Sticht Center on Aging, Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA.
J Gerontol A Biol Sci Med Sci. 2010 May;65(5):519-25. doi: 10.1093/gerona/glp217. Epub 2010 Jan 15.
Although weight loss reduces risk for comorbid diseases, many observational studies suggest that weight loss is associated with increased mortality risk, leading to reluctance by clinicians to consider weight reduction as a strategy to maintain health and independence in older adults. However, whether the observed weight loss is intentional is difficult to determine and may not accurately represent the mortality risk associated with intentional weight reduction. Data from the Arthritis, Diet, and Activity Promotion Trial (ADAPT) were used to determine whether randomization to a weight reduction program was associated with total mortality in overweight/obese older adults.
ADAPT (n = 318; mean age 69 +/- 6 years, body mass index 34 +/- 5 kg/m2, 72% female) assessed the influence of weight loss (achieved through dietary counseling and lifestyle modification) and/or exercise on function in overweight/obese older adults with knee osteoarthritis. ADAPT ended in December 1999. Participant vital was ascertained status through December 2006 using the National Death and Social Security Indexes.
The mortality rate for those randomized to the 18-month weight loss intervention (n = 159, mean weight loss = -4.8 kg, 15 deaths) was lower than that for those not randomized to the weight loss intervention (n = 159, mean weight loss = -1.4 kg, 30 deaths; hazard rate ratio = 0.5, 95% confidence interval 0.3-1.0). Results were not appreciably changed when analyses were stratified by age, gender, baseline weight status, or magnitude of weight loss.
In older adults, intentional weight loss was not associated with increased total mortality and may reduce mortality risk. Observational studies of weight loss, especially when intentionality cannot be rigorously established, may be misleading with respect to the effect of weight loss on mortality.
尽管减肥可以降低合并症的风险，但许多观察性研究表明，减肥与死亡率增加相关，这导致临床医生不愿意将减肥视为维持老年人健康和独立性的策略。然而，观察到的减肥是否是有意的很难确定，并且可能无法准确代表与有意减肥相关的死亡率。使用来自关节炎、饮食和活动促进试验 (ADAPT)的数据来确定减肥计划的随机分组是否与超重/肥胖老年人的总死亡率相关。
ADAPT（n = 318；平均年龄 69 +/- 6 岁，体重指数 34 +/- 5 kg/m2，72%为女性）评估了减肥（通过饮食咨询和生活方式改变实现）和/或运动对超重/肥胖老年膝关节骨关节炎患者功能的影响。ADAPT 于 1999 年 12 月结束。通过国家死亡和社会保障索引，在 2006 年 12 月之前确定参与者的生命状态。
随机分配到 18 个月减肥干预组（n = 159，平均体重减轻 = -4.8 kg，15 例死亡）的死亡率低于未随机分配到减肥干预组的死亡率（n = 159，平均体重减轻 = -1.4 kg，30 例死亡；风险率比 = 0.5，95%置信区间 0.3-1.0）。当按年龄、性别、基线体重状况或体重减轻幅度进行分层分析时，结果没有明显变化。
在老年人中，有意减肥与总死亡率增加无关，并且可能降低死亡率风险。对减肥的观察性研究，尤其是在无法严格确定有意性时，可能会对减肥对死亡率的影响产生误导。
