Department of Family Medicine, Sahmyook Medical Center, Seoul, Republic of Korea.
Department of Family Medicine, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Republic of Korea.
PLoS Med. 2018 Aug 21;15(8):e1002640. doi: 10.1371/journal.pmed.1002640. eCollection 2018 Aug.
The association of metabolic syndrome (MetS) with the development of Parkinson disease (PD) is currently unclear. We sought to determine whether MetS and its components are associated with the risk of incident PD using large-scale cohort data for the whole South Korean population.
Health checkup data of 17,163,560 individuals aged ≥40 years provided by the National Health Insurance Service (NHIS) of South Korea between January 1, 2009, and December 31, 2012, were included, and participants were followed up until December 31, 2015. The mean follow-up duration was 5.3 years. The hazard ratio (HR) and 95% confidence interval (CI) of PD were estimated using a Cox proportional hazards model adjusted for potential confounders. We identified 44,205 incident PD cases during follow-up. Individuals with MetS (n = 5,848,508) showed an increased risk of PD development compared with individuals without MetS (n = 11,315,052), even after adjusting for potential confounders including age, sex, smoking, alcohol consumption, physical activity, income, body mass index, estimated glomerular filtration rate, and history of stroke (model 3; HR, 95% CI: 1.24, 1.21-1.27). Each MetS component was positively associated with PD risk (HR, 95% CI: 1.13, 1.10-1.16 for abdominal obesity; 1.13, 1.10-1.15 for hypertriglyceridemia; 1.23, 1.20-1.25 for low high-density lipoprotein cholesterol; 1.05, 1.03-1.08 for high blood pressure; 1.21, 1.18-1.23 for hyperglycemia). PD incidence positively correlated with the number of MetS components (log-rank p < 0.001), and we observed a gradual increase in the HR for incident PD with increasing number of components (p < 0.001). A significant interaction between age and MetS on the risk of incident PD was observed (p for interaction < 0.001), and people aged ≥65 years old with MetS showed the highest HR of incident PD of all subgroups compared to those <65 years old without MetS (reference subgroup). Limitations of this study include the possibilities of misdiagnosis of PD and reverse causality.
Our population-based large-scale cohort study suggests that MetS and its components may be risk factors of PD development.
代谢综合征（MetS）与帕金森病（PD）的发展之间的关系目前尚不清楚。我们试图通过对整个韩国人群的大规模队列数据来确定 MetS 及其成分是否与 PD 的发病风险相关。
我们纳入了韩国国民健康保险服务（NHIS）在 2009 年 1 月 1 日至 2012 年 12 月 31 日期间提供的 17163560 名年龄≥40 岁的个体的健康检查数据，并对其进行了随访，直至 2015 年 12 月 31 日。使用 Cox 比例风险模型估计 PD 的风险比（HR）和 95%置信区间（CI），并对潜在混杂因素进行了调整。在随访期间，我们共发现 44205 例 PD 病例。与无 MetS 的个体（n=11315052）相比，患有 MetS（n=5848508）的个体 PD 发病风险增加，即使在校正了年龄、性别、吸烟、饮酒、体力活动、收入、体重指数、估算肾小球滤过率和卒中史等潜在混杂因素后（模型 3；HR，95%CI：1.24，1.21-1.27）。每个 MetS 成分与 PD 风险呈正相关（腹型肥胖：HR，95%CI：1.13，1.10-1.16；高甘油三酯血症：HR，95%CI：1.13，1.10-1.15；低高密度脂蛋白胆固醇血症：HR，95%CI：1.23，1.20-1.25；高血压：HR，95%CI：1.05，1.03-1.08；高血糖：HR，1.21，1.18-1.23）。PD 的发病率与 MetS 成分的数量呈正相关（对数秩检验 p<0.001），并且我们观察到随着成分数量的增加，PD 发病的 HR 逐渐增加（p<0.001）。年龄和 MetS 对 PD 发病风险的交互作用具有统计学意义（p<0.001），与<65 岁无 MetS 的人群相比，≥65 岁有 MetS 的人群发生 PD 的 HR 最高（参考亚组）。本研究的局限性包括 PD 诊断的可能性和反向因果关系。
我们的基于人群的大规模队列研究表明，MetS 及其成分可能是 PD 发展的危险因素。
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