An evidence-based assessment of federal guidelines for overweight and obesity as they apply to elderly persons
An evidence-based assessment of federal guidelines for overweight and obesity as they apply to elderly persons
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DOI：
10.1001/archinte.161.9.1194
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发表时间：
2001-05-14
影响因子：
--
通讯作者：
Krumholz, HM
中科院分区：
文献类型：
--
作者：
Heiat, A;Vaccarino, V;Krumholz, HM
背景资料：美国成人超重和肥胖的识别、评估和治疗临床指南将体重指数（BMI;体重（kg）除以身高（m）的平方）设定为25，作为所有成人（无论年龄）的理想体重上限。然而，超重和肥胖在老年人（大于或等于65岁）的预后重要性是有争议的。我们试图分析指南的背景下，目前可用的证据，是相关的老年adultes.Methods：我们搜索MEDLINE的所有英文研究之间的关联BMI和全因或心血管死亡率或冠心病事件从1966年1月至1999年10月。通过MEDLINE文章的参考书目识别其他相关文章。我们选择那些报告了BMI与65岁或以上非住院受试者死亡率之间的相关性并随访至少3年的研究进行详细回顾。我们控制了年龄、吸烟和基线健康状况。在筛选的444篇文章中，选择了13篇来评估指南。我们提取有关出版年份，研究设计，人口，招募期，随访持续时间，受试者人数，性别，年龄范围，纳入和排除标准，统计模型，包括变量和endpoint.Results：这些数据不支持BMI范围为25至27作为老年人全因和心血管死亡率的危险因素。男性和女性的结果没有实质性差异。大多数研究显示BMI与全因死亡率之间存在负相关或无相关性。三项研究表明超重（BMI大于或等于27）是65至74岁人群全因和心血管死亡率的重要预后因素，一项研究显示超重（BMI大于或等于28）与75岁或以上人群全因死亡率之间存在显著正相关。较高的BMI值是一致的，一个较小的相对死亡率风险在老年人相比，年轻和中年population.Conclusions：联邦指南标准的理想。体重（BMI 18.7至
Background: The US Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults set the body mass index (BMI; weight in kilograms divided by the square of height in meters) of 25 as the upper Limit of ideal weight for all adults regardless of age. However, the prognostic importance of overweight and obesity in elderly persons (greater than or equal to 65 years) is controversial. We sought to analyze the guidelines in the context of currently available evidence that is relevant to older adults.Methods: We searched MEDLINE for all English-language studies of the association between BMI and all-cause or cardiovascular mortality or coronary heart disease events from January 1966 through October 1999. Additional pertinent articles were identified through bibliographies of the MEDLINE articles. We selected studies for detailed review if they reported on the association between BMI and mortality for nonhospitalized subjects who were 65 years or older and had been followed up for at least 3 years. We controlled for age, smoking, and baseline health status. Of the 444 screened articles, 13 were selected to assess the guidelines. We extracted information regarding publication year, study design, population, recruitment period, follow-up duration, number of subjects, sex, age range, inclusion and exclusion criteria, and statistical models, including variables and end points.Results: These data do not support the BMI range of 25 to 27 as a risk factor for all-cause and cardiovascular mortality among elderly persons. The results were not substantially different for men and women. Most studies showed a negative or no association between BMI and all-cause mortality. Three studies indicated overweight (BMI greater than or equal to 27) as a significant prognostic factor for all-cause and cardiovascular mortality among 65- to 74-year-olds, and one study showed a significant positive association between overweight (BMI greater than or equal to 28) and all-cause mortality among those 75 years or older. Higher BMI values were consistent with a smaller relative mortality risk in elderly persons compared with young and middle-aged populations.Conclusions: Federal guideline standards for ideal. weight (BMI 18.7 to