Silventoinen Karri, Tynelius Per, Rasmussen Finn
Department of Social Research and Department of Public Health, University of Helsinki, Helsinki, Finland and Department of Public Health Sciences, Karolinska Institutet, Stockholm, SwedenDepartment of Social Research and Department of Public Health, University of Helsinki, Helsinki, Finland and Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
Department of Social Research and Department of Public Health, University of Helsinki, Helsinki, Finland and Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
Int J Epidemiol. 2014 Aug;43(4):1197-204. doi: 10.1093/ije/dyu091. Epub 2014 Apr 14.
Some studies have suggested that overweight is associated with lower mortality, but these results may be affected by reverse causality. We analysed how body mass index (BMI) in young adulthood is associated with mortality in the general population and after the diagnoses of coronary heart disease (CHD), stroke and cancer.
BMI was measured at an average age of 18 years in 734 438 Swedish men born in 1950-65. Diagnoses of CHD, stroke and cancer as well as all-cause mortality were derived from registers covering the whole population, up to 31 December 2010. The follow-up of 24.56 million person-years included 33 067 cases of mortality and 19 843 CHD, 13 578 stroke and 27 365 cancer diagnoses. Hazard ratios (HR) [with 95% confidence intervals (CI)] were estimated by the Cox proportional hazards model.
Higher mortality in the whole cohort (HR = 1.26, 1.21-1.32) as well as after the diagnosis of CHD (HR = 1.33, 1.09-1.63) or cancer (HR = 1.13, 1.01-1.25) was found in moderately overweight men (BMI 25.0-27.4 kg/m(2)) as compared with normal weight men (BMI 20.1-22.4 kg/m(2)); for stroke patients the result for the same BMI categories was not statistically significant (HR = 1.17, 0.94-1.45). Mortality increased with increasing weight status and was highest in obese men (BMI >30 kg/m(2)): HR = 2.17 (2.02-2.34) for the whole cohort, 2.35 (1.81-3.05) after the diagnosis of CHD, 2.08 (1.56-2.77) after stroke and 1.68 (1.40-2.01) after cancer.
Even moderate overweight in young adulthood increases all-cause mortality and mortality after the diagnosis of CHD, stroke and cancer in men. Preventing overweight in young adulthood remains as an important public health issue.
一些研究表明超重与较低的死亡率相关，但这些结果可能受到反向因果关系的影响。我们分析了青年时期的体重指数（BMI）与普通人群以及冠心病（CHD）、中风和癌症诊断后的死亡率之间的关联。
对734438名出生于1950 - 1965年的瑞典男性在平均18岁时测量了BMI。CHD、中风和癌症的诊断以及全因死亡率来自涵盖全体人群的登记资料，截至2010年12月31日。2456万人年的随访中包括33067例死亡病例以及19843例CHD、13578例中风和27365例癌症诊断。通过Cox比例风险模型估计风险比（HR）[及其95%置信区间（CI）]。
与正常体重男性（BMI 20.1 - 22.4 kg/m²）相比，中度超重男性（BMI 25.0 - 27.4 kg/m²）在整个队列（HR = 1.26，1.21 - 1.32）以及CHD（HR = 1.33，1.09 - 1.63）或癌症诊断后（HR = 1.13，1.01 - 1.25）的死亡率更高；对于中风患者，相同BMI类别的结果无统计学意义（HR = 1.17，0.94 - 1.45）。死亡率随体重状况增加而升高，在肥胖男性（BMI > 30 kg/m²）中最高：整个队列中HR = 2.17（2.02 - 2.34），CHD诊断后为2.35（1.81 - 3.05），中风后为2.08（1.56 -
