健康生活方式指数与妇女健康倡议中多种疾病风险的关联。
Association Between the Healthy Lifestyle Index and Risk of Multimorbidity in the Women's Health Initiative.
机构信息
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA.
Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California, USA.
出版信息
J Gerontol A Biol Sci Med Sci. 2023 Dec 1;78(12):2282-2293. doi: 10.1093/gerona/glad170.
BACKGROUND
Multimorbidity, defined as the presence of 2 or more chronic health conditions, is increasingly common among older adults. The combination of lifestyle characteristics such as diet quality, smoking status, alcohol intake, physical activity (PA), sleep duration, and body fat as assessed by body mass index (BMI) or waist circumference, and risk of multimorbidity are not well understood.
OBJECTIVES
We investigated the association between the healthy lifestyle index (HLI), generated by combining indicators of diet quality, smoking, alcohol, PA, sleep amount, and BMI, and risk of multimorbidity, a composite outcome that included cardiovascular disease (CVD), diabetes, cancer, and fracture.
METHODS
We studied 62 037 postmenopausal women aged 50-79 years at enrollment in the Women's Health Initiative, with no reported history of CVD, diabetes, cancer, or fracture at baseline. Lifestyle characteristics measured at baseline were categorized and a score (0-4) was assigned to each category. The combined HLI (0-24) was grouped into quintiles, with higher quintiles indicating a healthier lifestyle. Multivariable adjusted estimates of hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the risk of developing multimorbidity were obtained using Cox proportional hazard models.
RESULTS
Over an average follow-up period of 16.3 years, 5 656 women developed multimorbidity. There was an inverse association between the HLI levels and risk of multimorbidity (compared to the HLI_1st quintile: HR_2nd quintile = 0.81 95% CI 0.74-0.83, HR_3rd quintile = 0.77 95% CI 0.71-0.83, HR_4th quintile = 0.70 95% CI 0.64-0.76, and HR_5th quintile = 0.60 95% CI 0.54-0.66; p trend < .001). Similar associations were observed after stratification by age or BMI categories.
CONCLUSIONS
Among postmenopausal women, higher levels of the HLI were associated with a reduced risk of developing multimorbidity.
背景
多种慢性疾病，定义为存在 2 种或更多种慢性健康状况，在老年人中越来越常见。生活方式特征的组合，如饮食质量、吸烟状况、饮酒量、身体活动（PA）、睡眠时间和身体脂肪（通过体重指数（BMI）或腰围评估），以及多种慢性疾病的风险尚不清楚。
目的
我们研究了由饮食质量、吸烟、饮酒、PA、睡眠时间和 BMI 指标组合而成的健康生活方式指数（HLI）与多种慢性疾病风险之间的关系，多种慢性疾病是一种包括心血管疾病（CVD）、糖尿病、癌症和骨折在内的复合结局。
方法
我们研究了参加妇女健康倡议的 62037 名年龄在 50-79 岁的绝经后妇女，基线时没有报告 CVD、糖尿病、癌症或骨折病史。基线时测量的生活方式特征分为几类，并为每种类别分配一个分数（0-4）。组合的 HLI（0-24）分为五分位数，较高的五分位数表示更健康的生活方式。使用 Cox 比例风险模型获得多变量调整后的风险比（HR）和 95%置信区间（95%CI）的多因素调整估计值，用于发展多种慢性疾病的风险。
结果
在平均 16.3 年的随访期间，有 5656 名女性发生了多种慢性疾病。HLI 水平与多种慢性疾病的风险呈负相关（与 HLI 第 1 五分位数相比：HR 第 2 五分位数=0.81，95%CI 0.74-0.83，HR 第 3 五分位数=0.77，95%CI 0.71-0.83，HR 第 4 五分位数=0.70，95%CI 0.64-0.76，HR 第 5 五分位数=0.60，95%CI 0.54-0.66；p 趋势<.001）。在按年龄或 BMI 类别分层后也观察到类似的关联。
结论
在绝经后妇女中，较高的 HLI 水平与降低多种慢性疾病的风险相关。
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