柳叶刀:肥胖是导致“过早死亡”的第二大原因
2016/07/18
7月13日,发表在《柳叶刀》(The Lancet)杂志上的一项研究证实,超重或肥胖与过早死亡风险的增加密切相关。在欧洲和北美,肥胖已成为造成过早死亡的第二大原因,仅次于吸烟。


7月13日,发表在《柳叶刀》(The Lancet)杂志上的一项研究证实,超重或肥胖与过早死亡风险的增加密切相关。在欧洲和北美,肥胖已成为造成过早死亡的第二大原因,仅次于吸烟。

论文的第一作者、剑桥大学的Emanuele Di Angelantonio博士说:“平均而言,超重的人实际寿命会比预期寿命缩短约1年,而中度肥胖的人实际寿命会比预期寿命缩短约3年。此外,肥胖的男性比肥胖的女性过早死亡的风险更高。”

这一研究汇集了来自欧洲、北美以及其它地区先前发表的189项研究,涉及了超过390万成年人。参与这些研究的成年人的年纪都在20岁到90岁之间。研究期间,他们都不吸烟,同时没有任何慢性疾病。研究对至少又活了5年的人进行了分析,3,951,455名参与者中有385,879人死亡。

男女差异大

作者们定义的过早死亡年龄段为35-69岁。研究发现,随着BMI(Body Mass Index, BMI)的增加,过早死亡的风险也随之急剧增长。

BMI正常的男性和女性在70岁之前死亡(过早死亡)的风险分别为19%和11%;中度肥胖(BMI 30-35)的男性和女性过早死亡的风险分别上升至29.5% 和14.6%。换句话说,中度肥胖的男性过早死亡的风险增长了10.5%,而中度肥胖的女性过早死亡的风险增长了3.6%。

Emanuele Di Angelantonio博士说:“这与先前的一些研究结果是一致的。与肥胖的女性相比,肥胖的男性胰岛素抵抗程度、肝脂肪水平以及患糖尿病的风险更高。”

危害仅次于吸烟

该研究的共同作者、牛津大学的Sir Richard Peto教授说:“在欧洲和北美,肥胖已成为造成过早死亡的第二大原因,仅次于吸烟。”

具体来说,在欧洲和北美,约有四分之一的过早死亡是由吸烟造成的。不过,吸烟的人可以通过戒烟将过早死亡的风险减半。值得警惕的是,目前在欧洲,约有七分之一的过早死亡是由超重和肥胖造成的。在北美,这一比例已经达到了五分之一。

如何降低影响?

对于这一研究,WHO的专家表示,他们相信,建立成熟的童年期干预(childhood intervention)是在全球范围内大幅降低肥胖相关死亡率的关键。超重和肥胖很大程度上是可以预防的。此外,也有专家称,目前肥胖的流行依然在发展中,全球各地区应该对这一问题给予重视。

最后,值得注意的是,作者们指出,这一研究存在一个很重要的限制,即他们只是通过BMI来衡量肥胖,并没有评估身体不同部位的脂肪分布、肌肉质量或者肥胖相关的代谢因素,如血糖或胆固醇。

备注:本文编译自AJPmedicaldaily

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  • Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents

    Background Overweight and obesity are increasing worldwide. To help assess their relevance to mortality in different populations we conducted individual-participant data meta-analyses of prospective studies of body-mass index (BMI), limiting confounding and reverse causality by restricting analyses to never-smokers and excluding pre-existing disease and the first 5 years of follow-up. Methods Of 10 625 411 participants in Asia, Australia and New Zealand, Europe, and North America from 239 prospective studies (median follow-up 13·7 years, IQR 11·4–14·7), 3 951 455 people in 189 studies were never-smokers without chronic diseases at recruitment who survived 5 years, of whom 385 879 died. The primary analyses are of these deaths, and study, age, and sex adjusted hazard ratios (HRs), relative to BMI 22·5–<25·0 kg/m2. Findings All-cause mortality was minimal at 20·0–25·0 kg/m2 (HR 1·00, 95% CI 0·98–1·02 for BMI 20·0–<22·5 kg/m2; 1·00, 0·99–1·01 for BMI 22·5–<25·0 kg/m2), and increased significantly both just below this range (1·13, 1·09–1·17 for BMI 18·5–<20·0 kg/m2; 1·51, 1·43–1·59 for BMI 15·0–<18·5) and throughout the overweight range (1·07, 1·07–1·08 for BMI 25·0–<27·5 kg/m2; 1·20, 1·18–1·22 for BMI 27·5–<30·0 kg/m2). The HR for obesity grade 1 (BMI 30·0–<35·0 kg/m2) was 1·45, 95% CI 1·41–1·48; the HR for obesity grade 2 (35·0–<40·0 kg/m2) was 1·94, 1·87–2·01; and the HR for obesity grade 3 (40·0–<60·0 kg/m2) was 2·76, 2·60–2·92. For BMI over 25·0 kg/m2, mortality increased approximately log-linearly with BMI; the HR per 5 kg/m2 units higher BMI was 1·39 (1·34–1·43) in Europe, 1·29 (1·26–1·32) in North America, 1·39 (1·34–1·44) in east Asia, and 1·31 (1·27–1·35) in Australia and New Zealand. This HR per 5 kg/m2 units higher BMI (for BMI over 25 kg/m2) was greater in younger than older people (1·52, 95% CI 1·47–1·56, for BMI measured at 35–49 years vs 1·21, 1·17–1·25, for BMI measured at 70–89 years; pheterogeneity<0·0001), greater in men than women (1·51, 1·46–1·56, vs 1·30, 1·26–1·33; pheterogeneity<0·0001), but similar in studies with self-reported and measured BMI. Interpretation The associations of both overweight and obesity with higher all-cause mortality were broadly consistent in four continents. This finding supports strategies to combat the entire spectrum of excess adiposity in many populations.

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