身体肥胖指标与骨关节炎初次膝关节和髋关节置换风险之间的关系：一项前瞻性队列研究。

Relationship between body adiposity measures and risk of primary knee and hip replacement for osteoarthritis: a prospective cohort study.

作者信息

Wang Yuanyuan, Simpson Julie Anne, Wluka Anita E, Teichtahl Andrew J, English Dallas R, Giles Graham G, Graves Stephen, Cicuttini Flavia M

机构信息

Department of Epidemiology and Preventive Medicine, Monash University, Central and Eastern Clinical School, Alfred Hospital, Melbourne, VIC 3004, Australia.

出版信息

Arthritis Res Ther. 2009;11(2):R31. doi: 10.1186/ar2636. Epub 2009 Mar 5.

DOI:10.1186/ar2636

PMID:19265513

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2688176/

Abstract

INTRODUCTION

Total joint replacement is considered a surrogate measure for symptomatic end-stage osteoarthritis. It is unknown whether the adipose mass and the distribution of adipose mass are associated with the risk of primary knee and hip replacement for osteoarthritis. The aim of the present investigation was to examine this in a cohort study.

METHODS

A total of 39,023 healthy volunteers from Melbourne, Australia were recruited for a prospective cohort study during 1990 to 1994. Their body mass index, waist circumference, and waist-to-hip ratio were obtained from direct anthropometric measurements. The fat mass and percentage fat were estimated from bioelectrical impedance analysis. Primary knee and hip replacements for osteoarthritis between 1 January 2001 and 31 December 2005 were determined by data linkage to the Australian Orthopaedic Association National Joint Replacement Registry. Cox proportional hazards regression models were used to estimate the hazard ratios (HRs) for primary joint replacement associated with each adiposity measure.

RESULTS

Comparing the fourth quartile with the first, there was a threefold to fourfold increased risk of primary joint replacement associated with body weight (HR = 3.44, 95% confidence interval (CI) = 2.83 to 4.18), body mass index (HR = 3.44, 95% CI = 2.80 to 4.22), fat mass (HR = 3.51, 95% CI = 2.87 to 4.30), and percentage fat (HR = 2.99, 95% CI = 2.46 to 3.63). The waist circumference (HR = 2.77, 95% CI = 2.26 to 3.39) and waist-to-hip ratio (HR = 1.46, 95% CI = 1.21 to 1.76) were less strongly associated with the risk. Except for the waist-to-hip ratio, which was not significantly associated with hip replacement risk, all adiposity measures were associated with the risk of both knee and hip joint replacement, and were significantly stronger risk factors for knee.

CONCLUSIONS

Risk of primary knee and hip joint replacement for osteoarthritis relates to both adipose mass and central adiposity. This relationship suggests both biomechanical and metabolic mechanisms associated with adiposity contribute to the risk of joint replacement, with stronger evidence at the knee rather than the hip.

摘要

引言

全关节置换被视为有症状的终末期骨关节炎的替代指标。脂肪量及脂肪分布是否与原发性膝关节和髋关节骨关节炎置换风险相关尚不清楚。本研究的目的是在一项队列研究中对此进行检验。

方法

1990年至1994年期间，从澳大利亚墨尔本招募了总共39023名健康志愿者进行前瞻性队列研究。通过直接人体测量获得他们的体重指数、腰围和腰臀比。通过生物电阻抗分析估算脂肪量和脂肪百分比。通过与澳大利亚骨科协会国家关节置换登记处的数据链接，确定2001年1月1日至2005年12月31日期间原发性膝关节和髋关节骨关节炎置换情况。使用Cox比例风险回归模型来估计与每种肥胖指标相关的原发性关节置换的风险比（HR）。

结果

将第四四分位数与第一四分位数进行比较，与体重（HR = 3.44，95%置信区间（CI）= 2.83至4.18）、体重指数（HR = 3.44，95% CI = 2.�0至4.22）、脂肪量（HR = 3.51，95% CI = 2.87至4.30）和脂肪百分比（HR = 2.99，95% CI = 2.46至3.63）相关的原发性关节置换风险增加了三倍至四倍。腰围（HR = 2.77，95% CI = 2.26至3.39）和腰臀比（HR = 1.46，95% CI = 1.21至1.76）与风险的关联较弱。除腰臀比与髋关节置换风险无显著关联外，所有肥胖指标均与膝关节和髋关节置换风险相关，且是膝关节置换风险的显著更强危险因素。