Kalmijn S, Curb J D, Rodriguez B L, Yano K, Abbott R D
Department of Epidemiology and Biostatistics, Erasmus University Medical School, Rotterdam, The Netherlands.
Int J Obes Relat Metab Disord. 1999 Apr;23(4):395-402. doi: 10.1038/sj.ijo.0800832.
To assess the relationship of body weight and anthropometry to all-cause mortality in older men.
A prospective cohort study of 3741 elderly Japanese-American men, enrolled in the Honolulu Heart Program. For this report, the follow-up began at baseline examinations (1991-1993), when the men were aged 71-93 y.
Variables of interest were body mass index (BMI), waist-to-hip ratio (WHR), and the sum of the subscapular and triceps skinfold thickness. Possible confounders included age, education, physical activity index, smoking, alcohol consumption, systolic and diastolic blood pressure, cholesterol, glucose and insulin concentrations.
After an average of 4.5 y of follow-up, 766 men (21%) had died. Higher BMI was associated with lower adjusted mortality risks (relative risk (RR)) highest vs lowest quintile-based category = 0.5, 95% confidence interval (CI): 0.4-0.6, P-trend < 0.001). Results were independent of WHR, and did not change after excluding current and former smokers or those who died within one year of follow-up. The relation between WHR and mortality appeared to be U-shaped, but after adjustment for BMI, a higher WHR steadily increased the risk of dying (RR highest vs lowest category = 1.5, 95%CI: 1.1-2.0, P-trend=0.004). Especially in subjects with a high BMI, there was a positive association between WHR and mortality. The results for skinfold thickness were similar to the results for BMI, but less strong.
In older men, BMI and skinfold thickness showed a consistent inverse association with mortality, even after accounting for early mortality. The WHR, on the other hand, was positively related to mortality, especially when BMI was high. Thus, excess abdominal fat mass (FM) warrants closer concern than being overweight, in terms of affecting mortality in the elderly.
评估老年男性体重和人体测量指标与全因死亡率之间的关系。
对3741名日裔美国老年男性进行的前瞻性队列研究，这些男性参与了檀香山心脏项目。在本报告中，随访从基线检查（1991 - 1993年）开始，当时这些男性年龄在71 - 93岁。
感兴趣的变量包括体重指数（BMI）、腰臀比（WHR）以及肩胛下和肱三头肌皮褶厚度之和。可能的混杂因素包括年龄、教育程度、身体活动指数、吸烟、饮酒、收缩压和舒张压、胆固醇、血糖和胰岛素浓度。
平均随访4.5年后，766名男性（21%）死亡。较高的BMI与较低的校正后死亡风险相关（基于五分位数的最高组与最低组相比，相对风险（RR）= 0.5，95%置信区间（CI）：0.4 - 0.6，P趋势 < 0.001）。结果独立于WHR，在排除当前和既往吸烟者或随访一年内死亡者后无变化。WHR与死亡率之间的关系似乎呈U形，但在调整BMI后，较高的WHR稳步增加死亡风险（最高组与最低组相比，RR = 1.5，95%CI：1.1 - 2.0，P趋势 = 0.004）。特别是在BMI较高的受试者中，WHR与死亡率呈正相关。皮褶厚度的结果与BMI的结果相似，但相关性较弱。
在老年男性中，即使考虑早期死亡因素，BMI和皮褶厚度与死亡率仍呈现一致的负相关。另一方面，WHR与死亡率呈正相关，尤其是在BMI较高时。因此，就影响老年人死亡率而言，腹部脂肪量过多比超重更值得密切关注。
