肥胖比体适能不佳更致命


  【24drs.com】根据在线发表于12月20日国际流行病学期刊的一篇研究,青春期后期的有氧体适能程度低会增加早逝风险。
  
  这些研究结果发现,体适能好之肥胖男性的死亡风险,大于体适能不好但体重正常的男性,因而破除了肥胖但体适能好的概念。
  
  瑞典Umea大学社会医学与复健系研究生Gabriel Hogstrom等人写道,在这篇研究中,我们发现,18岁时的有氧体适能与早逝风险之间,呈现梯度性关联。
  
  另一个有趣的研究结果是,在追踪期间,体适能不佳之男性的任何原因死亡风险,比肥胖但体适能佳者低30%;这些结果不同于「肥胖但体适能好、不会增加死亡风险」的概念。
  
  许多研究支持「经常运动可降低死亡风险」的观念,不过,关于低体适能程度有害健康的研究,主要聚焦在年长者,少有研究探讨年轻族群有氧体适能与健康的直接关联。
  
  这篇研究的资料来自「Swedish Military Conscription Registry」,包括了在1969-1996年间征召入伍的1,317,713名瑞典男性(平均年龄18岁)。在入伍时,这些男性进行了基本评估,包括有氧体适能测试,测试到因为疲劳而停止为止,研究者采用全国登记资料探讨了所有原因以及特定原因的死亡;死亡率信息来自全国死因登记资料库。
  
  在平均28.8年追踪期间内,有44,301名男性死亡。
  
  校正年龄与入伍年之后,有氧体适能程度最高的男性,各种原因死亡风险比体适能程度最低者少51%(风险比[HR]为0.49;95%信赖区间[CI]为0.47 - 0.51),校正体重后的体适能分析也获得类似的结果(HR, 0.52;95% CI, 0.50 - 0.54)。
  
  酒精及麻醉剂滥用与死亡的关联最强(HR, 0.20;95% CI, 0.15 - 0.26)。
  
  肥胖男性受惠于体适能良好的程度低于正常体重男性(互动P值< .001),相较于肥胖且有氧体适能程度最高的男性,任何体适能程度、体重正常男性的所有原因死亡率风险都比较低(30% - 48%;所有的P值都 < .05)。
  
  当体重增加时,有氧体适能的效益降低,校正年龄与入伍年之后,体适能程度前半段的正常体重男性,死亡率风险比后半段者低34% (HR, 0.66;95% CI, 0.64 - 0.68),过重男性的这个效益降到28%,最肥胖者的效益则是消失殆尽。
  
  作者们写道,这个结果挑战了目前「肥胖者可以藉由体适能完全抵销死亡率风险」的观念。
  
  他们结论指出,尽管这篇研究因为观察型性质而有限制,这些研究结果认为,对于降低早逝风险,年轻时[身体质量指数]低比体适能程度更重要。
  
  最后,研究观察到较低的[身体质量指数]类别与体适能之间的关联,但是在肥胖者没有,增加了反驳「健康肥胖」的证据。
  
  资料来源:http://www.24drs.com/
  
  Native link:Obesity More Deadly Than Lack of Fitness

Obesity More Deadly Than Lack of Fitness

By Veronica Hackethal, MD
Medscape Medical News

Low aerobic fitness during late adolescence increases the risk for early death, according to a study published online December 20 in the International Journal of Epidemiology.

The results also undermine the "fat but fit" concept by showing that physically fit obese men are at higher risk for death than unfit normal-weight men.

"In the present study, we found a graded association between aerobic fitness at the age of 18 years and the risk of early death," write Gabriel Hogstrom, PhD, a postgraduate student in the Department of Community Medicine and Rehabilitation at Umea University, Sweden, and colleagues.

"Also of interest was the finding that the risk of death from any cause during follow-up was 30% lower in unfit normal-weight men than in obese fit men," they continued. "These results counter the notion that the 'fat but fit' condition does not increase mortality risk."

Much research supports the idea that frequent physical activity decreases the risk for death. Research on the detrimental health effects of low fitness levels, however, has focused mainly on older populations. Few studies have looked at the direct link between aerobic fitness and health in younger individuals.

The study drew data from the Swedish Military Conscription Registry and included 1,317,713 Swedish men (mean age, 18 years) conscripted into the Swedish military between 1969 and 1996. At the time of conscription, the men underwent baseline assessments that included aerobic fitness testing, in which they cycled until fatigue caused them to stop. The researchers looked at all-cause and cause-specific death, using national registers. Mortality information came from the National Cause of Death Registry.

During a mean follow-up of 28.8 years, 44,301 of the men died.

After adjusting for age and conscription year, men with the highest aerobic fitness levels had 51% lower risk for all-cause death (hazard ratio [HR], 0.49; 95% con?dence interval [CI], 0.47 - 0.51) compared with those with the lowest fitness levels. Similar findings resulted from analyses of weight-adjusted fitness (HR, 0.52; 95% CI, 0.50 - 0.54).

Alcohol and narcotic abuse had the strongest associations with death (HR, 0.20; 95% CI, 0.15 - 0.26).

Obese men benefited less than normal-weight men from being physically fit (P interaction < .001). Normal-weight men in all levels of aerobic fitness had lower risk for all-cause mortality (30% - 48%; P < .05 for all) compared with obese men with the highest levels of aerobic fitness.

The benefits of aerobic fitness decreased as weight increased. After adjusting for age and year, normal-weight men in the upper half of aerobic fitness had 34% lower risk for death than those in the lower half (HR, 0.66; 95% CI, 0.64 - 0.68). This benefit decreased to 28% in overweight men, and disappeared entirely in men with the highest levels of obesity.

This finding "challenges the currently held idea that obese individuals can fully compensate mortality risk by being physically fit," the authors write.

"Despite the limitation posed by the observational nature of this study, these results suggest that low [body mass index] early in life is more important than high physical fitness, with regard to reducing the risk [for] early death," they conclude.

"Finally, associations were observed between fitness and the risk of early death in lower [body mass index] categories, but not in the obese category, adding to the evidence against the existence of healthy obesity."

The authors have disclosed no relevant financial relationships.

Int J Epidemiol. Published online December 20, 2015.

    
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