摘要目的:本研究旨在基于多中心养老机构的前瞻性队列，探讨不同肥胖指标定义下的肌少性肥胖(sarcopenic obesity，SO)与老年人死亡风险之间的关系。方法:依据亚洲肌少症工作组2019年共识诊断肌少症；肥胖根据6种不同指标进行评估，包括腰围(waist circumference，WC)、腰臀比(waist-hip ratio，WHR)、腰围身高比(waist-height ratio，WHTR)、体质指数(body mass index，BMI)、内脏脂肪面积(visceral fat area，VFA)和体脂比(percentage of body fat，PBF)。本研究在自贡市15家养老机构建立了60岁及以上老年人的SO前瞻性队列，每年随访老年人的生存状态，连续随访2年。通过Cox比例风险回归模型分析不同肥胖指标定义的SO与死亡风险的相关性，并计算 HR值及其95% CI值。 结果:共纳入695名老年人，其中男性占67.1%。2年随访期间，共有88名老年人死亡。采用WC、WHR、WHTR、BMI、VFA和PBF定义的SO患病率分别为17.6%、30.1%、48.9%、3.0%、28.3%和58.7%。在以WC、WHR、WHTR、BMI和VFA定义SO时，SO组与非SO组的死亡率差异无统计学意义。然而，以PBF定义SO时，SO组的死亡率显著高于非SO组(16.9%比6.6%， P<0.01)。Cox比例风险回归分析显示，与非SO组比较，以PBF定义的SO组死亡风险显著增加( HR＝2.81，95% CI：1.67~4.73， P<0.001)。校正潜在混杂因素后，SO组的死亡风险仍显著高于非SO组( HR＝1.97，95% CI：1.14~3.38， P＝0.015)。 结论:不同肥胖指标下的SO患病率差异显著。以PBF定义的SO与养老机构老年人死亡风险显著相关。本研究为优化养老机构老年人SO的诊断标准提供了新证据。

abstractsObjective:To investigate the relationship between sarcopenic obesity(SO), defined by various obesity indicators, and mortality risk in older adults based on a prospective cohort from multiple nursing homes.Methods:Sarcopenia was diagnosed according to the 2019 consensus of the Asian Working Group for Sarcopenia.Obesity was defined using six different indicators: waist circumference(WC), waist-hip ratio(WHR), waist-height ratio(WHTR), body mass index(BMI), visceral fat area(VFA), and percentage of body fat(PBF).A prospective cohort of adults aged 60 and above was established across 15 nursing homes in Zigong City, with annual follow-ups on survival status conducted over two consecutive years.Cox proportional hazards regression models were employed to analyze the association between SO, defined by different obesity indicators, and mortality risk, calculating hazard ratios( HR)and their 95% confidence intervals( CI). Results:A total of 695 older adults were included in the study, of whom 67.1% were male.During the 2-year follow-up period, 88 participants died.The prevalence of SO as defined by WC, WHR, WHTR, BMI, VFA, PBF was found to be 17.6%, 30.1%, 48.9%, 3.0%, 28.3%, and 58.7%, respectively.When SO was defined using WC, WHR, WHTR, BMI, and VFA, there was no statistically significant difference in mortality rates between the SO and non-SO groups.However, when defined by PBF, the SO group exhibited a significantly higher mortality rate compared to the non-SO group(16.9% vs.6.6%, P<0.01).Cox proportional hazards regression analysis revealed that, compared to the non-SO group, the SO group defined by PBF had a significantly increased mortality risk( HR=2.81, 95% CI: 1.67-4.73, P<0.001).After adjusting for potential confounding factors, the mortality risk for the SO group remained significantly higher than that of the non-SO group( HR=1.97, 95% CI: 1.14-3.38, P=0.015). Conclusions:The prevalence of SO varies significantly across different obesity indicators.SO defined by PBF is significantly associated with mortality risk in nursing home residents.This study provides new evidence for further optimizing the diagnostic criteria for SO in this population.