Gaeta Maddalena, Rausa Emanuele, Malavazos Alexis E, Bonavina Luigi, Smuts Cornelius M, Ricci Cristian
Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, Unit of Hygiene, University of Pavia, Via Strada Nuova 65, Pavia, Italy.
Division of General Surgery, Papa Giovanni XXIII Hospital, University of Milan, Bergamo, Italy.
Obes Surg. 2018 Apr;28(4):900-906. doi: 10.1007/s11695-017-2981-2.
Type II obesity represents a major pandemic and public health threat in high-income countries. Type II obesity increases the risk of all-cause and specific-cause mortality, and it is widely acknowledged that bariatric surgery represents the only effective therapeutic option in these patients. The aim of the present study was to estimate US population attributable risk for all-cause and cause-specific mortality in type II obese subjects undergoing weight loss as resulting from bariatric surgery alone and supplemented with behavioral intervention.
The American National Health and Nutrition Examination Survey linked to the US death registry updated to 2011 was used to estimate type II obesity prevalence and all-cause and specific cause of death for type II obese adults undergoing weight loss. Multivariate adjusted proportional hazard Cox models were used to estimate mortality risks. Statistical analyses were performed on the most updated version of the database (June 2017).
A monotone positive trend for type II obesity was observed during the period 1999-2014 (p < 0.001). According to trend analysis, the rate of type II obesity in US adults is expected to rise up to 8.5%. Two- to sevenfold increased risk of all-cause and specific-cause mortality was observed for type II obese participants when compared to type I obese and overweight participants. Population attributable risk for all-cause and specific-cause mortality for type II obese subjects undergoing weight loss was ranging between 6 and 34%.
Bariatric surgery supplemented with behavioral intervention can result in a relevant reduction of mortality if extensively applied to the US population.
在高收入国家，II型肥胖是一种主要的流行病，对公众健康构成威胁。II型肥胖会增加全因死亡率和特定病因死亡率，并且人们普遍认为减肥手术是这些患者唯一有效的治疗选择。本研究的目的是评估仅接受减肥手术以及接受减肥手术并辅以行为干预的II型肥胖受试者的全因死亡率和特定病因死亡率在美国人群中的归因风险。
利用与美国死亡登记处相链接且更新至2011年的美国国家健康和营养检查调查，来评估II型肥胖成年人减肥后的II型肥胖患病率、全因死亡率和特定病因死亡率。采用多变量调整比例风险Cox模型来评估死亡风险。对数据库的最新版本（2017年6月）进行统计分析。
在1999 - 2014年期间观察到II型肥胖呈单调上升趋势（p < 0.001）。根据趋势分析，预计美国成年人的II型肥胖率将升至8.5%。与I型肥胖和超重参与者相比，II型肥胖参与者的全因死亡率和特定病因死亡率增加了2至7倍。接受减肥的II型肥胖受试者的全因死亡率和特定病因死亡率的人群归因风险在6%至34%之间。
如果广泛应用于美国人群，减肥手术辅以行为干预可显著降低死亡率。
