Weight change across adulthood in relation to all cause and cause specific mortality: prospective cohort study
Weight change across adulthood in relation to all cause and cause specific mortality: prospective cohort study
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DOI：
10.1136/bmj.l5584
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发表时间：
2019-10-16
影响因子：
105.7
通讯作者：
Pan, An
中科院分区：
文献类型：
--
作者：
Chen, Chen;Ye, Yi;Pan, An
目的：研究成年期体重变化与死亡率之间的关系。方法：前瞻性队列研究。SETTINGUS国家健康和营养检查调查（NHANES），1988-94和1999- 2014。参与者：36 051名40岁或40岁以上的人，基线时测量体重和身高，年轻时回忆体重（25岁）和中年期（基线前10年）。主要结果测量从基线到2015年12月31日的全因和原因特异性死亡率。在平均12.3年的随访期间，发生了10500例死亡。与保持正常体重的参与者相比，那些在青年和中年之间从非肥胖到肥胖的参与者的全因死亡率和心脏病死亡率风险分别高出22%（风险比1.22，95%置信区间1.11至1.33）和49%（1.49，1.21至1.83）。在此期间，体重指数从肥胖到非肥胖的变化与死亡风险没有显著相关性。从成年中期到成年晚期，肥胖到非肥胖的体重变化模式与全因死亡率（1.30，1.16至1.45）和心脏病死亡率（1.48，1.14至1.92）的风险增加相关，而在此期间从非肥胖到肥胖类别与死亡风险无显著相关性。整个成年期保持肥胖始终与全因死亡风险增加相关;从青年到中年的风险比为1.72（1.52至1.95），从青年到成年晚期的风险比为1.61（1.41至1.84），从青年到成年晚期的风险比为1.20（1.09至1.32）从中年到成年晚期。最大超重与整个成年期的死亡率有非常适度或零关联。在各种体重变化模式和癌症mortality.CONCLUSIONSStable肥胖在整个成年期，体重增加从年轻到中年，体重减轻从中年到晚期与死亡率的风险增加。研究结果表明，在整个成年期保持正常体重，特别是防止成年早期体重增加，对于防止晚年过早死亡非常重要。
OBJECTIVETo investigate the association between weight changes across adulthood and mortality.DESIGNProspective cohort study.SETTINGUS National Health and Nutrition Examination Survey (NHANES) 1988-94 and 1999-2014.PARTICIPANTS36 051 people aged 40 years or over with measured body weight and height at baseline and recalled weight at young adulthood (25 years old) and middle adulthood (10 years before baseline).MAIN OUTCOME MEASURESAll cause and cause specific mortality from baseline until 31 December 2015.RESULTSDuring a mean follow-up of 12.3 years, 10 500 deaths occurred. Compared with participants who remained at normal weight, those moving from the non-obese to obese category between young and middle adulthood had a 22% (hazard ratio 1.22, 95% confidence interval 1.11 to 1.33) and 49% (1.49, 1.21 to 1.83) higher risk of all cause mortality and heart disease mortality, respectively. Changing from obese to non-obese body mass index over this period was not significantly associated with mortality risk. An obese to non-obese weight change pattern from middle to late adulthood was associated with increased risk of all cause mortality (1.30, 1.16 to 1.45) and heart disease mortality (1.48, 1.14 to 1.92), whereas moving from the non-obese to obese category over this period was not significantly associated with mortality risk. Maintaining obesity across adulthood was consistently associated with increased risk of all cause mortality; the hazard ratio was 1.72 (1.52 to 1.95) from young to middle adulthood, 1.61 (1.41 to 1.84) from young to late adulthood, and 1.20 (1.09 to 1.32) from middle to late adulthood. Maximum overweight had a very modest or null association with mortality across adulthood. No significant associations were found between various weight change patterns and cancer mortality.CONCLUSIONSStable obesity across adulthood, weight gain from young to middle adulthood, and weight loss from middle to late adulthood were associated with increased risks of mortality. The findings imply that maintaining normal weight across adulthood, especially preventing weight gain in early adulthood, is important for preventing premature deaths in later life.