Association of Normal-Weight Central Obesity With All-Cause and Cause-Specific Mortality Among Postmenopausal Women
Association of Normal-Weight Central Obesity With All-Cause and Cause-Specific Mortality Among Postmenopausal Women
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DOI：
10.1001/jamanetworkopen.2019.7337
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发表时间：
2019-07-01
影响因子：
13.8
通讯作者：
Bao, Wei
中科院分区：
文献类型：
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作者：
Sun, Yangbo;Liu, Buyun;Bao, Wei
重要性目前的肥胖预防和控制公共卫生指南侧重于促进正常的身体质量指数（BMI），很少解决中心性肥胖，这是由高腰围（WC）反映的，在一般人群中很常见。正常体重中心性肥胖与长期健康结局的相关性研究很少。目的研究美国绝经后妇女正常体重中心性肥胖与全因死亡率和特定原因死亡率的相关性。在美国的40个临床中心，156624名绝经后妇女参加了妇女健康倡议的全国性前瞻性队列研究。从1993年到1998年。这些女性被观察到2017年2月。数据分析从2017年9月15日至2019年3月13日进行。（计算方法为体重（千克）除以身高（米）的平方;正常体重：BMI，18.5 - 24.9;超重：BMI，25.0 - 29.9;肥胖：BMI，>= 30）和WC（正常：主要结果和指标：全因死亡率、心血管疾病死亡率和癌症死亡率（平均[SD]年龄，63.2 [7.2]岁），在2811187人-年的随访期间，发生了43838例死亡，其中12965人死于心血管疾病（29.6%），11828人死于癌症（27.0%）。与体重正常、无向心性肥胖的女性相比，经人口统计学特征、社会经济地位、生活方式因素和激素使用调整后，全因死亡率的风险比为1.31（95%CI，1.20 - 1.42）在体重正常和中心性肥胖的女性中，0.91（95% CI，0.89 - 0.94）超重和无中心性肥胖的女性中，1.16（95% CI，1.13 - 1.20）超重和向心性肥胖的女性，0.93（95%CI，0.89 - 0.94），肥胖和中心性肥胖的女性为1.30（95%CI，1.27 - 1.34）。与体重正常但无中心性肥胖者相比，体重正常的中心性肥胖者心血管疾病死亡风险更高（风险比，1.25; 95% CI，1.05 - 1.46）和癌症死亡率（风险比，1.20;结论和相关性女性正常体重中心性肥胖与死亡率的过度风险相关，与BMI定义的肥胖伴向心性肥胖的女性相似。这些发现强调了未来公共卫生指南需要包括预防和控制中心性肥胖，即使是在BMI正常的个体中。
IMPORTANCE Current public health guidelines for obesity prevention and control focus on promoting a normal body mass index (BMI), rarely addressing central obesity, which is reflected by high waist circumference (WC) and common in the general population. Studies of the association of normal-weight central obesity with long-term health outcomes are sparse.OBJECTIVE To examine associations of normal-weight central obesity with all-cause and cause specific mortality in postmenopausal women in the United States.DESIGN, SETTING, AND PARTICIPANTS A nationwide prospective cohort study of 156 624 postmenopausal women enrolled in the Women's Health Initiative at 40 clinical centers in the United States between 1993 and 1998. These women were observed through February 2017. Data analysis was performed from September 15, 2017, to March 13, 2019.EXPOSURES Different combinations of BMI (calculated as weight in kilograms divided by height in meters squared; normal weight: BMI, 18.5-24.9; overweight: BMI, 25.0-29.9; and obesity: BMI, >= 30) and WC (normal: WC, 88 cm).MAIN OUTCOMES AND MEASURES Mortality from all causes, cardiovascular disease, and cancer.RESULTS Of the 156 624 women (mean [SD] age, 63.2 [7.2] years), during 2 811187 person-years of follow-up, 43 838 deaths occurred, including 12 965 deaths from cardiovascular disease (29.6%) and 11 828 deaths from cancer (27.0%). Compared with women with normal weight and no central obesity and adjusted for demographic characteristics, socioeconomic status, lifestyle factors, and hormone use, the hazard ratio for all-cause mortality was 1.31(95% CI, 1.20-1.42) among women with normal weight and central obesity, 0.91(95% CI, 0.89-0.94) among women with overweight and no central obesity, 1.16 (95% CI, 1.13-1.20) for women with overweight and central obesity, 0.93 (95% CI, 0.89-0.94) for women with obesity and no central obesity, and 1.30 (95% CI, 1.27-1.34)for women with obesity and central obesity. Compared with normal weight without central obesity, normal weight central obesity was associated with higher risk of cardiovascular disease mortality (hazard ratio, 1.25; 95% CI, 1.05-1.46) and cancer mortality (hazard ratio, 1.20; 95% CI, 1.01-1.43).CONCLUSIONS AND RELEVANCE Normal-weight central obesity in women was associated with excess risk of mortality, similar to that of women with BMI-defined obesity with central obesity. These findings underscore the need for future public health guidelines to include the prevention and control of central obesity, even in individuals with normal BMI.