正常体重中心性肥胖：对全因死亡率和心血管死亡率的影响。
Normal-Weight Central Obesity: Implications for Total and Cardiovascular Mortality.
作者信息
Sahakyan Karine R, Somers Virend K, Rodriguez-Escudero Juan P, Hodge David O, Carter Rickey E, Sochor Ondrej, Coutinho Thais, Jensen Michael D, Roger Véronique L, Singh Prachi, Lopez-Jimenez Francisco
出版信息
Ann Intern Med. 2015 Dec 1;163(11):827-35. doi: 10.7326/M14-2525. Epub 2015 Nov 10.
BACKGROUND
The relationship between central obesity and survival in community-dwelling adults with normal body mass index (BMI) is not well-known.
OBJECTIVE
To examine total and cardiovascular mortality risks associated with central obesity and normal BMI.
DESIGN
Stratified multistage probability design.
SETTING
NHANES III (Third National Health and Nutrition Examination Survey).
PARTICIPANTS
15,184 adults (52.3% women) aged 18 to 90 years.
MEASUREMENTS
Multivariable Cox proportional hazards models were used to evaluate the relationship of obesity patterns defined by BMI and waist-to-hip ratio (WHR) and total and cardiovascular mortality risk after adjustment for confounding factors.
RESULTS
Persons with normal-weight central obesity had the worst long-term survival. For example, a man with a normal BMI (22 kg/m2) and central obesity had greater total mortality risk than one with similar BMI but no central obesity (hazard ratio [HR], 1.87 [95% CI, 1.53 to 2.29]), and this man had twice the mortality risk of participants who were overweight or obese according to BMI only (HR, 2.24 [CI, 1.52 to 3.32] and 2.42 [CI, 1.30 to 4.53], respectively). Women with normal-weight central obesity also had a higher mortality risk than those with similar BMI but no central obesity (HR, 1.48 [CI, 1.35 to 1.62]) and those who were obese according to BMI only (HR, 1.32 [CI, 1.15 to 1.51]). Expected survival estimates were consistently lower for those with central obesity when age and BMI were controlled for.
LIMITATIONS
Body fat distribution was assessed based on anthropometric indicators alone. Information on comorbidities was collected by self-report.
CONCLUSION
Normal-weight central obesity defined by WHR is associated with higher mortality than BMI-defined obesity, particularly in the absence of central fat distribution.
PRIMARY FUNDING SOURCE
National Institutes of Health, American Heart Association, European Regional Development Fund, and Czech Ministry of Health.
背景
正常体重指数（BMI）的社区居住成年人中，中心性肥胖与生存率之间的关系尚不明确。
目的
研究中心性肥胖和正常BMI与全因死亡率及心血管疾病死亡率的风险。
设计
分层多阶段概率设计。
地点
美国国家健康与营养检查调查（NHANES）III。
参与者
15184名年龄在18至90岁之间的成年人（52.3%为女性）。
测量
采用多变量Cox比例风险模型，在调整混杂因素后，评估由BMI和腰臀比（WHR）定义的肥胖模式与全因死亡率及心血管疾病死亡率风险之间的关系。
结果
正常体重的中心性肥胖者长期生存率最差。例如，一名BMI正常（22kg/m²）且有中心性肥胖的男性，其全因死亡率风险高于BMI相似但无中心性肥胖的男性（风险比[HR]，1.87[95%CI，1.53至2.29]），且该男性的死亡风险是仅根据BMI判断为超重或肥胖参与者的两倍（HR分别为2.24[CI，1.52至3.32]和2.42[CI，1.30至4.53]）。正常体重的中心性肥胖女性的死亡风险也高于BMI相似但无中心性肥胖的女性（HR，1.48[CI，1.35至1.62]）以及仅根据BMI判断为肥胖的女性（HR，1.32[CI，1.15至1.51]）。在控制年龄和BMI后，中心性肥胖者的预期生存估计值始终较低。
局限性
仅基于人体测量指标评估体脂分布。合并症信息通过自我报告收集。
结论
由WHR定义的正常体重中心性肥胖比由BMI定义的肥胖与更高的死亡率相关，尤其是在没有中心性脂肪分布的情况下。
主要资金来源
美国国立卫生研究院、美国心脏协会、欧洲区域发展基金和捷克卫生部。
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