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這項研究發現，即使是正常體重的人，如果存在中心性肥胖（腰臀比高），他們的總體和心血管死亡風險也顯著增加。分析了超過15,000名成年人的長期存活率，發現中心性肥胖者與非中心性肥胖者相比，無論男性還是女性，其死亡風險都明顯較高。這項研究強調了即使在正常體重範圍內，脂肪分佈的重要性。

正常體重的中心性肥胖：對總和心血管死亡率的影響

Normal-Weight Central Obesity: Implications for Total and Cardiovascular Mortality

摘要

背景：

對於社區居民成年人中，中心性肥胖與正常身體質量指數（BMI）的存活率之間的關係尚不清楚。

目的：

檢查與中心性肥胖和正常BMI相關的總死亡率和心血管死亡率風險。

設計：

分層多階概率設計。

設定：

NHANES III（第三次全國健康和營養檢查調查）。

參與者：

年齡在18至90歲之間的15,184名成年人（52.3％為女性）。

測量：

使用多變量Cox比例風險模型來評估在調整混淆因素後，由BMI和腰臀比（WHR）定義的肥胖模式與總死亡率和心血管死亡風險的關係。

結果：

具有正常體重的中心性肥胖者有最差的長期存活率。例如，一個具有正常BMI（22 kg/m2）且中心肥胖的男性，其總死亡風險比相同BMI但無中心肥胖的男性高（風險比[HR]，1.87 [95％ CI，1.53至2.29]），並且此男性的死亡風險是僅根據BMI被評為過重或肥胖的參與者的兩倍（HR，2.24 [CI，1.52至3.32]和2.42 [CI，1.30至4.53]）。根據BMI而言，具有正常體重的中心肥胖的女性也比無中心肥胖的相同BMI女性（HR，1.48 [CI，1.35至1.62]）以及僅被評為BMI肥胖的女性（HR，1.32 [CI，1.15至1.51]）有更高的死亡風險。在控制年齡和BMI時，中心肥胖者的預期存活估計一直較低。

限制：

僅根據人體测量指標評估體脂分佈。共病症的信息是由自我報告收集的。

結論：

由WHR定義的正常體重中心肥胖與BMI定義的肥胖相比，死亡率更高，特別是在沒有中心脂肪分佈的情況下。

主要資金來源：

國家健康研究院，美國心臟協會，歐洲區域發展基金，和捷克衛生部。

Abstract

Background

The relationship between central obesity and survival in community-dwelling adults with normal body mass index (BMI) is not well-known.

Objective:

To examine total and cardiovascular mortality risks associated with central obesity and normal BMI.

Design:

Stratified mulstage probability design.

Setting:

NHANES III (Third National Health and Nutrition Examination Survey).

Participants:

15 184 adults (52.3% women) aged 18 to 90 years.

Measurements:

Multivariable Cox proportional hazards models were used to evaluate the relationship of obesity patterns defined by BMI and waist-to-hip ratio (WHR) and total and cardiovascular mortality risk after adjustment for confounding factors.

Results:

Persons with normal-weight central obesity had the worst long-term survival. For example, a man with a normal BMI (22 kg/m2) and central obesity had greater total mortality risk than one with similar BMI but no central obesity (hazard ratio [HR], 1.87 [95% CI, 1.53 to 2.29]), and this man had twice the mortality risk of participants who were overweight or obese according to BMI only (HR, 2.24 [CI, 1.52 to 3.32] and 2.42 [CI, 1.30 to 4.53], respectively). Women with normal-weight central obesity also had a higher mortality risk than those with similar BMI but no central obesity (HR, 1.48 [CI, 1.35 to 1.62]) and those who were obese according to BMI only (HR, 1.32 [CI, 1.15 to 1.51]). Expected survival estimates were consistently lower for those with central obesity when age and BMI were controlled for.

Limitations:

Body fat distribution was assessed based on anthropometric indicators alone. Information on comorbidities was collected by self-report.

Conclusion:

Normal-weight central obesity defined by WHR is associated with higher mortality than BMI-defined obesity, particularly in the absence of central fat distribution.

Primary Funding Source:

National Institutes of Health, American Heart Association, European Regional Development Fund, and Czech Ministry of Health.