Obesity, weight change, and functional decline in peripheral arterial disease
Obesity, weight change, and functional decline in peripheral arterial disease
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DOI：
10.1016/j.jvs.2006.02.036
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发表时间：
2006-06-01
影响因子：
4.3
通讯作者：
Pearce, William H.
中科院分区：
文献类型：
--
作者：
McDermott, Mary M.;Criqui, Michael H.;Pearce, William H.
背景：我们的目标是确定与理想体重指数(BMI)相比，肥胖是否与外周动脉疾病(PAD)患者的功能下降有关，并确定体重增减与PAD功能下降之间的关系。我们假设，基线肥胖和随访期间的体重增加都与PAD患者的功能下降有关。这项设计是一项前瞻性队列研究。受试者为389名患有PAD的男性和女性(平均踝臂指数为0.65+/-0.14)，前瞻性地进行了中位数48个月的随访。主要观察指标为功能评定(6分钟步行、常走和快走4米步行速度、综合成绩评分)。在基线和每年测量体重和身高。结果根据年龄、性别、种族、合并症、踝臂指数、教育程度、腿部症状、锻炼状况、抑郁症状、吸烟年限、前一年的功能和丢失数据的模式进行了调整。结果。与基线体重指数在20到25 kg/m(2)之间的PAD参与者相比，基线体重指数大于30 kg/m(2)的PAD参与者在6分钟步行能力(-13.1vs-26.5m/y；P=0.004)、普通步速(-0.028 vs-0.055 m/S/年；P=.024)和快节奏4米步行速度(-0.053 vs-0.086 m/S/年；P=.012)方面的年平均降幅显著大于那些基线体重指数在20到25 kg/m(2)之间的PAD参与者。基线后体重增加在5-10磅之间，经常步行锻炼的人在6分钟步行中的下降幅度明显小于不步行锻炼的体重没有明显变化的人(P=0.04)。肥胖与PAD患者的功能衰退有关。步行锻炼可以防止体重适度增加的PAD患者的功能下降。
Background: Our objectives were to determine whether obesity is associated with a greater functional decline compared with the ideal body mass index (BMI) among persons with peripheral arterial disease (PAD) and to determine the associations between weight gain and loss and functional declines in PAD. We hypothesized that baseline obesity and weight gain during follow-up would each be associated with functional declines in persons with PAD.Methods. The design was a prospective cohort study. The subjects were 389 men and women with PAD (mean ankle-brachial index, 0.65 +/- 0.14) who were followed up prospectively for a median of 48 months. The main outcome measures were functional assessments (6-minute walk, usual- and rapid-paced 4-m walking speed, and summary performance score). Weight and height were measured at baseline and annually.Results were adjusted for age, sex, race, comorbidities, ankle-brachial index, education, leg symptoms, exercise status, depressive symptoms, pack-years of cigarette smoking, prior-year functioning, and patterns of missing data. Results. Compared with those with a baseline BMI between 20 and 25 kg/m(2), PAD participants with baseline BMI greater than 30 kg/m(2) had a significantly greater average annual decline in 6-minute walk performance (- 13.1 vs -26.5 m/y; P =.004), usual-paced 4-m walking velocity (-0.028 vs -0.055 m/s per year; P =.024), and fast-paced 4-m walking velocity (-0.053 vs -0.086 m/s per year; P =.012). Persons with weight gain between 5 and 10 pounds after baseline who walked for exercise regularly had significantly less decline in the 6-minute walk than persons without significant weight change who did not walk for exercise (P =.04).Conclusions. Obesity is associated with functional decline in persons with PAD. Walking exercise may protect against functional decline in PAD persons with modest weight gain.