Audureau Etienne, Pouchot Jacques, Coste Joël
From the Biostatistics and Epidemiology Unit, Assistance Publique-Hôpitaux de Paris, Hôtel Dieu, Paris, France (E.A., J.C.); Research unit APEMAC, EA 4360, Université Paris-Descartes, Sorbonne Paris Cité, Université de Lorraine, France (E.A., J.P., J.C.); and Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France (J.P.).
Circ Cardiovasc Qual Outcomes. 2016 May;9(3):246-56. doi: 10.1161/CIRCOUTCOMES.115.002127. Epub 2016 May 10.
Negative effects of obesity on health-related quality of life (HRQoL) have been reported, especially in women, but the relative contribution of cardiometabolic and other obesity-related comorbidities to such effects remains unclear. Our objective was to model the association by sex between body mass index and HRQoL and to precisely quantify the indirect effects mediated by obesity-related comorbidities.
Data were drawn from the latest French Decennial Health Survey, a nationwide cross-sectional study conducted in 2003 (21 239 adults aged 25-64 years analyzed). HRQoL was measured by the 36-item short-form health survey questionnaire. A mediation analysis based on the counterfactual framework was performed to quantify the proportion of obesity effects on HRQoL mediated by related comorbidities, including cardiometabolic risk factors (diabetes mellitus, hypertension, dyslipidemia) and diseases (ischemic heart disease, cerebrovascular, and peripheral vascular disease), musculoskeletal disorders, and asthma. After multiple linear regression, inverse associations were found between increasing body mass index category and physically oriented and most mentally oriented 36-item short-form health survey dimensions, with evidence of greater effects in women. Mediation analysis revealed that obesity effects were significantly mediated by several comorbidities, more apparently in men (eg, proportion of obesity class II total effect mediated via cardiometabolic factors: general health 27.0% [men] versus 13.6% [women]; proportion of obesity class II total effect mediated via total count of comorbidities: physical functioning 17.8% [men] versus 7.7% [women] and general health 37.1% [men] versus 20.3% [women]).
Women have a greater overall impact of obesity on HRQoL, but with proportionally lower effects mediated by cardiometabolic and other obesity-related conditions, suggesting the possible role of other specific psychosocial processes.
已有报道称肥胖对健康相关生活质量（HRQoL）有负面影响，尤其是在女性中，但心脏代谢及其他肥胖相关合并症对此类影响的相对贡献仍不明确。我们的目标是建立体重指数与HRQoL之间按性别划分的关联模型，并精确量化由肥胖相关合并症介导的间接影响。
数据来自最新的法国十年期健康调查，这是一项2003年进行的全国性横断面研究（分析了21239名年龄在25 - 64岁的成年人）。HRQoL通过36项简短健康调查问卷进行测量。基于反事实框架进行中介分析，以量化肥胖对HRQoL的影响中由相关合并症介导的比例，这些合并症包括心脏代谢危险因素（糖尿病、高血压、血脂异常）和疾病（缺血性心脏病、脑血管疾病和外周血管疾病）、肌肉骨骼疾病以及哮喘。经过多元线性回归分析，发现体重指数类别增加与身体方面及多数心理方面的36项简短健康调查维度呈负相关，且在女性中影响更明显。中介分析显示，肥胖的影响由多种合并症显著介导，在男性中更为明显（例如，通过心脏代谢因素介导的II类肥胖总效应比例：总体健康方面，男性为27.0%，女性为13.6%；通过合并症总数介导的II类肥胖总效应比例：身体功能方面，男性为17.8%，女性为7.7%；总体健康方面，男性为37.1%，女性为20.3%）。
肥胖对女性HRQoL的总体影响更大，但由心脏代谢及其他肥胖相关状况介导的影响比例相对较低，这表明可能存在其他特定的心理社会过程在起作用。
