老年人的肌肉减少症、肌肉减少性肥胖与死亡率：来自第三次全国健康与营养检查调查的结果
Sarcopenia, sarcopenic obesity and mortality in older adults: results from the National Health and Nutrition Examination Survey III.
作者信息
Batsis J A, Mackenzie T A, Barre L K, Lopez-Jimenez F, Bartels S J
机构信息
1] Section of General Internal Medicine, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA [2] Geisel School of Medicine at Dartmouth, Hanover, NH, USA [3] Centers for Aging and Aging Research, Dartmouth College, Hanover, NH, USA.
Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
出版信息
Eur J Clin Nutr. 2014 Sep;68(9):1001-7. doi: 10.1038/ejcn.2014.117. Epub 2014 Jun 25.
BACKGROUND
Sarcopenia is defined as the loss of skeletal muscle mass and quality, which accelerates with aging and is associated with functional decline. Rising obesity prevalence has led to a high-risk group with both disorders. We assessed mortality risk associated with sarcopenia and sarcopenic obesity in elders.
METHODS
A subsample of 4652 subjects ≥60 years of age was identified from the National Health and Nutrition Examination Survey III (1988-1994), a cross-sectional survey of non-institutionalized adults. National Death Index data were linked to this data set. Sarcopenia was defined using a bioelectrical impedance formula validated using magnetic resonance imaging-measured skeletal mass by Janssen et al. Cutoffs for total skeletal muscle mass adjusted for height(2) were sex-specific (men: ≤5.75 kg/m(2); females ≤10.75 kg/m(2)). Obesity was based on % body fat (males: ≥27%, females: ≥38%). Modeling assessed mortality adjusting for age, sex, ethnicity (model 1), comorbidities (hypertension, diabetes, congestive heart failure, osteoporosis, cancer, coronary artery disease and arthritis), smoking, physical activity, self-reported health (model 2) and mobility limitations (model 3).
RESULTS
Mean age was 70.6±0.2 years and 57.2% were female. Median follow-up was 14.3 years (interquartile range: 12.5-16.1). Overall prevalence of sarcopenia was 35.4% in women and 75.5% in men, which increased with age. Prevalence of obesity was 60.8% in women and 54.4% in men. Sarcopenic obesity prevalence was 18.1% in women and 42.9% in men. There were 2782 (61.7%) deaths, of which 39.0% were cardiovascular. Women with sarcopenia and sarcopenic obesity had a higher mortality risk than those without sarcopenia or obesity after adjustment (model 2, hazard ratio (HR): 1.35 (1.05-1.74) and 1.29 (1.03-1.60)). After adjusting for mobility limitations (model 3), sarcopenia alone (HR: 1.32 ((1.04-1.69) but not sarcopenia with obesity (HR: 1.25 (0.99-1.58)) was associated with mortality. For men, the risk of death with sarcopenia and sarcopenic obesity was nonsignificant in both model-2 (HR: 0.98 (0.77-1.25), and HR: 0.99 (0.79-1.23)) and model 3 (HR: 0.98 (0.77-1.24) and HR: 0.98 (0.79-1.22)).
CONCLUSIONS
Older women with sarcopenia have an increased all-cause mortality risk independent of obesity.
背景
肌肉减少症被定义为骨骼肌质量和质量的丧失，其随着年龄增长而加速，并与功能衰退相关。肥胖患病率的上升导致了同时患有这两种疾病的高危人群。我们评估了老年人中与肌肉减少症和肌肉减少性肥胖相关的死亡风险。
方法
从全国健康与营养检查调查III（1988 - 1994年）中确定了一个4652名年龄≥60岁的受试者子样本，该调查是对非机构化成年人的横断面调查。国家死亡指数数据与该数据集相关联。肌肉减少症使用由扬森等人通过磁共振成像测量的骨骼肌质量验证的生物电阻抗公式进行定义。根据身高(2)调整后的总骨骼肌质量的临界值因性别而异（男性：≤5.75 kg/m(2)；女性≤10.75 kg/m(2)）。肥胖基于体脂百分比（男性：≥27%，女性：≥38%）。建模评估了在调整年龄、性别、种族（模型1）、合并症（高血压、糖尿病、充血性心力衰竭、骨质疏松症、癌症、冠状动脉疾病和关节炎）、吸烟、身体活动、自我报告的健康状况（模型2）和行动能力受限（模型3）后的死亡率。
结果
平均年龄为70.6±0.2岁，57.2%为女性。中位随访时间为14.3年（四分位间距：12.5 - 16.1）。女性肌肉减少症的总体患病率为35.4%，男性为75.5%，且随年龄增加。肥胖患病率女性为60.8%，男性为54.4%。肌肉减少性肥胖患病率女性为18.1%，男性为42.9%。有2782例（61.7%）死亡，其中39.0%为心血管疾病死亡。调整后，患有肌肉减少症和肌肉减少性肥胖的女性比没有肌肉减少症或肥胖的女性有更高的死亡风险（模型2，风险比(HR)：1.35(1.05 - 1.74)和1.29(1.03 - 1.60)）。在调整行动能力受限（模型3）后，单独的肌肉减少症（HR：1.32((1.04 - 1.69)）与死亡率相关，但肌肉减少性肥胖（HR：1.25(0.99 - 1.58)）与死亡率无关。对于男性，在模型2（HR：0.98(0.77 - 1.25)，HR：0.99(0.79 - 1.23)）和模型3（HR：0.98(0.77 - 1.24)和HR：0.98(0.79 - 1.22)）中，肌肉减少症和肌肉减少性肥胖的死亡风险均无统计学意义。
结论
患有肌肉减少症的老年女性全因死亡风险增加，与肥胖无关。
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