Department of Education, The Cooper Institute, Dallas, TX.
Department of Research, The Cooper Institute, Dallas, TX.
Mayo Clin Proc. 2014 Jun;89(6):772-80. doi: 10.1016/j.mayocp.2014.03.012. Epub 2014 May 5.
To examine the additive effects of an increased number of positive adiposity exposures on all-cause mortality in men before and after stratification by cardiorespiratory fitness (CRF) level.
A total of 36,836 men underwent a physical examination at the Cooper Clinic from January 1, 1971, through December 31, 2006. Exposures included body mass index, waist circumference, percentage of body fat, and CRF as determined by duration of a maximal exercise test. Participants were identified as being either obese (positive) or nonobese (negative) for each adiposity exposure and then grouped into 4 categories: group 1, negative for all adiposity exposures; group 2, positive for any 1 exposure; group 3, positive for any 2 exposures; and group 4, positive for all exposures. Then CRF was grouped as fit or unfit on the basis of the upper 80% and lower 20% of the age-standardized CRF distribution as previously reported in the Cooper Center Longitudinal Study. Hazard ratios were computed with Cox regression analysis.
A total of 2294 deaths occurred during a mean ± SD of 15.5 ± 8.1 years of follow-up. Adjusted hazard ratios across adiposity groups were 1.0 (referent), 1.05, 1.37, and 1.87 for groups 1 through 4, respectively (P for trend <.001). Mortality rates were significantly lower within each of the first 3 adiposity groups in fit compared with unfit men (P<.009 for all comparisons).
An increasing number of positive adiposity exposures were associated with increased mortality in men. Because moderate to high CRF attenuated mortality rates in all adiposity groups, measurement of CRF should be included for identifying men at increased risk for all-cause mortality.
在按心肺健康（CRF）水平分层后，研究男性中肥胖正暴露数量增加对全因死亡率的附加影响。
共有 36836 名男性于 1971 年 1 月 1 日至 2006 年 12 月 31 日在库珀诊所进行了体检。暴露因素包括体重指数、腰围、体脂百分比和最大运动测试持续时间确定的 CRF。根据每种肥胖暴露的情况，参与者被确定为肥胖（阳性）或非肥胖（阴性），然后分为 4 组：第 1 组，所有肥胖暴露均为阴性；第 2 组，任何 1 项暴露为阳性；第 3 组，任何 2 项暴露为阳性；第 4 组，所有暴露均为阳性。然后根据之前在库珀中心纵向研究中报告的年龄标准化 CRF 分布的上 80%和下 20%，将 CRF 分为健康或不健康。使用 Cox 回归分析计算危险比。
在平均随访 15.5±8.1 年期间，共发生 2294 例死亡。调整后的肥胖组危险比分别为 1.0（参考）、1.05、1.37 和 1.87（P<0.001）。在 fit 组中，与 unfit 组相比，在前 3 个肥胖组中，每个肥胖组的死亡率均显著降低（所有比较 P<.009）。
肥胖正暴露数量的增加与男性死亡率的增加相关。由于中等到高的 CRF 降低了所有肥胖组的死亡率，因此应测量 CRF 以识别全因死亡率风险增加的男性。
