Wannamethee S Goya, Shaper A Gerald, Lennon Lucy
Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, England.
Arch Intern Med. 2005 May 9;165(9):1035-40. doi: 10.1001/archinte.165.9.1035.
We have examined the relationship between intentional and unintentional weight loss and the reasons underlying intention to lose weight and all-cause mortality and mortality due to cardiovascular disease (CVD) and non-CVD causes in older men.
Prospective study of 4869 men aged 56 to 75 years drawn from general practices in 24 British towns, who in 1996 completed questionnaires about intentional and unintentional weight loss over the preceding 4 years and were followed up for a subsequent 7 years.
Unintentional but not intentional weight loss was associated with a significant increase in risk of all-cause mortality compared with men who reported no weight change, even after adjustment for lifestyle characteristics and preexisting disease (adjusted relative risk [RR], 1.71; 95% confidence interval [CI], 1.33-2.19; and RR, 1.00; 95% CI, 0.91-1.10, respectively). Men who lost weight intentionally as a result of personal choice showed significant benefit in all-cause mortality (RR, 0.59; 95% CI, 0.34-1.00; P = .05), which was largely owing to a significant reduction in mortality from non-CVD causes (RR, 0.36; 95% CI, 0.15-0.87). The benefit in these men was most apparent in markedly overweight men (BMI [calculated as weight in kilograms divided by the square of height in meters] > or = 28) and in younger men (age < 65 years). Men who lost weight intentionally owing to ill health or physician's advice showed an increased risk of all-cause mortality (RR, 1.37; 95% CI, 0.96-1.94). No harm or benefit was seen for CVD mortality, irrespective of reasons for intentional weight loss.
Intentional weight loss carried out for personal reasons is associated with a significant reduction in all-cause mortality in markedly overweight men, and the data suggest that the earlier the intervention, the greater the chance of benefit.
我们研究了老年男性有意和无意体重减轻之间的关系，以及体重减轻意图背后的原因与全因死亡率、心血管疾病（CVD）死亡率和非CVD原因死亡率之间的关系。
对来自英国24个城镇普通诊所的4869名年龄在56至75岁之间的男性进行前瞻性研究，这些男性在1996年完成了关于前4年有意和无意体重减轻的问卷调查，并在随后的7年中进行了随访。
与报告体重无变化的男性相比，即使在调整生活方式特征和既往疾病后，无意但非有意的体重减轻与全因死亡率风险显著增加相关（调整后的相对风险[RR]，1.71；95%置信区间[CI]，1.33 - 2.19；以及RR，1.00；95% CI，0.91 - 1.10）。因个人选择而有意减肥的男性在全因死亡率方面显示出显著益处（RR，0.59；95% CI，0.34 - 1.00；P = 0.05），这主要归因于非CVD原因导致的死亡率显著降低（RR，0.36；95% CI，0.15 - 0.87）。这些男性的益处在明显超重的男性（体重指数[以千克为单位的体重除以身高米数的平方计算]≥28）和较年轻的男性（年龄<65岁）中最为明显。因健康不佳或医生建议而有意减肥的男性全因死亡率风险增加（RR，1.37；95% CI，0.96 - 1.94）。无论有意减肥的原因如何，CVD死亡率均未显示出有害或有益影响。
因个人原因进行的有意减肥与明显超重男性的全因死亡率显著降低相关，数据表明干预越早，受益机会越大。
