Effects of physical inactivity and obesity on morbidity and mortality: current evidence and research issues
Effects of physical inactivity and obesity on morbidity and mortality: current evidence and research issues
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DOI：
10.1097/00005768-199911001-00025
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发表时间：
1999-11-01
期刊：
影响因子：
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通讯作者：
Brodney, S
中科院分区：
文献类型：
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作者：
Blair, SN;Brodney, S
目的：本次审查的目的是解决三个具体问题。 1) 较高水平的体力活动是否会减弱超重或肥胖者通常观察到的健康风险增加？ 2) 肥胖但活跃的人实际上比体重正常但久坐的人发病率和死亡风险更低吗？ 3) 超重和缺乏活动哪个是死亡率更重要的预测因素？方法：我们最初确定了 700 多篇文章，其中包括有关身体习惯（体重指数、身体成分或身体脂肪模式）和身体活动习惯的暴露变量以及发病率或死亡率等结果的信息。为了纳入审查，我们要求一篇文章包括按两个暴露变量的分层对我们的一个结果进行的分析。我们排除了评论文章和横断面分析报告。我们使用基于证据的方法来评估已发布数据的质量。结果：我们总结了 24 篇符合所有纳入标准的文章的结果。全因死亡率、心血管疾病死亡率、冠心病 (CHD)、高血压、2 型糖尿病和癌症的结果数据可用。除癌症外，所有结果的总结结果总体一致，表明活跃或健康的女性和男性似乎可以免受超重或肥胖的危害。这种明显的保护作用在肥胖个体中通常比正常体重或超重个体更强。有关癌症的数据太少，无法得出任何结论。结论：尚无关于本综述讨论的主题的随机临床试验。所有审查的研究均为前瞻性观察研究，因此所有结论均基于 C 类证据。审查中涉及的三个问题的结论是：1）定期体育活动明显减轻了与超重或肥胖相关的许多健康风险； 2) 体力活动似乎不仅可以降低超重和肥胖的健康风险，而且活跃的肥胖者实际上比久坐的正常体重者的发病率和死亡率更低，3) 缺乏活动和心肺健康水平低与超重和肥胖一样重要，都是死亡率的预测因素。研究需求包括将当前的观察扩展到更多样化的人群，包括对女性、老年人和少数群体进行更多研究，需要改进评估方法，并应开展随机临床试验来解决本综述中讨论的问题。由于规模、复杂性和成本，这些试验的设计需要以亚临床疾病过程的有效非侵入性测量作为结果。
Purpose: The purpose of this review was to address three specific questions. 1) Do higher levels of physical activity attenuate the increased health risk normally observed in overweight or obese individuals? 2) Do obese but active individuals actually have a lower morbidity and mortality risk than normal weight persons who are sedentary? 3) Which is a more important predictor of mortality, overweight or inactivity? Methods: We initially identified more than 700 articles that included information on the exposure variables of body habitus (body mass index, body composition, or body fat pattern) and physical activity habits, and on outcomes such as morbidity or mortality. To be included in the review, we required that an article include an analysis of one of our outcomes by strata of the two exposure variables. We excluded review articles and reports of cross-sectional analyses. We used an evidence-based approach to evaluate the quality of the published data. Results: We summarized results from 24 articles that met all inclusion criteria. Data were available for the outcomes of all-cause mortality, cardiovascular disease mortality, coronary heart disease (CHD), hypertension, type 2 diabetes mellitus, and cancer. Summary results for all outcomes except cancer were generally consistent in showing that active or fit women and men appeared to be protected against the hazards of overweight or obesity. This apparent protective effect was often stronger in obese individuals than in those of normal weight or who were overweight There were too few data on cancer to permit any conclusions. Conclusions: There are no randomized clinical trials on the topics addressed in this review. All studies reviewed were prospective observational studies, so all conclusions are based on Evidence Category C. The conclusions for the three questions addressed in the review are: 1) regular physical activity clearly attenuates many of the health risks associated with overweight or obesity; 2) physical activity appears to not only attenuate the health risks of overweight and obesity, but active obese individuals actually have lower morbidity and mortality than normal weight individuals who are sedentary, and 3) inactivity and low cardiorespiratory fitness are as important as overweight and obesity as mortality predictors. Research needs include extending current observations to more diverse populations, including more studies in women, the elderly, and minority groups, assessment methods need to be improved, and randomized clinical trials addressing the questions discussed in this review should be undertaken. Owing to size, complexity, and cost, these trials will need to be designed with valid noninvasive measures of subclinical disease processes as outcomes.