Li Zhi-Bing, Wang Man-Liu, Dong Sheng-Yong, Sun Ban-Ruo, Miao Xin-Yu, Fang Fu-Sheng, Dai Zheng-Xue, Li Chun-Lin, Tian Hui
Department of Geriatric Endocrinology, Chinese PLA General Hospital, Beijing, China.
Center of Biomedical Analysis, Tsinghua University, Beijing, China.
Exp Gerontol. 2017 Mar;89:87-92. doi: 10.1016/j.exger.2016.12.022. Epub 2017 Jan 3.
To assess the effect of baseline body mass index (BMI) status and weight change on mortality in older men with impaired glucose regulation (IGR).
Eight hundred eighty-five men with IGR aged 60 to 90 were included. Baseline and endpoint weight were measured. All-cause and cardiovascular mortality were observed during a median follow-up period of 10years. Multivariate Cox regressions were used to estimate associations between BMI, weight change and mortality.
Relative to normal weight, overweight was associated with lower all-cause mortality (hazard ratios, HRs [95% confidence interval, 95% CI]: 0.57 [0.41, 0.78]) and cardiovascular mortality (0.52 [0.29, 0.93]), whereas obesity did not significantly decrease or increase the mortality risk. Furthermore, compared to weight stability, all types of weight change led to increased mortality risk, except small weight gain. Specifically, after adjustment for covariates and the initial weight, the HRs (95% CI) of large weight loss were 1.64 (1.15, 2.34) for all-cause mortality and 1.85 (1.10, 3.14) for cardiovascular mortality, and the HRs (95% CI) of large weight gain were 1.55 (1.01, 2.40) for all-cause mortality and 2.11 (1.04, 4.30) for cardiovascular mortality. Similar associations were observed when weight change was redefined in sensitivity analyses.
Both BMI at baseline and weight change have independent U-shaped associations with all-cause and cardiovascular mortality among older men with IGR. The present study suggests that older men with IGR may ensure their best survival by being overweight at baseline or by maintaining their weight regardless of their baseline weight status.
评估基线体重指数（BMI）状态及体重变化对糖调节受损（IGR）老年男性死亡率的影响。
纳入885名年龄在60至90岁的IGR男性。测量基线和终点体重。在中位随访期10年期间观察全因死亡率和心血管死亡率。采用多变量Cox回归估计BMI、体重变化与死亡率之间的关联。
相对于正常体重，超重与较低的全因死亡率（风险比，HRs[95%置信区间，95%CI]：0.57[0.41，0.78]）和心血管死亡率（0.52[0.29，0.93]）相关，而肥胖并未显著降低或增加死亡风险。此外，与体重稳定相比，除了小幅体重增加外，所有类型的体重变化均导致死亡风险增加。具体而言，在调整协变量和初始体重后，大幅体重减轻的全因死亡率HRs（95%CI）为1.64（1.15，2.34），心血管死亡率为1.85（1.10，3.14），大幅体重增加的全因死亡率HRs（95%CI）为1.55（1.01，2.40），心血管死亡率为2.11（1.04，4.30）。在敏感性分析中重新定义体重变化时观察到类似的关联。
基线BMI和体重变化与IGR老年男性的全因死亡率和心血管死亡率均存在独立的U型关联。本研究表明，IGR老年男性可通过基线时超重或无论基线体重状况如何都保持体重来确保最佳生存。
