Fitzgerald Kathryn C, Salter Amber, Tyry Tuula, Fox Robert J, Cutter Gary, Marrie Ruth Ann
Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Division of Biostatistics, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
Mult Scler. 2020 Jul;26(8):976-986. doi: 10.1177/1352458519845836. Epub 2019 May 13.
Metabolic comorbidity is overrepresented in people with multiple sclerosis (MS) and is associated with adverse MS outcomes. Excess visceral adiposity, approximated using waist circumference (WC), is a risk factor for metabolic comorbidity and predicts poorer outcomes in other neurologic diseases.
To evaluate the association between WC and clinical and disease characteristics in people with MS.
North American Research Committee on MS (NARCOMS) registry participants reported height and weight (used to calculate body mass index (BMI)) and were mailed a tape measure with instructions to measure WC. We considered WC continuously and used cut-points derived from the abdominal obesity criteria for the metabolic syndrome (men: WC ⩾ 40 in; women: WC ⩾ 35 in). We assessed the association between WC and disability (Patient-Determined Disease Steps) and symptom severity (validated scales) using multivariable-adjusted multinomial models.
Of 6367 responders with MS, we included 5832 (92%). Of these, 3181 (55%) reported WC meeting criteria for the abdominal obesity component of metabolic syndrome. In multivariable models adjusting for overall obesity status, WC was associated with 47% increased odds of severe versus mild disability (odds ratio (OR): 1.47; 95% confidence interval (CI): 1.22-1.78).
Increased WC is associated with more severe disability, even after adjusting for overall obesity in this large cross-sectional survey.
代谢合并症在多发性硬化症（MS）患者中更为常见，且与MS不良预后相关。使用腰围（WC）估算的内脏脂肪过多是代谢合并症的一个危险因素，并可预测其他神经系统疾病的较差预后。
评估MS患者中WC与临床及疾病特征之间的关联。
北美多发性硬化症研究委员会（NARCOMS）登记参与者报告身高和体重（用于计算体重指数（BMI）），并收到一个卷尺及测量WC的说明。我们连续考虑WC，并使用从代谢综合征的腹部肥胖标准得出的切点（男性：WC⩾40英寸；女性：WC⩾35英寸）。我们使用多变量调整多项模型评估WC与残疾（患者确定的疾病阶段）和症状严重程度（经过验证的量表）之间的关联。
在6367名有MS的应答者中，我们纳入了5832名（92%）。其中，3181名（55%）报告WC符合代谢综合征腹部肥胖成分的标准。在调整总体肥胖状况的多变量模型中，WC与严重残疾与轻度残疾相比增加47%的几率相关（优势比（OR）：1.47；95%置信区间（CI）：1.22-1.78）。
在这项大型横断面调查中，即使在调整总体肥胖后，WC增加仍与更严重的残疾相关。
