Tager Ira B, Haight Thaddeus, Sternfeld Barbara, Yu Zhuo, van Der Laan Mark
Division of Epidemiology, School of Public Health, University California, Berkeley 94720-7360, USA.
Epidemiology. 2004 Jul;15(4):479-93. doi: 10.1097/01.ede.0000128401.55545.c6.
BACKGROUND: Study of the influence of physical activity and body composition in the context of the disablement process requires analytic techniques that can address time-dependent confounding related to exposures for the occurrence of functional limitation and disability. METHODS: We applied logistic marginal structural models to explore causal relationships between leisure time physical activity and a measure of relative muscle mass (the lean:fat mass ratio) and self-reported functional limitation. Subjects (n = 1655) were members of a population-based cohort recruited in Sonoma, California, in 1993-1994 (median age 70 years); they were surveyed 3 times over 6.5 years. RESULTS: Based on the marginal structural model, the causal odds ratio for functional limitation with a 0.5-unit increment in relative muscle mass was 0.56 in women (95% CI = 0.46-0.67). This reduction in odds was not altered by adjustment for baseline covariates. The corresponding causal odds ratio in men was 0.77 (0.65-0.92). This also was not influenced by baseline covariates or levels of physical activity. There was evidence for an independent causal effect of increased levels of physical activity on reduction of odds of functional limitation for men but not for women. Obese women experienced no protective effect of increased lean-to-fat mass. Normal-weight women experienced a benefit with increasing levels of physical activity. CONCLUSIONS: Marginal structural models provide a means to address time-dependent confounding, which can occur in longitudinal studies. These analyses indicate that leisure time physical activity exerts its beneficial effects through reductions in fat mass relative to lean body mass.
背景:在残疾过程的背景下研究身体活动和身体成分的影响,需要能够解决与功能受限和残疾发生的暴露相关的时间依赖性混杂因素的分析技术。 方法:我们应用逻辑边际结构模型来探讨休闲时间身体活动与相对肌肉量(瘦体重:脂肪量比)测量值和自我报告的功能受限之间的因果关系。受试者(n = 1655)是1993 - 1994年在加利福尼亚州索诺马招募的基于人群队列的成员(中位年龄70岁);他们在6.5年中接受了3次调查。 结果:基于边际结构模型,相对肌肉量增加0.5个单位时,女性功能受限的因果优势比为0.56(95%可信区间 = 0.46 - 0.67)。调整基线协变量后,这种优势比的降低没有改变。男性相应的因果优势比为0.77(0.65 - 0.92)。这也不受基线协变量或身体活动水平的影响。有证据表明,身体活动水平增加对男性功能受限优势比降低有独立的因果效应,但对女性没有。肥胖女性没有因瘦脂肪比增加而获得保护作用。正常体重女性随着身体活动水平的增加而受益。 结论:边际结构模型提供了一种解决纵向研究中可能出现的时间依赖性混杂因素的方法。这些分析表明,休闲时间身体活动通过相对于瘦体重减少脂肪量发挥其有益作用。
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