代谢性肥胖与高血压发病的队列研究

目的  探讨代谢性肥胖与高血压发病的关系,为人群高血压防制提供理论依据。方法  采用前瞻性队列研究设计,于2009年在江苏省宜兴市官林、徐舍2个乡镇采用整群抽样方法纳入4 128名成人进行流行病学基线调查。排除基线2 012名高血压病例,截至2020年7月对2 116名非高血压对象进行高血压发病随访。根据体重和代谢状态将研究对象分为4组：代谢正常体重正常(metabolically healthy and normal weight, MHNW)、代谢正常超重/肥胖(metabolically healthy overweight/obesity, MHO)、代谢异常体重正常(metabolically unhealthy and normal weight, MUNW)、代谢异常超重/肥胖(metabolically unhealthy overweight/obesity, MUO)。采用Cox比例风险回归模型对代谢性肥胖与高血压发病关联进行分析,进一步做分层分析、异质性检验及相加与相乘交互作用分析;排除随访第一年发病的高血压对象、排除偏瘦人群进行敏感性分析。结果  共随访到新发高血压637例,超重肥胖及代谢异常联合相较于体重正常代谢正常的人群归因危险度(population attributable risk, PAR)及PAR%分别为17.4%、57.93%。Cox回归分析结果显示：与MHNW相比,MHO、MUNW、MUO三组的高血压发病风险增加均有统计学意义,调整后的HR(95% CI)值分别为1.29(1.08~1.56)、1.48(1.09~2.01)、1.70(1.37~2.11),并呈风险递增的趋势(均有P < 0.001)。分层分析和异质性检验结果显示：女性MUO的高血压发病风险(调整HR：2.14)高于男性MUO(调整HR：1.22),P_{异质性检验}= 0.017。相乘交互作用分析结果显示：性别与代谢状态之间存在相乘交互作用,调整后的HR(95% CI)值为1.53(1.06~2.22),P=0.024。排除随访第一年高血压发病的对象或排除偏瘦人群进行敏感性分析,关联强度无明显变化。结论  代谢性肥胖增加人群高血压发病风险,尤其在女性人群中风险更高。因此,对超重肥胖及代谢异常相关人群进行主动健康干预预防高血压具有十分重要意义。     

白介素-5和白介素-13血清水平与不同肥胖表型的关联分析

目的 探究白介素-5(interleukin-5,IL-5)和白介素-13(interleukin-13,IL-13)血清水平与不同肥胖表型的关联,为肥胖及相关代谢性疾病的防控提供新思路。方法 2018年11月—2019年4月在中南大学湘雅二医院进行健康体检的人群中选择肥胖人群,基于代谢异常情况分为代谢异常型肥胖(metabolically unhealthy obesity,MUO)组和代谢健康型肥胖(metabolically healthy obesity,MHO)组(每组72人),同期选取体重及代谢正常并与肥胖人群进行性别、年龄匹配的体检人群73人设为健康对照(healthy control,HC)组;检测IL-5和IL-13血清水平,通过logistic回归分析两种细胞因子与不同肥胖表型的关联,通过逐步线性回归分析两种细胞因子的主要影响因素。结果 IL-13的MHO组和HC组间的比较有统计学意义(P<0.05),IL-5的MHO组和HC组间的比较无统计学意义。 MUO组的IL-5和IL-13的血清水平升高明显,与MHO组和HC组相比差异均有统计学意义(P<0.05)。IL-5和IL-13血清水平与MHO表型的发生未存在显著关联,但均与MUO表型的发生存在显著的正向关联:IL-5每升高2 pg/ml,MUO表型发生的优势比增加81%(OR=1.81,95%CI:1.40~2.35,P<0.001),IL-13每升高10 pg/ml, MUO表型发生的优势比增加5%(OR=1.05,95%CI:1.03~1.07,P<0.001);多元线性逐步回归分析显示收缩压(systolic blood pressure,SBP)(β=0.296,P=0.000)和空腹血糖(fasting plasma glucose,FPG)(β=0.217,P=0.008)是IL-5水平的独立影响因素,腰围(waist circumference,WC)(β=0.186,P=0.018)和尿酸(uric acid,UA )(β=0.200,P=0.019)是IL-13的独立影响因素。 结论 IL-5与IL-13与代谢健康型肥胖表型无显著相关,与代谢异常型肥胖表型具有显著正向关联,两种细胞因子可能在肥胖的发生发展进程中具有不同的作用。     

浅谈健步走的价值意义与科学方法

目的研究健走干预前后职业人群慢性病危险因素的变化情况,探索适合上海市职业人群的健走运动干预模式。方法选取1 475名机关、企事业单位员工进行为期100 d的健走干预,比较干预前后体重、BMI、腰围、体脂肪率和内脏脂肪指数,以及超重和肥胖率、中心性肥胖率、血压控制率的变化情况。结果通过100 d的干预,干预人群的体重减轻(1.52±2.75)kg(Z=-21.99,P＜0.01),BMI降低(0.55±1.03)kg/m²(Z=-21.64,P＜0.01),腰围缩小(2.10±5.27)cm(Z=-17.62,P＜0.01),体脂肪率降低(0.31±4.59)%(Z=-3.48,P＜0.01),内脏脂肪指数降低(0.12±1.99)(Z=-2.70,P＜0.01),收缩压和舒张压分别降低(2.51±10.87)mmHg (Z=-9.35,P＜0.01)和(1.67±8.26)mmHg (Z=-9.06,P＜0.01)。超重及肥胖率下降了7.86%,中心性肥胖率下降了6.92%,血压控制率上升了2.72%,干预前后比较差异均有统计学意义(χ²=916.48,P＜0.01;χ²=585.90,P＜0.01;χ²=366.37,P＜0.01)。结论职业人群通过健走运动干预可以降低人群中超重和肥胖率、中心性肥胖率,提高血压控制率,慢性病相关危险因素得到明显改善,对慢性病预防控制起到积极作用。     

利用社交软件对MSM线上干预动员线下HIV检测的调查研究

目的  了解通过社交软件线上干预动员MSM参与线下HIV检测的效果,并调查分析线下接受检测者的特征。方法  分析比较通过不同社交软件线上所接触动员人数与线下实际检测人数,描述线下接受检测的MSM人群特征,并对感染风险高、低分组的MSM特征差异进行比较。结果  线上干预动员MSM参与线下检测比例为23.78% (229/963),使用Blued动员线下检测比例高于其他社交软件(χ²=3.958,P=0.047),总动员比为100∶2.4,总动员效率为1.01人/d。220名有肛交性行为的MSM根据是否坚持使用安全套分为高危行为组(n=96)与低危行为组(n=124),高危组的梅毒知识知晓合格比例低于低危组(χ²=6.308,P=0.009),而HIV检测阳性结果的比例高于低危组(χ²=11.299,P=0.001)。结论  使用社交软件线上干预动员线下检测能有效接触HIV感染风险较高的MSM和及时发现已感染的病例,在运用社交软件与目标人群建立联系并互动时,主动接触比被动响应更能提高MSM应答的比例。     

2012-2018年重庆市缺血性脑卒中发病死亡趋势

目的  了解重庆市缺血性脑卒中发病死亡趋势变化,为开展脑卒中防治提供建议。方法  2012—2018年缺血性脑卒中个案资料来源于重庆市心脑血管疾病监测,采用SPSS 25.0软件分析计算发病率、标化发病率、死亡率、标化死亡率、构成比。不同地区、不同性别发病率与死亡率的比较采用χ²检验。率的趋势变化采用年度变化百分比(annual percent change, APC)表示。结果  2012年重庆市缺血性脑卒中发病率、标化发病率分别为172.78/10万、140.80/10万,2018年发病率、标化发病率分别为186.63/10万、139.17/10万,APC分别为1.71%、0.80%,变化趋势差异无统计学意义(均有P>0.05)。缺血性脑卒中发病率男性高于女性,城市高于农村(均有P < 0.05)。农村地区缺血性脑卒中发病率以年均6.29%的速度上升(t=2.83, P=0.037)。缺血性脑卒中死亡率与标化死亡率分别由2012年17.89/10万、16.11/10万上升至2018年的39.03/10万、26.12/10万,分别以年均15.37%(t=6.68, P=0.001)与7.79%(t=5.43, P < 0.001)的速度上升。缺血性脑卒中死亡率男性高于女性(均有P < 0.05)。农村地区缺血性脑卒中死亡率与标化死亡率分别以年均14.91%(t=8.72, P < 0.001)与12.86%(t=7.63,P=0.001)上升。结论  重庆市缺血性脑卒中发病率与死亡率较高,发病率相对稳定,死亡率上升,男性与农村是缺血性脑卒中防治重点。     

北京市肺炎球菌疫苗免费接种政策对老年人肺炎住院的影响

目的  分析北京市肺炎球菌疫苗免费接种政策实施前后北京市老年人群肺炎住院情况的变化,评估该项政策对老年人肺炎防治的效果。方法  利用北京市城镇职工医疗保险数据库2014―2019年收集的老年人群住院数据,以2019年1月作为政策的干预分界点,应用中断时间序列模型(interrupted time series, ITS)分析政策实施前后北京市老年人群肺炎住院人次的变化。结果  免费接种政策实施前北京市≥65岁老年人因肺炎住院人次呈上升趋势(RR=1.019,P < 0.001),政策实施后上升趋势有所减缓(RR=0.971,P=0.013);敏感性分析中,≥65岁老年人因股骨骨折住院人次在政策实施前后则没有明显变化(RR=0.992,P=0.503)。结论  肺炎疫苗免费接种政策与老年人肺炎住院趋势减缓有一定关联,应进一步采取相关策略提高该疫苗的接种可及性。     

基于海南省队列BMI与睡眠时长和睡眠质量关系的横断面研究

目的  本研究旨在探索海南省中老年人群BMI与睡眠时长和睡眠质量的关系,为超重肥胖防控提供参考依据。方法  对2018年海南省18个市县的体检队列人群中5 169名调查对象进行体格检查和问卷调查。调查对象为本地居住时间≥5年,年龄35~75岁,无严重肢体残疾或精神疾病的常住人口。对BMI的影响因素进行描述性分析和单因素分析,应用有序Logistic回归分析模型分析BMI与睡眠时长和睡眠质量的关系。结果  不同BMI调查对象在性别、教育程度、家庭年收入、年龄、吸烟、饮茶、午睡、睡眠质量、睡眠时长方面差异均有统计学意义(均有P < 0.05)。有序Logistic回归分析模型进一步分析结果显示,长枕组、睡眠质量较差和很差均为BMI水平增加的危险因素(均有P < 0.05);长枕组“BMI高”的OR值为规范枕组的1.336倍(95% CI：1.094~1.632);睡眠质量较差者与很差者“BMI高”的OR值分别为睡眠质量很好者的1.294倍(95% CI：1.082~1.548)和1.948倍(95% CI：1.131~3.357)。结论  海南省中老年人睡眠时间延长、睡眠质量差都会增加超重肥胖的风险。     

中国成人肥胖症防治专家共识

  目的  了解陕西省城市成年人群肥胖代谢表型异质性的流行特征,为肥胖代谢表型的个体分层化识别和分类管理提供可靠依据。  方法  收集2017 — 2019年中国西北区域自然人群队列研究陕西城市队列基线调查中13072名20 ～ 89岁无重大疾病城市成年人群的相关数据,以肥胖和代谢异常状况区分人群的肥胖代谢亚型为代谢健康型非肥胖（MHNO）、代谢不健康型非肥胖（MUNO）、代谢健康型肥胖（MHO）和代谢不健康型肥胖（MUO）,对比分析不同肥胖代谢表型人群的异质性及流行病学特征。  结果  陕西省13072名城市成年人群中,MHNO者8700人（66.55 %）,MUNO者2949人（22.56 %）,MHO者535人（4.09 %）,MUO者888人（6.79 %）。在男性人群中,MHNO、MUNO、MHO和MUO者比例分别为55.8 %、27.9 %、6.1 %和10.2 %,肥胖代谢表型随年龄的增加而变化（χ²_趋势 = 9.143,P_趋势 = 0.002）;MUNO的比例随年龄的增加而上升（χ²_趋势 = 217.096,P_趋势 < 0.001）,NHNO和MHO的比例均随年龄的增加而下降（均P_趋势 < 0.001）。在女性人群中,MHNO、MUNO、MHO和MUO者比例分别为55.8 %、27.9 %、4.09 %和6.79 %,肥胖代谢表型随年龄的增加而变化（χ²_趋势 = 486.235,P_趋势 < 0.001）;MUNO、MHO和MUO的比例均随年龄的增加而上升（均P_趋势 < 0.05）,NHNO的比例随年龄的增加而下降（χ²_趋势 = 738.600,P_趋势 < 0.001）。当肥胖标准从BMI ≥ 28变为BMI ≥ 25时,MHO的比例从4.09 %增加至16.06 %;当代谢异常标准从 ≥ 2项指标异常变为 ≥ 0项指标异常时,MHO的比例从4.09 %降低至1.02 %。  结论  陕西省城市成年人群肥胖代谢异质性明显,存在肥胖且代谢正常的人群但比例较低,而肥胖人群的代谢异常问题较为突出。     

中国7~17岁儿童青少年宏量营养素摄入与超重肥胖的关系

目的  探讨7~17岁儿童青少年宏量营养素摄入与超重肥胖的关系。方法  1997—2011年基于“中国居民健康与营养调查”的6轮调查数据,纳入膳食及BMI数据完整的7~17岁儿童青少年为研究对象。依照中国肥胖问题工作组制定标准判定超重肥胖,采用Logistic回归分析模型分析宏量营养素摄入与儿童青少年超重肥胖的关系。结果  最终纳入6 360名研究对象,其中7~＜12岁儿童青少年3 529人(55.5%),男生3 360人(52.8%),超重肥胖1 060人(16.7%)。校正相关混杂因素后,与脂肪供能比 < 25%组相比,≥30%组增加20%肥胖风险(OR=1.20, 95% CI：1.03~1.41, P=0.023);与蛋白质供能比 < 10%组相比,≥15%组增加61%肥胖风险(OR=1.61, 95% CI：1.25~2.04, P < 0.001);与碳水化合物供能比 < 55%组相比,55%~ < 65%组降低20%肥胖风险(OR=0.80, 95% CI：0.68~0.95, P=0.011),≥65%组降低21%肥胖风险(OR=0.79, 95% CI：0.66~0.94, P=0.010);脂肪及蛋白质供能比越高、碳水化合物供能比越低,发生超重肥胖的风险越高(P < 0.05);男生摄入过量蛋白质更可能发生肥胖(P=0.034)。结论  儿童青少年摄入过量脂肪和蛋白质可增加超重肥胖发生风险。     

1990—2019年中国老年人群HIV/AIDS疾病负担及其变化趋势

目的  分析1990-2019年我国老年人群HIV/AIDS的感染、新发感染、死亡以及伤残调整生命年(disability-adjusted life years, DALYs)率的变化情况。方法  利用全球疾病负担研究(Globe Burden of Disease Study 2019, GBD 2019)数据, 根据年龄、性别、年份对疾病负担指标进行统计描述, 并利用Joinpoint回归模型进行时间趋势分析, 计算感染、新发感染、死亡和DALYs率的年度变化百分比(annual percentage change, APC)和平均年度变化百分比(average annual percentage change, AAPC)。结果  1990-2019年中国老年人群HIV/AIDS的标化感染率从7.56/10⁵增至48.90/10⁵; 标化新发感染率从1.03/10⁵增至1.89/10⁵; 标化死亡率从0.35/10⁵增至2.97/10⁵; 标化DALYs率从11.01/10⁵增至90.51/10⁵。根据Joinpoint回归模型结果显示, 1990-2019年, 中国老年人群HIV/AIDS标化感染率、标化新发感染率、标化死亡率和标化DALYs率整体呈上升趋势, AAPC分别为6.71%、1.91%、7.65%和7.52%, 差异均有统计学意义(均有P < 0.05)。结论  中国老年人群HIV/AIDS的疾病负担严重, 各项疾病负担指标总体呈上升趋势。应加强HIV/AIDS的早期筛查与健康教育, 根据老年人群HIV/AIDS的疾病负担特点, 制定有针对性地预防措施。     

Body Composition and Cardiorespiratory Fitness Between Metabolically Healthy Versus Metabolically Unhealthy Obese Black and White Adolescents

Purpose

We compared body composition and cardiorespiratory fitness (CRF) between metabolically healthy overweight/obese (MHO) versus metabolically unhealthy overweight/obese (MUO) adolescents in 189 black and white adolescents (BMI ≥ 85th percentile, 12–18 years of age).

全天体力活动对代谢异常型肥胖青少年健康改善效果评价

目的 探讨4周封闭训练营的全天体力活动对代谢异常型肥胖(MUO)青少年身体成分、心血管代谢风险的改善作用,为不同代谢状态的肥胖青少年健康促进提供证据支撑。方法 于2019年7—8月招募深圳某封闭训练营10～17岁肥胖青少年58名,测量受试者入营前的身体成分、血压、血脂4项和空腹血糖等指标,分为MUO组(31名)和代谢健康型肥胖(MHO)组(27名)。采用Actigraph w-GT3x BT三轴运动加速度计记录两组4周在封闭训练营中9:00—19:00的全天体力活动情况。结营后比较两组干预前后上述指标的差异及组内的变化。结果 51.6%的MUO青少年过渡为MHO青少年;体重、体质量指数(BMI)-Z评分、体脂肪量、收缩压(SBP)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)和空腹血糖(FPG)的时间与组别交互作用有统计学意义(F值分别为11.25,11.25,11.04,4.89,16.75,5.92,5.57,P值均<0.05)。组别的主效应显示,入营前MUO组的BMI-Z评分、SBP、TG和FPG高于MHO组,HDL-C低于MHO组(F值分别为5.60,6.62,20...     

Evolution of Metabolic Phenotypes of Obesity in Coronary Patients after 5 Years of Dietary Intervention: From the CORDIOPREV Study

Background: Obesity phenotypes with different metabolic status have been described previously. We analyzed metabolic phenotypes in obese coronary patients during a 5-year follow-up, and examined the factors influencing this evolution. Methods: The CORDIOPREV study is a randomized, long-term secondary prevention study with two healthy diets: Mediterranean and low-fat. All obese patients were classified as either metabolically healthy obese (MHO) or metabolically unhealthy obese (MUO). We evaluated the changes in the metabolic phenotypes and related variables after 5 years of dietary intervention. Results: Initially, 562 out of the 1002 CORDIOPREV patients were obese. After 5 years, 476 obese patients maintained their clinical and dietary visits; 71.8% of MHO patients changed to unhealthy phenotypes (MHO-Progressors), whereas the MHO patients who maintained healthy phenotypes (MHO-Non-Progressors) lost more in terms of their body mass index (BMI) and had a lower fatty liver index (FLI-score) (p < 0.05). Most of the MUO (92%) patients maintained unhealthy phenotypes (MUO-Non-Responders), but 8% became metabolically healthy (MUO-Responders) after a significant decrease in their BMI and FLI-score, with improvement in all metabolic criteria. No differences were found among dietary groups. Conclusions: A greater loss of weight and liver fat is associated with a lower progression of the MHO phenotype to unhealthy phenotypes. Likewise, a marked improvement in these parameters is associated with regression from MUO to healthy phenotypes.     

Association between Metabolic Phenotypes of Body Fatness and Incident Stroke: A Prospective Cohort Study of Chinese Community Residents

This study aimed to assess the association of body mass index (BMI)-based and waist circumference (WC)-based metabolic phenotypes with the risk of stroke among Chinese community residents. A total of 34,294 participants (mean ± standard deviation age: 56.05 ± 11.26 years) with no previous stroke diagnosis history were included in this cohort study. BMI-based metabolic phenotypes were classified into eight groups: metabolically healthy and normal weight (MHNW), metabolically healthy and underweight (MHUW), metabolically healthy and overweight (MHOW), metabolically healthy and obese (MHO), metabolically unhealthy and normal weight (MUNW), metabolically unhealthy and underweight (MUUW), metabolically unhealthy and overweight (MUOW), and metabolically unhealthy and obese (MUO). WC-based metabolic phenotypes were classified into four groups: metabolically healthy and normal WC (MHNWC), metabolically healthy and oversized WC (MHOWC), metabolically unhealthy and normal WC (MUNWC), and metabolically unhealthy and oversized WC (MUOWC). The association of these phenotypes with developing stroke events was examined using proportional hazards models. A total of 546 cases of first-stroke onset were recorded over a median follow-up time of 4.97 years. Compared with the reference group, the obesity phenotypes showed higher risks for stroke. The adjusted HRs (95% CIs) of MHUW, MHOW, MHO, MUNW, MUUW, MUOW, and MUO phenotypes were 1.01 (0.41, 2.49), 1.47 (1.09, 2.00), 1.33 (0.80, 2.22), 2.49 (1.87, 3.30), 3.92 (1.44, 10.72), 2.14 (1.64, 2.79), and 2.60 (1.91, 3.55), respectively. The adjusted HRs (95% CIs) of MHOWC, MUNWC, and MUOWC were 1.41 (1.02, 1.94), 2.25 (1.76, 2.87), and 2.16 (1.63, 2.87), respectively. The metabolic phenotypes defined by an alternative definition all showed significant positive associations (except for MHUW), with the adjusted HR ranging from 1.51 to 3.08 based on BMI and from 1.68 to 2.24 based on WC. The risk of stroke increased with the increase in metabolic abnormality numbers in different BMI and WC groups (all p trend < 0.001). The present study suggests that maintaining normal body weight or WC and improving metabolic health are of great significance in preventing cerebrovascular diseases.     

Do Temporal Eating Patterns Differ in Healthy versus Unhealthy Overweight/Obese Individuals?

This study examined whether the temporal patterns of energy and macronutrient intake in early and late eating windows were associated with metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO) among non-shift workers. A total of 299 overweight/obese non-shift workers (Age: 40.3 ± 6.9 years; 73.6% women; BMI: 31.7 ± 5.0 kg/m²) were recruited in the Klang Valley area of Malaysia. The biochemical parameters were determined from fasting blood samples, whereas information on dietary intake and timing was obtained from a 7-day diet history questionnaire. The midpoint of eating was used to determine the early and late windows. Compared to MHO non-shift workers (n = 173), MUO non-shift workers (n = 126) had lower energy intake from carbohydrates and protein during the early window. In contrast, MUO participants had greater energy intake from carbohydrates and fat during the late window. Participants with unhealthy metabolic status (regardless of their chronotypes) had similar temporal patterns of energy intake characterized by smaller energy intake during the early window and greater energy intake during the late window compared with participants with healthier metabolic status. Overall, the lowest percentile of energy intake during the early window was associated with an increased risk of MUO, after adjustment for potential confounders [odds ratio (OR) = 4.30, 95% confidence interval (CI) 1.41–13.11]. The greater the energy intake during the late window, the greater the risk of MUO (OR = 2.38, 95% CI 1.11–5.13) (OR = 2.33, 95% CI 1.03–5.32) (OR = 4.45, 95% CI 1.71–11.56). In summary, consuming less energy earlier in the day and more energy and carbohydrate later in the day was associated with a greater risk of MUO. Thus, a prospective study is needed to explore the potential role of chrono-nutrition practices in modifying risk factors to delay the transition of MHO to MUO.     

Adherence to the DASH,MeDi, and MIND diet scores and the incidence of metabolically unhealthy phenotypes

BackgroundA metabolically unhealthy phenotype is associated with the risk of cardiometabolic events and can be prevented by adherence to healthy dietary patterns. The present study was designed to investigate the association between high adherence to the Dietary Approaches to Stop Hypertension (DASH), Mediterranean (MeDi), and Mediterranean-DASH intervention for neurodegenerative delay (MIND) diet scores and the incidence of metabolically unhealthy phenotypes in adults across body mass index (BMI) categories.MethodsIn this cohort study, 512 subjects with metabolically healthy normal weight (MHNW) at baseline and 787 subjects with metabolically healthy overweight/obesity (MHOW/MHO) at baseline were included. Dietary intake was collected by a validated food frequency questionnaire, and DASH, MeDi, and MIND scores were calculated. The Joint Interim Statement (JIS) criteria were used to define a metabolically unhealthy status.ResultsA total of 137 and 388 subjects with metabolically unhealthy normal weight (MUNW) and metabolically unhealthy overweight/obesity (MUOW/MUO) phenotypes, respectively, were observed, over a mean of 5.91 years of follow-up. The Cox proportional hazard regression indicated participants in the third tertile of the DASH score had a lower risk of the MUNW phenotype (HR: 0.59; 95% CI: 0.37–0.92) than those in the lowest tertile. Similarly, the highest adherence to the MeDi and MIND scores was also linked to a 46% (HR: 0.54; 95% CI: 0.36–0.81) and 47% (HR: 0.53; 95% CI: 0.34–0.83) lower risk of the MUNW phenotype, respectively. As well, there was an inverse relationship between the highest adherence to the DASH (HR: 0.66; 95% CI: 0.50–0.86), MeDi (HR: 0.74; 95% CI: 0.58–0.93), and MIND (HR: 0.57; 95% CI: 0.43–0.74) scores and the risk of MUOW/MUO. There was no interaction between age and the three dietary patterns in relation to a metabolically unhealthy phenotype.ConclusionHigh compliance with the DASH, MeDi, and MIND scores was associated with a lower risk of MUNW. An inverse relationship between these three dietary patterns and the incidence of the metabolically unhealthy phenotype was also observed in individuals who had MHOW/MHO at baseline.     

Prolonged or Transition to Metabolically Unhealthy Status,Regardless of Obesity Status,Is Associated with Higher Risk of Cardiovascular Disease Incidence and Mortality in Koreans

The risk of chronic disease and mortality may differ by metabolic health and obesity status and its transition. We investigated the risk of cardiovascular disease (CVD) and cancer incidence and mortality according to metabolic health and obesity status and their transition using the nationally representative Korea National Health and Nutrition Examination Survey (KNHANES) and the Ansan-Ansung (ASAS) cohort of the Korean Genome and Epidemiology Study. Participants that agreed to mortality linkage (n = 28,468 in KNHANES and n = 7530 adults in ASAS) were analyzed (mean follow-up: 8.2 and 17.4 years, respectively). Adults with no metabolic risk factors and BMI <25 or ≥25 kg/m² were categorized as metabolically healthy non-obese (MHN) or metabolically healthy obese (MHO), respectively. Metabolically unhealthy non-obese (MUN) and metabolically unhealthy obese (MUO) adults had ≥1 metabolic risk factor and a BMI < or ≥25 kg/m², respectively. In KNHANES participants, MUN, and MUO had higher risks for cardiovascular mortality, but not cancer mortality, compared with MHN adults. MHO had 47% and 35% lower risks of cancer mortality and all-cause mortality, respectively, compared to MHN. Similar results were observed in the ASAS participants. Compared to those persistently MHN, the risk of CVD was greater when continuously MUN or MUO. Transitioning from a metabolically healthy state to MUO also increased the risk of CVD. Few associations were found for cancer incidence. Using a nationally representative cohort and an 18-year follow-up cohort, we observed that the risk of CVD incidence and mortality and all-cause mortality, but not cancer incidence or mortality, increases with a continuous or a transition to an unhealthy metabolic status in Koreans.     

河北省中老年人代谢综合征患病现状及影响因素

目的  了解河北省中老年人代谢综合征（metabolic syndrome,MS）的患病现状及影响因素。方法  利用京津冀地区生活社区自然人群慢性病队列研究数据,分析河北省七个区县4 546名40~80岁居民MS的患病情况,采用多因素Logistic回归分析模型探讨MS患病的相关影响因素。结果  MS患病率为25.30%,其中男性患病率为28.59%,女性为23.09%;汉族患病率为28.15%,满族为21.07%。MS各组分中,超重肥胖、高血压、高血糖和血脂紊乱的患病率分别为50.99%、46.70%、22.06%和43.16%。多因素Logistic回归分析模型分析结果显示,女性（OR=0.69,95% CI：0.57~0.83,P＜0.001）、满族（OR=0.68,95% CI：0.59~0.79,P＜0.001）和较高的文化程度（相对于小学及以下文化者,高中/初中和大专及以上OR分别为0.83和0.75）是保护因素,高龄（与40~岁年龄组相比,50~岁、60~岁和70~岁年龄组OR分别为1.81、1.76和1.50）是危险因素。结论  河北省中老年人MS患病率较高,特别是在高龄、男性、汉族和低文化程度人群中。在对人群进行针对性防控的同时应采取积极措施控制体重。