中国成年人群体质量指数与健康相关生命质量的关系：健康与慢病不同亚组的分层分析

The relationship between body mass index and health-related quality of life in the adult Chinese population： among the healthy and chronic disease subgroups

目的 探讨中国成年人群健康与慢病不同亚组体质量指数（body mass index,BMI）与健康相关生命质量（health-related quality of life,HRQOL）的关系.方法 21 108例样本源于中国9省市横断面健康状况调查数据库.采用秩和检验比较不同BMI分类的HRQOL得分差异;应用多因素logistic回归模型分析排除混杂因素影响后,探讨不同BMI分类对HRQOL的独立影响.结果 （1）健康人群SF-36生理领域（PCS）和心理领域（MCS）均是超重组得分最高[（83.69± 14.09）分,（80.29± 15.41）分],体质量过轻组最低[（81.20±14.05）分,（74.82± 16.41）分];慢病人群PCS超重组得分最高[（74.63±18.51）分],MCS肥胖组得分最高[（76.75±18.83）分];HRQOL在健康人群和慢病人群间的差异大于不同BMI分类间的差异.（2）以正常体质量组为参照,排除性别、年龄、婚姻状况、文化程度、运动习惯、烟酒嗜好影响的logistic回归分析显示：体质量过轻组PCS[健康OR=1.23（1.10～ 1.35）,慢病OR=1.48（1.20～ 1.82）]、MCS[健康OR=1.14（1.03～1.26）,慢病OR=1.37（1.11 ～ 1.68）]及其多个维度HRQOL减损的危险度增加有统计学意义;超重组生理领域及其一般健康维度、MCS[健康OR=0.81 （0.72～0.91）,慢病OR=0.80（0.71～0.91）]及其多个维度HRQOL减损的危险度降低有统计学意义;肥胖组生理功能维度[健康OR=1.91（1.25～ 2.92）,慢病OR=1.65（1.21 ～ 2.26）] HRQOL减损的危险度增加有统计学意义,但MCS及其情感职能、精神健康维度HRQOL减损的危险度降低有统计学意义.结论 无论健康还是慢病,BMI对HRQOL的影响趋势相似：体质量过轻者生理领域和心理领域HRQOL均较差,超重和肥胖者心理领域HRQOL较好,肥胖者生理功能维度HRQOL较差.这种关系在慢病人群中更明显.

Objective To investigate the relationship between body mass index （BMI） and health-related quality of life （HRQOL） in the adult Chinese population.Methods Data of 21 108 adults was collected from a cross-sectional survey performed in 9 provinces of China （Jiangsu,Anhui,Gansu,Qinghai,Fujian,Beijing,Jilin,Jiangxi and Henan province）.Rank sum test was used to compare HRQOL with different BMI category.Multiple logistic regression analysis was used to assess the impact of different BMI category on HRQOL after adjusted for sex,age,marital,education,physical activity status,and tobacco and alcohol addiction.Results （1） For healthy subjects,the overweight BMI group had the highest HRQOL score in the physical component summary （PCS） （83.69±14.09） and mental component summary （MCS）（80.29± 15.41）,while the underweight group had the worst HRQOL（81.20-± 14.05,74.82± 16.41）.For subjects with chronic condition,overweight had the highest H RQOL score in the PCS（74.63± 18.51）,and obese group had the best HRQOL in the MCS （76.75± 18.83）.The variation among healthy and chronic disease subjects was much greater than the differences among BMI category groups.（2） Compared with normal weight,data on odds ratio（ORs） of impaired HRQOL in PCS（healthy subjects OR=1.23（1.10-1.35）,chronic disease subjects OR=1.48（1.20-1.82）） MCS（healthy subjects OR=1.14（1.03-1.26）,chronic disease subjects OR=1.37 （1.11-1.68）） and multiple dimensions increased among underweight.ORs of impaired HRQOL in PCS and general health dimension,MCS （healthy subjects OR =0.81 （0.72-0.91）,chronic disease subjects OR=0.80（0.71-0.91）） and multiple dimensions decreased among overweight.ORs of impaired HRQOL in physical functioning dimension （healthy subjects OR=1.91 （1.25-2.92）,chronic disease subjects OR=1.65（1.21-2.26）） while in MCS and role emotional and mental health dimension decreased among obese.Conclusion Whatever health or chronic disease,the influence of BMI on HRQOL is similar：the HRQOL score for the underweight group is significantly lower than that for other BMI groups in PCS and MCS.Overweight and the obese people has better HRQOL in MCS,and the obese people has poor physical function.The relation above between BMI and HRQOL is more obvious in people with chronic disease.