Zhang Yuyu, Shi Mingyue, Dong Zhao, Li Tingting, Gong Yangfan, Ge Wei
Department of General Practice, Xijing Hospital, Fourth Military Medical University, Changle West Road #127, Xi'an, Shaanxi Province, 710032, P.R. China.
Aging Clin Exp Res. 2024 Dec 3;36(1):230. doi: 10.1007/s40520-024-02891-8.
Whether excess visceral fat tissue increases the risk of death in older individuals remains controversial.
To investigate the association between the Chinese Visceral Adiposity Index (CVAI) and all-cause mortality risk in older Chinese individuals.
This cohort study utilized data of individuals aged ≥ 65 years in 2014 to 2018 wave from the Chinese Longitudinal Healthy Longevity Survey database. Older individuals in the 2014 wave were included and followed up in 2018. CVAI was calculated based on age, body size, and blood lipid parameters, with higher values indicating increased visceral fat. Survival status was determined from official death certificates, local primary healthcare providers, or the family members of participants. Kaplan-Meier survival curve and log-rank test were employed to analyze cumulative mortality risk through CVAI tertiles (tertile 1: CVAI index < 97.34; tertile 2: 97.43 ≤ CVAI index < 132.21; and tertile 3: CVAI index ≥ 132.21). A Cox proportional hazards regression model was used to assess the relationship between the CVAI groups and all-cause mortality risk. Additionally, a sensitivity analysis was performed by excluding participants who died within the first year of follow-up. A subgroup analysis was performed based on age and sex, and a restricted cubic spline plot was created to analyze the dose-response relationship between CVAI and mortality risk.
A total of 1414 individuals were included, and the mean age of the participants was 84.6 (standard deviation: 10.9) years, of which 46.4% were women and 32.8% were died during a median follow-up time of 36.4 months. In the multivariable adjusted Cox regression model, we observed a significantly lower risk of mortality in the CVAI tertile 2 and 3 groups than in the tertile 1 group. The hazard ratios (HR) of the tertile 2 and 3 groups were 0.68 (95% CI, approximately 0.52-0.89) and 0.63 (95% CI, approximately 0.48-0.82), respectively. Subgroup analysis revealed that the protective effect of higher CVAI levels on mortality was more pronounced in participants aged 65-79 years and in women.
Our study established a linear relationship between CVAI and mortality risk among community-dwelling older adults, with higher CVAI levels associated with a lower risk of all-cause mortality. These findings highlight the potential importance of visceral adiposity in predicting mortality risk in community-dwelling older adults.
内脏脂肪组织过多是否会增加老年人的死亡风险仍存在争议。
研究中国内脏脂肪指数（CVAI）与中国老年人群全因死亡风险之间的关联。
这项队列研究利用了中国老年健康长寿纵向调查数据库中2014年至2018年波次中年龄≥65岁个体的数据。纳入2014年波次的老年人并在2018年进行随访。根据年龄、体型和血脂参数计算CVAI，数值越高表明内脏脂肪增加。通过官方死亡证明、当地基层医疗服务提供者或参与者家属确定生存状态。采用Kaplan-Meier生存曲线和对数秩检验分析通过CVAI三分位数（三分位数1：CVAI指数<97.34；三分位数2：97.43≤CVAI指数<132.21；三分位数3：CVAI指数≥132.21）的累积死亡风险。使用Cox比例风险回归模型评估CVAI组与全因死亡风险之间的关系。此外，通过排除随访第一年内死亡的参与者进行敏感性分析。基于年龄和性别进行亚组分析，并创建受限立方样条图以分析CVAI与死亡风险之间的剂量反应关系。
共纳入1414名个体，参与者的平均年龄为84.6岁（标准差：10.9），其中46.4%为女性，在36.4个月的中位随访时间内32.8%的人死亡。在多变量调整的Cox回归模型中，我们观察到CVAI三分位数2组和3组的死亡风险显著低于三分位数1组。三分位数2组和3组的风险比（HR）分别为0.68（95%CI，约0.52 - 0.89）和0.63（95%CI，约0.48 - 0.82）。亚组分析显示，较高的CVAI水平对死亡率的保护作用在65 - 79岁的参与者和女性中更为明显。
我们的研究在社区居住的老年人中建立了CVAI与死亡风险之间的线性关系，较高的CVAI水平与较低的全因死亡风险相关。这些发现凸显了内脏脂肪在预测社区居住老年人死亡风险方面的潜在重要性。
