有意减肥与全因死亡率：随机临床试验的荟萃分析
Intentional weight loss and all-cause mortality: a meta-analysis of randomized clinical trials.
作者信息
Kritchevsky Stephen B, Beavers Kristen M, Miller Michael E, Shea M Kyla, Houston Denise K, Kitzman Dalane W, Nicklas Barbara J
机构信息
Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America.
Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America; Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States of America.
出版信息
PLoS One. 2015 Mar 20;10(3):e0121993. doi: 10.1371/journal.pone.0121993. eCollection 2015.
BACKGROUND
Obesity is associated with increased mortality, and weight loss trials show rapid improvement in many mortality risk factors. Yet, observational studies typically associate weight loss with higher mortality risk. The purpose of this meta-analysis of randomized controlled trials (RCTs) of weight loss was to clarify the effects of intentional weight loss on mortality.
METHODS
2,484 abstracts were identified and reviewed in PUBMED, yielding 15 RCTs reporting (1) randomization to weight loss or non-weight loss arms, (2) duration of ≥18 months, and (3) deaths by intervention arm. Weight loss interventions were all lifestyle-based. Relative risks (RR) and 95% confidence intervals (95% CI) were estimated for each trial. For trials reporting at least one death (n = 12), a summary estimate was calculated using the Mantel-Haenszel method. Sensitivity analysis using sparse data methods included remaining trials.
RESULTS
Trials enrolled 17,186 participants (53% female, mean age at randomization = 52 years). Mean body mass indices ranged from 30-46 kg/m2, follow-up times ranged from 18 months to 12.6 years (mean: 27 months), and average weight loss in reported trials was 5.5±4.0 kg. A total of 264 deaths were reported in weight loss groups and 310 in non-weight loss groups. The weight loss groups experienced a 15% lower all-cause mortality risk (RR = 0.85; 95% CI: 0.73-1.00). There was no evidence for heterogeneity of effect (Cochran's Q = 5.59 (11 d.f.; p = 0.90); I2 = 0). Results were similar in trials with a mean age at randomization ≥55 years (RR = 0.84; 95% CI 0.71-0.99) and a follow-up time of ≥4 years (RR = 0.85; 95% CI 0.72-1.00).
CONCLUSIONS
In obese adults, intentional weight loss may be associated with approximately a 15% reduction in all-cause mortality.
背景
肥胖与死亡率增加相关，减肥试验表明许多死亡风险因素会迅速改善。然而，观察性研究通常将体重减轻与较高的死亡风险联系起来。这项对减肥随机对照试验（RCT）的荟萃分析的目的是阐明有意减肥对死亡率的影响。
方法
在PUBMED中识别并审查了2484篇摘要，产生了15项RCT报告，这些报告（1）随机分为减肥组或非减肥组，（2）持续时间≥18个月，（3）按干预组报告死亡情况。减肥干预均基于生活方式。对每项试验估计相对风险（RR）和95%置信区间（95%CI）。对于报告至少一例死亡的试验（n = 12），使用Mantel-Haenszel方法计算汇总估计值。使用稀疏数据方法的敏感性分析包括其余试验。
结果
试验招募了17186名参与者（53%为女性，随机分组时的平均年龄 = 52岁）。平均体重指数范围为30 - 46 kg/m²，随访时间范围为18个月至12.6年（平均：27个月），报告的试验中平均体重减轻为5.5±4.0 kg。减肥组共报告264例死亡，非减肥组报告310例死亡。减肥组全因死亡率风险降低15%（RR = 0.85；95%CI：0.73 - 1.00）。没有证据表明效应存在异质性（Cochran's Q = 5.59（11自由度；p = 0.90）；I² = 0）。在随机分组时平均年龄≥55岁的试验（RR = 0.84；95%CI 0.71 - 0.99）和随访时间≥4年的试验（RR = 0.85；95%CI 0.72 - 1.00）中结果相似。
结论
在肥胖成年人中，有意减肥可能与全因死亡率降低约15%相关。
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