Felson D T, Anderson J J, Naimark A, Walker A M, Meenan R F
Boston City Hospital, Massachusetts.
Ann Intern Med. 1988 Jul 1;109(1):18-24. doi: 10.7326/0003-4819-109-1-18.
To determine whether obesity preceded knee osteoarthritis and was thus a possible cause.
Cohort study with weight and other important variables measured in 1948 to 1951 (mean age of subjects, 37 years) and knee arthritis evaluated in 1983 to 1985 (mean age of subjects, 73 years).
Population-based participants; a subset (n = 1420) of the Framingham Heart Study cohort.
For those subjects in the Framingham Study having knee radiographs taken as part of the 18th biennial examination (1983 to 1985), we examined Metropolitan Relative Weight, a measure of weight adjusted for height at the onset of the study (1948 to 1951). Relative risks were computed as the cumulative incidence rate of radiographic knee osteoarthritis in the heaviest weight groups at examination 1 divided by the cumulative rate in the lightest 60% weight groups at examination 1. Relative risks were adjusted for age, physical activity level, and uric acid level.
In 1983 to 1985, 468 subjects (33%) had radiographic knee osteoarthritis. For men, the risk of knee osteoarthritis was increased in those in the heaviest quintile of weight at examination 1 compared with those in the lightest three quintiles (age-adjusted relative risk, 1.51; 95% confidence interval [CI], 1.14 to 1.98); risk was not increased for those in the second heaviest quintile (relative risk, 1.0). The association between weight and knee osteoarthritis was stronger in women than in men; for women in the most overweight quintile at examination 1, relative risk was 2.07 (95% CI, 1.67 to 2.55), and for those in the second heaviest group, relative risk was 1.44 (95% CI, 1.11 to 1.86). This link between obesity and subsequent osteoarthritis persisted after controlling for serum uric acid level and physical activity level, and was strongest for persons with severest radiographic disease. Obesity at examination 1 was associated with the risk of developing both symptomatic and asymptomatic osteoarthritis.
These results and other corroborative cross-sectional data show that obesity or as yet unknown factors associated with obesity cause knee osteoarthritis.
确定肥胖是否先于膝关节骨关节炎出现，从而是否可能是其病因。
队列研究，于1948年至1951年测量体重及其他重要变量（受试者平均年龄37岁），并于1983年至1985年评估膝关节关节炎情况（受试者平均年龄73岁）。
基于人群的参与者；弗明汉心脏研究队列的一个子集（n = 1420）。
对于弗明汉研究中那些在第18次两年一次检查（1983年至1985年）时拍摄了膝关节X光片的受试者，我们检查了都市相对体重，这是一种在研究开始时（1948年至1951年）根据身高调整后的体重测量指标。相对风险计算为检查1时体重最重组的膝关节X光片骨关节炎累积发病率除以检查1时体重最轻的60%组的累积发病率。相对风险根据年龄、身体活动水平和尿酸水平进行了调整。
在1983年至1985年，468名受试者（33%）有膝关节X光片骨关节炎。对于男性，检查1时体重最重的五分位数组的人患膝关节骨关节炎的风险高于体重最轻的三个五分位数组的人（年龄调整后的相对风险为1.51；95%置信区间[CI]，1.14至1.98）；第二重五分位数组的人风险未增加（相对风险为1.0）。体重与膝关节骨关节炎之间的关联在女性中比在男性中更强；对于检查1时超重最严重的五分位数组的女性，相对风险为2.07（95%CI，1.67至2.55），对于第二重组的女性，相对风险为1.44（95%CI，1.11至1.86）。在控制血清尿酸水平和身体活动水平后，肥胖与随后的骨关节炎之间的这种联系仍然存在，并且对于X光片疾病最严重的人最强。检查1时的肥胖与出现有症状和无症状骨关节炎的风险相关。
这些结果以及其他确证性横断面数据表明，肥胖或与肥胖相关的未知因素会导致膝关节骨关节炎。
