糖尿病患者体重指数与全因死亡率的关联：一项系统评价与荟萃分析。
Association of body mass index with all-cause mortality in patients with diabetes: a systemic review and meta-analysis.
作者信息
Chang Hsiao-Wen, Li Yi-Hwei, Hsieh Chang-Hsun, Liu Pang-Yen, Lin Gen-Min
机构信息
1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan ; 2 Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan ; 3 Department of Public Health, Tzu-Chi University, Hualien, Taiwan ; 4 Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan ; 5 Department of Medicine, Hualien Armed Forces General Hospital, Hualien, Taiwan.
出版信息
Cardiovasc Diagn Ther. 2016 Apr;6(2):109-19. doi: 10.21037/cdt.2015.12.06.
BACKGROUND
The obesity paradox phenomenon has been found in different populations, such as heart failure and coronary heart disease, which suggest that patients with established cardiovascular disease (CVD) and with normal weight had higher risk of mortality than those with overweight or obesity. However, the obesity paradox is controversial among patients with diabetes which has been considered as the coronary heart disease equivalent. The aim of our study was to summarize current findings on the relationship between body mass index (BMI) and all-cause mortality in patients with diabetes and make a meta-analysis.
METHODS
We searched previous studies from MEDLINE, EMBASE, and the Cochrane databases using the keywords: BMI, mortality, diabetes, and obesity paradox or reverse epidemiology. Finally, sixteen studies were identified and 385,925 patients were included. Patients were divided into five groups based on BMI (kg/m(2)) levels: underweight (<18.5), normal weight (18.5-24.9), overweight (25-29.9), mild obesity (30-34.9), and morbid obesity (>35). A random effect meta-analysis was performed by the inverse variance method.
RESULTS
As compared with the normal weight, the underweight had higher risk of mortality [hazard ratio (HR): 1.59, 95% confidence interval (CI): 1.32-1.91]. In contrast, the overweight and the mild obesity had lower risk of mortality than the normal weight (HR: 0.86, 95% CI: 0.78-0.96, and 0.88, 95% CI: 0.78-1.00, respectively), but the morbid obesity did not (HR: 0.99, 95% CI: 0.84-1.16). In addition, the subgroup analysis by sex showed that the overweight had the lowest mortality as compared with the normal weight (HR: 0.82, 95% CI: 0.74-0.90) and the obesity in males, but the risk of mortality did not differ among groups in females. Notably, the heterogeneity was significant in most of group comparisons.
CONCLUSIONS
Our meta-analysis showed a U-shaped relationship between BMI and all-cause mortality in patients with diabetes. The significant heterogeneity among studies suggested that many confounders such as sex difference may affect the association.
背景
肥胖悖论现象已在不同人群中被发现，如心力衰竭和冠心病患者，这表明已确诊心血管疾病（CVD）且体重正常的患者比超重或肥胖患者有更高的死亡风险。然而，肥胖悖论在被视为等同于冠心病的糖尿病患者中存在争议。我们研究的目的是总结目前关于体重指数（BMI）与糖尿病患者全因死亡率之间关系的研究结果并进行荟萃分析。
方法
我们使用关键词“BMI”“死亡率”“糖尿病”“肥胖悖论”或“反向流行病学”在MEDLINE、EMBASE和Cochrane数据库中检索既往研究。最终，确定了16项研究，纳入385,925例患者。根据BMI（kg/m²）水平将患者分为五组：体重过轻（<18.5）、正常体重（18.5 - 24.9）、超重（25 - 29.9）、轻度肥胖（30 - 34.9）和病态肥胖（>35）。采用逆方差法进行随机效应荟萃分析。
结果
与正常体重相比，体重过轻患者的死亡风险更高[风险比（HR）：1.59，95%置信区间（CI）：1.32 - 1.91]。相反，超重和轻度肥胖患者的死亡风险低于正常体重患者（HR分别为：0.86，95%CI：0.78 - 0.96；0.88，95%CI：0.78 - 1.00），但病态肥胖患者并非如此（HR：0.99，95%CI：0.84 - 1.16）。此外，按性别进行的亚组分析显示，与正常体重以及男性肥胖患者相比，超重患者的死亡率最低（HR：0.82，95%CI：0.74 - 0.90），但女性各体重组之间的死亡风险无差异。值得注意的是，大多数组间比较的异质性都很显著。
结论
我们的荟萃分析显示糖尿病患者中BMI与全因死亡率之间呈U形关系。研究间显著的异质性表明，诸如性别差异等许多混杂因素可能会影响这种关联。
Zotero 插件