中国老年人中心性肥胖和维生素D水平与衰弱的关系研究

doi:10.12114/j.issn.1007-9572.2024.0399

摘要/Abstract

摘要： 背景中国老年人随着年龄增长衰弱发生率增高，探究老年人中心性肥胖与维生素D水平在衰弱发生、发展过程中的作用对衰弱管理至关重要。目的使用交叉滞后模型探究维生素D水平在老年人中心性肥胖与衰弱之间的纵向中介作用，为老年人衰弱管理提供理论参考依据。方法选取中国老年健康影响因素跟踪调查（CLHLS）2011—2012年（T1）和2014年（T2）中1 364名老年人为研究对象。测定研究对象的维生素D水平，并采用体质量校正腰围指数（WWI）测量中心性肥胖、衰弱指数（FI）测量衰弱。通过交叉滞后模型分析老年人中心性肥胖与衰弱之间的因果时序关系，并探讨维生素D是否作为中介因素参与中心性肥胖与衰弱的发生。结果 T1老年人衰弱检出率为21.8%（298/1 364），T2衰弱检出率为31.2%（425/1 364）。在两个时间点上，WWI与维生素D水平均呈负相关（P<0.05），与FI均呈正相关（P<0.05）；维生素D水平与FI均呈负相关（P<0.05）。交叉滞后模型结果显示，T1 WWI能够预测T2 FI（β=1.124，P<0.05），T1 FI能够预测T2 WWI（β=0.125，P<0.05）。纵向中介效应分析表明，T1 WWI不仅可以直接预测T2 FI（β=0.040，P<0.05），还可以通过T2维生素D水平的中介作用预测T2 FI（β=-0.131，P<0.05）。结论中心性肥胖不仅可以直接影响老年人的衰弱，同时也能通过维生素D水平的部分纵向中介作用间接影响老年人的衰弱。老年人应定期监测中心性肥胖与维生素D水平，预防或延缓衰弱的发生。

关键词: 衰弱, 中心性肥胖, 维生素D, 老年人, 交叉滞后分析

Abstract:

Background

The incidence of frailty among the elderly in China increases with age, investigating the mechanisms by which central obesity and vitamin D levels contribute to the development of frailty is essential for effective management strategies.

Objective

A cross-lagged model was employed to investigate the longitudinal mediating role of vitamin D levels in the relationship between central obesity and frailty among the elderly, thereby offering a theoretical framework for the management of frailty in this population.

Methods

The study subjects were 1 364 elderly individuals selected from the Chinese Longitudinal Healthy Longevity Study (CLHLS) in 2011-2012 (T1) and 2014 (T2). The vitamin D levels of the study subjects were measured, and abdominal obesity was assessed using the weight-adjusted-waist index (WWI), while frailty was measured using the frailty index (FI). A cross-lagged model was implemented to analyze the causal temporal relationship and underlying mechanisms between central obesity, vitamin D levels, and frailty among the elderly.

Results

The detection rate of frailty in the elderly was 21.8% (298/1 364) at T1 and 31.2% (425/1 364) at T2. At two time points, WWI was negatively correlated with vitamin D levels (P<0.05) and positively correlated with FI (P<0.05) ; vitamin D levels were negatively correlated with FI (P<0.05). Cross-lagged model results showed that WWI at T1 could predict FI at T2 (β=1.124, P<0.05), and FI at T1 could predict WWI at T2 (β=0.125, P<0.05). Longitudinal mediation effect analysis showed that T1 WWI could not only directly predict T2 FI (β=0.040, P<0.05), but also predict T2 FI through the mediating effect of T2 vitamin D level (β=-0.131, P<0.05) .

Conclusion

Abdominal obesity can not only directly predict frailty in the elderly, but also indirectly affect frailty in the elderly through the longitudinal mediating effect of vitamin D levels. Elderly people should regularly monitor abdominal obesity and vitamin D levels, to prevent or delay the onset of debilitation.

Key words: Frailty, Abdominal obesity, Vitamin D, Aged, Cross-lagged analysis

尹单,贺惠娟,李梦盈,等. 中国老年人中心性肥胖和维生素D水平与衰弱的关系研究[J]. 中国全科医学, 2025, 28(08): 933-938. DOI: 10.12114/j.issn.1007-9572.2024.0399.
YIN Dan,HE Huijuan,LI Mengying, et al. Association between Abdominal Obesity, Vitamin D Levels and Frailty in Chinese Elder Adults[J]. Chinese General Practice, 2025, 28(08): 933-938. DOI: 10.12114/j.issn.1007-9572.2024.0399.

图/表 5

图1 样本纳入流程图

Figure 1 Flow chart of sample inclusion

表1 WWI、维生素D水平和FI的相关性分析

Table 1 Correlation analysis of WWI，vitamin D levels and FI

变量	T1 WWI	T2 WWI	T1维生素D水平	T2维生素D水平	T1 FI
T2 WWI	0.324^a	1.000	—	—	—
T1维生素D水平	-0.178^a	-0.130^a	1.000	—	—
T2维生素D水平	-0.159^a	-0.223^a	0.349^a	1.000	—
T1 FI	0.222^a	0.191^a	-0.279^a	-0.247^a	1.000
T2 FI	0.205^a	0.216^a	-0.296^a	-0.315^a	0.707^a

图2 中心性肥胖与衰弱交叉滞后模型注：WWI=体质量校正腰围指数，FI=衰弱指数，T1为基线数据，T2为随访数据；aP<0.05；图中的数字为路径的标准化回归系数，实线表示回归系数显著。

Figure 2 A cross-lagged models of abdominal obesity and debilitating

图3 维生素D水平在中心性肥胖与衰弱之间的纵向中介作用注：aP<0.05。

Figure 3 Longitudinal mediation of the association between abdominal obesity and debility by vitamin D levels

图4 维生素D水平在衰弱与中心性肥胖之间的纵向中介作用注：aP<0.05；虚线表示回归系数不显著。

Figure 4 Longitudinal mediation of vitamin D levels between debility and abdominal obesity

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