Combined effects of overweight and smoking in late adolescence on subsequent mortality: nationwide cohort study.
Combined effects of overweight and smoking in late adolescence on subsequent mortality: nationwide cohort study.
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DOI：
10.1136/bmj.b496
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发表时间：
2009-02-24
期刊：
影响因子：
--
通讯作者：
Rasmussen F
中科院分区：
文献类型：
--
作者：
Neovius M;Sundström J;Rasmussen F
目的探讨青春期后期超重和吸烟对成人死亡率的综合影响。设计记录关联研究，并根据肌肉力量、社会经济地位和年龄调整 Cox 比例风险比。设置瑞典兵役征兵登记册、死亡原因登记册和人口普查数据。参与者包括 45 920 名瑞典男性（平均年龄 18.7 岁，标准差 0.5），随访时间为 38 年。主要结果测量 1969-70 年强制征兵测试中的体重指数（体重过轻（BMI <18.5）、正常体重（18.5-24.9）、超重（25-29.9）和肥胖（≥30））、肌肉力量和自我报告的吸烟情况（不吸烟、轻度吸烟者（每天 1-10 支）、重度吸烟者（> 10 支/天））。皆造成死亡。结果 超过 170 万人年，有 2897 人死亡。与正常体重男性（发病率17/10 000人年，95%置信区间16至18）相比，超重（风险比1.33、1.15至1.53；发病率23、20至26）和肥胖男性（风险比2.14、1.61至2.85；发病率38、 27 至 48），在对吸烟者和非吸烟者的单独分析中具有类似的相对估计值。在体重不足的男性中，没有发现风险增加（风险比 0.97、0.86 至 1.08；发病率 18、16 至 19），尽管体重极度不足（BMI <17）与死亡率增加相关（风险比 1.33、1.07 至 1.64；发病率 24、19 至 29）。 BMI 和吸烟状况之间的相互作用导致的相对超额风险在任何阶层中都不显着。此外，除了肥胖和大量吸烟的组合（相对过度风险1.5，-0.7至3.7）之外，所有相互作用的估计值都很小。与不吸烟者（发病率14、13至15）相比，轻度吸烟者（风险比1.54、1.41至1.70；发病率15、14至16）和重度吸烟者（风险比2.11、1.92至2.31；发病率26、24至27）的风险均增加。结论 无论吸烟状况如何，青春期后期的超重和肥胖都会增加成人死亡的风险。肥胖和超重分别与大量吸烟和少量吸烟一样危险，但体重指数和吸烟状况之间没有相互作用。全球肥胖流行和青少年吸烟仍然是强化公共卫生举措的重要目标。
Objective To investigate the combined effects on adult mortality of overweight and smoking in late adolescence. Design Record linkage study with Cox proportional hazard ratios adjusted for muscle strength, socioeconomic position, and age. Setting Swedish military service conscription register, cause of death register, and census data. Participants 45 920 Swedish men (mean age 18.7, SD 0.5) followed for 38 years. Main outcome measures Body mass index (underweight (BMI <18.5), normal weight (18.5-24.9), overweight (25-29.9), and obesity (≥30)), muscle strength, and self reported smoking (non-smoker, light smoker (1-10 cigarettes/day), heavy smoker (>10/day)) at mandatory military conscription tests in 1969-70. All cause mortality. Results Over 1.7 million person years, 2897 men died. Compared with normal weight men (incidence rate 17/10 000 person years, 95% confidence interval 16 to 18), risk of mortality was increased in overweight (hazard ratio 1.33, 1.15 to 1.53; incidence rate 23, 20 to 26) and obese men (hazard ratio 2.14, 1.61 to 2.85; incidence rate 38, 27 to 48), with similar relative estimates in separate analyses of smokers and non-smokers. No increased risk was detected in underweight men (hazard ratio 0.97, 0.86 to 1.08; incidence rate 18, 16 to 19), though extreme underweight (BMI <17) was associated with increased mortality (hazard ratio 1.33, 1.07 to 1.64; incidence rate 24, 19 to 29). The relative excess risk due to interaction between BMI and smoking status was not significant in any stratum. Furthermore, all estimates of interaction were of small magnitude, except for the combination of obesity and heavy smoking (relative excess risk 1.5, −0.7 to 3.7). Compared with non-smokers (incidence rate 14, 13 to 15), risk was increased in both light (hazard ratio 1.54, 1.41 to 1.70; incidence rate 15, 14 to 16) and heavy smokers (hazard ratio 2.11, 1.92 to 2.31; incidence rate 26, 24 to 27). Conclusions Regardless of smoking status, overweight and obesity in late adolescence increases the risk of adult mortality. Obesity and overweight were as hazardous as heavy and light smoking, respectively, but there was no interaction between BMI and smoking status. The global obesity epidemic and smoking among adolescents remain important targets for intensified public health initiatives.
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影响因子：
168.9
作者：
Renehan, Andrew G.;Tyson, Margaret;Zwahlen, Marcel
通讯作者：
Zwahlen, Marcel
影响因子：
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影响因子：
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影响因子：
105.7
作者：
SONNEHOLM, S;SORENSEN, TIA;CHRISTENSEN, U
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CHRISTENSEN, U