中国中老年人锥度指数与衰弱风险的关联性

Association between conicity index and frailty in Chinese middle and old-aged adults

摘要

目的 分析锥度指数与衰弱发生风险之间的关系，明确其衰弱预测能力，为早期衰弱预防及衰弱管理措施的制定提供理论依据。方法 基于中国健康与养老追踪调查（CHARLS）数据，使用 Cox 比例风险回归模型分析锥度指数与衰弱发生风险的关联，限制性立方样条（RCS）探究二者非线性剂量-反应关系。采用受试者工作特征（ROC）曲线和时间依赖性 ROC 评估锥度指数对衰弱的预测性能。结果 完全调整的 Cox 回归模型中，锥度指数每增加 0.1 个单位，衰弱风险增加 14.0%（HR= 1.140,95% CI 1.086~1.196,P<0.001）。对锥度指数进行三分位数分组，与最低水平组相比，最高水平组衰弱风险增加 27.1% （HR =1.271,95% CI 1.138 ∼1.420,P<0.001）。趋势性检验显示随着锥度指数三分位数水平升高，衰弱风险呈上升趋势（P_趋势<0.001) 。RCS 结果显示，锥度指数与衰弱发生风险之间呈 J 型非线性关系（P_总体<0.001,P_非线性=0.001），当锥度指数 >1.2 时衰弱风险呈快速上升趋势。ROC和时间依赖性ROC结果显示，与体质量指数（AUC=0.525,95%CI0.512∼0.538）和腰围（AUC=0.550,95%CI0.537∼0.562）相比，锥度指数的衰弱预测性能最好（AUC=0.600,95%CI0.587∼0.613），且随着随访年的延长，锥度指数对衰弱的预测性能逐渐增强。结论 中国中老年人群中锥度指数与衰弱存在显著正相关关系，锥度指数可成为衰弱预防和衰弱管理的潜在有效指标。

Abstract

Objective To analyze the relationship between conicity index and the risk of frailty occurrence，and clarify its predictive capacity for frailty，providing a theoretical basis for early frailty prevention and formulation of frailty management strategies. Methods Based on data from the China Health and Retirement Longitudinal Study（CHARLS），Cox proportional hazards regression models were employed to examine the association between conicity index and the risk of frailty incidence.Restricted cubic splines（RCS）were utilized to explore potential non-linear dose-response relationships between these variables.The predictive performance of conicity index for frailty was evaluated using receiver operating characteristic（ROC）curves and time-dependent ROC analysis. Results In fully adjusted Cox regression model，each 0.1 -unit increase in conicity index was associated with a 14.0% elevated risk of frailty HR=1.140,95%CI1.086-1.196,P<0.001）.When conicity index was stratified into tertiles，compared with the lowest tertile，the highest tertile of conicity index demonstrated a 27.1% increased risk of frailty（HR=1.271,95%CI1.138-1.420,P<0.001）.A significant trend test showed that the risk of frailty increased with elevated tertile levels of conicity index（P_trend <0.001）.RCS analysis revealed a J-shaped nonlinear relationship between conicity index and frailty incidence risk（P_overall<0.001;P_non-linear=0.001），and the risk of frailty rose rapidly when conicity index exceeded 1.2.ROC and time-dependent ROC analyses results demonstrated that conicity index had the best predictive performance for frailty（AUC=0.600,95%CI0.587-0.613）compared with body mass index（AUC=0.525,95%CI0.512-0.538）and waist circumference AUC=0.550,95%CI0.537-0.562.Moreover，the predictive ability of conicity index for frailty increased gradually with increasing follow-up years. Conclusion Conicity index is positively associated with the frailty among Chinese middle and old-aged adults，and it may serve as a potentially effective indicator for frailty prevention and management.

关键词

锥度指数 / 衰弱 / 中老年人 / CHARLS / 纵向研究 / 预测性能

Key words

conicity index / frailty / middle and old-aged adults / CHARLS / longitudinal study / predictive performance

参考文献

[1] Liu X, Yang X. Research progress on frailty in elderly people[J]. Clin Interv Aging, 2024, 19:1493-1505.

[2] Hoogendijk EO, Afilalo J, Ensrud KE, et al. Frailty:implications for clinical practice and public health[J]. Lancet, 2019, 394(10206):1365-1375.

[3] Biritwum RB, Minicuci N, Yawson AE, et al. Prevalence of and factors associated with frailty and disability in older adults from China,Ghana,India,Mexico,Russia and South Africa[J]. Maturitas, 2016, 91:8-18.

[4] Damluji AA, Chung SE, Xue QL, et al. Frailty and cardiovascular outcomes in the National Health and Aging Trends Study[J]. Eur Heart J, 2021, 42(37):3856-3865.

[5] Afonso C, Sousa-Santos AR, Santos A, et al. Frailty status is related to general and abdominal obesity in older adults[J]. Nutr Res, 2021, 85:21-30.

[6] Xu J, Chen M, Cui J, et al. Association between conicity index and frailty in older Americans:the NHANES cross-sectional study, 2007-2018[J]. Sci Rep, 2025, 15(1): 17857.

[7] Valdez R, Seidell JC, Ahn YI, et al. A new index of abdominal adiposity as an indicator of risk for cardiovascular disease.A cross-population study[J]. Int J Obes Relat Metab Disord, 1993, 17(2):77-82.

[8] Theou O, Brothers TD, Mitnitski A, et al. Operationalization of frailty using eight commonly used scales and comparison of their ability to predict all-cause mortality[J]. J Am Geriatr Soc, 2013, 61(9):1537-1551.

[9] Jayanama K, Theou O, Godin J, et al. Relationship of body mass index with frailty and all-cause mortality among middleaged and older adults[J]. BMC Med, 2022, 20(1): 404.

[10] Uchai S, Andersen LF, Hopstock LA, et al. Body mass index, waist circumference and pre-frailty/frailty:the Troms ∅ study 1994-2016[J]. BMJ Open, 2023, 13(2):e065707.

[11] Popko K, Gorska E, Stelmaszczyk-Emmel A, et al. Proinflammatory cytokines II-6 and TNF-α and the development of inflammation in obese subjects[J]. Eur J Med Res, 2010, 15(Suppl 2):120-122.

[12] García-Esquinas E, José García-García F, León-Muñoz LM,et al. Obesity,fat distribution,and risk of frailty in two populationbased cohorts of older adults in Spain[J]. Obesity(Silver Spring), 2015, 23(4):847-855.

[13] Yuan L, Chang M, Wang J. Abdominal obesity,body mass index and the risk of frailty in community-dwelling older adults:a systematic review and meta-analysis[J]. Age Ageing, 2021, 50 (4): 1118-1128.

[14] Yang H, Xiao J, Zhang W, et al. Sex differences in the association between inflammatory biomarkers(Hs-CRP,IL-6,IL-10, TNF-α )and frailty in hospitalized adults aged ⩾65 in Taizhou, China:a cross-sectional study[J]. Clin Interv Aging, 2025, 20: 2267-2281.

[15] Xu Y, Wang M, Chen D, et al. Inflammatory biomarkers in older adults with frailty:a systematic review and meta-analysis of cross-sectional studies[J]. Aging Clin Exp Res, 2022, 34 (5):971-987.

[16] Goodpaster BH, Theriault R, Watkins SC, et al. Intramuscular lipid content is increased in obesity and decreased by weight loss[J]. Metabolism, 2000, 49(4):467-472.

[17] Porter Starr KN, McDonald SR, Bales CW. Obesity and physical frailty in older adults:a scoping review of lifestyle intervention trials[J]. J Am Med Dir Assoc, 2014, 15(4):240-250.

[18] Beddows CA, Shi F, Horton AL, et al. Pathogenic hypothalamic extracellular matrix promotes metabolic disease[J]. Nature, 2024, 633(8031):914-922.

[19] Dzięgielewska-Gęsiak S, Muc-Wierzgoń M. Inflammation and oxidative stress in frailty and metabolic syndromes-two sides of the same coin[J]. Metabolites, 2023, 13(4): 475.

[20] Damanti S, Citterio L, Zagato L, et al. DNA polymorphisms in inflammatory and endocrine signals linked to frailty are also associated with obesity:data from the FRASNET cohort[J]. Front Endocrinol(Lausanne), 2024, 15: 1412160.

[21] Crow RS, Lohman MC, Titus AJ, et al. Association of obesity and frailty in older adults:NHANES 1999-2004[J]. J Nutr Health Aging, 2019, 23(2):138-144.

[22] Koenen M, Hill MA, Cohen P, et al. Obesity,adipose tissue and vascular dysfunction[J]. Circ Res, 2021, 128 (7):951968.

[23] Martins CA, do Prado CB, Santos Ferreira JR, et al. Conicity index as an indicator of abdominal obesity in individuals with chronic kidney disease on hemodialysis[J]. PLoS One, 2023, 18 (4): e0284059.

基金资助

国家自然科学基金项目(32301421)