中國疾控中心施小明團隊：高齡老人體質指數與日常生活自理能力失能風險的關係

2018年9月7日，JAMA Network Open刊登了中國疾病預防控制中心環境與健康相關產品安全所施小明研究團隊的最新研究成果「Association of body mass index with disability in activities of daily living among Chinese adults 80 years of age or older」。該原創性論著文章基於客觀方法測量體質指數（BMI）與國際通用方法測量日常生活自理能力（ADL），利用16 022名80歲及以上高齡老人70 606人年隨訪樣本信息，分析發現中國高齡老人較高的BMI與較低的ADL失能風險存在關聯關係，研究提示高齡老人BMI推薦標準需要重新審視，在高齡老人的體重管理和ADL失能風險控制方面應更多關注低體重而非超重或肥胖。

撰文 呂躍斌 （論文第一作者）

隨著高血壓、中風、2型糖尿病等患病率在全世界範圍內的逐年增加，肥胖已成為一個日益嚴峻的公共衛生問題。該研究通過縱向研究探討了中國高齡老人（80歲以上）BMI與其ADL中失能風險之間的關係，發現在高齡老人預防 ADL 失能中，需更加註意體重過低不是超重或肥胖的問題。

BMI 與成年人身體機能受損及死亡率均呈U型關係，但這種關係隨著年齡增長而逐步減弱。80歲以上高齡老人是中國人群中數量增長最快的群體，探究在這一年齡組 BMI 與日常生活能力中殘疾風險是否存在關聯極具現實意義。

本文使用懲罰樣條 Cox 模型、Cox 比例風險模型，並控制相關混雜因素。利用中國23個省份，16 022名高齡老人探討中國高齡老人 BMI 與 ADL失能的相關性。

BMI 與 ADL 失能呈線性相關，BMI每增加1 kg/m2, ADL失能風險降低4.5%。將BMI按照中國肥胖問題工作組頒布的指南分級時，與BMI正常組（BMI:18.5 ~ 24.0）相比，體重過低組（BMI

圖1 不同分位數BMI中國高齡老人ADL殘疾的發生率

（圖片來源：JAMA Network Open）

中高齡老年人群 ADL 失能的發生率整體顯示出隨 BMI 分位數升高而降低的趨勢。整個隊列人群發生率為11.5例/100人-年，第一分位組高達14.3例/100人-年，而第五分位組為8.4例/100人-年。

圖2 Cox比例風險回歸模型中BMI與ADL失能的相關性

（圖片來源：JAMA Network Open）

通過懲罰樣條 Cox 回歸模型分析 ADL 殘疾發生風險與 BMI 的潛在曲線關係，結果顯示二者整體上線性關係（P

圖3 80歲以上成年人BMI與ADL殘疾的關係

（圖片來源：JAMA Network Open ）

控制基本信息、生活方式、基礎疾病等混雜因素後，按中國指南肥胖分級以及BMI分位數分組進行COX回歸分析均顯示BMI低伴隨著ADL殘疾的發生風險顯著升高。

公共衛生及臨床實踐意義：

施小明研究團隊在此項以社區為基礎的中國高齡老人前瞻性大型隊列研究中發現對於80歲或以上的老年人，BMI 較高組 ADL 失能風險較低。因此，為了預防 ADL失能，在80歲及以上的老年人中應該更加關注體重過低，而不是超重或肥胖的問題。研究結果進一步支持了世界衛生組織或中國肥胖工作組有關超重和肥胖的指南並不適用於高齡老人的觀點。隨著預期壽命的增加以及超重、肥胖人群數量的增加，在未來的研究中，重新評估 BMI 在80歲或以上老年人群的疾病人口負擔中的作用是極為重要的。同時，在公共衛生政策制定時可能需要根據80歲以上高齡老人的特殊性為其制定特定的體重管理指南，從而更好地開展高齡老人肥胖相關疾病的防控工作，降低失能風險，提高生活質量，促進健康長壽。

施小明研究團隊今年還在BMJ雜誌以及兩次在中科院一區期刊Journal of the American Medical Directors Association（JAMDA，影響因子5.325）發表有關體質指數和血壓與高齡老人健康的關係研究，研究結果均提示對這一年齡段的人群應審慎地、個體化地開展體重管理和血壓管理。這一系列原創性研究成果對高齡老人疾病防控和健康促進具有重要指導意義，為相關公共衛生政策的制定提供重要參考依據。

相關論文信息

標題Association of Body Mass Index with Disability in Activities of Daily Living Among Chinese Adults 80 Years of Age or Older

發表日期September 7, 2018

期刊JAMA Network Open

作者Yue-Bin Lv; Jin-Qiu Yuan; Chen Mao; et al

doi:10.1001/jamanetworkopen.2018.1915

摘要Importance Body mass index (BMI) shows a U-shaped association with impaired physical functioning among adults; the association is reduced or eliminated with aging.

Objective To examine whether BMI is associated with subsequent disability in activities of daily living (ADL) in Chinese adults age 80 years or older.

Design, Setting, and Participants Data were obtained on 16 022 adults age 80 years or older who were able to perform ADL independently at baseline from the Chinese Longitudinal Healthy Longevity Study, a community-based prospective cohort study conducted in 23 provinces of China. The study was initiated in 1998, with follow-up and recruitment of new participants in 2000, 2002, 2005, 2008, 2011, and 2014.

Main Outcomes and Measures Disability in ADL was defined as dependence in eating, toileting, bathing, dressing, indoor activities, and/or continence.

Results Among the 16 022 participants, 45.2% were men and 54.8% were women, with a mean (SD) age of 92.2 (7.2) years and a mean (SD) BMI (calculated as weight in kilograms divided by height in meters squared) of 19.3 (3.8). During 70 606 person-years of follow-up, 8113 participants with disability in ADL were identified. Cox proportional hazards regression models with penalized splines showed that BMI was linearly associated with disability in ADL: each 1-kg/m2 increase in BMI corresponded to a 4.5% decrease in the risk of disability in ADL. In comparison with individuals in the fourth quintile for BMI, the adjusted hazard ratio for disability in ADL was 1.38 (95% CI, 1.29-1.48) in the first quintile, 1.37 (95% CI, 1.28-1.47) in the second quintile, 1.11 (95% CI, 1.04-1.19) in the third quintile, and 0.85 (95% CI, 0.79-0.91) in the fifth quintile (P?

Conclusions and Relevance Higher BMI was associated with a lower risk of disability in ADL among Chinese adults age 80 years or older, which suggests that current recommendations for BMI may need to be revisited. More attention should be paid on underweight, rather than overweight or obesity, for the prevention of disability in ADL after age 80 years.

論文鏈接

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2701738#full-text-tab

參考文獻

1．Lv YB, Yuan JQ, Mao C, Gao X, Yin ZX, Kraus VB, Luo JS, Chen HS, Zeng Y, Wang WT, Wang JN, Shi XM*.Association of Body Mass Index With Disability in Activities of Daily Living Among Chinese Adults 80 Years of Age or Older. JAMA Network Open.2018;1(5):e181915.DOI:https://doi.org/10.1001/jamanetworkopen.2018.1915(Published 07 September 2018)

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