摘要:

目的  研究湖北省≥18歲居民體質(zhì)指數(shù)（BMI）與健康相關(guān)生命質(zhì)量（HRQOL）的關(guān)系。

方法  于2013年運(yùn)用多階段分層整群隨機(jī)抽樣方法，在湖北省共納入研究對(duì)象27 814人。采用歐洲5維健康量表（EQ-5D）對(duì)居民HRQOL進(jìn)行評(píng)價(jià)；分析不同BMI分組與HRQOL得分以及EQ-5D各維度之間的關(guān)系。

結(jié)果  不同性別低體重人群EQ-5D和EQ-VAS得分均低于正常體重人群，而超重或肥胖人群EQ-5D和EQ-VAS得分與正常體重人群沒有明顯差異。相對(duì)于正常體重者，不同性別低體重人群在EQ-5D各維度出現(xiàn)問題的風(fēng)險(xiǎn)均增加；超重男性出現(xiàn)“焦慮或抑郁”問題的風(fēng)險(xiǎn)降低（OR = 0.776，95 % CI = 0.626～0.961），超重女性出現(xiàn)“疼痛或不適”的風(fēng)險(xiǎn)升高（OR = 1.150，95 % CI = 1.105～1.303）；不同性別肥胖人群出現(xiàn)“行動(dòng)能力”和“自我照顧能力”方面問題的風(fēng)險(xiǎn)較大，且肥胖女性更容易出現(xiàn)“焦慮或抑郁”問題（OR = 1.381，95 % CI = 1.028～1.856）。

結(jié)論  低體重人群HRQOL較差，超重和肥胖人群也存在一定的影響其生命質(zhì)量的生理和心理問題。

Abstract:

Objective  To study the association between body mass index (BMI) and the health-related quality of life (HRQOL) among adult residents in Hubei province.

Methods  We conducted a survey among 27 814 ≥ 18 years old residents recruited using stratified multistage cluster sampling across Hubei province in 2013. The Euro-Quality of Life-5 Dimension (EQ-5D) was adopted to assess the HRQOL of the participants. The relationship between categorized BMI and the scores of HRQOL and each dimension of EQ-5D were analyzed.

Results  The scores of EQ-5D and EuroQol Visual Analogue Scale (EQ-VAS) were lower in both underweight male and female participants than in the participants with normal weight but there was no statistical difference in the scores between the overweight or obese participants and the normal weight participants. Both the male and female underweight participants had higher risks of health problems than the normal weight participants in the five dimensions of EQ-5D. Overweight male participants had a lower risk of anxiety/depression than the normal weight participants (odds ratio [OR] = 0.776, 95% confidence interval [95% CI]: 0.626 – 0.961); overweight female participants had a higher risk of pain/discomfort than the normal weight female participants (OR = 1.150, 95% CI: 1.105 – 1.303); obese male and female participants had greater risks of mobility and self-care than normal weight participants and obese female participants were more likely to suffer from anxiety/depression than the normal weight female participants (OR = 1.381, 95% CI: 1.028 – 1.856).

Conclusion  The HRQOL of underweight residents is relatively poor and the HRQOL is influenced by some physical or psychological problems among overweight or obese residents in Hubei province.

表  1   不同BMI分組人群HRQOL得分

BMI分組 男性 女性 EQ-5D EQ-VAS EQ-5D EQ-VAS 低體重 0.910 ± 0.192 c 75.32 ± 16.68 c 0.931 ± 0.168 c 77.04 ± 16.70 c 正常 0.964 ± 0.113 81.84 ± 13.24 0.963 ± 0.112 80.91 ± 13.49 超重 0.968 ± 0.110 82.00 ± 13.26 0.950 ± 0.121 c 78.52 ± 14.22 c 肥胖 0.953 ± 0.129 a 80.28 ± 15.26 0.934 ± 0.140 c 76.92 ± 14.88 c　　注：正常體重組分別與低體重組、超重組和肥胖組比較；Kruskal-Wallis檢驗(yàn)：a P < 0.05，c P < 0.001。

表  2   不同BMI分組人群EQ-5D各維度出現(xiàn)問題狀況（%）

維度 男性 女性 低體重 正常 超重 肥胖 低體重 正常 超重 肥胖 MO 13.98 bcd 4.95 a 3.91 ad 7.29 ac 9.75 bc 4.52 acd 6.24 abd 10.57 bc SC 9.07 bcd 2.88 a 2.51 a 4.38 a 6.87 bc 2.84 ad 3.25 ad 6.23 bc UA 12.04 bcd 4.72 a 3.73 a 4.58 a 9.75 bc 4.23 acd 5.55 ab 7.92 b PD 22.69 bcd 11.08 a 10.11 a 13.96 a 19.73 b 12.99 acd 17.99 b 20.19 b AD 12.31 bcd 5.60 ac 4.15 ab 5.42 a 11.04 bc 6.16 acd 7.61 abd 11.32 bc　　注：a與低體重組比較，P < 0.05；b與正常體重組比較，P < 0.05；c與超重組比較，P < 0.05；d與肥胖組比較P < 0.05。

表  3   BMI與HRQOL關(guān)系的多元線性回歸模型分析

特征 低體重vs正常 超重vs正常 肥胖vs正常 β 95 % CI β 95 % CI β 95 % CI 男性 　EQ-5D – 0.030 – 0.037～0.023 a 0.002 – 0.003～0.007 – 0.009 – 0.020～0.001 　EQ-VAS – 3.314 – 4.061～2.566 a 0.258 – 0.241～0.757 – 0.888 – 1.967～0.191 女性 　EQ-5D – 0.023 – 0.029～0.017 a 0.000 – 0.005～0.004 – 0.008 – 0.018～0.002 　EQ-VAS – 2.699 – 3.290～– 2.049 a – 0.100 – 0.611～0.412 – 0.355 – 1.405～0.696　　注：a P < 0.001；模型中BMI分組以正常體重組為參照。

表  4   BMI與EQ-5D各維度關(guān)系的logistic回歸模型分析

特征 低體重vs正常 超重vs正常 肥胖vs正常 OR值 95 % CI OR值 95 % CI OR值 95 % CI 男性 　MO 1.784 1.426～2.231 c 0.931 0.740～1.172 1.764 1.183～2.630 b 　SC 1.914 1.456～2.515 c 1.055 0.792～1.406 1.701 1.030～2.808 a 　UA 1.573 1.238～2.000 c 0.900 0.709～1.142 0.980 0.603～1.590 　PD 1.565 1.313～1.866 c 0.945 0.813～1.098 1.303 0.976～1.741 　AD 1.511 1.213～1.882 c 0.776 0.626～0.961 a 0.947 0.619～1.449 女性 　MO 1.506 1.214～1.867 c 1.185 0.970～1.448 1.788 1.285～2.488 c 　SC 1.602 1.245～2.061 c 0.948 0.729～1.231 1.599 1.062～2.406 a 　UA 1.706 1.376～2.116 c 1.094 0.888～1.348 1.336 0.930～1.920 　PD 1.403 1.206～1.632 c 1.150 1.015～1.303 a 1.084 0.851～1.380 　AD 1.611 1.339～1.939 c 1.010 0.851～1.198 1.381 1.028～1.856 a　　注：a P < 0.05，b P < 0.01，c P < 0.001；模型中BMI分組以正常體重組為參照。 [1]

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