Visual acuity and increased mortality: the role of allostatic load and functional status.
Visual acuity and increased mortality: the role of allostatic load and functional status.
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视力和死亡率增加：稳态负荷和功能状态的作用。
DOI：
10.1167/iovs.14-14202
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发表时间：
2014
影响因子：
4.4
通讯作者：
Lee,DavidJ
中科院分区：
文献类型：
--
作者：
Zheng,DDiane;Christ,SharonL;Lam,ByronL;Tannenbaum,StaceyL;Bokman,ChristineL;Arheart,KristopherL;McClure,LauraA;Fernandez,CristinaA;Lee,DavidJ
目的：视力不佳可能会在精神上影响功能状态并影响非稳态负荷（AL），这是对身体调节系统的累积生理磨损和撕裂的测量。我们研究了视力（VA）对死亡率的直接影响以及通过其对老年人功能状态和AL的影响对死亡率的间接影响。方法：分析了1999-2004年国家健康与营养调查（NHANES）中4981名参与者（年龄≥ 60岁）至2006年的死亡率相关数据。功能状态通过日常生活活动（ADL）和工具性日常生活活动（IADL）进行评估。AL指数由10种生物标志物组成：收缩压和舒张压、体重指数（BMI）、糖化血红蛋白、总胆固醇、甘油三酯、白蛋白、C-反应蛋白、同型半胱氨酸和肌酐清除率。视力分类为无（20/20-20/25）、轻度（20/30-20/40）、中度（20/50-20/80）或重度（≥ 20/200）视力损害。使用代表ADL、IADL和AL的三个中介变量的结构方程模型研究VA对全因和心血管疾病（CVD）相关死亡率的影响。结果：调整所有协变量后，VA类别的1个单位变化增加死亡风险（风险比[HR]= 1.17; 95%置信区间[CI] 1.05，1.32）; IADL和AL预测死亡率（HR= 1.15; CI 1.10，1.20和HR= 1.13; CI 1.06，1.20）。日常生活活动不能预测死亡率（HR= 0.98; CI 0.91，1.05）。VA越差，AL越高（β= 0.11; P= 0.013），IADL越差（β= 1.06; P< 0.001）。VA恶化通过AL（HR= 1.01; CI 1.00，1.03）和IADL（HR= 1.16; CI 1.09，1.23）间接增加死亡风险。VA对死亡率（包括通过IADL和AL）的总效应为HR= 1.38（CI 1.23，1.54）。当检查心血管疾病相关死亡率时，发现了类似但略强的相关模式，但与癌症相关死亡率无关。非稳态负荷，特别是IADL可能是VA损害和死亡率之间的介质。VA损伤的老年人可能从旨在预防IADL功能状态下降的干预措施中获益，以降低死亡风险。
Purpose.: Poor vision may detrimentally impact functional status and affect allostatic load (AL), a measure of cumulative physiological wear and tear on the body's regulatory systems. We examined the direct effects of visual acuity (VA) on mortality and its indirect effect on mortality through its impact on functional status and AL in older adults.Methods.: Data from 4981 participants (age≥ 60 years) from the 1999–2004 National Health and Nutrition Examination Survey (NHANES) with mortality linkage through 2006 were analyzed. Functional status was assessed by activities of daily living (ADL) and instrumental activities of daily living (IADL). The AL index was composed of 10 biomarkers: systolic and diastolic blood pressures, body mass index (BMI), glycosylated hemoglobin, total cholesterol, triglycerides, albumin, C-reactive protein, homocysteine, and creatinine clearance. Visual acuity was categorized as no (20/20–20/25), mild (20/30–20/40), moderate (20/50–20/80), or severe (≥ 20/200) visual impairment. Structural equation modeling using three mediating variables representing ADL, IADL, and AL examined the effects of VA on all-cause and cardiovascular disease (CVD)-related mortality.Results.: Adjusting for all covariates, a one-unit change in VA category increased mortality risk (hazard ratio [HR]= 1.17; 95% confidence interval [CI] 1.05, 1.32); IADL and AL predicted mortality (HR= 1.15; CI 1.10, 1.20 and HR= 1.13; CI 1.06, 1.20, respectively). Activities of daily living did not predict mortality (HR= 0.98; CI 0.91, 1.05). Worse VA was associated with increased AL (β= 0.11; P= 0.013) and worse IADL (β= 1.06; P< 0.001). Worse VA increased mortality risk indirectly through AL (HR= 1.01; CI 1.00, 1.03) and IADL (HR= 1.16; CI 1.09, 1.23). The total effect of VA on mortality including through IADL and AL was HR= 1.38 (CI 1.23, 1.54). Similar but slightly stronger patterns of association were found when examining CVD-related mortality, but not cancer-related mortality.Conclusions.: Allostatic load and particularly IADL may function as mediators between VA impairment and mortality. Older adults with VA impairment could potentially benefit from interventions designed to prevent IADL functional status decline to reduce the risk of mortality.
5-氮杂胞苷对细胞转化进行性的影响。
影响因子：
5.3
作者：
Hsiao,WL;Gattoni-Celli,S;Weinstein,IB
通讯作者：
Weinstein,IB