Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea.
Clin Endocrinol (Oxf). 2013 Sep;79(3):364-70. doi: 10.1111/cen.12154. Epub 2013 May 11.
The purpose of this study was to investigate the impact of body mass index (BMI) and the presence of metabolic syndrome (MetS) on all-cause and cardiovascular mortality in elderly Korean men and women, and especially to compare metabolically obese normal-weight (MONW) and metabolically healthy obese (MHO) subjects.
A total of 2317 elderly people (over 60 years of age) were studied using follow-up data from the South-West Seoul (SWS) Study, a prospective cohort study. Mortality from all causes and cardiovascular disease (CVD) were evaluated according to the combination of the presence or absence of MetS and Asian-specific body mass index (BMI) criteria (BMI <23 kg/m²; normal weight, BMI 23-24·9 kg/m²; overweight, BMI ≥25 kg/m²; obesity).
During a median follow-up of 10·3 years, 393 subjects died, including 126 from CVD. Among subjects with MetS, all-cause and CVD mortality were significantly higher in normal-weight subjects than overweight or obese individuals in Cox proportional-hazard models adjusted for confounding factors. Furthermore, among six groups with various MetS/BMI combinations, MONW individuals had the highest risk, whereas overweight subjects without MetS had the lowest risk of death from all causes and CVD [HR = 2·2 (95% CI = 1·4-3·4), HR = 3·0 (95% CI = 1·4-6·6) respectively]. Interestingly, all-cause mortality was significantly higher in MONW than MHO individuals.
In contrast to MHO subjects, elderly individuals with the MONW phenotype exhibited greater all-cause mortality during 10 years of follow-up.
本研究旨在探讨体重指数（BMI）和代谢综合征（MetS）的存在对老年韩国男女全因和心血管死亡率的影响，并特别比较代谢正常的肥胖（MONW）和代谢健康的肥胖（MHO）人群。
本研究使用了来自西南首尔（SWS）研究的前瞻性队列研究的随访数据，共纳入了 2317 名老年人（年龄大于 60 岁）。根据 MetS 的存在与否以及亚洲特定 BMI 标准（BMI＜23kg/m²；正常体重，BMI 23-24·9kg/m²；超重，BMI≥25kg/m²；肥胖），评估了全因和心血管疾病（CVD）死亡率。
在中位随访 10·3 年期间，有 393 名受试者死亡，其中 126 名死于 CVD。在患有 MetS 的受试者中，Cox 比例风险模型校正混杂因素后，正常体重受试者的全因和 CVD 死亡率明显高于超重或肥胖个体。此外，在六种具有不同 MetS/BMI 组合的组别中，MONW 个体的死亡风险最高，而无 MetS 的超重个体的全因和 CVD 死亡风险最低[HR=2·2（95%CI=1·4-3·4），HR=3·0（95%CI=1·4-6·6）]。有趣的是，MONW 个体的全因死亡率明显高于 MHO 个体。
与 MHO 个体不同，MONW 表型的老年个体在 10 年随访期间的全因死亡率更高。
