Body-mass index, blood pressure, and cause-specific mortality in India: a prospective cohort study of 500 810 adults.
Body-mass index, blood pressure, and cause-specific mortality in India: a prospective cohort study of 500 810 adults.
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DOI：
10.1016/s2214-109x(18)30267-5
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发表时间：
2018-07
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影响因子：
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通讯作者：
Lewington S
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作者：
Gajalakshmi V;Lacey B;Kanimozhi V;Sherliker P;Peto R;Lewington S
主要在高收入国家研究了特定原因死亡率和体重指数(BMI)之间的关系。我们在印度调查了体重指数、收缩压和死亡率之间的关系。1998年1月1日至2001年12月31日，从印度金奈的普通人群中招募了年龄在35岁或以上的男性和女性参加一项前瞻性研究。参与者接受了采访(收集的数据包括年龄、性别、教育程度、社会经济地位、病史、吸烟和饮酒)，并测量了(身高、体重和血压)。死亡是通过与金奈市死亡记录的联系以及通过受过培训的毕业非医疗现场工作者的家庭访问进行积极监测来确定的。在基线调查之后，在2002-05年对家庭进行了一次访问，然后每两年访问一次，直到2015年。在这些重复访问期间，2015年3月31日之前发生的任何死亡的结构化叙述都被记录下来，用于医生编码。2013-14年间，还根据基线对参与者的随机样本进行了重新调查，以评估收缩压和BMI的长期变异性。使用Cox回归(烟草、酒精和社会因素的标准化)将年龄在35-69岁的死亡率比(RR)与收缩压、BMI或根据通常的收缩压调整后的BMI联系起来。招募了500名 810参与者。在排除慢性病或不完整数据后，414名 746名年龄在35-69岁(平均46[SD9]；45%女性)的参与者留了下来。招募时平均收缩压为127 mm Hg(SD 15)，平均BMI为23.2 kg/m2(SD 3.8)。重新测量和基线测量的相关系数分别为0·50和0·88。低BMI与贫穷、烟草和酒精密切相关。在年龄在35-69岁的29名 519人死亡中，14名 935人的死因是心血管疾病(12名 504名心脏病患者，1,881名中风患者和550名其他患者)。血管死亡率与收缩压显著相关：正常收缩压每升高20 mm Hg，卒中死亡率为2.45(95%CI 2.16-2.78)，心源性死亡率为1.74(1·-1.84)，所有血管死亡率为1.84(1.75-1.94)。尽管BMI对收缩压(每千克/平方米增加约1毫米汞柱)和糖尿病患病率有很大影响，但BMI与心脏或中风死亡率几乎没有关系，即使是1级肥胖(即BMI在30·0-35·0千克/平方米)也只有轻微的超标。在对正常收缩压进行额外调整后，在15·0-30·0 kg/m2范围内，BMI与心脏病和中风的死亡率呈负相关：当体重不足的参与者(即BMI 15·0-18.5 kg/m2)与超重的参与者(即BMI 25·0-30·0 kg/m2)进行比较时，血压调整的RR分别为心脏死亡率1.28(95%可信区间1.20-1.38)和中风死亡率1.46(1.22-1.73)。在这一南亚人群中，BMI与血管死亡率几乎没有关联，尽管BMI增加与收缩压升高有关，而收缩压反过来又与血管死亡率增加有关。因此，一些与低于平均水平的BMI密切相关的因素肯定会产生重要的不良影响，这可能与所有人群相关。英国医学研究理事会、英国心脏基金会、英国癌症研究。
The association between cause-specific mortality and body-mass index (BMI) has been studied mainly in high-income countries. We investigated the relations between BMI, systolic blood pressure, and mortality in India. Men and women aged 35 years or older were recruited into a prospective study from the general population in Chennai, India between Jan 1, 1998, and Dec 31, 2001. Participants were interviewed (data collected included age, sex, education, socioeconomic status, medical history, tobacco smoking, and alcohol intake) and measured (height, weight, and blood pressure). Deaths were identified by linkage to Chennai city mortality records and through active surveillance by household visits from trained graduate non-medical fieldworkers. After the baseline survey, households were visited once in 2002–05, then biennially until 2015. During these repeat visits, structured narratives of any deaths that took place before March 31, 2015, were recorded for physician coding. During 2013–14, a random sample of participants was also resurveyed as per baseline to assess long-term variability in systolic blood pressure and BMI. Cox regression (standardised for tobacco, alcohol, and social factors) was used to relate mortality rate ratios (RRs) at ages 35–69 years to systolic blood pressure, BMI, or BMI adjusted for usual systolic blood pressure. 500 810 participants were recruited. After exclusion of those with chronic disease or incomplete data, 414 746 participants aged 35–69 years (mean 46 [SD 9]; 45% women) remained. At recruitment, mean systolic blood pressure was 127 mm Hg (SD 15), and mean BMI was 23·2 kg/m2 (SD 3·8). Correlations of resurvey and baseline measurements were 0·50 for systolic blood pressure and 0·88 for BMI. Low BMI was strongly associated with poverty, tobacco, and alcohol. Of the 29 519 deaths at ages 35–69 years, the cause was vascular for 14 935 deaths (12 504 cardiac, 1881 stroke, and 550 other). Vascular mortality was strongly associated with systolic blood pressure: RRs per 20 mm Hg increase in usual systolic blood pressure were 2·45 (95% CI 2·16–2·78) for stroke mortality, 1·74 (1·64–1·84) for cardiac mortality, and 1·84 (1·75–1·94) for all vascular mortality. Although BMI strongly affected systolic blood pressure (an increase of about 1 mm Hg per kg/m2) and diabetes prevalence, BMI was little related to cardiac or stroke mortality, with only small excesses even for grade 1 obesity (ie, BMIs of 30·0–35·0 kg/m2). After additional adjustment for usual systolic blood pressure, BMI was inversely related to cardiac and stroke mortality throughout the range 15·0–30·0 kg/m2: when underweight participants (ie, BMI 15·0–18·5 kg/m2) were compared with overweight participants (ie, BMI 25·0–30·0 kg/m2), the blood-pressure-adjusted RR was 1·28 (95% CI 1·20–1·38) for cardiac mortality and 1·46 (1·22–1·73) for stroke mortality. In this South Asian population, BMI was little associated with vascular mortality, even though increased BMI is associated with increased systolic blood pressure, which in turn is associated with increased vascular mortality. Hence, some close correlates of below-average BMI must have important adverse effects, which could be of relevance in all populations. UK Medical Research Council, British Heart Foundation, Cancer Research UK.