nutrition 2004;15(3)
154
¢Í´Õ¢Í§¡ÒÃ㪠BMI-for-age ã¹à´ç¡áÅÐÇÑÂùØ
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à·Ò¡Ñ¹¼ÙËÔ§¨ÐÁÕà»ÍÃૹµ¢Í§ä¢ÁѹµÍ¹éÓ˹ѡµÑÇÁÒ¡¡ÇÒ¼ÙªÒ àÁ×èÍà»ÃÕºà·ÕºÃÐËÇÒ§¤¹á¡
áÅФ¹Ë¹ÁØ ÊÒÇ·ÕÁè ¤Õ Ò ´Ñª¹ÕÁÇÅ¡ÒÂà·Ò¡Ñ¹¤¹á¡¨ÐÁÕ»ÃÔÁÒ³ä¢ÁѹÁÒ¡¡ÇÒ¤¹Ë¹ÁØ ÊÒÇ ÊÓËÃѺã¹à´ç¡¹Ñ¹é
¨Ò¡¡ÒÃÈÖ¡ÉҢͧ Pietrobelli A áÅФ³Ð (¾È. 2541, ¤È. 1998) 12 ã¹à´ç¡ªÒÂáÅÐËÔ§·ÕÍè ÒÂØ 5-19 »
¾º¤ÇÒÁÊÑÁ¾Ñ¹¸ÍØ ÂÒ§ÁÕ¹ÂÑ ÊӤѢͧ¤Ò´Ñª¹ÕÁÇÅ¡Ò¡Ѻà»ÍÃૹµ¢Í§ä¢Áѹã¹ÃÒ§¡Ò·ÕÇè ´Ñ â´Â
DEXA (r = 0.79-0.83, p <0.05) â´Â·ÑèÇ令ҴѪ¹ÕÁÇÅ¡ÒÂã¹à´ç¡¨Ð¤ÍÂæŴŧ㹪ǧÇÑ¡͹àÃÕ¹
áÅШФÍÂæà¾ÔèÁ¢Öé¹àÁ×èÍà¢ÒÊÙÇÑÂàÃÕ¹áÅÐÇѼÙãË ¡ÒÃ¹Ó BMI-for-age ÁÒãªã¹à´ç¡áÅÐÇÑÂÃعÁÕ
»ÃÐ⪹´§Ñ ¹Õé
1. ÊÒÁÒö㪠BMI-for-age ä´ã¹ÇÑÂÃعËÅѧ¨Ò¡·ÕèÁÕ¡ÒÃà¨ÃÔàµÔºâµ·Ò§à¾ÈáÅÇ à¾ÃÒФÒ
´Ñª¹ÕÁÇÅ¡Ò¨Ðà»ÅÕè¹á»Å§ä»µÒÁÍÒÂØáÅСÒÃà¨ÃÔàµÔºâµ·Ò§à¾È´Ñ§¡ÅÒÇáÅÇ¢Ò§µ¹
2. ¤Ò BMI-for-age ÁÕ¤ÇÒÁÊÑÁ¾Ñ¹¸Ø·Õè´Õ¾ÍÊÁ¤ÇáѺ»ÃÔÁÒ³¢Í§ä¢Áѹã¹ÃÒ§¡Ò·ÕèÇÑ´ä´¨Ò¡
Ëͧ»¯ÔºÑµÔ¡ÒôÇÂà¤Ã×èͧÁ×Í·ÕèÁÕÃÒ¤Òᾧ
3. ÊÒÁÒö㪠BMI-for-age µÔ´µÒÁ¤ÇÒÁÍǹáÅмÍÁ¢Í§à´ç¡ä´µÍ ä»ã¹Í¹Ò¤µ
4. BMI-for-age ÁÕ¤ÇÒÁÊÑÁ¾Ñ¹¸Ø¡Ñº´Ñª¹Õ·Ò§ÊØ¢ÀÒ¾ºÒ§ÍÂÒ§ã¹à´ç¡àª¹ «ÕÃÑèÁÍÔ¹«ÙÅÔ¹áÅÐ
¤ÇÒÁ´Ñ¹âÅËÔµ ¨Ò¡§Ò¹ÇԨѢͧ Travers áÅФ³Ð13 ¾ºÇÒà´ç¡ªÒÂáÅÐËÔ§·ÕèÍÒÂØ 9.7-15.5 » ÁÕ¤Ò
´Ñª¹ÕÁÇÅ¡ÒÂÊÑÁ¾Ñ¹¸Ø¡ÑºÃдѺ«ÕÃÑèÁÍÔ¹«ÙÅÔ¹ÍÂÒ§ÁÕ¹ÑÂÊÓ¤Ñ·Ò§Ê¶ÔµÔ (r = 0.63, p <0.0001) Êǹ
Moussa áÅФ³Ð14 ÈÖ¡ÉÒã¹à´ç¡ÍÒÂØ 6-18 »¨Ó¹Ç¹ 440 ¤¹ ¾º¤ÇÒÁÊÑÁ¾Ñ¹¸ØÍÂÒ§ÁÕ¹ÑÂÊÓ¤Ñ
·Ò§Ê¶Ôµ¢Ô ͧ¤Ò´Ñª¹ÕÁÇÅ¡Ò¡Ѻ¤ÇÒÁ´Ñ¹âÅËÔµ«ÕÊâµÅÕ (systolic blood pressure, r = 0.5, p <0.0001)
áÅФÇÒÁ´Ñ¹âÅËÔµä´áÍÊâµÅÕ (diastolic blood pressure, r = 0.46, p <0.0001)
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ÀÒÇÐâÀª¹Ò¡ÒÃ
Underweight
Mild degree
Moderate degree
Severe degree
Normal
Overweight
Obesity
Mild degree
Moderate degree
Severe degree
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<14.5-13.0
<13.0-11.5
<11.5
14.5-18.0
>18.0-19.5
>19.5-21.0
>21.0-22.5
>22.5
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à»Å×ͧ¤Ò㪨Ò¹ÍÂÁÒ¡ ¤Ò´Ñª¹ÕÁÇÅ¡Ò¢ͧà´ç¡áÅÐÇÑÂÃع¨Ð¢Ö鹡Ѻà¾È ÍÒÂØ à¼Ò¾Ñ¹¸ØáÅСÒÃà¨ÃÔ
àµÔºâµ·Ò§à¾È ´Ñ§¹Ñ鹨֧¤ÇÃ㪠BMI-for-age ÁÒ»ÃÐàÁÔ¹ÀÒÇÐâÀª¹Ò¡Òâͧà´ç¡áÅÐÇÑÂÃع ͧ¤¡Ã
Center for Disease Control (CDC) ¢Í§»ÃÐà·ÈÊËÃÑ°ÍàÁÃÔ¡Òá¹Ð¹ÓãË㪡ÃÒ¿ BMI-for-age
á·¹·Õè¡ÃÒ¿ weight-for-height ÊÓËÃѺà´ç¡·Ø¡¤¹·ÕèÍÒÂØ 2-20 » 㹡óշÕèµÍ§»ÃÐàÁÔ¹ÀÒÇÐ
âÀª¹Ò¡Òâͧà´ç¡ÇÑ¡͹àÃÕ¹ÍÒÂØ 1-7 »áÅÐäÁÁÕ¡ÃÒ¿ÍÒ§ÍÔ§¢Í§¡ÒÃà¨ÃÔàµÔºâµ¢Í§¹éÓ˹ѡáÅÐ
ÊǹÊÙ§ãËãªËÃ×ÍäÁÁ¡Õ ÃÒ¿ÍÂãÙ ¹Á×Í ÍÒ¨ãª¤Ò ´Ñª¹ÕÁÇÅ¡ÒÂÁÒªÇÂ㹡ÒûÃÐàÁÔ¹ÀÒÇÐâÀª¹Ò¡ÒÃ
(¼ÍÁ »Ã¡µÔ ¹éÓ˹ѡà¡Ô¹ Íǹ) «Ö觤ÒÍÒ§ÍÔ§ÊÓËÃѺà´ç¡»Ã¡µÔà·Ò¡Ñº 14.5-18.0 ¡¡/Á2 áÅФÇÃãª
à¾×èÍ¡ÒûÃÐàÁÔ¹àº×éͧµ¹ (screening) à·Ò¹Ñé¹äÁ¤ÇÃãªà¾×èÍ¡ÒÃÇÔ¹Ô¨©ÑÂâä
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156
àÍ¡ÊÒÃÍÒ§ÍÔ§
1. Hammer LD, Kraemer HC, Wilson DM, Ritter PL, Dornbusch SM. Standardized percentile curves of body-mass
index for children and adolescents. Am J Dis Child 1991;145:259263.
2. Cronk CE, Roche AF. Race- and sex-specific reference data for triceps and subscapular skinfolds and weight/
stature2. Am J Clin Nutr 1982:35:347-354.
3. Rolland-Cachera MF, Deheeger M, Bellisle F, Sempe M, Guilloud-Bataille M, Patois E. Adiposity rebound in children:
a simple indicator for predicting obesity. Am J Clin Nutr 1984:39:129-135.
4. Rolland-Cachera M-R Bellisle R Sempe M. The prediction in boys and girls of the weight/height index and various
skinfold measurements in adults: a two-decade follow-up study. Int J Obes Relat Metab Disord 1989;13:305-311.
5. Clarke WR. Lauer RM. Does childhood obesity track into adulthood? Crit Rev Food Sci Nutr 1993;33:423-430.
6. Tienboon P, Wahlqvist ML. A prospective study of weight and height going from infancy to adolescence. Asia Pac
J Clin Nutr 2002;11:42-47.
7. Muramatsu S, Sato Y, Masaru M, Miyao M, Muramatsu T, Ito A. A longitudinal study of obesity in Japan: relationship of body habitus between at birth and at age 17. Int J Obes Relat Metab Disord 1990;14:39-45.
8. Rolland-Cachera ME, Deheeger M, Guilloud-Bataille M, Avons P, Sempe M. Tracking the development of adiposity
from one month of age to adulthood. Ann Hum Biol 1987;14:219-229.
9. Center for Disease Control. BMI-for-age charts. United States of America 2000.
10. Strawbridge WJ, Wallhagen MI, Sherma SJ. New NHLBI clinical guidelines for obesity and overweight: Will they
promote health? Am J Pub Health 2000;90:340-343.
11. Obesity. Preventing and managing the global epidemic. Report of a WHO consultation on obesity. Geneva: World
Health Organization 1998.
12. Pietrobelli A, Faith MS, Allison DB, Gallagher D, Chiumello G, Heymsfeld SB. Body mass index as a measure of
adiposity among children and adolescents: a validation study. J Pediatr 1998;132:204-210.
13. Travers SH, Jeffers BW, Bloch CA, Hill JO, Eckel RH. Gender and Tanner stage differences in body composition
and insulin sensitivity in early pubertal children. J Clin Endocrinol Metab 1995;80:172-178.
14. Moussa MA, Skaik MB, Selwanes SB, Yaghy OY, Bin-Othman SA. Factors associated with obesity in school
children. Int J Obes Relat Metab Disord 1994;18:513-515.
15. Tienboon P. Body mass index as an indicator for undernutrition in children. Chiang Mai Med Bull 1995;34:62.
16. Tienboon P. Nutrition and human immunodeficiency virus infection. In: Tienboon P, Chuntrasakul C, Siltham S,
Yamwong P, Chockvivatanavanich S (eds). Nutrition and metabolic support in clinical practice, Bangkok: Ruen Kaew
Press, 1998:91-114.
17. Tienboon P. Pediatric nutrition and AIDS: overview. In: Program and abstract book of the 1st Asian Congress of
Pediatric Nutrition. Bangkok: Federation of Pediatric Nutrition Organization of Asia 2000:148-160.
18. Tienboon P. Nutrition problems of hospitalised children in a developing country: Thailand. Asia Pac J Clin Nutr
2002;11(4):258-262.
19. Tienboon P. Using of body mass index to assess undernutrition and overnutrition of preschool children. Thai J
Paren and Enter 2003;14(2):122-129.
ÇÒÃÊÒÃâÀª¹ºÓºÑ´ ¾.È. 2547 »·Õè 15 ©ºÑº·Õè 3 Thai Journal of Parenteral and Enteral Nutrition 2004;15(3)
´Ñª¹ÕÁÇÅ¡ÒÂ㹡ØÁÒÃàǪÈÒʵÃ
(Body Mass Index in Pediatrics)
´Ã. ¹¾. »ÃÐʧ¤ à·Õ¹ºØ MD, FRCPedT, BS, MCN (Nutrition), FICN (Nutrition), PhD (Nutrition),
Cert. Specialist, Clinical Nutrition and Metabolism.
˹ÇÂâÀª¹ÈÒʵà ÀÒ¤ÇÔªÒ¡ØÁÒÃàǪÈÒʵà ¤³Ðá¾·ÂÈÒʵà ÁËÒÇÔ·ÂÒÅÑÂàªÕ§ãËÁ àªÕ§ãËÁ 50200.
Email: [email protected]
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¤ÇÒÁ˹Òá¹¹¢Í§ÃÒ§¡ÒÂâ´Â¡ÒêÑ觹éÓ˹ѡ㵹éÓ (body density measurement using under
water weighing method) ¡ÒÃÇÑ´»ÃÔÁÒ³â»á·Êà«ÕÂÁ·Ñ§é ËÁ´ã¹ÃÒ§¡Ò (total body potassium-40
measurement), Dual energy x-ray absorptiometry (DEXA), bioelectrical impedance (BEI)
measurement, ¡ÒÃ㪠deuterium oxide dilution technic áÅÐÍ×è¹æ ໹µ¹ ÇÔ¸Õ¡ÒÃàËÅÒ¹ÕéÊÔé¹
à»Å×ͧ¤Òãª¨Ò ÂÊÙ§áÅкҧÇÔ¸äÕ ÁàËÁÒÐÊÁ·Õ¨è йÓÁÒãªã¹à´ç¡ ¨Ö§·Óã˼¤Ù ¹ËѹÁÒʹ㨡ÒÃÇÑ´´Ñª¹Õ
ÁÇÅ¡Ò¡ѹÁÒ¡¢Öé¹ Hammer LD (1991) 1 ¨Ö§ä´¾ÔÁ¾¡ÃÒ¿´Ñª¹ÕÁÇÅ¡Ò¢ͧà´ç¡·Ñé§à¾ÈªÒÂáÅÐ
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15 »¾ºÇÒ 19% ¢Í§à´ç¡·ÕèÍǹ㹢Ǻ»áá¨Ð¡ÅÒÂ໹à´ç¡ÍǹàÁ×èÍÍÒÂØ 6-7 » áÅÐ 24% ¢Í§
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¡ÃÒ¿´Ñª¹ÕÁÇÅ¡Ò¢ͧ CDC Body mass index for age (BMI-for-age)
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National Center for Health and Statistics (NCHS) ·Õ¾è ÁÔ ¾ã¹» ¾È. 2520 (¤È. 1977) ÁÒ·º·Ç¹
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BMI-for-age á·¹·Õè¡ÃÒ¿ weight-for-height ÊÓËÃѺà´ç¡·Ø¡¤¹·ÕèÍÒÂØ 2-20 » ¡ÃÒ¿¢Í§¡ÒÃà¨ÃÔ
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2. ÁÕ¡ÒûÃѺ»Ãاàʹ¡ÃÒ¿ (smooth curve) ãË´Õ¢Öé¹
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4. ÁÕàʹ¡ÃÒ¿·Õè 85th percentile µÒÁÍÒÂØáÅÐà¾Èà¾×èÍãªÊÓËÃѺ»ÃÐàÁÔ¹ÀÒÇйéÓ˹ѡà¡Ô¹
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Disease Control (CDC) ¢Í§»ÃÐà·ÈÊËÃÑ°ÍàÁÃÔ¡Ò9 ä´¡Ó˹´¤ÒÍÒ§ÍÔ§äǴѧµÒÃÒ§·Õè 1
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18.4-17.0
¼ÍÁ
<18.5
»Ã¡µÔ
18.5-22.9
¹éÓ˹ѡà¡Ô¹/Íǹ
>=23.0
ÍǹàÅ硹Í (At risk)
23.0-24.9
Íǹ»Ò¹¡ÅÒ§ (Obese grade 1)
25.0-29.9
ÍǹÁÒ¡ (Obese grade 2)
>30.0
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áÅШФÍÂæà¾ÔèÁ¢Öé¹àÁ×èÍà¢ÒÊÙÇÑÂàÃÕ¹áÅÐÇѼÙãË ¡ÒÃ¹Ó BMI-for-age ÁÒãªã¹à´ç¡áÅÐÇÑÂÃعÁÕ
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1. ÊÒÁÒö㪠BMI-for-age ä´ã¹ÇÑÂÃعËÅѧ¨Ò¡·ÕèÁÕ¡ÒÃà¨ÃÔàµÔºâµ·Ò§à¾ÈáÅÇ à¾ÃÒФÒ
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2. ¤Ò BMI-for-age ÁÕ¤ÇÒÁÊÑÁ¾Ñ¹¸Ø·Õè´Õ¾ÍÊÁ¤ÇáѺ»ÃÔÁÒ³¢Í§ä¢Áѹã¹ÃÒ§¡Ò·ÕèÇÑ´ä´¨Ò¡
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3. ÊÒÁÒö㪠BMI-for-age µÔ´µÒÁ¤ÇÒÁÍǹáÅмÍÁ¢Í§à´ç¡ä´µÍ ä»ã¹Í¹Ò¤µ
4. BMI-for-age ÁÕ¤ÇÒÁÊÑÁ¾Ñ¹¸Ø¡Ñº´Ñª¹Õ·Ò§ÊØ¢ÀÒ¾ºÒ§ÍÂÒ§ã¹à´ç¡àª¹ «ÕÃÑèÁÍÔ¹«ÙÅÔ¹áÅÐ
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Moussa áÅФ³Ð14 ÈÖ¡ÉÒã¹à´ç¡ÍÒÂØ 6-18 »¨Ó¹Ç¹ 440 ¤¹ ¾º¤ÇÒÁÊÑÁ¾Ñ¹¸ØÍÂÒ§ÁÕ¹ÑÂÊÓ¤Ñ
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áÅФÇÒÁ´Ñ¹âÅËÔµä´áÍÊâµÅÕ (diastolic blood pressure, r = 0.46, p <0.0001)
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ÃÐËÇÒ§ 14.5-18.0 ¡¡/Á2 ´Ñ§µÒÃÒ§·Õè 4 áµÍÂÒ§äáçµÒÁ¼ÇÙ ¨Ô ÂÑ ä´à¹¹ÇÒ¤ÇÃãª¤Ò ´Ñª¹ÕÁÇÅ¡ÒÂÍÒ§ÍÔ§
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´Ñ§¡ÅÒÇà¾×èÍÇѵ¶Ø»ÃлÃÐʧ¤ã¹¡ÒûÃÐàÁÔ¹àº×éͧµ¹ (screening) ÁÒ¡¡ÇÒ·Õè¨Ðãªà»¹¡ÒÃÇÔ¹Ô¨©ÑÂâä
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Underweight
Mild degree
Moderate degree
Severe degree
Normal
Overweight
Obesity
Mild degree
Moderate degree
Severe degree
´Ñª¹ÕÁÇÅ¡Ò (¡¡/Á2)
<14.5-13.0
<13.0-11.5
<11.5
14.5-18.0
>18.0-19.5
>19.5-21.0
>21.0-22.5
>22.5
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à»Å×ͧ¤Ò㪨Ò¹ÍÂÁÒ¡ ¤Ò´Ñª¹ÕÁÇÅ¡Ò¢ͧà´ç¡áÅÐÇÑÂÃع¨Ð¢Ö鹡Ѻà¾È ÍÒÂØ à¼Ò¾Ñ¹¸ØáÅСÒÃà¨ÃÔ
àµÔºâµ·Ò§à¾È ´Ñ§¹Ñ鹨֧¤ÇÃ㪠BMI-for-age ÁÒ»ÃÐàÁÔ¹ÀÒÇÐâÀª¹Ò¡Òâͧà´ç¡áÅÐÇÑÂÃع ͧ¤¡Ã
Center for Disease Control (CDC) ¢Í§»ÃÐà·ÈÊËÃÑ°ÍàÁÃÔ¡Òá¹Ð¹ÓãË㪡ÃÒ¿ BMI-for-age
á·¹·Õè¡ÃÒ¿ weight-for-height ÊÓËÃѺà´ç¡·Ø¡¤¹·ÕèÍÒÂØ 2-20 » 㹡óշÕèµÍ§»ÃÐàÁÔ¹ÀÒÇÐ
âÀª¹Ò¡Òâͧà´ç¡ÇÑ¡͹àÃÕ¹ÍÒÂØ 1-7 »áÅÐäÁÁÕ¡ÃÒ¿ÍÒ§ÍÔ§¢Í§¡ÒÃà¨ÃÔàµÔºâµ¢Í§¹éÓ˹ѡáÅÐ
ÊǹÊÙ§ãËãªËÃ×ÍäÁÁ¡Õ ÃÒ¿ÍÂãÙ ¹Á×Í ÍÒ¨ãª¤Ò ´Ñª¹ÕÁÇÅ¡ÒÂÁÒªÇÂ㹡ÒûÃÐàÁÔ¹ÀÒÇÐâÀª¹Ò¡ÒÃ
(¼ÍÁ »Ã¡µÔ ¹éÓ˹ѡà¡Ô¹ Íǹ) «Ö觤ÒÍÒ§ÍÔ§ÊÓËÃѺà´ç¡»Ã¡µÔà·Ò¡Ñº 14.5-18.0 ¡¡/Á2 áÅФÇÃãª
à¾×èÍ¡ÒûÃÐàÁÔ¹àº×éͧµ¹ (screening) à·Ò¹Ñé¹äÁ¤ÇÃãªà¾×èÍ¡ÒÃÇÔ¹Ô¨©ÑÂâä
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àÍ¡ÊÒÃÍÒ§ÍÔ§
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