Batsis J A, Singh S, Lopez-Jimenez F
John A. Batsis, MD, FACP, Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, Telephone: (603) 653-9500, Facsimile: (603) 650-0915, E-mail:
J Nutr Health Aging. 2014;18(2):123-30. doi: 10.1007/s12603-013-0366-3.
The impact of adiposity on mortality in older adults remains controversial. Some reports suggest that measures of general adiposity such as body mass index (BMI) predict better survival. We assessed the relationship between measures of adiposity and mortality in older adults.
Cross-sectional analysis of a population-based sample.
Non-institutionalized persons in the United States participating in the National Health and Nutrition Examination Surveys III and its linked mortality dataset.
A subsample of 4,489 non-institutionalized survey participants aged >60 years with measures of body composition using bioimpedance. To account for possible residual confounding, smokers, subjects with heart failure, respiratory disease, kidney disease and cancer were excluded (n=2,920). Data from 1569 subjects were analysed.
BMI, waist circumference (WC), waist-hip ratio (WHR), lean mass (LM) and % Body Fat (BF) were classified by tertiles (lowest=referent). Proportional-hazard models evaluated the association of anthropometric indices with overall and cardiovascular mortality.
Mean age was 69.4years, and 265(16.9%) were >80 years. There were 717(47.6%) women and 792 deaths of which 284 [35.9%] were cardiovascular related. Elevated BMI was associated with reduced cardiovascular mortality (HR 0.53 [0.30-0.84]), and remained significant after adjusting for LM (HR 0.54 [0.31-0.93]). Elevated %BF was associated with reduced mortality from cardiovascular causes (HR 0.52 [0.29-0.91]). Low BMI was associated with higher risk of cardiovascular (HR 3.66 [1.25-10.69]) and overall death (HR 2.44 [1.22-4.90]).
Measures of adiposity in older participants are associated with lower mortality from cardiovascular causes that cannot be explained by major known confounders between obesity and mortality. Further studies need to elucidate a possible protective role and interplay between adiposity and skeletal muscle in older adults.
肥胖对老年人死亡率的影响仍存在争议。一些报告表明，诸如体重指数（BMI）等一般肥胖指标能更好地预测生存率。我们评估了老年人肥胖指标与死亡率之间的关系。
对基于人群的样本进行横断面分析。
参与第三次全国健康与营养检查调查及其关联死亡率数据集的美国非机构化人群。
4489名年龄大于60岁的非机构化调查参与者的子样本，使用生物电阻抗测量身体成分。为了考虑可能的残余混杂因素，排除了吸烟者、患有心力衰竭、呼吸系统疾病、肾脏疾病和癌症的受试者（n = 2920）。对1569名受试者的数据进行了分析。
BMI、腰围（WC）、腰臀比（WHR）、瘦体重（LM）和体脂百分比（BF）按三分位数分类（最低值为参照）。比例风险模型评估人体测量指数与全因死亡率和心血管死亡率之间的关联。
平均年龄为69.4岁，265人（16.9%）年龄大于80岁。有717名女性（47.6%），共792例死亡，其中284例（35.9%）与心血管疾病相关。BMI升高与心血管死亡率降低相关（风险比[HR]0.53[0.30 - 0.84]），在调整LM后仍具有显著性（HR 0.54[0.31 - 0.93]）。BF百分比升高与心血管原因导致的死亡率降低相关（HR 0.52[0.29 - 0.91]）。低BMI与心血管疾病（HR 3.66[1.25 - 10.69]）和全因死亡（HR 2.44[1.22 - 4.90]）的较高风险相关。
老年参与者的肥胖指标与心血管原因导致的较低死亡率相关，这无法用肥胖与死亡率之间已知的主要混杂因素来解释。需要进一步研究以阐明肥胖与骨骼肌在老年人中可能存在的保护作用及相互作用。
