中国绝经后女性生殖因素、生活方式行为与认知衰退的队列研究
该社区队列研究前瞻性随访1379名≥60岁认知正常的中国绝经后女性平均1.8年，评估绝经年龄、初潮年龄、产次、首次活产年龄和母乳喂养时长与认知衰退的关联。结果显示绝经年龄<46岁、46–50岁及母乳喂养>35个月、24–35个月与认知衰退风险升高相关，且早期绝经或长母乳喂养与不健康生活方式存在相加交互作用。
要点
- 绝经年龄<46岁及46–50岁者认知衰退风险高于>55岁者
- 母乳喂养24–35个月或>35个月者认知衰退风险高于<12个月者
- 早期绝经或长母乳喂养与缺乏运动等不良生活方式存在相加交互
核心结论
- 不健康生活方式行为可能加重具有不良生殖因素女性的认知衰退。
研究设计与样本
- 基于中国上海社区的队列研究，前瞻性随访1379名年龄≥60岁认知正常的绝经后女性，平均随访1.8年。
- 基线评估绝经年龄、初潮年龄、产次、首次活产年龄和母乳喂养时长，采用logistic回归分析生殖因素及其与生活方式行为的联合效应。
- 通过相对超额风险交互作用（RERI）和归因比例（AP）评估相加交互作用。
主要发现
- 与绝经年龄>55岁相比，绝经年龄<46岁的OR为2.55（95%CI 1.07–6.06），46–50岁的OR为2.32（95%CI 1.11–4.83）。
- 与母乳喂养<12个月相比，母乳喂养>35个月的OR为2.15（95%CI 1.02–4.51），24–35个月的OR为2.31（95%CI 1.13–4.71）。
- 早期绝经（≤50岁）合并蔬菜摄入不足的OR为1.84（95%CI 1.12–3.01），合并缺乏运动的OR为2.11（95%CI 1.28–3.48），合并睡眠时长欠佳的OR为2.15（95%CI 1.32–3.51），合并不利复合生活方式指数（CLI）的OR为1.76（95%CI 1.06–2.94）。
- 长母乳喂养时长（>23个月）合并缺乏运动的OR为2.10（95%CI 1.23–3.59），合并睡眠欠佳的OR为2.11（95%CI 1.26–3.55），合并不利CLI的OR为2.16（95%CI 1.19–3.91）。
- 早期绝经与缺乏运动之间存在相加交互作用（RERI=1.08，95%CI 0.37–1.80；AP=0.51，95%CI 0.19–0.83），长母乳喂养与缺乏运动之间也存在相加交互作用（RERI=0.89，95%CI 0.15–1.63；AP=0.42，95%CI 0.07–0.78）。
关键数值与推荐
- 认知衰退定义为简易精神状态检查（MMSE）评分年下降幅度超过平均下降1.0个标准差。
临床怎么用
- 对具有早期绝经或长母乳喂养等不良生殖因素的绝经后女性，应关注并干预其生活方式行为以降低认知衰退风险。
局限性
- 平均随访时间较短（1.8年），可能影响长期关联的观察。
- 样本来自中国上海社区，结果外推需谨慎。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
ABSTRACT Objective To investigate the association of reproductive factors and their joint effects with lifestyle behaviours with cognitive decline in Chinese postmenopausal women. Design Community-based cohort study. Setting Shanghai, China. Population or Sample We prospectively followed 1379 cognitively normal postmenopausal women aged ≥ 60 years for 1.8 years on average. Methods Menopausal age, menarche age, parity, age at first live birth and breastfeeding duration were assessed at baseline. Associations between reproductive factors or their joint effects with lifestyle behaviours and cognitive decline were examined using logistic regression. The additive interaction was evaluated by the relative excess risk due to interaction (RERI) and the attributable proportion due to interaction (AP). Main Outcome Measures Cognitive decline was defined as an annual decline in Mini-Mental State (MMSE) Examination score exceeding mean decline by 1.0 SD. Results The ORs (95% CIs) for cognitive decline were 2.55 (1.07, 6.06) for menopausal age < 46 years and 2.32 (1.11, 4.83) for menopausal age 46–50 years compared with menopausal age > 55 years. Meanwhile breastfeeding > 35 months (2.15, 1.02–4.51) and breastfeeding 24–35 months (2.31, 1.13–4.71) had higher risks of cognitive decline than breastfeeding < 12 months. Moreover, the combination of early menopause (≤ 50 years) and insufficient vegetable intake (1.84, 1.12–3.01), physical inactivity (2.11, 1.28–3.48), suboptimal sleep duration (2.15, 1.32–3.51), or an unfavourable composite lifestyle index (CLI) (1.76, 1.06–2.94) was associated with an increased risk of cognitive decline compared with the combination of late menopause (> 50 years) and each favourable lifestyle behaviour. Similarly, prolonged breastfeeding duration (> 23 months) combined with physical inactivity (2.10, 1.23–3.59), suboptimal sleep (2.11, 1.26–3.55), or an unfavourable CLI (2.16, 1.19–3.91) showed elevated risks compared with the combination of short breastfeeding duration (≤ 23 months) and each favourable lifestyle behaviour. In addition, we found additive interactions between early menopause and physical inactivity (RERI = 1.08, 95% CI: 0.37–1.80; AP = 0.51, 95% CI: 0.19–0.83), as well as between long breastfeeding duration and physical inactivity (RERI = 0.89, 95% CI: 0.15–1.63; AP = 0.42, 95% CI: 0.07–0.78). Conclusions Unhealthy lifestyle behaviours may exacerbate cognitive decline in women with adverse reproductive factors.
引用
- BJOG：Reproductive Factors, Lifestyle Behaviours and Cognitive Decline in Chinese Postmenopausal Women: A Cohort Study
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。