The changing relationship of obesity and disability, 1988-2004
The changing relationship of obesity and disability, 1988-2004
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DOI：
10.1001/jama.298.17.2020
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发表时间：
2007-11-07
影响因子：
120.7
通讯作者：
Chang, Virginia W.
中科院分区：
文献类型：
--
作者：
Alley, Dawn E.;Chang, Virginia W.
最近的研究表明，肥胖人群可能已经越来越健康，自20世纪60年代以来，死亡率和心血管危险因素的下降表明。然而，这些改善是否降低了残疾风险尚不清楚。肥胖人群可能会活得更长，风险因素得到更好的控制，但矛盾的是，他们会经历更多的残疾。60岁及以上的成年人（N = 9928），测量的体重指数来自全国代表性国家健康和营养检查调查的2波（国家残疾人健康和营养状况调查III [1988-1994年]和国家残疾人健康和营养状况调查1999 - 2004年）。主要结果测量报告在2个残疾领域中执行任务有很大困难或无能力：功能限制（步行四分之一英里，走上10级台阶，弯腰，举重10磅，在房间之间行走，和从无扶手椅上站立）和日常生活活动（ADL）限制结果肥胖人群功能障碍患病率增加5.4%（从36.8%-42.2%; P = 0.03）之间的2次调查，和ADL损害没有改变。在时间1（1988-1994），肥胖个体功能障碍的几率是正常体重个体的1.78倍（95%置信区间[CI]，1.47-2.16）。在时间2（1999-2004），该比值比增加到2.75（95%CI，2.39-3.17），因为在此期间肥胖个体的功能障碍的比值比增加了43%（OR 1.43; 95%CI，1.18-1.75），但在非肥胖个体中没有变化。在ADL受损方面，在时间1时，肥胖个体的比值并不显著大于正常体重个体（OR，1.31; 95%CI，0.92-1.88），但在时间2时增加至2.05（95%CI，1.45-2.88）。这是因为ADL障碍的几率并没有改变肥胖个体，但减少了34%，在非肥胖个体（OR，0.66; 95%CI，0.50-0.88）。结论最近的心血管疾病的改善并没有伴随着减少残疾的肥胖老年人口。相反，1999-2004年调查的肥胖参与者比1988-1994年调查的肥胖参与者更有可能报告功能障碍，并且在非肥胖老年人中观察到的ADL障碍的减少并没有发生在肥胖者中。随着时间的推移，与肥胖相关的死亡率下降，沿着出现肥胖的年龄更小，可能导致肥胖老年人口中残疾负担的增加。
Context Recent studies suggest that the obese population may have been growing healthier since the 1960s, as indicated by a decrease in mortality and cardiovascular risk factors. However, whether these improvements have conferred decreased risk for disability is unknown. The obese population may be living longer with better-controlled risk factors but paradoxically experiencing more disability.Objective To determine whether the association between obesity and disability has changed over time.Design, Setting, and Participants Adults aged 60 years and older (N = 9928) with measured body mass index from 2 waves of the nationally representative National Health and Nutrition Examination Surveys (NHANES III [1988-1994] and NHANES 19992004).Main Outcome Measures Reports of much difficulty or inability to perform tasks in 2 disability domains: functional limitations (walking one-fourth mile, walking up 10 steps, stooping, lifting 10 lb, walking between rooms, and standing from an armless chair) and activities of daily living (ADL) limitations (transferring, eating, and dressing).Results Among obese individuals, the prevalence of functional impairment increased 5.4% (from 36.8%-42.2%; P = .03) between the 2 surveys, and ADL impairment did not change. At time 1 (1988-1994), the odds of functional impairment for obese individuals were 1.78 times greater than for normal-weight individuals (95% confidence interval [CI], 1.47-2.16). At time 2 (1999-2004), this odds ratio increased to 2.75 (95% CI, 2.39-3.17), because the odds of functional impairment increased by 43% (OR 1.43; 95% CI, 1.18-1.75) among obese individuals during this period, but did not change among nonobese individuals. With respect to ADL impairment, odds for obese individuals were not significantly greater than for individuals with normal weight (OR, 1.31; 95% CI, 0.92-1.88) at time 1, but increased to 2.05 (95% CI, 1.45-2.88) at time 2. This was because the odds of ADL impairment did not change for obese individuals but decreased by 34% among nonobese individuals (OR, 0.66; 95% CI, 0.50-0.88).Conclusions Recent cardiovascular improvements have not been accompanied by reduced disability within the obese older population. Rather, obese participants surveyed during 1999-2004 were more likely to report functional impairments than obese participants surveyed during 1988-1994, and reductions in ADL impairment observed for nonobese older individuals did not occur in those who were obese. Over time, declines in obesity-related mortality, along with a younger age at onset of obesity, could lead to an increased burden of disability within the obese older population.