Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County, Taiwan.
Department of Health Services Administration, China Medical University, Taichung, Taiwan.
BMC Public Health. 2018 Feb 14;18(1):142. doi: 10.1186/s12889-018-5038-0.
The effect of cardio-metabolic profile on the relationship of body mass index (BMI) with mortality is unclear. The aim of this study was to explore association between BMI and mortality at all ages, taking account of cardio-metabolic disorders.
We followed 377,929 individuals (≥ 20 years), who registered for health checkups in 1996-2007, until 2008 and found 9490 deaths. From multivariable Cox proportional hazards models we estimated mortality hazard ratios (HR) for those in high blood pressure, hyperglycemia, high waist circumference, dyslipidemia, and different BMIs categories (the underweight [< 18.5 kg/m], low normal weight [18.5-21.9 kg/m], normal weight [22-23.9 kg/m, the referent], overweight [24-26.9 kg/m], obese1 [27-29.9 kg/m], and obese2 [≥ 30 kg/m]). Population attributable risk (PAR) provided estimates of the population mortality burden attributable to high blood pressure, hyperglycemia, high waist circumference, dyslipidemia, and deviant BMIs.
Higher blood pressure, hyperglycemia, high waist circumference, and dyslipidemia were significantly predictive of higher mortality for nearly all ages. Compared with the referent BMI, underweight (HR = 1.69, 95% confidence interval = 1.51-1.90) and low normal weight (HR = 1.19, 1.11-1.28) were significant mortality risks, while overweight (HR = 0.82, 0.76-0.89) and obese1 (HR = 0.88, 0.79-0.97) were protective against premature death. The mortality impact of obesity was largely attributable to cardio-metabolic profile and attenuated by age. The population mortality burden with high blood pressure (PAR = 7.29%), hyperglycemia (PAR = 5.15%), high waist circumference (PAR = 4.24%), and dyslipidemia (PAR = 5.66%) was similar to that in the underweight (PAR = 5.50%) or low normal weight (PAR = 6.04%) groups. Findings for non-smokers and by gender were similar.
The effect of BMI on mortality varies with age and is affected by cardio-metabolic status. Compared to any deviant BMI, abnormal cardio-metabolic status has a similar or even greater health impact at both the individual and population levels.
心血管代谢特征对体重指数（BMI）与死亡率之间关系的影响尚不清楚。本研究的目的是探讨在考虑到心血管代谢紊乱的情况下，BMI 与所有年龄段的死亡率之间的关系。
我们对 1996-2007 年期间参加健康检查的 377929 名（≥20 岁）个体进行了随访，直至 2008 年，并发现了 9490 例死亡。我们使用多变量 Cox 比例风险模型，估计了患有高血压、高血糖、高腰围、血脂异常和不同 BMI 类别（体重不足[<18.5kg/m]、低正常体重[18.5-21.9kg/m]、正常体重[22-23.9kg/m，参照组]、超重[24-26.9kg/m]、肥胖 1 型[27-29.9kg/m]和肥胖 2 型[≥30kg/m]）人群的死亡率风险比（HR）。人群归因风险（PAR）提供了高血压、高血糖、高腰围、血脂异常和异常 BMI 导致的人群死亡率负担的估计值。
较高的血压、高血糖、高腰围和血脂异常与几乎所有年龄段的更高死亡率显著相关。与参照 BMI 相比，体重不足（HR=1.69，95%置信区间[CI]=1.51-1.90）和低正常体重（HR=1.19，1.11-1.28）是显著的死亡风险因素，而超重（HR=0.82，0.76-0.89）和肥胖 1 型（HR=0.88，0.79-0.97）则对过早死亡具有保护作用。肥胖的死亡影响主要归因于心血管代谢特征，并随年龄而减弱。高血压（PAR=7.29%）、高血糖（PAR=5.15%）、高腰围（PAR=4.24%）和血脂异常（PAR=5.66%）的人群死亡率负担与体重不足（PAR=5.50%）或低正常体重（PAR=6.04%）人群相似。非吸烟者和不同性别人群的研究结果相似。
BMI 对死亡率的影响因年龄而异，并受心血管代谢状态的影响。与任何异常 BMI 相比，异常心血管代谢状态对个体和人群的健康影响具有相似性，甚至更大。
