Changes in waist circumference and risk of all-cause and CVD mortality: results from the European Prospective Investigation into Cancer in Norfolk (EPIC-Norfolk) cohort study
Changes in waist circumference and risk of all-cause and CVD mortality: results from the European Prospective Investigation into Cancer in Norfolk (EPIC-Norfolk) cohort study
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DOI：
10.1186/s12872-019-1223-z
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发表时间：
2019-10-28
影响因子：
2.1
通讯作者：
Khaw, Kay-Tee
中科院分区：
文献类型：
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作者：
Mulligan, Angela A.;Lentjes, Marleen A. H.;Khaw, Kay-Tee
背景：腹部脂肪测量与全因死亡率和心血管疾病（CVD）密切相关。然而，关于身体脂肪分布变化的后果，数据有限且相互矛盾。本文的主要目的是研究腰围（WC）变化与全因和心血管疾病死亡率之间的关系，并检查这些变化与体重变化的关系。方法：欧洲癌症与营养前瞻性调查（EPIC-Norfolk）研究在1993年至1997年期间招募了25,639名参与者，年龄在39-79岁之间，其中一些人还参加了第二次检查（1998-2000），并随访至2016年的死亡率。如果参与者在两个时间点都有腰围、体重和身高测量，他们就有资格入选；排除了自我报告有心血管疾病或癌症病史、体重指数< 18.5 kg/m2或缺少协变量数据的参与者，留下12337名参与者供分析。中位（IQR）随访时间为16.4（15.7,17.2）年。采用Cox比例风险分析，按WC变化类别确定全因死亡（2866例）和心血管疾病死亡（822例）的风险比（hr）。结果：经多变量调整后，身高增加（WCG）达到50 cm的男性和女性全因死亡率的hr （95% ci）分别为1.51（1.29-1.75）和1.25（1.06-1.46）。对于WCG为0.5 cm的男性和女性的CVD死亡率，hr分别为1.84（1.39-2.43）和1.15（0.85-1.55）。在对体重和体重同时变化的分析中，男性体重减轻和体重减轻时的最大风险（hr） （95% ci）为：全因死亡率为1.80(1.13-2.86)，心血管疾病死亡率为2.22（1.03-4.82）。在女性中，体重减轻并维持WC （WCM）的女性全因死亡率（HR 1.50(1.16-1.95)）和心血管疾病死亡率（HR 1.81(1.15-2.85)）的风险最高。结论：客观测量WCG bbb50 cm，与随后男性较高的总死亡风险和较高的CVD死亡风险相关。专注于预防中心性肥胖增加的干预措施，而不是在以后的生活中降低体重本身，可能对健康有更大的好处。
Background: Measures of abdominal adiposity are strongly associated with all-cause mortality and cardiovascular disease (CVD). However, data are limited and conflicting regarding the consequences of changes in body fat distribution. The main aims of this paper are to investigate the association between changes in waist circumference (WC) and all-cause and CVD mortality and to examine these changes in relation to concurrent changes in weight.Methods: The European Prospective Investigation into Cancer and Nutrition (EPIC-Norfolk) study recruited 25,639 participants between 1993 and 1997, aged 39-79, a number of whom also attended a second examination (1998-2000), and were followed up to 2016 for mortality. Participants were eligible for inclusion if they had WC, weight and height measurements at both time-points; those with a self-reported history of CVD or cancer, body mass index < 18.5 kg/m2 or missing data on covariates were excluded, leaving 12,337 participants for analyses. The median (IQR) follow-up time was 16.4 (15.7, 17.2) years. Hazard Ratios (HRs) for all-cause (2866 deaths) and CVD mortality (822 deaths), by categories of WC change, were determined using Cox proportional hazards analyses.Results: After multivariable adjustment, the HRs (95% CIs) for all-cause mortality for men and women with a WC gain (WCG) > 5 cm were 1.51 (1.29-1.75) and 1.25 (1.06-1.46) respectively. For CVD mortality in men and women with a WCG > 5 cm, the HRs were 1.84 (1.39-2.43) and 1.15 (0.85-1.55) respectively. In analyses of concurrent changes in WC and weight, the greatest risk (HRs) (95% CIs) in men occurred with weight loss and WCG: 1.80 (1.13-2.86) for all-cause and 2.22 (1.03-4.82) for CVD mortality. In women, the greatest risk for both all-cause (HR 1.50 (1.16-1.95)) and CVD mortality (HR 1.81 (1.15-2.85)) was observed in those with weight loss and maintenance of WC (WCM).Conclusions: Objectively measured WCG > 5 cm, was associated with subsequent higher total mortality risk and higher CVD mortality risk in men. Interventions focusing on preventing increase in central adiposity rather than lowering weight per se in later life may potentially have greater health benefits.