AP-HP, Hôpital Henri-Mondor, Public Health Department, F-94000, Créteil, France; Université Paris-Est, UPEC, DHU A-TVB, IMRB- EA 7376 CEpiA (Clinical Epidemiology and Ageing Unit), F-94000, Créteil, France; AP-HP, Hôpital Henri-Mondor, Clinical Research Unit (URC-Mondor), F-94000, Créteil, France.
AP-HP, Hôpital Henri-Mondor, Clinical Research Unit (URC-Mondor), F-94000, Créteil, France.
Clin Nutr. 2018 Oct;37(5):1638-1644. doi: 10.1016/j.clnu.2017.07.023. Epub 2017 Aug 5.
The hypothesis of reverse epidemiology holds that, obesity may reduce the risk of clinical adverse events in older subjects. However, this association is controversial and rarely explored according to the underlying health status. We tested this phenomenon by assessing the association between body mass index (BMI) and clinical adverse events in community dwelling older women according to their frailty status.
EPIDOS is a multicenter prospective cohort of community-dwelling women aged 75 and older recruited between 1992 and 1994. At baseline, we collected demographics, BMI (<21 kg/m: underweight; 21-24.9: normal weight; 25-29.9: overweight and ≥30: obesity), frailty through Fried model, and clinical characteristics. All-cause mortality, falls, hip fractures, and hospital admission were collected within 5 years of follow-up and were analyzed using univariate and multivariate survival analysis by using Kaplan-Meier methods and Cox Hazard Proportional models.
Of 6662 women (mean age, 80.4 years), 11.6%; 95% Confidence Interval (95% CI) CI [10.8%-12.3%] were frail. By multivariate analysis, the risk of death in frail women (compared to not-frail normal weight women) decreases with increase of BMI: adjusted Hazard Ratio (aHR) = 2.04 [1.23-3.39]; aHR = 3.07 [2.21-4.26]; aHR = 1.83 [1.31-2.56]; aHR = 1.76 [1.15-2.70]; p < 0.001. Frail overweight and obese women had a significant lower risk of death than frail normal-weight women (p = 0.004). Similar features were found for fall risk and hip fracture and for not-frail women. The relative risks of hospital admission for normal weight, overweight and obese frail women were similar (aHR = 1.50 [1.22-1.84], aHR =1.48 [1.26-1.74] and aHR =1.53 [1.24-1.89], respectively).
Our results suggest that overweight and obesity reduce the risks of clinical adverse events in frail community-dwelling older women and that frailty definition through Fried model had to be re-calibrated for overweight and obese individuals.
反向流行病学假说认为，肥胖可能会降低老年患者临床不良事件的风险。然而，这种关联存在争议，且根据潜在健康状况进行的相关研究很少。我们通过评估根据虚弱状况，社区居住的老年女性的体重指数（BMI）与临床不良事件之间的关联来检验这一现象。
EPIDOS 是一项多中心前瞻性队列研究，纳入了 1992 年至 1994 年期间年龄在 75 岁及以上的社区居住女性。基线时，我们收集了人口统计学、BMI（<21kg/m：消瘦；21-24.9：正常体重；25-29.9：超重；≥30：肥胖）、通过 Fried 模型评估的虚弱状况和临床特征。在 5 年的随访期间，我们收集了全因死亡率、跌倒、髋部骨折和住院情况，并使用 Kaplan-Meier 方法和 Cox 风险比例模型进行单变量和多变量生存分析。
在 6662 名女性（平均年龄 80.4 岁）中，11.6%（95%置信区间 95%CI [10.8%-12.3%]）为虚弱。多变量分析显示，与非虚弱正常体重女性相比，虚弱女性的死亡风险随着 BMI 的增加而降低：调整后的危险比（aHR）=2.04[1.23-3.39]；aHR=3.07[2.21-4.26]；aHR=1.83[1.31-2.56]；aHR=1.76[1.15-2.70]；p<0.001。虚弱的超重和肥胖女性的死亡风险显著低于虚弱的正常体重女性（p=0.004）。对于非虚弱女性，跌倒风险和髋部骨折也有类似的特征。正常体重、超重和肥胖虚弱女性的住院风险相对风险相似（aHR=1.50[1.22-1.84]，aHR=1.48[1.26-1.74]和 aHR=1.53[1.24-1.89]）。
我们的结果表明，超重和肥胖降低了虚弱的社区居住老年女性发生临床不良事件的风险，并且需要通过 Fried 模型重新校准超重和肥胖个体的虚弱定义。
