体重指数轨迹先于首次报告自我健康状况不佳：英国老龄化纵向研究的纵向病例对照分析。
Body mass index trajectories preceding first report of poor self-rated health: A longitudinal case-control analysis of the English Longitudinal Study of Ageing.
机构信息
Department of Public Health, Aarhus University, Aarhus, Denmark.
Danish Diabetes Academy, Odense, Denmark.
出版信息
PLoS One. 2019 Feb 22;14(2):e0212862. doi: 10.1371/journal.pone.0212862. eCollection 2019.
BACKGROUND
Studies have consistently found that obesity is associated with poor self-rated health, but how body mass index (BMI) developed in the lead up to poor self-rated health is unknown.
METHODS
We nested a longitudinal case-control study in the English Longitudinal Study of Ageing (1998-2015) to investigate BMI trajectories in the years preceding a first self-report of poor health. Participants rated their health at each data collection; every other collection included a BMI assessment by a nurse. Case status was defined as a first report of poor health during follow-up. Three age- and sex-matched controls were identified per case using density sampling. BMI trajectories were fitted to time backwards prior to first report of poor health using mixed-effects models. Age and sex were potential modifiers. We conducted subgroup analyses of those not reporting certain chronic diseases or smoking.
RESULTS
We identified 732 cases and 2195 controls. Age, but not sex, modified the association between BMI and self-rated health. Participants reporting poor health at age 60 had a 1.5 kg/m2 (95%CI: 0.8 to 2.1) higher BMI at the time of reporting than controls, and their BMI had previously increased markedly (1.3 kg/m2 95%CI: 0.9 to 1.8 over ten years). After age 75, cases no longer had higher BMI than controls, and their BMI had decreased sharply prior to reporting poor health (e.g. -2.0 kg/m2 95%CI: -2.6 to -1.5 per decade on average for those reporting poor health at age 90). Age was also an effect modifier among those without diabetes, however BMI trajectories were more similar among the middle-aged. The subgroup analysis of those without cardiovascular disease, cancer and chronic lung disease showed similar results to the main findings.
CONCLUSION
Development of BMI was associated with poor self-rated health; however, the nature of the association depended markedly on age.
背景
研究一致发现肥胖与自评健康状况不佳有关，但体重指数（BMI）在导致自评健康状况不佳之前是如何发展的尚不清楚。
方法
我们将一项纵向病例对照研究嵌套在英国老龄化纵向研究（1998-2015 年）中，以调查在首次自我报告健康状况不佳之前的几年中 BMI 轨迹。参与者在每次数据收集时都对自己的健康状况进行评分；每隔一次收集，护士都会对他们的 BMI 进行评估。病例状态定义为随访期间首次报告健康状况不佳。使用密度抽样法，为每个病例确定了三个年龄和性别匹配的对照。使用混合效应模型，根据时间从前向后拟合 BMI 轨迹，直到首次报告健康状况不佳。年龄和性别可能是修饰因素。我们对未报告某些慢性疾病或吸烟的人群进行了亚组分析。
结果
我们确定了 732 例病例和 2195 例对照。年龄，但不是性别，修饰了 BMI 与自评健康之间的关联。在 60 岁时报告健康状况不佳的参与者，其报告时的 BMI 比对照组高 1.5 kg/m2（95%CI：0.8 至 2.1），并且他们的 BMI 此前显著增加（10 年内增加 1.3 kg/m2，95%CI：0.9 至 1.8）。75 岁以后，病例的 BMI 不再高于对照组，并且在报告健康状况不佳之前，他们的 BMI 急剧下降（例如，对于那些在 90 岁时报告健康状况不佳的人，平均每十年下降 2.0 kg/m2，95%CI：2.6 至 1.5）。在没有糖尿病的人群中，年龄也是一个效应修饰因素，但是 BMI 轨迹在中年人群中更为相似。对于没有心血管疾病、癌症和慢性肺部疾病的亚组分析，结果与主要发现相似。
结论
BMI 的发展与自评健康状况不佳有关；然而，关联的性质在很大程度上取决于年龄。
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