Yoon Seo Yeon, Heo Seok-Jae, Lee Hyo Jeong, Shin Jaeyong, Kim Yong Wook, Yang Seung Nam, Park Yoon Ghil
Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Republic of Korea.
Department of Biostatistics and Computing, Yonsei University Graduate School, Seoul, Republic of Korea.
J Am Med Dir Assoc. 2022 Oct;23(10):1719.e1-1719.e7. doi: 10.1016/j.jamda.2022.07.015. Epub 2022 Aug 23.
Although weight loss is a frequent symptom in Parkinson disease (PD), there have been few studies on the association between body mass index (BMI) and mortality. The objective of this study was to investigate the association between BMI and change in BMI at diagnosis in patients with PD and all-cause mortality.
Cohort study using Korean National Health Insurance Service-Elderly Cohort data.
Patients with new-onset PD were selected using the International Classification of Diseases 10th edition code (G20). Then, patients who were diagnosed more than 3 times with PD and had been prescribed anti-parkinsonian medication for ≥30 days were included. Those with a combined diagnosis of atypical parkinsonism and secondary parkinsonism were excluded.
The primary outcome was all-cause mortality. Anthropometric data, including height and weight, were obtained from the health screening data to calculate BMI. The Cox proportional hazards model was used to assess mortality risk by BMI.
Among the 2703 patients with PD, 492 (18.20%) died during the 11-year follow-up period. There was a significant inverse dose-response relationship between baseline BMI and mortality [<18.5 kg/m: hazard ratio (HR), 1.872, 95% CI, 1.338-2.494; 23-25 kg/m: HR, 0.695, 95% CI, 0.546-0.886; 25-30 kg/m: HR, 0.644, 95% CI, 0.476-0.869; ≥30 kg/m: HR, 0.396, 95% CI, 0.165-0.950]. Change in BMI of 10% revealed a significant association with mortality. Subgroup analyses by sex showed a significant inverse dose-response relationship between BMI and all-cause mortality only in women.
We demonstrated an inverse dose-response association between BMI at diagnosis and mortality in patients with PD, especially in women. Early detection of PD before weight loss progression and proper management might improve mortality. The small number of obese PD participants in our study should be considered when interpreting and generalizing results.
虽然体重减轻是帕金森病（PD）的常见症状，但关于体重指数（BMI）与死亡率之间关联的研究较少。本研究的目的是调查PD患者诊断时的BMI及BMI变化与全因死亡率之间的关联。
使用韩国国民健康保险服务老年队列数据进行队列研究。
采用国际疾病分类第10版代码（G20）选择新发PD患者。然后，纳入那些被诊断为PD超过3次且已服用抗帕金森药物≥30天的患者。排除合并非典型帕金森综合征和继发性帕金森综合征诊断的患者。
主要结局是全因死亡率。从健康筛查数据中获取身高和体重等人体测量数据以计算BMI。采用Cox比例风险模型评估BMI相关的死亡风险。
在2703例PD患者中，492例（18.20%）在11年随访期内死亡。基线BMI与死亡率之间存在显著的剂量反应负相关[<18.5kg/m²：风险比（HR），1.872，95%置信区间（CI），1.338 - 2.494；23 - 25kg/m²：HR，0.695，95%CI，0.546 - 0.886；25 - 30kg/m²：HR，0.644，95%CI，0.476 - 0.869；≥30kg/m²：HR，0.396，95%CI，0.165 - 0.950]。BMI变化10%与死亡率显著相关。按性别进行的亚组分析显示，仅在女性中BMI与全因死亡率之间存在显著的剂量反应负相关。
我们证明了PD患者诊断时的BMI与死亡率之间存在剂量反应负相关，尤其是在女性中。在体重减轻进展之前早期发现PD并进行适当管理可能会改善死亡率。在解释和推广结果时应考虑到本研究中肥胖PD参与者数量较少这一情况。
