Strangeways Research Laboratory, European Prospective Investigation into Cancer and Nutrition, Department of Public Health and Primary Care, University of Cambridge, Worts Causeway, Cambridge, UK.
MRC Epidemiology Unit, Cambridge, School of Clinical Medicine, Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK.
Eur J Epidemiol. 2018 Jan;33(1):37-53. doi: 10.1007/s10654-017-0343-y. Epub 2017 Dec 20.
Studies have reported a higher mortality risk associated with weight loss, particularly in middle-aged and older adults, although some of these studies did find that gaining weight was also associated with an increased mortality risk. We examined changes in weight in relation to mortality in a prospective population-based cohort study of men and women, resident in Norfolk, UK. Participants were assessed at baseline (1993-1997) and at a second examination (1998-2000), as part of the European Prospective Investigation into Cancer and Nutrition (EPIC-Norfolk) study, and followed up to 2015 for mortality. Participants with a self-reported history of cancer or cardiovascular disease, body mass index < 18.5 kg/m or missing data on adjustment variables, at either time-point were excluded, leaving 12,580 participants, aged 39-78 in 1993-1997, eligible for analyses. Cox proportional hazards models were used to determine Hazard Ratios (HRs) for all-cause (2603 deaths), cardiovascular (749 deaths), cancer (981 deaths), respiratory (226 deaths) and other causes of mortality (647 deaths) by categories of weight change. After multivariate adjustment, the HRs (95% CIs) for all-cause mortality for men and women who lost more than 5 kg were 1.85 (1.48-2.31) and 1.64 (1.31-2.05) respectively. Higher hazards were also found for specific causes of mortality and weight loss > 5 kg. Similar associations were observed after excluding deaths in the first 5 years of follow-up. Results for weight gain were inconclusive. We conclude that objectively measured weight loss, but not weight gain, was associated with subsequent higher mortality risk in this population-based study of middle-aged and elderly men and women. However, undiagnosed, pre-existing disease and the inability to account for weight cycling need to be remembered when interpreting these results. Unravelling the causal pathways underlying this association will require more detailed studies, including that of changes in body composition.
研究报告称，体重减轻与更高的死亡率相关，特别是在中年和老年人中，尽管其中一些研究确实发现体重增加也与更高的死亡率相关。我们在一项针对英国诺福克地区男性和女性的前瞻性基于人群的队列研究中，检查了体重变化与死亡率之间的关系。参与者在基线（1993-1997 年）和第二次检查（1998-2000 年）时接受评估，作为欧洲癌症与营养前瞻性调查（EPIC-Norfolk）研究的一部分，并随访至 2015 年以了解死亡率。在任何一个时间点，有癌症或心血管疾病病史、体重指数 < 18.5kg/m 或调整变量数据缺失的参与者被排除在外，留下 12580 名参与者，1993-1997 年年龄为 39-78 岁，符合分析条件。使用 Cox 比例风险模型确定体重变化类别与全因（2603 例死亡）、心血管（749 例死亡）、癌症（981 例死亡）、呼吸（226 例死亡）和其他原因死亡率（647 例死亡）的危险比（HRs）。经过多变量调整后，男性和女性体重减轻超过 5 公斤的全因死亡率 HR（95%CI）分别为 1.85（1.48-2.31）和 1.64（1.31-2.05）。对于特定的死亡率原因和体重减轻 > 5 公斤，也发现了更高的风险。在排除随访前 5 年内的死亡后，观察到类似的关联。体重增加的结果不确定。我们的结论是，在这项针对中年和老年男性和女性的基于人群的研究中，客观测量的体重减轻而不是体重增加与随后的更高死亡率风险相关。然而，在解释这些结果时，需要记住未确诊的、预先存在的疾病和无法解释的体重波动。要阐明这种关联的因果途径，需要进行更详细的研究，包括身体成分的变化。
