中国成年人体质指数与主要慢性病死亡风险的前瞻性研究

王醴湘; 樊萌语; 余灿清; 郭彧; 卞铮; 谭云龙; 裴培; 陈君石; 吕筠; 李立明

Abstract

王醴湘,樊萌语,余灿清,郭彧,卞铮,谭云龙,裴培,陈君石,吕筠,李立明.中国成年人体质指数与主要慢性病死亡风险的前瞻性研究[J].Chinese journal of Epidemiology,2017,38(2):205-211

中国成年人体质指数与主要慢性病死亡风险的前瞻性研究

Association between body mass index and both total and cause-specific mortality in China: findings from data through the China Kadoorie Biobank

Received:July 26, 2016

DOI：10.3760/cma.j.issn.0254-6450.2017.02.014

KeyWord: 体质指数慢性病死亡风险前瞻性研究

English Key Word: Body mass index Chronic disease Mortality Prospective study

FundProject:国家自然科学基金（81390544，81390541）；香港Kadoorie Charitable基金；英国Wellcome Trust（088158/Z/09/Z，104085/Z/14/Z）

Author Name	Affiliation	E-mail
Wang Lixiang	Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
Fan Mengyu	Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
Yu Canqing	Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
Guo Yu	Chinese Academy of Medical Sciences, Beijing 100730, China
Bian Zheng	Chinese Academy of Medical Sciences, Beijing 100730, China
Tan Yunlong	Chinese Academy of Medical Sciences, Beijing 100730, China
Pei Pei	Chinese Academy of Medical Sciences, Beijing 100730, China
Chen Junshi	China National Center for Food Safety Risk Assessment, Beijing 100022, China
Lyu Jun	Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China	lvjun@bjmu.edu.cn
Li Liming	Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China Chinese Academy of Medical Sciences, Beijing 100730, China

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Abstract:

目的探讨BMI与全死因死亡和缺血性心脏病、脑血管病、恶性肿瘤、呼吸系统疾病等死因别死亡的前瞻性关联。方法利用中国慢性病前瞻性研究队列的10个地区人群数据，剔除基线时自报患有冠心病、脑卒中、恶性肿瘤、慢性阻塞性肺病和糖尿病的个体后，纳入基线时30~79岁的研究对象共428 593人。利用Cox比例风险模型计算9组BMI人群死亡风险比值（HR）及其95%CI。结果研究人群累计随访3 085 054人年（平均随访7.2年）。随访期间男性7 862人、女性6 315人死亡。多因素调整后，与BMI（kg/m²）为20.5~22.4的人群相比，BMI<18.5（HR=1.40，95%CI：1.31~1.50）、BMI为18.5~20.4（HR=1.11，95%CI：1.05~1.17）和BMI≥35.0（HR=2.05，95%CI：1.60~2.61）的人群全死因死亡风险升高。各疾病死亡风险相对较低的BMI（kg/m²）范围：缺血性心脏病为18.5~23.9，脑血管病为<26.0，恶性肿瘤为26.0~34.9，呼吸系统疾病为24.0~25.9。结论低体重和肥胖人群的全死因死亡与死因别死亡风险升高。人群队列更长期的随访以及更多关于BMI与主要慢性病发病风险的评估，将有助于全面了解BMI对人群健康的影响。

English Abstract:

Objective To evaluate the associations between body mass index (BMI) and both total and cause-specific mortality. Methods After excluding participants with heart disease, stroke, cancer, chronic obstructive pulmonary disease, and diabetes at baseline study, 428 593 participants aged 30-79 in the China Kadoorie Biobank study were chosen for this study. Participants were categorized into 9 groups according to their BMI status. Cox regression analysis was used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of mortality on BMI. Results Among 3 085 054 person-years of the follow-up program between 2004 and 2013 (median 7.2 years), a total of 7 862 men and 6 315 women died. After adjusting for known or potential confounders, an increased risks of all-cause deaths were shown among participants with a BMI less than 18.5 (HR=1.40, 95%CI:1.31-1.50), between 18.5-20.4 (HR=1.11, 95%CI:1.05-1.17), and more than 35.0 (HR=2.05, 95%CI:1.60-2.61), when compared to those with BMI between 20.5-22.4. Ranges of BMI with lower risk of cause-specific mortality were:18.5-23.9 for ischemic heart disease, <26.0 for cerebro-vascular disease, 26.0-34.9 for cancers, and 24.0-25.9 for respiratory diseases. Conclusions In this large prospective study, both underweight and obesity were associated with the increased total and certain cause-specific mortality, which were independent from other risk factors of death. Programs related to extensive follow-up, thorough analysis BMI and the risks of incidence on major chronic diseases all need to be developed, in order to better understand the impact of BMI on human health.

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