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肥胖及相关代谢指标与膝骨关节炎的关联:基于中国中老年人群的横断面研究

Association Between Obesity-Related Metabolic Indices and Knee Osteoarthritis:A Cross-Sectional Study in Middle-Aged and Older Chinese Adults

    摘要
  • 摘要: 目的 基于中国健康与养老追踪调查(China Health and Retirement Longitudinal Study,CHARLS)数据,分析肥胖及相关代谢指标与中老年人群(≥ 45岁)膝骨关节炎(knee osteoarthritis,KOA)发病风险的关系。方法 提取CHARLS数据库中2011-2012年和2015-2016年2个调查周期的数据,收集肥胖指标体质量指数(body mass index,BMI)、腰围(waist circumference,WC)、腰高比(waist-to-height ratio,WHtR)、内脏脂肪指数(visceral adiposity index,VAI)、体型指数(a body shape index,ABSI)、体圆指数(body roundness index,BRI)、脂质积累指数(lipidaccumulation product,LAP)、圆锥指数(conicity index,CI)、中国内脏脂肪指数(Chinese visceral adiposity index,CVAI)和代谢指标甘油三酯-葡萄糖指数(triglyceride glucose index,TyG)、TyG-BMI、TyG-WC、TyG-WHtR以及协变量(包括一般人口学特征、生活方式、健康状况)资料,采用多因素Logistic回归分析构建3种模型,根据性别亚组分析关联异质性,构建受试者工作特征(receiver operating characteristic,ROC)曲线并计算曲线下面积(area underthe curve,AUC)评估各项指标对KOA的诊断效能。结果 共纳入受试者9527名,KOA患病率为9.59%(914/9527)。线性回归校正混杂因素后发现,BMI (OR=1.02,95% CI:1.00~1.04,P=0.048)、BRI (OR=1.06,95% CI:1.01~1.13,P=0.030)、LAP (OR=1.03,95% CI:1.00~1.05,P=0.020)、TyG-BMI (OR=1.02,95% CI:1.00~1.05,P=0.020)和TyG-WHtR (OR=1.13,95% CI:1.02~1.25,P=0.020)与KOA存在显著正相关。亚组分析显示,在女性受试者中,BMI (OR=1.03,95% CI:1.01~1.06,P=0.020)、WHtR (OR=1.18,95% CI:1.02~1.36,P=0.020)、BRI (OR=1.08,95% CI:1.01~1.16,P=0.020)、LAP (OR=1.03,95% CI:1.01~1.06,P=0.020)、CVAI (OR=1.04,95% CI:1.01~1.07,P=0.009)、TyG-BMI (OR=1.03,95% CI:1.01~1.06,P=0.006)、TyG-WC (OR=1.10,95% CI:1.01~1.19,P=0.020)、TyG-WHtR (OR=1.18,95% CI:1.04~1.34,P=0.010)与KOA的发生均呈显著正相关;而在男性受试者中,所有指标与KOA均不存在显著关联(P均>0.05)。检验性别与肥胖及代谢指标的交互作用发现,WC (P=0.010)、CVAI (P=0.002)和TyG-WC (P=0.020)与KOA之间的关联在男女之间存在显著差异。ROC诊断效能评估显示,各项指标的诊断效能均有限(AUC:BRI为0.547、TyG-WHtR为0.544、其余均≤ 0.530)。结论 BMI、BRI、LAP、TyG-BMI、TyG-WHtR可作为中老年女性人群KOA风险评估的辅助指标,但其独立筛查价值有限,需结合临床评估和其他风险因素综合判断。

     

    Abstract: Objective To investigate the association between obesity-related metabolic indices and the risk of knee osteoarthritis (KOA) in middle-aged and older Chinese adults (≥ 45 years) using data from the China Health and Retirement Longitudinal Study (CHARLS). Methods Data from two CHARLS survey waves (2011-2012 and 2015-2016) were analyzed. Obesity indices-including body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), visceral adiposity index (VAI), a body shape index (ABSI), body roundness index (BRI), lipid accumulation product (LAP), conicity index (CI), and Chinese visceral adiposity index (CVAI) -and metabolic indices-triglyceride glucose index (TyG), TyG-BMI, TyG-WC, and TyG-WHtR-were collected. Covariates comprised demographic characteristics, lifestyle factors, and health status. Three multivariate logistic regression models were constructed. Sex-subgroup analyses assessed heterogeneity, and receiver operating characteristic (ROC) curves with area under the curve (AUC) were used to evaluate diagnostic performance. Results Among 9527 participants, the prevalence of KOA was 9.59% (914/9527). After adjusting for confounders, linear regression revealed significant positive associations between KOA and BMI (OR=1.02, 95% CI:1.00-1.04, P=0.048), BRI (OR=1.06, 95% CI:1.01-1.13, P=0.030), LAP (OR=1.03, 95% CI:1.00-1.05, P=0.020), TyG-BMI (OR=1.02, 95% CI:1.00-1.05, P=0.020), and TyG-WHtR (OR=1.13, 95% CI:1.021.25, P=0.020). Sex-stratified analyses showed that in women, BMI (OR=1.03, 95% CI:1.01-1.06, P=0.020), WHtR (OR=1.18, 95% CI:1.02-1.36, P=0.020), BRI (OR=1.08, 95% CI:1.011.16, P=0.020), LAP (OR=1.03, 95% CI:1.01-1.06, P=0.020), CVAI (OR=1.04, 95% CI:1.01-1.07, P=0.009), TyG-BMI (OR=1.03, 95% CI:1.01-1.06, P=0.006), TyG-WC (OR=1.10, 95% CI:1.01-1.19, P=0.02), and TyG-WHtR (OR=1.18, 95% CI:1.04-1.34, P=0.010) were positively associated with KOA, whereas no significant associations were observed in men (P>0.05 for all indices). Significant sex interactions were found for WC (P=0.010), CVAI (P=0.002), and TyG-WC (P=0.020). ROC analysis indicated limited diagnostic utility for all indices (AUC:BRI=0.547, TyGWHtR=0.544; others ≤ 0.530). Conclusions BMI, BRI, LAP, TyG-BMI, and TyG-WHtR may serve as auxiliary indicators for KOA risk assessment in middle-aged and older women, but their standalone screening value remains modest. Clinical evaluation and integration with other risk factors are recommended for comprehensive risk stratification.

     

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