探讨有糖尿病和无糖尿病的澳大利亚男女人群中 BMI 与死亡率之间的关联：AusDiab 研究。
Exploring the association between BMI and mortality in Australian women and men with and without diabetes: the AusDiab study.
机构信息
The University of Queensland Diamantina Institute, Faculty of Medicine, The University of Queensland, Level 6, Translational Research Institute, 37 Kent Street, Woolloongabba, QLD, 4102, Australia.
Independent Researcher, Brisbane, QLD, Australia.
出版信息
Diabetologia. 2019 May;62(5):754-758. doi: 10.1007/s00125-019-4830-4. Epub 2019 Feb 26.
AIMS/HYPOTHESIS: There is conflicting evidence about the obesity paradox-the counterintuitive survival advantage of obesity among certain subpopulations of individuals with chronic conditions. It is believed that results supporting the obesity paradox are due to methodological flaws, such as collider bias. The aim of this study was to examine the association between obesity and mortality in Australian men and women. In addition, we explored whether obesity would appear to be protective if the analysis was restricted to a subpopulation with disease, and to discuss the potential role of collider bias in producing such a result.
METHODS
The examined cohort included 10,575 Australian adults (4844 men and 5731 women) aged 25-91 years who were recruited for the AusDiab baseline survey in 1999 and followed-up through 2014. The main predictor variable was BMI categorised as normal weight (18.5 to <25 kg/m), overweight (25 to <30 kg/m) and obese (≥30 kg/m), and the outcome of interest was all-cause mortality. Hazard ratios were estimated from Cox proportional hazards regression models in the entire cohort and then in subpopulations with and without diabetes.
RESULTS
A total of 1477 deaths occurred during 145,384 person-years (median 14.6 years) of follow-up. Mortality was higher in obese than in normal-weight individuals for the full population (HR 1.18; 95% CI 1.05, 1.32). When an interaction between diabetes status and BMI category was added to the model, there was no evidence of an interaction between BMI and diabetes status (p = 0.92). When participants with and without diabetes were analysed separately, there was no evidence of an association between obesity and mortality in those with diabetes (HR 0.91; 95% CI 0.62, 1.33).
CONCLUSIONS/INTERPRETATION: In the entire AusDiab cohort, we found a significantly higher mortality among obese participants as compared with their normal-weight counterparts. We found no difference in the obesity-mortality association between individuals with and without diabetes.
目的/假设：关于肥胖悖论——即某些慢性病患者亚群中肥胖的反直觉生存优势，存在相互矛盾的证据。人们认为，支持肥胖悖论的结果是由于方法上的缺陷，如共发偏差。本研究旨在检验澳大利亚男性和女性肥胖与死亡率之间的关系。此外，我们还探讨了如果将分析仅限于患有疾病的亚人群，肥胖是否会表现出保护作用，并讨论了共发偏差在产生这种结果中的潜在作用。
方法
本研究的队列包括 10575 名年龄在 25-91 岁的澳大利亚成年人（4844 名男性和 5731 名女性），他们于 1999 年参加了 AusDiab 基线调查，并在 2014 年进行了随访。主要预测变量为 BMI，分类为正常体重（18.5 至<25kg/m）、超重（25 至<30kg/m）和肥胖（≥30kg/m），感兴趣的结局为全因死亡率。使用 Cox 比例风险回归模型在整个队列中以及在有和没有糖尿病的亚人群中估计了风险比。
结果
在 145384 人年（中位数 14.6 年）的随访期间，共有 1477 人死亡。在整个人群中，肥胖者的死亡率高于正常体重者（HR 1.18；95%CI 1.05，1.32）。当在模型中加入糖尿病状态和 BMI 类别之间的交互作用时，BMI 和糖尿病状态之间没有交互作用的证据（p=0.92）。当分别分析有和没有糖尿病的参与者时，在有糖尿病的参与者中，肥胖与死亡率之间没有关联（HR 0.91；95%CI 0.62，1.33）。
结论/解释：在整个 AusDiab 队列中，我们发现肥胖参与者的死亡率明显高于正常体重者。我们没有发现有糖尿病和无糖尿病个体之间肥胖与死亡率之间的关联有差异。
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