Sarcopenia, sarcopenic obesity and mortality in older adults: results from the National Health and Nutrition Examination Survey III
Sarcopenia, sarcopenic obesity and mortality in older adults: results from the National Health and Nutrition Examination Survey III
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DOI：
10.1038/ejcn.2014.117
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发表时间：
2014-09-01
影响因子：
4.7
通讯作者：
Bartels, S. J.
中科院分区：
文献类型：
--
作者：
Batsis, J. A.;Mackenzie, T. A.;Bartels, S. J.
背景：肌肉减少症被定义为骨骼肌质量和质量的损失，随着衰老而加速，并与功能衰退相关。肥胖患病率的上升导致了患有这两种疾病的高危人群。我们评估了老年人与肌肉减少症和肌肉减少症肥胖相关的死亡风险。 方法：从全国健康和营养检查调查 III（1988-1994 年）中确定了 4652 名 60 岁以上受试者的子样本，该调查是一项针对非机构化成年人的横断面调查。国家死亡指数数据与该数据集相关联。 Janssen 等人使用生物电阻抗公式来定义肌少症，该公式使用磁共振成像测量的骨骼质量进行验证。根据身高调整后的总骨骼肌质量的临界值(2) 具有性别特异性（男性：= 38%）。模型根据年龄、性别、种族（模型 1）、合并症（高血压、糖尿病、充血性心力衰竭、骨质疏松症、癌症、冠状动脉疾病和关节炎）、吸烟、体力活动、自我报告的健康状况（模型 2）和活动受限（模型 3）来评估死亡率。 结果：平均年龄为 70.6 +/- 0.2 岁，其中 57.2% 为女性。中位随访时间为 14.3 年（四分位数范围：12.5-16.1）。女性肌少症的总体患病率为 35.4%，男性为 75.5%，且随着年龄的增长而增加。女性肥胖率为 60.8%，男性肥胖率为 54.4%。女性肌少症肥胖患病率为 18.1%，男性为 42.9%。死亡人数为 2782 人（61.7%），其中 39.0% 死于心血管疾病。调整后，患有肌少症和肌少症肥胖的女性比没有肌少症或肥胖的女性死亡风险更高（模型2，风险比（HR）：1.35（1.05-1.74）和1.29（1.03-1.60））。调整活动限制后（模型 3），单独的肌肉减少症（HR：1.32（（1.04-1.69））但肌肉减少症伴肥胖（HR：1.25（0.99-1.58））与死亡率相关。对于男性来说，肌肉减少症和肌肉减少症肥胖的死亡风险在模型 2 中均不显着（HR：0.98） (0.77-1.25) 和 HR: 0.99 (0.79-1.23)) 和模型 3 (HR: 0.98 (0.77-1.24) 和 HR: 0.98 (0.79-1.22))。结论：患有肌少症的老年女性的全因死亡风险增加，与肥胖无关。
BACKGROUND: Sarcopenia is defined as the loss of skeletal muscle mass and quality, which accelerates with aging and is associated with functional decline. Rising obesity prevalence has led to a high-risk group with both disorders. We assessed mortality risk associated with sarcopenia and sarcopenic obesity in elders.METHODS: A subsample of 4652 subjects >= 60 years of age was identified from the National Health and Nutrition Examination Survey III (1988-1994), a cross-sectional survey of non-institutionalized adults. National Death Index data were linked to this data set. Sarcopenia was defined using a bioelectrical impedance formula validated using magnetic resonance imaging-measured skeletal mass by Janssen et al. Cutoffs for total skeletal muscle mass adjusted for height(2) were sex-specific (men: = 38%). Modeling assessed mortality adjusting for age, sex, ethnicity (model 1), comorbidities (hypertension, diabetes, congestive heart failure, osteoporosis, cancer, coronary artery disease and arthritis), smoking, physical activity, self-reported health (model 2) and mobility limitations (model 3).RESULTS: Mean age was 70.6 +/- 0.2 years and 57.2% were female. Median follow-up was 14.3 years (interquartile range: 12.5-16.1). Overall prevalence of sarcopenia was 35.4% in women and 75.5% in men, which increased with age. Prevalence of obesity was 60.8% in women and 54.4% in men. Sarcopenic obesity prevalence was 18.1% in women and 42.9% in men. There were 2782 (61.7%) deaths, of which 39.0% were cardiovascular. Women with sarcopenia and sarcopenic obesity had a higher mortality risk than those without sarcopenia or obesity after adjustment (model 2, hazard ratio (HR): 1.35 (1.05-1.74) and 1.29 (1.03-1.60)). After adjusting for mobility limitations (model 3), sarcopenia alone (HR: 1.32 ((1.04-1.69) but not sarcopenia with obesity (HR: 1.25 (0.99-1.58)) was associated with mortality. For men, the risk of death with sarcopenia and sarcopenic obesity was nonsignificant in both model-2 (HR: 0.98 (0.77-1.25), and HR: 0.99 (0.79-1.23)) and model 3 (HR: 0.98 (0.77-1.24) and HR: 0.98 (0.79-1.22)).CONCLUSIONS: Older women with sarcopenia have an increased all-cause mortality risk independent of obesity.