唧唧堂编辑二朵2013-12-26 11:36 PM

Association of All-Cause Mortality With Overweight and Obesity Using Standard Body Mass Index Categories:  A Systematic Review and Meta-analysis 使用标准BMI分类计算的超重和肥胖和全因死亡率之间的关系

Abstract Importance Estimates of the relative mortality risks associated with normal weight, overweight, and obesity may help to inform decision making in the clinical setting. 重要性 预测与正常体重、超重及肥胖相联系的相关死亡风险可为临床决策提供帮助。 Objective To perform a systematic review of reported hazard ratios (HRs) of all-cause mortality for overweight and obesity relative to normal weight in the general population. 目标 我们旨在对已发表报道的那些相较于普通人口正常体重程度来说的超重和肥胖的全因死亡危险比率进行系统综述及荟萃分析。 Data Sources PubMed and EMBASE electronic databases were searched through September 30, 2012, without language restrictions. 数据来源 我们检索了PubMed和EMBASE电子数据库中至2012年9月30日的数据,检索中未设定任何语言限制。 Study Selection Articles that reported HRs for all-cause mortality using standard body mass index (BMI) categories from prospective studies of general populations of adults were selected by consensus among multiple reviewers. Studies were excluded that used nonstandard categories or that were limited to adolescents or to those with specific medical conditions or to those undergoing specific procedures. PubMed searches yielded 7034 articles, of which 141 (2.0%) were eligible. An EMBASE search yielded 2 additional articles. After eliminating overlap, 97 studies were retained for analysis, providing a combined sample size of more than 2.88 million individuals and more than 270 000 deaths. 研究选择 评审团中多个评审者从面向普通成年人口的前瞻性研究中共同选取了遵循标准体重指数类别(BMI)来报道全因死亡风险比率的一些文章,且进行了进一步筛选。采用非标准分类法或仅局限于青少年群体或采用特殊医疗条件或经过特殊治疗途径的那些研究已经被剔除。我们从PubMed数据库搜索到了7034篇相关文献,且选取了其中的141 (2.0%)篇纳入了研究分析中。此外我们又通过EMBASE数据库搜索到了另外两篇文献补充到了研究分析中。在剔除了重复的文献后,我们最后确定了作为实验样本的97项研究,这些研究总共为我们提供了超过288万个体的样本规模和超过27万例的死亡事例。 Data Extraction Data were extracted by 1 reviewer and then reviewed by 3 independent reviewers. We selected the most complex model available for the full sample and used a variety of sensitivity analyses to address issues of possible overadjustment (adjusted for factors in causal pathway) or underadjustment (not adjusted for at least age, sex, and smoking). 数据提取 研究中首先由1位评审者析取数据,然后另外3位独立评审者随之进行复审。我们选择了适用于全样本分析的最复杂的模型以及使用了各种敏感性分析来对可能造成的过度校正(对原因途径因子进行校正)或欠缺校正(至少对年龄、性别和吸烟等因素未校正)的事件进行分析处理。 Results Random-effects summary all-cause mortality HRs for overweight (BMI of 25-<30), obesity (BMI of ≥30), grade 1 obesity (BMI of 30-<35), and grades 2 and 3 obesity (BMI of ≥35) were calculated relative to normal weight (BMI of 18.5-<25). The summary HRs were 0.94 (95% CI, 0.91-0.96) for overweight, 1.18 (95% CI, 1.12-1.25) for obesity (all grades combined), 0.95 (95% CI, 0.88-1.01) for grade 1 obesity, and 1.29 (95% CI, 1.18-1.41) for grades 2 and 3 obesity. These findings persisted when limited to studies with measured weight and height that were considered to be adequately adjusted. The HRs tended to be higher when weight and height were self-reported rather than measured. 结果 结果显示,超重(BMI25—30)、肥胖症(BMI ≥30)、1级肥胖(BMI為30—35)、2级和3级肥胖(BMI≥35)的全因死亡率风险比的计算(HR)是相较于正常体重(BMI为18.5—25)的。风险比分析结果表明,超重的死亡风险为0.94 (95%置信区间为0.91—0.96);肥胖(全部分级总和)的死亡风险为1.18 (95% 置信区间为1.12—1.25);1级肥胖的死亡风险为0.95 (95% 置信区间为0.88—1.01);而2级和3级肥胖的死亡风险为1.29 (95% 置信区间为1.18—1.41)。这些发现仅与那些测量了患者体重、身高并进行了合适校正的研究相一致。与测量患者体重、身高指标的研究相比,自报体重、身高指标的研究的风险比更高。 Conclusions and Relevance Relative to normal weight, both obesity (all grades) and grades 2 and 3 obesity were associated with significantly higher all-cause mortality. Grade 1 obesity overall was not associated with higher mortality, and overweight was associated with significantly lower all-cause mortality. The use of predefined standard BMI groupings can facilitate between-study comparisons. 结论 与正常体重者相比,所有肥胖患者(所有肥胖等级)以及2级肥胖、3级肥胖可引起全因死亡率的显著增加。总体来说,1级肥胖不会引起死亡率升高,超重可引起全因死亡率的显著降低。预定义标准BMI分组的运用可使得组间比较更佳便利。






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