Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA.
Population Sciences in the Pacific Program (Cancer Epidemiology), University of Hawaii Cancer Center, Manoa, HI, USA.
Ethn Health. 2022 Apr;27(3):658-671. doi: 10.1080/13557858.2020.1771680. Epub 2020 Jun 7.
While cardiometabolic abnormalities are associated with elevated risk of morbidity, they may not occur in all individuals with obesity. Less is known about associations with mortality, especially cancer mortality. This study examined associations between cardiometabolic-weight categories and mortality from cardiovascular disease (CVD), cancer, and all causes. Cox proportional hazards regressions of time to all-cause, CVD, and cancer mortalities were used to examine associations with cardiometabolic-weight status, in the Multiethnic Cohort (=157,865). Cardiometabolic-weight status categories were: Metabolically Healthy Normal Weight, Metabolically Healthy Obese, Metabolically Healthy Overweight, Metabolically Unhealthy Normal Weight, Metabolically Unhealthy Obese, and Metabolically Unhealthy Overweight. Higher mortality, especially for all-cause and CVD, was found for all metabolically unhealthy groups no matter the weight classification when compared to the Metabolically Healthy Normal Weight category across sex-ethnic groups. For all-cause mortality, a reduction in mortality was seen for males in the Metabolically Healthy Overweight category (HR: 0.88, 95% CI: 0.84, 0.93), especially for African American, Native Hawaiian, and Latino males. Mortality was elevated in the Metabolically Healthy Obese category for all-cause and CVD mortality in both sexes (HR: 1.08-1.93). Few associations were seen with cancer mortality. Past examinations of cardiometabolic-weight status and mortality have been hampered by a lack of diversity. In a racially/ethnically diverse population, metabolically unhealthy groups exhibited a substantially higher risk of death from all causes and CVD than metabolically healthy groups. A reduction in all-cause mortality was seen for some males classified as Metabolically Healthy Overweight; however, being classified as Metabolically Healthy Obese elevated mortality risk for males and females compared to Metabolically Healthy Normal Weight. Future research is needed to examine how sex-ethnic differences in body fat distribution and changes in weight over time influence associations between cardiometabolic-weight status and mortality.
虽然心血管代谢异常与发病率升高相关，但并非所有肥胖者都存在这些异常。关于其与死亡率的关联，尤其是癌症死亡率的关联，人们知之甚少。本研究旨在探讨心血管代谢体重类别与心血管疾病（CVD）、癌症和全因死亡率之间的关联。采用 Cox 比例风险回归分析，评估了多民族队列（n=157865）中，心血管代谢体重状况与全因、CVD 和癌症死亡率之间的相关性。心血管代谢体重状况类别包括：代谢健康正常体重、代谢健康肥胖、代谢健康超重、代谢不健康正常体重、代谢不健康肥胖和代谢不健康超重。无论体重分类如何，与代谢健康正常体重组相比，在所有性别和种族群体中，所有代谢不健康组的死亡率更高，尤其是全因和 CVD 死亡率更高。对于全因死亡率，与代谢健康正常体重组相比，男性中代谢健康超重组的死亡率降低（HR：0.88，95%CI：0.84，0.93），尤其是对于非裔美国人、夏威夷原住民和拉丁裔男性。在所有性别中，代谢健康肥胖组的全因和 CVD 死亡率均升高（HR：1.08-1.93）。与癌症死亡率的相关性很少。过去对心血管代谢体重状况和死亡率的研究受到多样性不足的限制。在一个种族/民族多样化的人群中，代谢不健康组的全因和 CVD 死亡率明显高于代谢健康组。对于一些被归类为代谢健康超重的男性，全因死亡率有所降低；然而，与代谢健康正常体重相比，男性和女性被归类为代谢健康肥胖会增加死亡率风险。未来需要进一步研究，以探讨性别和种族在体脂分布上的差异以及体重随时间的变化如何影响心血管代谢体重状况与死亡率之间的关联。
