Grabowski D C, Ellis J E
Department of Health Care Organization and Policy, The University of Alabama at Birmingham, Birmingham, Alabama, USA.
J Am Geriatr Soc. 2001 Jul;49(7):968-79. doi: 10.1046/j.1532-5415.2001.49189.x.
To determine the excess mortality associated with obesity (defined by body mass index (BMI)) in older people, with and without adjustment for other risk factors associated with mortality and for demographic factors.
Retrospective cohort analysis of the Longitudinal Study of Aging (LSOA).
Nationally representative sample of community-dwelling older people.
Seven thousand five hundred and twenty-seven participants age 70 and older in 1984.
We used Cox regression to calculate proportional hazards ratios for mortality over 96 months. We tested the hypothesis that increased BMI (top 15%) increased mortality rates in older people.
Death occurred in 38% of the cohort: 54% of the thin (lowest 10% of the population, BMI <19.4 kg/m(2)), 33% of the obese (highest 15%, BMI> 28.5 kg/m(2)), and 37% of the remaining participants (normal) died. Adjustment for demographic factors, health services utilization, and functional status still demonstrated reduced mortality in obese older people (hazard ratio 0.86, 95% confidence interval (CI) = 0.77-0.97) compared with normal. After adjustment, thin older people remained more likely to die (hazard ratio 1.46, 95% CI = 1.30-1.64) than normal older people. Sensitivity analyses for income, mortality during the first two years of follow-up, and medical comorbidities did not substantively alter the conclusions.
Obesity may be protective compared with thinness or normal weight in older community-dwelling Americans.
确定老年人中与肥胖（由体重指数（BMI）定义）相关的额外死亡率，同时考虑和不考虑与死亡率相关的其他风险因素以及人口统计学因素。
对老龄化纵向研究（LSOA）进行回顾性队列分析。
具有全国代表性的社区居住老年人样本。
1984年年龄在70岁及以上的7527名参与者。
我们使用Cox回归计算96个月内死亡率的比例风险比。我们检验了BMI升高（最高15%）会增加老年人死亡率的假设。
该队列中38%的人死亡：消瘦者（体重最低的10%人群，BMI<19.4 kg/m²）中有54%死亡，肥胖者（最高15%，BMI>28.5 kg/m²）中有33%死亡，其余参与者（正常体重）中有37%死亡。在对人口统计学因素、医疗服务利用情况和功能状态进行调整后，与正常体重的老年人相比，肥胖老年人的死亡率仍然降低（风险比0.86，95%置信区间（CI）=0.77 - 0.97）。调整后，消瘦的老年人仍然比正常体重的老年人更易死亡（风险比1.46，95% CI = 1.30 - 1.64）。对收入、随访前两年的死亡率以及合并症进行的敏感性分析并未实质性改变结论。
在美国社区居住的老年人中，与消瘦或正常体重相比，肥胖可能具有保护作用。
