Wilsgaard Tom, Jacobsen Bjarne K, Mathiesen Ellisiv B, Njølstad Inger
Institute of Community Medicine, University of Tromsø, Tromsø, Norway.
Gend Med. 2009 Dec;6(4):575-86. doi: 10.1016/j.genm.2009.12.003.
Weight loss has been associated with increased mortality, but findings have been inconsistent.
The aim of this study was to examine the association between weight loss and mortality, with a focus on gender differences.
This was a population-based cohort study in northern Norway of adults, aged 20 to 54 years in 1979, who participated in 2 or 3 consecutive health surveys in 1979-80, 1986-87, and 1994-95. Weight and height were measured at each survey. The Cox proportional hazards regression model was used to estimate hazard ratios for mortality between levels of body mass index (BMI) change during 11 years of follow-up. Participants with prior cardiovascular disease or cancer, or incident cancer within the first 2 years of follow-up, were excluded, as were participants who were pregnant, had missing data, or did not give written consent.
A total of 4881 men and 5051 women participated in the present study. The mean age at start of follow-up was 50.8 years (range, 35-70 years) in men and 49.2 years (range, 35-65 years) in women. In men, weight loss was associated with increased all-cause, cardiovascular, and noncardiovascular mortality. The hazard ratio for men for all-cause mortality with a 10-year BMI decrease of 2 kg/m(2) versus a BMI increase of 1 kg/m(2) was 2.09 (95% CI, 1.56-2.81). The association was not significantly modified by initial BMI, age, smoking status, or self-reported attempts of weight loss, or by exclusion of subjects with self-reported poor health, diabetes mellitus, high blood pressure, or high alcohol intake. In women, no association between BMI change and mortality was observed. However, in the subgroup of women who reported no weight-loss attempts, BMI change was significantly associated with mortality risk (P = 0.022).
In this study of a Norwegian population, weight loss was associated with excess mortality in men in all subgroups of weight-loss attempts, daily smoking, and overweight. In women, the only significant effect of BMI change on mortality was observed in those who reported no weight-loss attempts. The observed findings could not be explained by preexisting disease.
体重减轻与死亡率增加有关，但研究结果并不一致。
本研究旨在探讨体重减轻与死亡率之间的关联，重点关注性别差异。
这是一项基于挪威北部人群的队列研究，研究对象为1979年年龄在20至54岁之间的成年人，他们在1979 - 1980年、1986 - 1987年和1994 - 1995年连续参加了2次或3次健康调查。每次调查均测量体重和身高。采用Cox比例风险回归模型估计在11年随访期间体重指数（BMI）变化水平之间的死亡率风险比。排除既往有心血管疾病或癌症、随访前2年内发生癌症的参与者，以及怀孕、有缺失数据或未签署书面同意书的参与者。
共有4881名男性和5051名女性参与了本研究。男性随访开始时的平均年龄为50.8岁（范围35 - 70岁），女性为49.2岁（范围35 - 65岁）。在男性中，体重减轻与全因死亡率、心血管死亡率和非心血管死亡率增加有关。10年期间BMI下降2 kg/m²的男性与BMI增加1 kg/m²的男性相比，全因死亡率的风险比为2.09（95%可信区间，1.56 - 2.81）。初始BMI、年龄、吸烟状况或自我报告的减肥尝试，以及排除自我报告健康状况不佳、患有糖尿病、高血压或高酒精摄入量的受试者，均未对该关联产生显著影响。在女性中，未观察到BMI变化与死亡率之间的关联。然而，在未报告有减肥尝试的女性亚组中，BMI变化与死亡风险显著相关（P = 0.022）。
在这项针对挪威人群的研究中，在所有减肥尝试、每日吸烟和超重亚组的男性中，体重减轻与过高死亡率相关。在女性中，BMI变化对死亡率的唯一显著影响见于未报告有减肥尝试的女性。观察到的结果无法用既往疾病来解释。
