Survival in Older Men May Benefit From Being Slightly Overweight and Centrally Obese-A 5-Year Follow-up Study in 4,000 Older Adults Using DXA
Survival in Older Men May Benefit From Being Slightly Overweight and Centrally Obese-A 5-Year Follow-up Study in 4,000 Older Adults Using DXA
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DOI：
10.1093/gerona/glp099
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发表时间：
2010-01-01
影响因子：
5.1
通讯作者：
Woo, Jean
中科院分区：
文献类型：
--
作者：
Auyeung, Tung Wai;Lee, Jenny S. W.;Woo, Jean
老年超重是否危险仍存在争议。身体质量指数(BMI)高估了肥胖程度，无法衡量中心性肥胖程度。我们使用双能X射线吸收测量仪(DXA)来测量肥胖，并假设总体肥胖、肥胖分布和肌肉质量可能单独影响生存。我们招募了2000名男性和2000名女性，年龄在65岁或以上。测量基线BMI、腰臀比(WHR)、体脂指数(BFI=全身脂肪/身高平方)、相对躯干脂肪(RTF=躯干脂肪/全身脂肪)和身体肌肉质量指数(BMMI=全身肌肉质量/身高平方)。死亡率在63.3(中位数)个月后通过死亡登记确定。242名男性和78名女性死亡。在男性中，BMI、BFI和BMMI每增加五分位数，死亡风险比(HR)分别持续下降0.85(p<；.005)、0.86(p<；.005)和0.86(p<；.005)。中心性肥胖症(RTF和WHR)五分位数之间呈J型关系，最小值出现在第三个WHR五分位数(0.92~0.94)和第四个RTF五分位数(平均0.94)。当用BFI测试RTF时，高和低中心性肥胖都是不利的，而一般肥胖则变得微不足道(p=0.062)。当BFI和BMMI一起测试时，增加肥胖而不是肌肉质量有利于生存(BFI五分位数，HR 0.97，p.015；BMMI五分位数，HR 1.00，p.997)。老年男性对超重和肥胖的危险具有抵抗力；轻度超重、肥胖，甚至中心性肥胖可能具有保护作用。这可能对BMI和WHR在老年人群中的建议临界值产生重大影响。
Whether overweight in old age is hazardous remains controversial. Body mass index (BMI) overestimates adiposity and fails to measure central adiposity. We used dual-energy x-ray absorptiometry (DXA) to measure adiposity and hypothesized that overall adiposity, distribution of adiposity, and muscle mass might individually affect survival.We recruited 2000 men and 2000 women aged 65 years or older. Baseline BMI, waist-hip ratio (WHR), body fat index (BFI = total body fat/height square), relative truncal fat (RTF = trunk fat/total body fat), and body muscle mass index (BMMI = total body muscle mass/height square) were measured. Mortality was ascertained by death registry after 63.3 (median) months.Two hundred and forty-two men and 78 women died. In men, mortality hazard ratio (HR) decreased consistently by 0.85 (p < .005), 0.86 (p < .005), and 0.86 (p < .005) per every quintile increase in BMI, BFI, and BMMI, respectively. A J-shaped relationship was observed in central adiposity (RTF and WHR) quintiles; the minimum values were at the 3rd WHR quintile (0.92-0.94) and 4th RTF quintile (mean WHR, 0.94). When RTF was tested with BFI, both high and low central adiposity were unfavorable while general adiposity became marginally insignificant (p = 0.062). When BFI and BMMI were tested together, increasing adiposity rather than muscle mass favored survival (BFI quintile, HR 0.97, p .015; BMMI quintile, HR 1.00, p .997).Older men were resistive to hazards of overweight and adiposity; and mild-grade overweight, obesity, and even central obesity might be protective. This may bear significant implication on the recommended cutoff values for BMI and WHR in the older population.