代謝健康／不健康之肥胖／過重與心血管疾病風險間的關係：台灣具代表性的世代研究

Association between metabolically healthy/ unhealthy obesity/ overweight and the risk of cardiovascular disease: a representative cohort study in Taiwan

葉姿麟(Tzu-Lin Yeh) ； 簡國龍(Kuo-Liong Chien)

《台灣公共衛生雜誌》 39卷5期 (2020/10) Pp. 553-564

https://doi.org/10.6288/TJPH.202010_39(5).109111

摘要

目標：探討台灣代謝健康肥胖者（Metabolically healthy obesity, MHO）和心血管疾病（Cardiovascular disease, CVD）間的關係。方法：受試者來自於三高主題資料庫。本研究將身體質量指數（body mass index, BMI）區分為：體重過輕（BMI ＜ 18.5 kg/m^2）、正常體重（BMI18.5至23.9 kg/m^2）和肥胖／過重（BMI ≥24 kg/m^2）。無糖尿病、高血壓、高血脂症且符合以下定義為代謝健康：（1）空腹三酸甘油酯 ＜150 mg/dL；（2）男性高密度脂蛋白膽固醇 ≥40 mg/dL或女性高密度脂蛋白膽固醇 ≥50 mg/dL；（3）空腹血糖 ＜100 mg/dL；（4）收縮壓 ＜130且舒張壓 ＜85mmHg。研究終點是以全民健康保險資料確認之發生CVD事件或死亡。使用Cox迴歸模型估計風險比（hazard ratio, HRs）和95%信賴區間（confidence interval, CI）。結果：5,719名受試者年齡平均值（標準差）為44.0（15.5）歲，50.2%為女性，其中1,479名為參考組（代謝健康正常體重者），493名MHO者平均年齡43.3歲，女性比例47.1%。在追蹤中位數（四分位差）13.7（13.6-13.8）年間，共發生了449個CVD事件或死亡，其中MHO組發生了25個CVD事件或死亡。MHO組經多變項調整後之HR為1.75，意即相較於參考組顯著增加了75%的CVD風險，95%CI為1.02－2.99。結論：無論目前代謝健康與否，鼓勵所有肥胖者應積極維持正常體重，以減少將來之CVD風險。

關鍵字

代謝健康肥胖 ； 代謝症候群 ； 心血管疾病 ； 三高主題資料庫 ； 社區前瞻性世代研究

並列摘要

Objectives: To investigate the relationship between individuals with metabolically healthy obesity (MHO) and the cardiovascular disease (CVD) risk in Taiwan. Methods: Participants from the Taiwanese Survey on Hypertension, Hyperglycemia, and Hyperlipidemia databases were recruited, and classified into three body mass index (BMI) categories: underweight (BMI ＜ 18.5 kg/m^2), normal weight (BMI 18.5 to 23.9 kg/m^2), and overweight/obesity (BMI ≥24 kg/m^2). Participants without diabetes, hypertension, hyperlipidemia and had healthy metabolic profiles (1) fasting triglyceride ＜150 mg/dL; (2) high-density lipoprotein cholesterol ≥40 mg/dL in men or ≥50 mg/dL in women; (3) fasting glucose ＜100 mg/dL; (4) systolic blood pressure ＜130 and diastolic blood pressure ＜85 mmHg were defined as metabolically health. Our endpoints were CVD events or death, ascertained by the National Health Insurance Research Database. Multivariable adjusted hazard ratios (HRs) and 95% confidence intervals (CI) by Cox regression analysis were performed. Results: A total of 5,719 participants with mean (standard deviation) age 44.0 (15.5) years old, 50.2% women was recruited. Among the total participants, 1,479 individuals were metabolically healthy normal weight (the reference group), 493 participants were the MHO group with the mean age 43.3 years old and women percentage 47.1%. During a median (interquartile range) follow-up time of 13.7 (13.6-13.8) years, 449 ascertained CVD events or deaths developed, 25 CVD events or deaths developed in the MHO group. Compared with the reference group, MHO had a significant higher CVD risk, adjusted HR with 95% CI was 1.75 (1.02-2.99). Conclusions: Aggressive body weight control, even in current metabolically healthy status, is mandatory for CVD control.

並列關鍵字

metabolically healthy obesity ； metabolic syndrome ； cardiovascular disease ； Taiwanese Survey on Hypertension, Hyperglycemia, and Hyperlipidemia databases ； community-based prospective cohort study

參考文獻

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