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Great obesity, but not slight obesity, linked to higher all-cause mortality 严重肥胖而非轻度肥胖与死亡率增高相关  

2013-01-05 10:58:26|  分类: 默认分类 |  标签: |举报 |字号 订阅

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在1月2日的《JAMA》上报告的对97项临床研究的Meta分析显示,与正常体重相比,较高程度的肥胖与全因死亡率增高相关,而低度肥胖和超重却与死亡率降低相关。


Great obesity, but not slight obesity, linked to higher all-cause mortality 严重肥胖而非轻度肥胖与死亡率增高相关 - gloryking3 - gloryking3的博客

研究者进行文献回顾,并在其Meta分析中纳入所有报告使用标准分级测定体重指数(BMI)的成人全因死亡率的前瞻性、观察性队列研究。BMI低于18.5 kg/m2为体重过低,介于18.5~25 kg/m2为正常体重,介于25~30 kg/m2为超重,介于30~35 kg/m2为1级肥胖,介于35~40 kg/m2为2级肥胖,≥40 kg/m2为3级肥胖。Meta分析中纳入的41项研究来自美国或加拿大,37项来自欧洲,7项来自澳大利亚,4项来自中国大陆或台湾,2项来自日本,2项来自以色列,2项来自巴西,1项来自印度,1项来自墨西哥。共纳入280万受试者,随访期间共发生270,000例死亡。


结果显示,与正常体重相比,超重和1级肥胖与死亡率显著降低相关,危险比(HR)分别为0.94和0.95。相反,与正常体重相比,2级和3级肥胖与死亡率显著增高相关,HR为1.29(JAMA 2013;309:71-82)。一些敏感性分析的结果也强烈支持上述发现。


研究者总结认为,与正常体重相比,超重和低度肥胖与成人全因死亡率降低相关,而更严重的肥胖与死亡率增高相关。


研究者披露无相关利益冲突。



Higher grades of obesity were associated with greater all-cause mortality than was normal weight, but low-grade obesity and overweight were linked to lower mortality in a meta-analysis of 97 clinical studies reported in the Jan. 2 issue of JAMA.


These findings, from a systematic review that included nearly 3 million study subjects on five continents, are "broadly consistent" with those of several previous studies and two previous meta-analyses: Excess mortality occurs only at the highest levels of obesity, while mortality is lower among overweight and slightly obese individuals than among people of normal weight, said Katherine M. Flegal, Ph.D., of the National Center for Health Statistics, Hyattsville, Md., and her associates.


Excess mortality occurs only at the highest levels of obesity, while mortality is lower among overweight and slightly obese individuals than among people of normal weight, says a recent study. 
 
The investigators reviewed the literature and included in their meta-analysis all prospective, observational cohort studies that reported all-cause mortality in adults whose body mass index was measured using standard categories. A BMI of less than 18.5 was underweight, that of 18.5 to less than 25 was normal weight, a BMI of 25 to less than 30 was overweight, that of 30 to less than 35 was grade 1 obesity, a BMI of 35 to less than 40 was grade 2 obesity, and a BMI of 40 or greater was grade 3 obesity.


The researchers included 41 studies from the United States or Canada, 37 from Europe, 7 from Australia, 4 from China or Taiwan, 2 from Japan, 2 from Israel, 2 from Brazil, 1 from India, and 1 from Mexico. Overall there were 2.8 million subjects and 270,000 deaths during follow-up.


Overweight and grade 1 obesity were associated with significantly lower mortality than was normal weight, with hazard ratios of 0.94 and 0.95, respectively. In contrast, grade 1 and grade 2 obesity were associated with significantly higher mortality than was normal weight, with an HR of 1.29, Dr. Flegal and her colleagues said (JAMA 2013;309:71-82).


These findings remained robust in several sensitivity analyses.


The reasons why overweight and slight obesity might be protective are still unknown. Some have proposed that slightly heavy patients might present for medical care earlier than normal weight and severely obese patients when symptoms arise, and they also may be more likely to receive optimal medical treatment because caregivers recognize that their weight confers risk. It also is possible that slightly increased body fat may exert cardioprotective metabolic effects and provide better metabolic reserves when illness occurs, the investigators said.


Their meta-analysis also demonstrated that studies relying on patients’ self-report of weight and height are subject to important bias, because these measures are not accurately reported across all categories of age, sex, and race.


No financial conflicts of interest were reported.


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