中国60岁及以上老年人群累积体质指数与认知功能的关联  

Association between cumulative body mass index exposure and cognitive function among elderly people aged 60 years and older in China

作　　者：王琬玥 陈恕凤 李建新 曹杰 黄克勇 赵颖馨[2] 沈冲[3] 胡东生[4,5] 黄建凤 顾东风 鲁向锋 刘芳超 Wang Wanyue;Chen Shufeng;Li Jianxin;Cao Jie;Huang Keyong;Zhao Yingxin;Shen Chong;Hu Dongsheng;Huang Jianfeng;Gu Dongfeng;Lu Xiangfeng Liu Fangchao(Department of Epidemiology,Fuwai Hospital,Chinese Academy of Medical Sciences Peking Union Medical College/National Center for Cardiovascular Diseases,Beijing 102300,China;Institute of Basic Medicine,Shandong First Medical University,Shandong Academy of Medicine Sciences,Jinan 250062,China;School of Public Health,Nanjing Medical University,Nanjing 211166,China;School of Public Health,Zhengzhou University,Zhengzhou 450001,China;School of Public Health,Shenzhen University,Shenzhen 518060,China;School of Medicine,Southern University of Science and Technology,Shenzhen 518055,China)

机构地区：[1]中国医学科学院、北京协和医学院、国家心血管病中心、阜外医院流行病研究部,北京102300 [2]山东第一医科大学、山东省医学科学院基础医学研究所,济南250062 [3]南京医科大学公共卫生学院,南京211166 [4]郑州大学公共卫生学院,郑州450001 [5]深圳大学公共卫生学院,深圳518060 [6]南方科技大学医学院,深圳518055

出　　处：《中华医学杂志》2024年第46期4229-4239,共11页National Medical Journal of China

基　　金：中国医学科学院医学与健康科技创新工程(2021-I2M-1-010);中央高水平医院临床科研业务费(2022-GSP-GG-1、2022-GSP-GG-2)。

摘　　要：目的分析我国60岁及以上老年人群累积体质指数(BMI)与认知功能的关联。方法研究对象来自中国动脉粥样硬化性心血管疾病风险预测研究(China-PAR),纳入于1992-1994年至2018-2021年至少参加2次体格检查并于2018-2021年参加认知功能调查的27227名≥60岁老年人。采用简易智力状态检查量表(MMSE)测量认知评分,根据教育水平定义文盲人群MMSE≤17分、小学学历人群MMSE≤20分、中学或以上学历人群MMSE≤24分为认知功能受损。采用多元线性回归或多元logistic回归模型,分析总人群与60~64、65~69、70~74、≥75岁年龄段人群10年加权累积BMI与认知评分或认知功能受损的关联。采用限制性立方样条探讨暴露-反应关系。结果研究对象年龄为(72.3±5.8)岁,男性10639名(39.1%),MMSE得分(24.9±6.8)分,认知功能受损者4171例(15.4%)。总人群中,累积BMI280 kg/m^(2)时,随累积BMI增加,认知评分增加、认知功能受损风险降低(β=0.095,95%CI:0.060~0.130;OR=0.962,95%CI:0.946~0.978);累积BMI≥280 kg/m^(2)时,累积BMI与认知评分、认知功能受损风险的关联均无统计学意义(β=-0.105,95%CI:-0.212~0.001;OR=1.047,95%CI:0.992~1.102)。年龄分层分析显示,75岁老年人群中,累积BMI与认知评分及认知功能受损均呈现潜在“U型关联”;当累积BMI280 kg/m^(2)时,60~64、65~69、70~74岁年龄组累积BMI每增加10 kg/m^(2),与认知功能受损关联OR值(95%CI)分别为0.983(0.904~1.069)、0.953(0.919~0.987)和0.951(0.922~0.982);累积BMI≥280 kg/m^(2)时,OR值(95%CI)分别为1.548(1.134~2.186)、1.037(0.938~1.139)和1.109(1.014~1.208)。而在≥75岁人群中,累积BMI增加与认知评分增加、认知功能受损风险降低相关(β=0.132,95%CI:0.074~0.190;OR=0.961,95%CI:0.944~0.979)。结论总人群中,10年累积BMI280 kg/m^(2)时,随累积BMI增加,认知功能受损风险降低,10年累积BMI≥280 kg/m^(2)时,累积BMI与认知功能的关联在不同年龄段老年人中存在差异,提示应�ObjectiveTo analyze the relationship between cumulative body mass index(BMI)and cognitive score or cognitive impairment at different age groups among elderly adults aged≥60 years old.MethodsParticipants were recruited from the Prediction for Atherosclerotic Cardiovascular Disease Risk in China(China-PAR).A total of 27227 participants aged≥60 years old,who completed at least 2 physical examinations between 1992-1994 and 2018-2021,and completed cognitive function tests from 2018 to 2021,were included in the final analysis.Cognitive score was assessed using the Minimum Mental State Examination(MMSE).Cognitive impairment was defined based on education level:illiterate individuals with MMSE≤17,primary school graduates with MMSE≤20,and secondary school graduates with MMSE≤24.Multivariate linear regression or multivariate logistic regression models were used to analyze the association between 10-year weighted cumulative BMI and cognitive score or cognitive impairment in the general population,as well as in specific age groups(including 60-64 years,65-69 years,70-74 years,and≥75 years).Restricted cubic spline was adopted to explore the dose-response relationship.ResultsThe age of enrolled participants was(72.3±5.8)years,and 10639(39.1%)were males.The mean MMSE score was(24.9±6.8),and 4171(15.4%)participants had cognitive impairment.In the general population,the MMSE score increased and the risk of cognitive impairment decreased with the increase in cumulative BMI when cumulative BMI was280 kg/m^(2)(β=0.095,95%CI:0.060-0.130;OR=0.962,95%CI:0.946-0.978).When cumulative BMI≥280 kg/m 2,the associations between cumulative BMI level and MMSE score and cognitive impairment risk were not statistically significant(β=-0.105,95%CI:-0.212-0.001;OR=1.047,95%CI:0.992-1.102).Subgroup analysis according to age groups revealed a potential"U-shaped"correlation between cumulative BMI and MMSE score or cognitive impairment risk in participants aged75 years old.For cumulative BMI levels280 kg/m^(2),the OR and 95%CI for cogn

关 键 词：老年人 体质指数 认知 认知功能受损 年龄因素 前瞻性队列研究 

分 类 号：R161.7[医药卫生—公共卫生与预防医学]