Obesity, race, and risk for death or functional decline among Medicare beneficiaries: a cohort study.
Obesity, race, and risk for death or functional decline among Medicare beneficiaries: a cohort study.
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DOI：
10.7326/0003-4819-154-10-201105170-00003
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发表时间：
2011-05-17
影响因子：
39.2
通讯作者：
McCarthy EP
中科院分区：
文献类型：
--
作者：
Wee CC;Huskey KW;Ngo LH;Fowler-Brown A;Leveille SG;Mittlemen MA;McCarthy EP
肥胖对健康结果的不利影响在老年人和非裔美国人中可能低于美国普通人群。研究和比较美国老年人肥胖与全因死亡率和功能下降之间的关系。纵向队列研究。对1994-2000年医疗保险当前受益人调查数据的二次分析，该调查与截至2008年4月22日的医疗保险登记文件有关。1994-2000年医疗保险当前受益人调查的20，975名社区居住参与者，年龄在65岁及以上。截至2008年4月22日的全因死亡; 2年内日常生活活动（ADL）和工具性日常生活活动（IADL）新发/恶化残疾。在研究样本中，37%的人超重（BMI 25-30 kg/m2），18%的人肥胖（BMI>30 kg/m2）; 48%的人在14年的随访期间死亡; 27%的人在基线时有ADL，43%的人有IADL残疾。在基线时无严重残疾的患者中，17%在2年内发生了新发/恶化的ADL残疾; 26%发生了新发/恶化的IADL残疾。调整后，BMI>35 kg/m2的成年人是唯一高于正常BMI范围的死亡风险较高的人群[男性风险比为1.49（1.20，1.85），女性风险比为1.21（1.06，1.39）]，与参考组（BMI=22.0-24.9 kg/m2）相比，BMI-性别相互作用p=0.003。相反，超重和肥胖与新的或进行性ADL和IADL残疾相关，呈剂量依赖性，特别是对于白色男性和女性。我们发现BMI和性别之间存在显著的相互作用，但BMI和种族之间没有任何结果，尽管非裔美国人相对于白人的ADL残疾风险估计普遍减弱。观察性研究;基线数据是自我报告的;检测白人和非裔美国人之间差异的能力有限。在美国老年人中，肥胖与死亡率无关，除了那些至少中度严重肥胖的人。然而，较低的肥胖水平与两年内新的或恶化的残疾有关。预防老年人残疾的努力应该针对那些超重或肥胖的人。
The adverse impact of obesity on health outcomes may be lower in older adults and African Americans than the general US population. To examine and compare the relationship between obesity and all-cause mortality and functional decline among older US adults. Longitudinal cohort study. Secondary analysis of data from the 1994-2000 Medicare Current Beneficiary Survey linked to Medicare Enrollment files through 4/22/2008. 20,975 community-dwelling participants of the 1994-2000 Medicare Current Beneficiary Survey who were aged 65 and older. All-cause mortality through 4/22/2008; new/worsening disability in performing activities of daily living (ADL) and instrumental activities of daily living (IADL) within 2 years. Of the study sample, 37% were overweight (BMI 25-30 kg/m2), and 18% were obese (BMI>30 kg/m2); 48% died during the 14 years of follow-up; 27% had ADL and 43% had IADL disability at baseline. Of those without severe disability at baseline, 17% developed new/worsening ADL disability within 2 years; 26% developed new/worsening IADL disability. After adjustment, adults with a BMI>35 kg/m2 were the only group above the normal BMI range that were at higher risk of mortality [Hazard Ratio in men, 1.49 (1.20, 1.85) and in women, 1.21 (1.06, 1.39)] when compared to the reference group (BMI=22.0-24.9 kg/m2), p=0.003 for BMI-sex interaction. In contrast, both overweight and obesity were associated with new or progressive ADL and IADL disability in a dose-dependent fashion, particularly for White men and women. We detected significant interactions between BMI and sex, but not between BMI and race for any outcome although risk estimates for ADL disability appeared generally attenuated in African Americans relative to Whites. Observational study; baseline data are self-reported; limited power to detect differences between Whites and African Americans. Among older US adults, obesity was not associated with mortality except for those with at least moderately severe obesity. However, lower levels of obesity were associated with the development of new or worsening disability within two years. Efforts to prevent disability in older adults should target those who are overweight or obese.
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影响因子：
158.5
作者：
Calle, EE;Thun, MJ;Heath, CW
通讯作者：
Heath, CW
影响因子：
4.5
作者：
Villanueva EV
通讯作者：
Villanueva EV
DOI：
10.1111/j.1532-5415.2009.02486.x
发表时间：
2009-11-01
影响因子：
6.3
作者：
Kuk, Jennifer L.;Ardern, Chris I.
通讯作者：
Ardern, Chris I.
影响因子：
6.9
作者：
Manini, Todd M.;Newman, Anne B.;Fielding, Roger;Blair, Steven N.;Perri, Michael G.;Anton, Stephen D.;Goodpaster, Bret C.;Katula, Jeff A.;Rejeski, Walter J.;Kritchevsky, Stephen B.;Hsu, Fang-Chi;Pahor, Marco
通讯作者：
Pahor, Marco
影响因子：
8.9
作者：
Janssen, I.;Mark, A. E.
通讯作者：
Mark, A. E.