Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, South Korea.
Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, South Korea.
Ann Med. 2021 Dec;53(1):1646-1658. doi: 10.1080/07853890.2021.1976416.
The impact of the changes in the obesity status on mortality has not been established; thus, we investigated the long-term influence of body fat (BF) changes on all-cause deaths and cardiovascular outcomes in a general population.
A total of 8374 participants were observed for 12 years. BF was measured at least two times using a bioimpedance method. The causes of death were acquired from the nationwide database. A major adverse cardiovascular event (MACE) was defined as a composite of myocardial infarction, coronary artery disease, stroke, and cardiovascular death. Standard deviations (SDs) were derived using a local regression model corresponding to the time elapsed between the initial and final BF measurements () and were used to standardize the changes in BF (ΔBF/).
The incidence rates of all-cause death, cardiovascular death, and MACE were the highest in the participants with ΔBF/ <-1 and lowest in the participants with ΔBF/ ≥1. Multivariate Cox proportional hazard models adjusted for relevant covariates, including baseline obesity and physical activity, showed that the risks of all-cause deaths (hazard ratio [HR] 0.58; 95% confidence intervals [CI] 0.53-0.64), cardiovascular deaths (HR 0.63; 95% CI 0.51-0.78) and MACEs (HR 0.68; 95% CI 0.62-0.75) decreased as ΔBF/ increased. Subgroup analyses showed that existing cardiovascular diseases weakened the associations between higher ΔBF/ and better outcomes, while high physical activity and exercise did not impact the associations.
Increasing BF was associated with a lower risk of all-cause death, cardiovascular death, and MACE in the general population.Key messagesIncreasing body fat is associated with a lower risk of all-cause death, cardiovascular death, and major cardiovascular adverse events in a low-risk ageing general population, independently of physical activity, underlying cardiovascular disease burden, changes in muscle mass, and baseline obesity status.Fatness measured at baseline requires adjustment for the changes in fatness during the follow-up to reveal its impact on the clinical outcomes.
肥胖状况变化对死亡率的影响尚未确定；因此，我们在一般人群中研究了体脂 (BF) 变化对全因死亡和心血管结局的长期影响。
共有 8374 名参与者接受了 12 年的观察。使用生物阻抗法至少两次测量 BF。从全国数据库中获取死亡原因。主要不良心血管事件 (MACE) 定义为心肌梗死、冠心病、中风和心血管死亡的综合。使用与初始和最终 BF 测量之间经过的时间相对应的局部回归模型得出标准差 (SD)，并用于标准化 BF 的变化 (ΔBF/)。
在 ΔBF/ <-1 的参与者中，全因死亡、心血管死亡和 MACE 的发生率最高，而在 ΔBF/ ≥1 的参与者中最低。调整了包括基线肥胖和体力活动在内的相关协变量的多变量 Cox 比例风险模型显示，全因死亡风险（风险比 [HR] 0.58；95%置信区间 [CI] 0.53-0.64）、心血管死亡风险（HR 0.63；95% CI 0.51-0.78）和 MACE 风险（HR 0.68；95% CI 0.62-0.75）随着 ΔBF/ 的增加而降低。亚组分析表明，现有的心血管疾病削弱了更高的 ΔBF/与更好结果之间的关联，而高体力活动和锻炼没有影响这些关联。
在一般人群中，BF 的增加与全因死亡、心血管死亡和 MACE 的风险降低相关，独立于体力活动、潜在的心血管疾病负担、肌肉量的变化和基线肥胖状况。在基线测量的肥胖程度需要调整随访期间的肥胖变化，以揭示其对临床结果的影响。
