Zhang Rong, Dong Sheng-Yong, Wang Wei-Min, Fei Shu-Yang, Xiang Hang, Zeng Qiang
Health Management Institute, Chinese PLA General Hospital, Beijing, China.
Department of Cardiology, Chinese Navy General Hospital, Beijing, China.
J Geriatr Cardiol. 2018 Jun;15(6):422-427. doi: 10.11909/j.issn.1671-5411.2018.06.004.
Older adults are prone to obesity and metabolic abnormalities and recommended to pursue a normal weight especially when obesity and metabolic abnormalities are co-existed. However, few studies have reported the possible differences in the effect of obesity on outcomes between older adults with metabolic abnormalities and those without metabolic abnormalities.
A total of 3485 older men were included from 2000 to 2014. All-cause mortality and cardiovascular mortality were obtained during a mean follow-up of five years. Metabolic abnormalities were defined as having established hypertension, diabetes, or dyslipidemia and taking the disease-related medications. All participants were stratified by the presence or absence of metabolic abnormalities.
In the non-metabolic abnormalities group, all-cause and cardiovascular deaths were lowest in overweight participants and highest in obese participants. In the metabolic abnormalities group, mortality was also lowest in overweight participants but highest in participants with normal weight. After adjustment for covariates, hazard ratios (95% CI) for all-cause death and cardiovascular death were 0.68 (0.51, 0.92) and 0.59 (0.37, 0.93), respectively, in overweight participants with metabolic abnormalities. Furthermore, obesity was not associated with mortality risk in both groups. These findings were unchanged in stratified analyses.
Overweight was negatively associated with mortality risk in older men with metabolic abnormalities but not in those without metabolic abnormalities. Obesity did not increase death risk regardless of metabolic abnormalities. These findings suggest that the recommendation of pursuing a normal weight may be wrong in overweight/obese older men, especially for those with metabolic abnormalities.
老年人容易肥胖和出现代谢异常，尤其当肥胖与代谢异常并存时，建议保持正常体重。然而，很少有研究报道肥胖对有代谢异常的老年人与无代谢异常的老年人结局影响的可能差异。
纳入2000年至2014年的3485名老年男性。在平均五年的随访期间获取全因死亡率和心血管死亡率。代谢异常定义为患有确诊的高血压、糖尿病或血脂异常并正在服用相关疾病的药物。所有参与者按是否存在代谢异常进行分层。
在无代谢异常组中，全因死亡和心血管死亡在超重参与者中最低，在肥胖参与者中最高。在代谢异常组中，死亡率同样在超重参与者中最低，但在体重正常的参与者中最高。在对协变量进行调整后，有代谢异常的超重参与者的全因死亡和心血管死亡的风险比（95%可信区间）分别为0.68（0.51，0.92）和0.59（0.37，0.93）。此外，肥胖在两组中均与死亡风险无关。这些发现在分层分析中未改变。
超重与有代谢异常的老年男性的死亡风险呈负相关，但与无代谢异常的老年男性无关。无论是否存在代谢异常，肥胖均未增加死亡风险。这些发现表明，对于超重/肥胖的老年男性，尤其是有代谢异常的男性，建议保持正常体重可能是错误的。
