Truthmann Julia, Mensink Gert B M, Bosy-Westphal Anja, Hapke Ulfert, Scheidt-Nave Christa, Schienkiewitz Anja
Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.
Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany.
Health Qual Life Outcomes. 2017 Jun 10;15(1):122. doi: 10.1186/s12955-017-0688-7.
This study examined sex-specific differences in physical health-related quality of life (HRQoL) across subgroups of metabolic health and obesity. We specifically asked whether (1) obesity is related to lower HRQoL independent of metabolic health status and potential confounders, and (2) whether associations are similar in men and women.
We used cross-sectional data from the German Health Interview and Examination Survey 2008-11. Physical HRQoL was measured using the Short Form-36 version 2 physical component summary (PCS) score. Based on harmonized ATPIII criteria for the definition of the metabolic health and a body mass index ≥ 30 kg/m to define obesity, individuals were classified as metabolically healthy non-obese (MHNO), metabolically unhealthy non-obese (MUNO), metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO). Sex-specific analyses including multivariable linear regression analyses were based on PCS as the dependent variable, metabolic health and obesity category as the independent variable with three categories and MHNO as the reference, and age, education, lifestyle and comorbidities as confounders.
This study included 6860 participants (3298 men, 3562 women). Compared to MHNO, all other metabolic health and obesity categories had significantly lower PCS in both sexes. As reflected by the beta coefficients [95% confidence interval] from bivariable linear regression models, a significant inverse association with PCS was strongest for MUO (men: -7.0 [-8.2; -5.8]; women: -9.0 [-10.2; -7.9]), intermediate for MUNO (men: -4.2 [-5.3; -3.1]; women: -5.6 [-6.8; -4.4]) and least pronounced for MHO (men: -2.2 [-3.6; -0.8]; women -3.9 [-5.4; -2.5]). Differences in relation to MHNO remained statistically significant for all groups after adjusting for confounders, but decreased in particular for MUNO (men:-1.3 [-2.3; -0.3]; women: -1.5 [-2.7; -0.3].
Obesity was significantly related to lower physical HRQoL, independent of metabolic health status. Potential confounders including age, educational status, health-related behaviors, and comorbidities explained parts of the inverse relationship. Associations were evident in both sexes and consistently more pronounced among women than men.
本研究调查了代谢健康和肥胖亚组中与身体健康相关的生活质量（HRQoL）的性别差异。我们特别询问：（1）肥胖是否与较低的HRQoL相关，而与代谢健康状况和潜在混杂因素无关；（2）男性和女性的关联是否相似。
我们使用了2008 - 2011年德国健康访谈与检查调查的横断面数据。使用简短健康调查问卷第2版的身体成分汇总（PCS）得分来衡量身体HRQoL。根据用于定义代谢健康的统一ATPIII标准以及体重指数≥30 kg/m²来定义肥胖，个体被分为代谢健康非肥胖（MHNO）、代谢不健康非肥胖（MUNO）、代谢健康肥胖（MHO）和代谢不健康肥胖（MUO）。包括多变量线性回归分析在内的性别特异性分析以PCS作为因变量，代谢健康和肥胖类别作为具有三个类别的自变量且以MHNO作为参照，以及年龄、教育程度、生活方式和合并症作为混杂因素。
本研究纳入了6860名参与者（3298名男性，3562名女性）。与MHNO相比，所有其他代谢健康和肥胖类别在两性中的PCS均显著较低。双变量线性回归模型的β系数[95%置信区间]表明，与PCS的显著负相关在MUO中最强（男性：-7.0 [-8.2；-5.8]；女性：-9.0 [-10.2；-7.9]），在MUNO中居中（男性：-4.2 [-5.3；-3.1]；女性：-5.6 [-6.8；-4.4]），在MHO中最不明显（男性：-2.2 [-3.6；-0.8]；女性 -3.9 [-5.4；-2.5]）。在调整混杂因素后，所有组与MHNO的差异仍具有统计学意义，但MUNO的差异尤其减小（男性：-1.3 [-2.3；-0.3]；女性：-1.5 [-2.7；-0.3]）。
肥胖与较低的身体HRQoL显著相关，与代谢健康状况无关。包括年龄、教育状况、健康相关行为和合并症在内的潜在混杂因素解释了部分负相关关系。两性中均存在关联，且在女性中始终比男性更明显。
