动力性腹部肥胖与老年人长期步态速度和跌倒的关系。

Dynapenic abdominal obesity and the effect on long-term gait speed and falls in older adults.

机构信息

Department of Epidemiology and Health Statistics, Public Health College, Qingdao University, Qingdao, China.

Department of Emergency, Affiliated Hospital of Qingdao University, Qingdao, China.

出版信息

Clin Nutr. 2022 Jan;41(1):91-96. doi: 10.1016/j.clnu.2021.11.011. Epub 2021 Nov 15.

DOI:10.1016/j.clnu.2021.11.011

PMID:34864458

Abstract

BACKGROUND

Although both dynapenia and abdominal obesity have negative impact on physical function and health, few prospective studies evaluate the association of dynapenic abdominal obesity (D/AO) with gait speed and falls. Our aim was to examine the combined effect of low muscle strength and abdominal obesity on long-term gait speed and falls in older adults.

METHODS

We used longitudinal data from the English Longitudinal Study of Ageing (ELSA), including 4987 individuals aged 60 years and over. Grip strength and waist circumference were measured at baseline. Gait speed and fall events (falls, recurrent falls, and fall-related injury) were evaluated during a 14-year follow-up. The study population were divided into nondynapenic nonabdominal obesity (ND/NAO), nondynapenic abdominal obesity (ND/AO), dynapenic nonabdominal obesity (D/NAO), and D/AO, according to the sex-specific grip strength (<16 kg for women and <26 kg for men) and waist circumference (>88 cm for women and >102 cm for men). We used generalized estimating equation (GEE) model with gait speed as the outcome and cox proportional hazards models with fall events as the outcome.

RESULTS

GEE model showed that gait speed decreased during the 14-year follow-up in all groups (all P < 0.001). Participants with ND/AO, D/NAO, and D/AO at baseline exhibited a worse gait speed than those with ND/NAO (all P < 0.001). No significant difference in the rate of gait speed decline between four groups was found (P = 0.062). Cox regression analysis showed that D/NAO and D/AO highly predicted falls, and the hazard ratio (HR) was 1.181 (95% CI: 1.002, 1.392) for D/NAO and 1.195 (95% CI: 1.006, 1.421) for D/AO. D/AO was the unique condition associated with recurrent falls and fall-related injury, and the HRs were 1.276 (95% CI: 1.018, 1.599) and 1.348 (95% CI: 1.066, 1.704), respectively.

CONCLUSION

Dynapenia abdominal obesity, determined by low grip strength and high waist circumference, exhibits worse gait speed and increases the risk of fall events in older adults. Effort to maintain the mobility should focus on improving muscle strength and reducing excess body fat.

摘要

背景

尽管肌肉减少症和腹部肥胖均对身体功能和健康产生负面影响，但很少有前瞻性研究评估肌肉减少性腹部肥胖（D/AO）与步态速度和跌倒之间的关系。我们的目的是研究老年人中低肌肉力量和腹部肥胖对长期步态速度和跌倒的综合影响。

方法

我们使用来自英国老龄化纵向研究（ELSA）的纵向数据，包括 4987 名 60 岁及以上的个体。在基线时测量握力和腰围。在 14 年的随访期间评估步态速度和跌倒事件（跌倒、复发性跌倒和跌倒相关伤害）。根据性别特异性握力（女性<16 kg，男性<26 kg）和腰围（女性>88 cm，男性>102 cm），将研究人群分为非肌肉减少性非腹部肥胖（ND/NAO）、非肌肉减少性腹部肥胖（ND/AO）、肌肉减少性非腹部肥胖（D/NAO）和 D/AO。我们使用广义估计方程（GEE）模型将步态速度作为因变量，使用 Cox 比例风险模型将跌倒事件作为因变量。

结果

GEE 模型显示，在 14 年的随访期间，所有组的步态速度均下降（均 P < 0.001）。基线时患有 ND/AO、D/NAO 和 D/AO 的参与者的步态速度比 ND/NAO 差（均 P < 0.001）。四组之间的步态速度下降率无显著差异（P = 0.062）。Cox 回归分析表明，D/NAO 和 D/AO 高度预测跌倒，D/NAO 的危险比（HR）为 1.181（95%CI：1.002，1.392），D/AO 的 HR 为 1.195（95%CI：1.006，1.421）。D/AO 是与复发性跌倒和跌倒相关伤害相关的唯一条件，HR 分别为 1.276（95%CI：1.018，1.599）和 1.348（95%CI：1.066，1.704）。