Body Mass Index and the Risk of Serious Non-AIDS Events and All-Cause Mortality in Treated HIV-Positive Individuals: D:A:D Cohort Analysis
Body Mass Index and the Risk of Serious Non-AIDS Events and All-Cause Mortality in Treated HIV-Positive Individuals: D:A:D Cohort Analysis
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DOI：
10.1097/qai.0000000000001722
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发表时间：
2018-08-15
影响因子：
3.6
通讯作者：
Law, Matthew G.
中科院分区：
文献类型：
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作者：
Achhra, Amit C.;Sabin, Caroline;Law, Matthew G.
背景：体重指数(BMI)[体重(Kg)/身高(m(2))]与严重的非艾滋病事件之间的关系尚不清楚。方法：我们跟踪了D：A：D研究参与者从他们第一次测量BMI到第一次出现终点或结束随访(N=41,149随访295,147人年)。终点是心血管疾病(CVD)、糖尿病、非艾滋病定义癌症(NADCs)和BMI-NADCs(已知与普通人群中的BMI相关的癌症)；以及全因死亡。使用泊松回归模型，我们分析了BMI的时间更新，滞后1年，分类为18.5，23，25，27.5和30 kg/m(2)。结果：参与者主要是男性(73%)，平均年龄40岁(SD 9.7)，基线BMI中位数23.3(四分位数范围21.2-25.7)。总体而言，BMI与除糖尿病以外的所有结果的风险在统计学上显示出显著的J型关系。BMI为30(95%可信区间)与23-25的相对危险度(RR)分别为：心血管密度：1.46(1.15-1.84)和1.31(1.03-1.67)；NADDC：1.78：1.39-2.28和1.17(0.88-1.54)；BMI-NADCs：1.29(0.662.55)和1.92(1.10-3.36)。全因死亡率存在性别交互作用(P<；0.001)，男性RR分别为2.47(2.12-2.89)和1.21(0.97-1.50)，女性RR分别为1.6(1.30-1.98)和1.02(0.74-1.42)。中等BMI类别的RR保持在1左右。糖尿病的风险随着体重指数的增加而线性增加(P<；0.001)。结论：低体重指数(30)会增加心血管疾病、多种癌症和全因死亡率，在体重指数为23-25和25-30时风险相对较低。高BMI也与患糖尿病的风险有关。
Background: The relationship between body mass index (BMI) [weight (kg)/height (m(2))] and serious non-AIDS events is not well understood.Methods: We followed D:A:D study participants on antiretroviral therapy from their first BMI measurement to the first occurrence of the endpoint or end of follow-up (N = 41,149 followed for 295,147 person-years). The endpoints were cardiovascular disease (CVD); diabetes; non-AIDS-defining cancers (NADCs) and BMI-NADCs (cancers known to be associated with BMI in general population); and all-cause mortality. Using Poisson regression models, we analyzed BMI as time-updated, lagged by 1 year, and categorized at: 18.5, 23, 25, 27.5, and 30 kg/m(2).Results: Participants were largely male (73%) with the mean age of 40 years (SD 9.7) and baseline median BMI of 23.3 (interquartile range: 21.2-25.7). Overall, BMI showed a statistically significant Jshaped relationship with the risk of all outcomes except diabetes. The relative risk (RR) for the BMI of 30 (95% confidence interval) compared with 23-25, respectively, was as follows: CVD: 1.46 (1.15-1.84) and 1.31 (1.03-1.67); NADCs: 1.78 1.39-2.28) and 1.17 (0.88-1.54); and "BMI-NADCs": 1.29 (0.662.55) and 1.92 (1.10-3.36). For all-cause mortality, there was an interaction by sex (P < 0.001): RR in males: 2.47 (2.12-2.89) and 1.21 (0.97-1.50); and in females: 1.60 (1.30-1.98) and 1.02 (0.74-1.42). RR remained around 1 for intermediate categories of BMI. The risk of diabetes linearly increased with increasing BMI (P < 0.001).Conclusions: Risk of CVD, a range of cancers, and all-cause mortality increased at low BMI ( 30 with a relatively low risk at BMI of 23-25 and 25-30. High BMI was also associated with risk of diabetes.