School of Public Health, Peking University Health Science Center, Beijing, P. R. China.
Centre for Chronic Disease, School of Medicine, The University of Queensland, Herston, Queensland, Australia.
PLoS One. 2018 Feb 23;13(2):e0193368. doi: 10.1371/journal.pone.0193368. eCollection 2018.
Although obesity is recognized as an important risk of mortality, how the amount and distribution of body fat affect mortality risk is unclear. Furthermore, whether fat distribution confers any additional risk of mortality in addition to fat amount is not understood.
This data linkage cohort study included 16415 participants (8554 females) aged 18 to 89 years from National Health and Nutrition Examination Survey III (1988-1994) and its linked mortality data (31 December 2011). Cox proportional hazard models and parametric survival models were used to estimate the association between body fat percentage (BF%), based on bioelectrical impedance analysis, and waist-hip ratio (WHR) with mortality.
A total of 4999 deaths occurred during 19-year follow-up. A U-shaped association between BF% and mortality was found in both sexes, with the adjusted hazard ratios for other groups between 1.02 (95% confidence interval: 0.89, 1.18) and 2.10 (1.47, 3.01) when BF% groups of 25-30% in males and 30-35% in females were used as references. A non-linear relationship between WHR and mortality was detected in males, with the adjusted hazard ratios among other groups ranging from 1.05 (0.94, 1.18) to 1.52 (1.15, 2.00) compared with the WHR category of 0.95-1.0. However in females, the death risk constantly increased across the WHR spectrum. Joint impact of BF% and WHR suggested males with BF% of 25-30% and WHR of 0.95-1.0 and females with BF% of 30-35% and WHR <0.9 were associated with the lowest mortality risk and longest survival age compared with their counterparts in other categories.
This study supported the use of body fat distribution in addition to fat amount in assessing the risk of all-cause mortality.
尽管肥胖已被确认为死亡的一个重要危险因素，但目前尚不清楚体内脂肪的含量和分布如何影响死亡风险。此外，人们还不清楚脂肪分布除了与脂肪含量有关外，是否会带来任何额外的死亡风险。
本数据链接队列研究纳入了来自国家健康和营养调查 III（1988-1994 年）及其相关死亡率数据（2011 年 12 月 31 日）的 16415 名年龄在 18 至 89 岁的参与者（女性 8554 名）。使用 Cox 比例风险模型和参数生存模型来评估基于生物电阻抗分析的体脂肪百分比（BF%）和腰围臀围比（WHR）与死亡率之间的关联。
在 19 年的随访期间，共发生 4999 例死亡。在两性中均发现 BF%与死亡率之间存在 U 型关联，当男性中 BF%组为 25-30%，女性中 BF%组为 30-35%作为参考时，其他组的校正后风险比在 1.02（95%置信区间：0.89，1.18）和 2.10（1.47，3.01）之间。在男性中，检测到 WHR 与死亡率之间存在非线性关系，与 WHR 类别为 0.95-1.0 相比，其他组的校正后风险比在 1.05（0.94，1.18）至 1.52（1.15，2.00）之间。然而，在女性中，随着 WHR 谱的变化，死亡风险持续增加。BF%和 WHR 的联合影响表明，男性中 BF%为 25-30%，WHR 为 0.95-1.0，女性中 BF%为 30-35%，WHR<0.9 与其他类别相比，死亡风险最低，生存年龄最长。
本研究支持在评估全因死亡率风险时，除了脂肪含量外，还应考虑脂肪分布。
