Veronese Nicola, Li Yanping, Manson JoAnn E, Willett Walter C, Fontana Luigi, Hu Frank B
Division of Geriatrics and Nutritional Science, Washington University, St Louis, MO, USA.
Division of Geriatrics, Department of Medicine, University of Padua, Italy.
BMJ. 2016 Nov 24;355:i5855. doi: 10.1136/bmj.i5855.
To evaluate the combined associations of diet, physical activity, moderate alcohol consumption, and smoking with body weight on risk of all cause and cause specific mortality.
Longitudinal study with up to 32 years of follow-up.
Nurses' Health Study (1980-2012) and Health Professionals Follow-up Study (1986-2012).
74 582 women from the Nurses' Health Study and 39 284 men from the Health Professionals Follow-up Study who were free from cardiovascular disease and cancer at baseline.
Exposures included body mass index (BMI), score on the alternate healthy eating index, level of physical activity, smoking habits, and alcohol drinking while outcome was mortality (all cause, cardiovascular, cancer). Cox proportional hazard models were used to calculate the adjusted hazard ratios of all cause, cancer, and cardiovascular mortality with their 95% confidence intervals across categories of BMI, with 22.5-24.9 as the reference.
During up to 32 years of follow-up, there were 30 013 deaths (including 10 808 from cancer and 7189 from cardiovascular disease). In each of the four categories of BMI studied (18.5-22.4, 22.5-24.9, 25-29.9, ≥30), people with one or more healthy lifestyle factors had a significantly lower risk of total, cardiovascular, and cancer mortality than individuals with no low risk lifestyle factors. A combination of at least three low risk lifestyle factors and BMI between 18.5-22.4 was associated with the lowest risk of all cause (hazard ratio 0.39, 95% confidence interval 0.35 to 0.43), cancer (0.40, 0.34 to 0.47), and cardiovascular (0.37, 0.29 to 0.46) mortality, compared with those with BMI between 22.5-24.9 and none of the four low risk lifestyle factors.
Although people with a higher BMI can have lower risk of premature mortality if they also have at least one low risk lifestyle factor, the lowest risk of premature mortality is in people in the 18.5-22.4 BMI range with high score on the alternate healthy eating index, high level of physical activity, moderate alcohol drinking, and who do not smoke. It is important to consider diet and lifestyle factors in the evaluation of the association between BMI and mortality.
评估饮食、体育活动、适度饮酒和吸烟与体重综合关联对全因死亡率和特定病因死亡率风险的影响。
长达32年随访的纵向研究。
护士健康研究（1980 - 2012年）和卫生专业人员随访研究（1986 - 2012年）。
护士健康研究中的74582名女性和卫生专业人员随访研究中的39284名男性，他们在基线时无心血管疾病和癌症。
暴露因素包括体重指数（BMI）、替代健康饮食指数得分、体育活动水平、吸烟习惯和饮酒情况，而结局为死亡率（全因、心血管疾病、癌症）。使用Cox比例风险模型计算BMI各分类下全因、癌症和心血管疾病死亡率的调整风险比及其95%置信区间，以22.5 - 24.9为参照。
在长达32年的随访期间，共发生30013例死亡（包括10808例癌症死亡和7189例心血管疾病死亡）。在所研究的四个BMI类别（18.5 - 22.4、22.5 - 24.9、25 - 29.9、≥30）中，具有一种或多种健康生活方式因素的人群，其全因、心血管疾病和癌症死亡风险显著低于无低风险生活方式因素的个体。与BMI在22.5 - 24.9且无四种低风险生活方式因素的人群相比，至少三种低风险生活方式因素与BMI在18.5 - 22.4之间的组合与全因（风险比0.39，95%置信区间0.35至0.43）、癌症（0.40，0.34至0.47）和心血管疾病（0.37，0.29至0.46）死亡率的最低风险相关。
尽管BMI较高的人若至少有一个低风险生活方式因素，其过早死亡风险可能较低，但过早死亡风险最低的是BMI在18.5 - 22.4范围内、替代健康饮食指数得分高、体育活动水平高、适度饮酒且不吸烟的人群。在评估BMI与死亡率之间的关联时，考虑饮食和生活方式因素很重要。
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