老年人群体质量指数与慢性代谢性疾病的关系

doi:10.3969/j.issn.1674-8115.2024.02.011

摘要/Abstract

摘要：

目的·评估老年人群体质量指数（body mass index，BMI）与慢性代谢性疾病发生风险的关系。方法·以2014—2021年在上海交通大学医学院附属仁济医院体检中心进行体检的老年人（≥60岁）为研究对象。收集其各项生化指标。由经过培训的护士测量其身高、体质量和血压。采用问卷法收集研究对象既往慢性代谢性疾病史。收缩压≥140 mmHg（1 mmHg=0.133 kPa）、舒张压≥90 mmHg或既往有高血压病史，定义为高血压。空腹血糖≥7.0 mmol/L或既往有糖尿病病史，定义为糖尿病。总胆固醇≥6.2 mmol/L、三酰甘油≥2.3 mmol/L或既往有脂代谢异常病史，定义为脂质代谢紊乱。BMI与高血压、糖尿病和脂质代谢紊乱之间的关系采用受试者操作特征（receiver operator characteristic，ROC）曲线和二元Logistic回归进行分析评估。结果·共收集59 083例研究对象的资料，其中男性30 807例，女性28 276例，平均年龄（67.9±6.3）岁。高血压、糖尿病和脂质代谢紊乱的发生率分别为76.5%（45 219/59 083）、24.1%（14 225/59 083）和50.0%（29 544/59 083）。与60~74岁的老年人群相比，75岁及以上的老年人患高血压和糖尿病的比例更高，患脂质代谢紊乱和无代谢异常的比例更低。通过ROC曲线分析，BMI对于高血压、糖尿病和脂质代谢紊乱的切点值分别为24.3、23.9和23.9 kg/m²。老年男性高血压和糖尿病的BMI切点值和老年女性十分接近（高血压BMI切点值：老年男性24.3 kg/m²vs 老年女性24.2 kg/m²；糖尿病BMI切点值：老年男性24.0 kg/m²vs 老年女性23.7 kg/m²），但老年男性脂质代谢紊乱的BMI切点值明显高于老年女性（老年男性24.0 kg/m²vs 老年女性22.5 kg/m²）。60~74岁老年人的BMI对慢性代谢性疾病的切点值（24.2~24.7 kg/m²）高于75岁及以上的老年人（22.9~23.8 kg/m²）。结论·60~74岁老年人群应将BMI控制在24.0 kg/m²以下，而75岁及以上老年人群应将BMI控制在23.0 kg/m²以下，则有利于降低其慢性代谢性疾病的风险。

关键词: 身体质量指数, 慢性代谢性疾病, 老年人

Abstract:

Objective ·To evaluate the relationship between body mass index (BMI) and chronic metabolic diseases. Methods ·The elderly (≥60 years old) who were underwent physical examination in the Physical Examination Center of Renji Hospital, Shanghai Jiao Tong University School of Medicine from 2014 to 2021 were studied. Their results of biochemical indicators were collected. Their height, body weight, and blood pressure were measured by trained nurses. The history of chronic metabolic diseases was collected by self-reported questionnaire. Systolic blood pressure ≥140 mmHg (1 mmHg=0.133 kPa), diastolic blood pressure ≥90 mmHg, or self-reported hypertension history was defined as hypertension. Fasting blood glucose ≥7.0 mmol/L or self-reported history of diabetes was defined as diabetes. Total cholesterol≥6.2 mmol/L, triglyceride≥2.3 mmol/L, or self-reported history of dyslipidemia was defined as dyslipidemia. The relationship between BMI and hypertension, diabetes, and dyslipidemia was evaluated by using receiver operator characteristic (ROC) curve analysis and binary logistic regression. Results ·Data of 59 083 subjects were collected [30 807 men and 28 276 women, average age: (67.9±6.3) years old]. The prevalence of hypertension, diabetes and dyslipidemia was 76.5% (45 219/59 083), 24.1% (14 225/59 083) and 50.0% (29 544/59 083), respectively. Compared to the elderly people aged 60?74 years, those aged 75 years and above had a higher proportion of hypertension and diabetes, and a lower proportion of dyslipidemia and no metabolic abnormalities. With ROC analysis, the BMI cut-off values for hypertension, diabetes, and dyslipidemia were 24.3, 23.9, and 23.9 kg/m². The BMI cut-off values for hypertension and diabetes in elderly men were similar to those in elderly women (for hypertension: 24.3 kg/m² in elderly men vs 24.2 kg/m² in elderly women; for diabetes: 24.0 kg/m² in elderly men vs 23.7 kg/m² in elderly women); however, BMI cut-off value for dyslipidemia was obviously higher in elderly men than that in elderly women (24.0 kg/m² in elderly men vs 22.5 kg/m²in elderly women). The BMI cut-off value for chronic metabolic diseases was higher in the elderly people aged 60?74 years than that in the elderly people aged 75 years and above (24.2?24.7 kg/m²vs 22.9?23.8 kg/m²). Conclusion ·Elderly people aged 60?74 years should maintain the BMI below 24.0 kg/m², while those aged 75 years and above should aim for the BMI below 23.0 kg/m², so as to reduce the risk of chronic metabolic diseases.

Key words: body mass index (BMI), chronic metabolic disease, elderly

中图分类号:

R153.3

蒋莹, 李清瑶, 陈之琦, 汪佳璐, 李云, 徐仁应. 老年人群体质量指数与慢性代谢性疾病的关系[J]. 上海交通大学学报（医学版）, 2024, 44(2): 250-257.

JIANG Ying, LI Qingyao, CHEN Zhiqi, WANG Jialu, LI Yun, XU Renying. Association between body mass index and chronic metabolic diseases in Chinese aged population[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(2): 250-257.

图/表 4

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Clinical index	Total (n=59 083)	Male (n=30 807)	Female (n=28 276)	P value
Age/year	67.9±6.3	67.9±6.4	67.8±6.2	0.030
Height/cm	161.7±8.4	167.5±6.0	155.4±5.7	0.000
Body mass/kg	64.7±10.7	69.6±9.9	59.4±9.0	0.000
BMI/(kg·m^-2)	24.7±3.2	24.8±3.1	24.6±3.4	0.000
FBG/(mmol·L^-1)	5.8±1.6	5.8±1.6	5.7±1.5	0.000
SBP/mmHg	139.5±18.4	138.8±18.4	140.2±18.5	0.000
DBP/mmHg	79.3±10.4	79.9±10.4	78.7±10.3	0.000
TC/(mmol·L^-1)	5.1±1.0	4.9±1.0	5.4±1.0	0.000
TAG/(mmol·L^-1)	1.40 (1.01, 1.99)	1.36 (0.97, 1.95)	1.46 (1.07, 2.04)	0.000
ALT/(IU·L^-1)	22.0±18.5	22.3±17.1	21.6±20.0	0.000
AST/(IU·L^-1)	23.5±12.4	23.0±11.4	24.1±13.3	0.000
eGFR/[mL·(min·1.73 m²)^-1]	85.8±11.1	85.3±11.4	86.3±10.8	0.000
Hypertension/n(%)	45 219 (76.5)	23 137 (75.1)	22 082 (78.1)	0.000
Diabetes/n(%)	14 225 (24.1)	7 960 (25.8)	6 265 (22.2)	0.000
Hyperlipoidemia/n(%)	29 544 (50.0)	13 266 (43.1)	16 278 (57.6)	0.000

Clinical index	Total (n=59 083)	Male (n=30 807)	Female (n=28 276)	P value
Age/year	67.9±6.3	67.9±6.4	67.8±6.2	0.030
Height/cm	161.7±8.4	167.5±6.0	155.4±5.7	0.000
Body mass/kg	64.7±10.7	69.6±9.9	59.4±9.0	0.000
BMI/(kg·m^-2)	24.7±3.2	24.8±3.1	24.6±3.4	0.000
FBG/(mmol·L^-1)	5.8±1.6	5.8±1.6	5.7±1.5	0.000
SBP/mmHg	139.5±18.4	138.8±18.4	140.2±18.5	0.000
DBP/mmHg	79.3±10.4	79.9±10.4	78.7±10.3	0.000
TC/(mmol·L^-1)	5.1±1.0	4.9±1.0	5.4±1.0	0.000
TAG/(mmol·L^-1)	1.40 (1.01, 1.99)	1.36 (0.97, 1.95)	1.46 (1.07, 2.04)	0.000
ALT/(IU·L^-1)	22.0±18.5	22.3±17.1	21.6±20.0	0.000
AST/(IU·L^-1)	23.5±12.4	23.0±11.4	24.1±13.3	0.000
eGFR/[mL·(min·1.73 m²)^-1]	85.8±11.1	85.3±11.4	86.3±10.8	0.000
Hypertension/n(%)	45 219 (76.5)	23 137 (75.1)	22 082 (78.1)	0.000
Diabetes/n(%)	14 225 (24.1)	7 960 (25.8)	6 265 (22.2)	0.000
Hyperlipoidemia/n(%)	29 544 (50.0)	13 266 (43.1)	16 278 (57.6)	0.000

Clinical index	60‒74 years old (n=50 185)	≥75 years old (n=8 898)
Hypertension/n(%)	37 603 (74.9)	7 616 (85.6)
Diabetes/n(%)	11 811 (23.5)	2 414 (27.1)
Hyperlipoidemia/n(%)	25 661 (51.1)	3 883 (43.6)
No chronic metabolic diseases/n(%)	6 195 (12.3)	717 (8.1)

Clinical index	60‒74 years old (n=50 185)	≥75 years old (n=8 898)
Hypertension/n(%)	37 603 (74.9)	7 616 (85.6)
Diabetes/n(%)	11 811 (23.5)	2 414 (27.1)
Hyperlipoidemia/n(%)	25 661 (51.1)	3 883 (43.6)
No chronic metabolic diseases/n(%)	6 195 (12.3)	717 (8.1)

Classification	BMI cut-off point/(kg·m^-2)	Sensitivity	1-specificity	AUC	P value
Total (n=59 083)
Hypertension	24.3	0.57	0.39	0.62	0.000
Diabetes	23.9	0.69	0.55	0.60	0.000
Hyperlipoidemia	23.9	0.68	0.55	0.58	0.000
Male (n=30 807)
Hypertension	24.3	0.61	0.44	0.61	0.000
Diabetes	24.0	0.70	0.57	0.59	0.000
Hyperlipoidemia	24.0	0.70	0.54	0.61	0.000
Female (n=28 276)
Hypertension	24.2	0.56	0.36	0.63	0.000
Diabetes	23.7	0.69	0.55	0.60	0.000
Hyperlipoidemia	22.5	0.76	0.67	0.56	0.000
60‒74 years old (n=50 185)
Hypertension	24.5	0.76	0.67	0.63	0.000
Diabetes	24.7	0.59	0.45	0.60	0.000
Hyperlipoidemia	24.2	0.61	0.51	0.57	0.000
≥75 years old (n=8 898)
Hypertension	23.2	0.66	0.49	0.61	0.000
Diabetes	22.9	0.77	0.63	0.60	0.000
Hyperlipoidemia	23.8	0.65	0.49	0.60	0.000