Klenk Jochen, Nagel Gabriele, Ulmer Hanno, Strasak Alexander, Concin Hans, Diem Günter, Rapp Kilian
Institute of Epidemiology, University of Ulm, Helmholtzstrasse 22, 89081 Ulm, Germany.
Eur J Epidemiol. 2009;24(2):83-91. doi: 10.1007/s10654-009-9312-4. Epub 2009 Jan 29.
There is still a debate about the role of body mass index (BMI) as a risk factor for all-cause mortality. Most investigations with large sample sizes focused on populations from the United States, studies from Central-European cohorts are not available. We investigated the association between BMI and all-cause mortality and cause-specific mortality within a cohort in Austria. Design of this article is "Cohort study". The Subjects used were 184,697 men and women (mean age 41.7 +/- 15.4 years). Weight and height were measured. Cox proportional hazards models were used to estimate hazard ratios (HR). During a median follow-up of 15.1 years 15,557 deaths (6,077 from cardiovascular disease, 4,443 from cancer and 606 from respiratory disease) were seen. A U-shaped association between BMI and all-cause mortality was observed in men and women. Compared with the reference category (BMI 22.5-24.9 kg/m(2)) high risks were found both in the highest category of BMI (> or =35 kg/m(2)) with HR of 2.13 (95% CI, 1.82-2.48) in men and 1.60 (95% CI, 1.42-1.81) in women and in the lowest category (<18.5 kg/m(2)) with HR of 2.57 (95% CI, 2.17-3.05) in men and 1.40 (95% CI, 1.21-1.62) in women. Similar patterns were seen among ever-smokers and non-smokers. Increased mortality with increasing BMI was driven by cardiovascular diseases and to a lesser extent by cancers. Respiratory diseases contributed to mortality in the lowest BMI category independently from smoking status. Underweight and obesity were both associated with higher all-cause mortality in men and women.
关于体重指数（BMI）作为全因死亡率风险因素的作用仍存在争议。大多数大样本量的调查集中在美国人群，尚无来自中欧队列的研究。我们在奥地利的一个队列中研究了BMI与全因死亡率以及特定病因死亡率之间的关联。本文的设计为“队列研究”。所使用的受试者为184,697名男性和女性（平均年龄41.7±15.4岁）。测量了体重和身高。采用Cox比例风险模型来估计风险比（HR）。在中位随访15.1年期间，共观察到15,557例死亡（6,077例死于心血管疾病，4,443例死于癌症，606例死于呼吸系统疾病）。在男性和女性中均观察到BMI与全因死亡率呈U形关联。与参考类别（BMI 22.5 - 24.9 kg/m²）相比，在BMI最高类别（≥35 kg/m²）中，男性的HR为2.13（95%CI，1.82 - 2.48），女性为1.60（95%CI，1.42 - 1.81）；在BMI最低类别（<18.5 kg/m²）中，男性的HR为2.57（95%CI，2.17 - 3.05），女性为1.40（95%CI，1.21 - 1.62）。在曾经吸烟者和非吸烟者中也观察到类似模式。随着BMI升高死亡率增加主要由心血管疾病导致，癌症的影响较小。呼吸系统疾病在BMI最低类别中导致死亡率增加，且与吸烟状况无关。体重过轻和肥胖在男性和女性中均与较高的全因死亡率相关。
