解释肥胖悖论：男性长期随访期间的心血管风险、体重变化和死亡率

Explaining the obesity paradox: cardiovascular risk, weight change, and mortality during long-term follow-up in men.

作者信息

Strandberg Timo E, Strandberg Arto Y, Salomaa Veikko V, Pitkälä Kaisu H, Tilvis Reijo S, Sirola Jonne, Miettinen Tatu A

机构信息

Institute of Health Sciences/Geriatrics, University of Oulu and University Hospital, Unit of General Practice, FIN-90014 Oulu, Finland.

出版信息

Eur Heart J. 2009 Jul;30(14):1720-7. doi: 10.1093/eurheartj/ehp162. Epub 2009 May 9.

DOI:10.1093/eurheartj/ehp162

PMID:19429917

Abstract

AIMS

To examine life-long weight trajectories behind the 'obesity paradox', and whether cardiovascular disease (CVD) risk contributes.

METHODS AND RESULTS

Cardiovascular disease risk and body mass index (BMI) at mean ages of 25, 47 (year 1974), and 73 years (year 2000) were available of a socioeconomically homogenous sample of 1114 men, without chronic diseases and diabetes in 1974. Overweight was defined as BMI > 25 kg/m(2), and 7-year mortality (2000-06) from the mean age of 73 years determined (188 deaths). Between 1974 and 2000, 44.3% (n = 494) were constantly overweight, 31.0% (n = 345) constantly normal weight, 12.2% (n = 136) moved from normal to overweight, and 12.5% (n = 139) moved from overweight to normal. The last group had highest CVD risk in midlife, and in late life more co-morbidities and greatest total mortality (P < 0.001). Adjusted mortality hazard ratio was 2.0 (95% confidence interval, CI 1.3-3.0; constantly normal weight group as referent). The hazard ratio remained similar (1.9, 95% CI 1.2-3.0) after adjustment for prevalent diseases in 2000.

CONCLUSION

In old age, both normal weight and overweight men are a mixture of individuals with different weight trajectories during their life course. Overweight and high-CVD risk in midlife with subsequent weight decrease predict the worst prognosis in late life.

摘要

目的

研究“肥胖悖论”背后的终生体重轨迹，以及心血管疾病（CVD）风险是否起作用。

方法与结果

在1974年对1114名社会经济状况相同且无慢性病和糖尿病的男性样本，获取了其25岁、47岁（1974年）和73岁（2000年）时的心血管疾病风险和体重指数（BMI）。超重定义为BMI>25kg/m²，并确定了从73岁平均年龄起的7年死亡率（2000 - 2006年）（188例死亡）。1974年至2000年间，44.3%（n = 494）持续超重，31.0%（n = 345）体重一直正常，12.2%（n = 136）从正常体重变为超重，12.5%（n = 139）从超重变为正常体重。最后一组在中年时CVD风险最高，在晚年有更多合并症和最高的总死亡率（P<0.001）。调整后的死亡风险比为2.0（95%置信区间，CI 1.3 - 3.0；以体重一直正常组为参照）。在对2000年的现患疾病进行调整后，风险比仍相似（1.9，95%CI 1.2 - 3.0）。