McDermott Mary M, Criqui Michael H, Ferrucci Luigi, Guralnik Jack M, Tian Lu, Liu Kiang, Greenland Philip, Tan Jin, Schneider Joseph R, Clark Elizabeth, Pearce William H
Department of Medicine, Northwestern University's Feinberg School of Medicine, Chicago, IL 60611, USA.
J Vasc Surg. 2006 Jun;43(6):1198-204. doi: 10.1016/j.jvs.2006.02.036.
Our objectives were to determine whether obesity is associated with a greater functional decline compared with the ideal body mass index (BMI) among persons with peripheral arterial disease (PAD) and to determine the associations between weight gain and loss and functional declines in PAD. We hypothesized that baseline obesity and weight gain during follow-up would each be associated with functional declines in persons with PAD.
The design was a prospective cohort study. The subjects were 389 men and women with PAD (mean ankle-brachial index, 0.65 +/- 0.14) who were followed up prospectively for a median of 48 months. The main outcome measures were functional assessments (6-minute walk, usual- and rapid-paced 4-m walking speed, and summary performance score). Weight and height were measured at baseline and annually. Results were adjusted for age, sex, race, comorbidities, ankle-brachial index, education, leg symptoms, exercise status, depressive symptoms, pack-years of cigarette smoking, prior-year functioning, and patterns of missing data.
Compared with those with a baseline BMI between 20 and 25 kg/m2, PAD participants with baseline BMI greater than 30 kg/m2 had a significantly greater average annual decline in 6-minute walk performance (-13.1 vs -26.5 m/y; P = .004), usual-paced 4-m walking velocity (-0.028 vs -0.055 m/s per year; P = .024), and fast-paced 4-m walking velocity (-0.053 vs -0.086 m/s per year; P = .012). Persons with weight gain between 5 and 10 pounds after baseline who walked for exercise regularly had significantly less decline in the 6-minute walk than persons without significant weight change who did not walk for exercise (P = .04).
Obesity is associated with functional decline in persons with PAD. Walking exercise may protect against functional decline in PAD persons with modest weight gain.
我们的目标是确定与外周动脉疾病（PAD）患者中的理想体重指数（BMI）相比，肥胖是否与更大程度的功能衰退相关，并确定PAD患者体重增加和减少与功能衰退之间的关联。我们假设基线肥胖和随访期间体重增加均与PAD患者的功能衰退相关。
本研究设计为前瞻性队列研究。研究对象为389例PAD患者（平均踝臂指数为0.65±0.14），前瞻性随访时间中位数为48个月。主要结局指标为功能评估（6分钟步行试验、常速和快速4米步行速度以及综合表现评分）。在基线和每年测量体重和身高。结果针对年龄、性别、种族、合并症、踝臂指数、教育程度、腿部症状、运动状态、抑郁症状、吸烟包年数、上一年功能以及缺失数据模式进行了调整。
与基线BMI在20至25kg/m²之间的患者相比，基线BMI大于30kg/m²的PAD参与者在6分钟步行表现方面的平均每年下降幅度显著更大（-13.1 vs -26.5米/年；P = 0.004），常速4米步行速度方面（-0.028 vs -0.055米/秒/年；P = 0.024），以及快速4米步行速度方面（-0.053 vs -0.086米/秒/年；P = 0.012）。基线后体重增加5至10磅且定期进行步行锻炼的患者，其6分钟步行试验中的衰退程度明显低于体重无显著变化且不进行步行锻炼的患者（P = 0.04）。
肥胖与PAD患者的功能衰退相关。步行锻炼可能预防体重适度增加的PAD患者出现功能衰退。
