代謝健康與體重與全死因死亡風險之相關性：台灣世代研究
 
陳信豪^1,2,3　蕭雅純⁴　劉俞旻^2,3,5

  
目的：代謝健康的過重/肥胖者(metabolically healthy overweight/obesity, MHOO)定義為過重/肥胖卻沒有代謝異常等因子，如高血壓，糖尿病或高血脂。在先前研究中，MHOO的全死因死亡風險與代謝健康且正常體重(metabolically healthy normal weight, MHNW)者相比，結果分岐，因此本研究目的是使用代謝健康的最新定義，探討MHOO是否與較高的全死因死亡風險相關。
方法：本研究由2002-2015年台灣高血壓，高血糖和高血脂調查的5,763名參與者組成，過重/肥胖定義為BMI (body mass index) ≥24 kg/m2，代謝健康定義為沒有高血壓，糖尿病或高血脂且具有健康的代謝狀態（收縮壓<130 mmHg且舒張壓<85 mmHg，飯前血糖<100 mg/dL，三酸甘油酯< 150 mg/dL，HDL男性>40 mg/dL或女性> 50 mg/dL）；我們使用Cox比例風險回歸模型研究不同BMI與代謝狀態分組與全死因死亡率間的關係。
結果：在經過中位數13.7年的追蹤共621例死亡。在調整共變項後，MHOO (HR 0.94，95% CI 0.59-1.50)與MHNW相比，死亡率無明顯差異。次族群分析和敏感性分析顯示相似結果，而年齡可能是重要的修飾因子(effect modifier)；與老年人相比，小於65歲代謝不健康者即使體重正常，死亡風險仍較高(HR 2.06，95% CI 1.39-3.04)；而老年人體重過輕且代謝不健康其死亡風險顯著升高(HR 2.91，95% CI 1.64-5.17)，但代謝不健康之過重肥胖長者且其風險並未升高。
結論：代謝健康之過重肥胖者並不會增加全死因死亡風險，而小於65歲者即使正常體重也應保持代謝健康的狀態，而體重過輕且代謝不健康之長者更應該值得關注。
（台灣家醫誌2021; 31: 38-52）DOI: 10.3966/168232812021033101005
 
關鍵詞：代謝健康、體重、肥胖、全死因死亡
 

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¹新竹馬偕紀念醫院家庭醫學科、⁴內分泌暨新陳代謝科、⁵心臟內科；²馬偕醫護管理專科學校；³馬偕醫學院醫學系
受理日期：110年2月18日　修改日期：110年3月18日　同意刊登：110年3月31日

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The Association of Metabolically Healthy Status and Body
Weight on All-cause Mortality: A Representative Cohort
Study in Taiwan
 
Hsin-Hao Chen^1,2,3, Ya-Chun Hsiao⁴ and Lawrence Yu-Min Liu^2,3,5

 
Objective: The objective of this study was to investigate the impact of metabolically healthy status and body weight on all-cause mortality in Taiwan using an updated definition of metabolic health.
Methods: The cohort comprised 5,763 participants from the Taiwanese Survey on Hypertension, Hyperglycemia, and Hyperlipidemia (TwSHHH) from 2002 to 2015. Overweight/obesity was defined as BMI ≥ 24 kg/m2 and metabolically healthy status was defined as absence of hypertension, diabetes, or hyperlipidemia, combined with a healthy cardiometabolic profile. We used a Cox proportional hazards regression model to investigate the relationship between baseline BMImetabolic groups and mortality. We also performed subgroup analysis to explore potential effect modifiers.
Results:We observed a total of 621 deaths over a median of 13.7 years of followup. Metabolically healthy overweight/obesity (MHOO) (HR 0.94, 95% CI 0.59-1.50) was not associated with elevated risk of all-cause mortality compared with metabolically healthy normal weight (MHNW) after adjusting for covariates. The three BMI groups of metabolically unhealthy all showed a significantly higher risk of mortality. Subgroup analysis showed that age is a significant effect modifier. People less than 65 years old that were metabolically unhealthy had elevated risk of mortality even when they were within normal weight (HR 2.06, 95% CI 1.39-3.04). Among elderly people, those underweight and metabolically unhealthy showed significantly elevated risk (HR 2.91, 95% CI 1.64-5.17), but those metabolically unhealthy and with normal weight or overweight/obesity did not.
Conclusion:MHOO without cardiometabolic risk factors was not associated with increased all-cause mortality. People under 65 years old should maintain a metabolically healthy status even within normal weight. More attention should be paid to the elderly with underweight and metabolically unhealthy status.
(Taiwan J Fam Med 2021; 31: 38-52) DOI: 10.3966/168232812021033101005
 
Key words: all-cause mortality, body weight, metabolic health, obesity
 

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¹Department of Family Medicine, ⁴Division of Endocrinology and Metabolism, ⁵Division of Cardiology, Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu City; ²MacKay Junior College of Medicine, Nursing, and Management, Taipei City; ³Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.
Received: February 18, 2021; Revised: March 18, 2021; Accepted: March 31, 2021.
Corresponding author: Lawrence Yu-min Liu, No. 690, Sec. 2, Guangfu Rd., East Dist., Hsinchu City 300, Taiwan. Email:5954@mmh.org.tw