Park Y-M, Steck S E, Fung T T, Zhang J, Hazlett L J, Han K, Merchant A T
Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, USA.
Int J Obes (Lond). 2016 Oct;40(10):1541-1549. doi: 10.1038/ijo.2016.114. Epub 2016 Jun 24.
The Mediterranean diet has been consistently associated with reduced mortality risk. Few prospective studies have examined whether the benefits from a Mediterranean diet are equally shared by obese individuals with varying metabolic health.
The objective of this study was to investigate the association between Mediterranean diet, metabolic phenotypes and mortality risk in a representative obese US population.
Data from 1739 adults aged 20-88 years were analyzed from participants of the National Health and Nutrition Examination Survey III, 1988-1994 followed up for deaths until 31 December 2011 in a prospective cohort analysis. Mediterranean Diet Scores (MDS) were created to assess the adherence to Mediterranean diet. Participants were classified as metabolically healthy obese (MHO) phenotype (0 or 1 metabolic abnormality) or metabolically unhealthy obese (MUO) phenotype (two or more metabolic abnormalities), based on high glucose, insulin resistance, blood pressure, triglycerides, C-reactive protein and low high-density lipoprotein cholesterol.
The MHO phenotype (n=598) was observed in 34.8% (s.e., 1.7%) of those who were obese (mean body mass index was 33.4 and 34.8 in MHO and MUO phenotypes, respectively). During a median follow-up of 18.5 years, there were 77 (12.9%) and 309 (27.1%) deaths in MHO and MUO individuals, respectively. In MHO individuals, the multivariable-adjusted hazard ratio (HR) of all-cause mortality in the highest tertile compared with the first tertile of MDS was 0.44 (95% confidence interval (CI), 0.26-0.75; P for trend <0.001), after adjustment for potential confounders. A five-point (1 s.d.) increment in the adherence to MDS was associated with a 41% reduction in the risk of all-cause mortality (HR, 0.59; 95% CI, 0.37-0.94). Similar findings were obtained when we restricted our analyses to those with or without prevalent diabetes mellitus and hypertension. We did not observe mortality risk reduction in either individuals with MUO phenotype or all obese participants combined.
Adherence to a Mediterranean dietary pattern appears to reduce mortality in the MHO phenotype, but not among the MUO phenotype in an obese population.
地中海饮食一直与降低死亡风险相关。很少有前瞻性研究探讨不同代谢健康状况的肥胖个体是否能同等程度地从地中海饮食中获益。
本研究旨在调查美国有代表性的肥胖人群中，地中海饮食、代谢表型与死亡风险之间的关联。
对1988 - 1994年第三次全国健康与营养检查调查的1739名20 - 88岁成年人的数据进行分析，在前瞻性队列分析中随访至2011年12月31日的死亡情况。创建地中海饮食评分（MDS）以评估对地中海饮食的依从性。根据高血糖、胰岛素抵抗、血压、甘油三酯、C反应蛋白和低高密度脂蛋白胆固醇，将参与者分为代谢健康肥胖（MHO）表型（0或1种代谢异常）或代谢不健康肥胖（MUO）表型（两种或更多种代谢异常）。
在肥胖者中，34.8%（标准误，1.7%）的人表现为MHO表型（n = 598）（MHO和MUO表型的平均体重指数分别为33.4和34.8）。在中位随访18.5年期间，MHO个体和MUO个体分别有77例（12.9%）和309例（27.1%）死亡。在MHO个体中，调整潜在混杂因素后，MDS最高三分位数与第一三分位数相比，全因死亡率的多变量调整风险比（HR）为0.44（95%置信区间（CI），0.26 - 0.75；趋势P<0.001）。MDS依从性增加5分（1个标准差）与全因死亡风险降低41%相关（HR，0.59；95%CI：0.37 - 0.94）。当我们将分析限制在有或无糖尿病和高血压的人群中时，也得到了类似的结果。我们未观察到MUO表型个体或所有肥胖参与者的死亡风险降低。
坚持地中海饮食模式似乎可降低肥胖人群中MHO表型个体的死亡率，但对MUO表型个体无效。
