Taieb Adam Ben, Roberts Erika, Luckevich Maria, Larsen Sara, le Roux Carel W, de Freitas Paulo Gomes, Wolfert Dingeman
Wickenstones Ltd., Oxford, UK.
Novo Nordisk Canada Inc., Mississauga, ON, Canada.
Diabetol Metab Syndr. 2022 Dec 7;14(1):186. doi: 10.1186/s13098-022-00952-4.
Obesity and overweight are major risk factors for several chronic diseases. There is limited systematic evaluation of risk equations that predict the likelihood of developing an obesity or overweight associated complication. Predicting future risk is essential for health economic modelling. Availability of future treatments rests upon a model's ability to inform clinical and decision-making bodies. This systematic literature review aimed to identify studies reporting (1) equations that calculate the risk for individuals with obesity, or overweight with a weight-related complication (OWRC), of developing additional complications, namely T2D, cardiovascular (CV) disease (CVD), acute coronary syndrome, stroke, musculoskeletal disorders, knee replacement/arthroplasty, or obstructive sleep apnea; (2) absolute or proportional risk for individuals with severe obesity, obesity or OWRC developing T2D, a CV event or mortality from knee surgery, stroke, or an acute CV event.
Databases (MEDLINE and Embase) were searched for English language reports of population-based cohort analyses or large-scale studies in Australia, Canada, Europe, the UK, and the USA between January 1, 2011, and March 29, 2021. Included reports were quality assessed using an adapted version of the Newcastle Ottawa Scale.
Of the 60 included studies, the majority used European cohorts. Twenty-nine reported a risk prediction equation for developing an additional complication. The most common risk prediction equations were logistic regression models that did not differentiate between body mass index (BMI) groups (particularly above 40 kg/m) and lacked external validation. The remaining included studies (31 studies) reported the absolute or proportional risk of mortality (29 studies), or the risk of developing T2D in a population with obesity and with prediabetes or normal glucose tolerance (NGT) (three studies), or a CV event in populations with severe obesity with NGT or T2D (three studies). Most reported proportional risk, predominantly a hazard ratio.
More work is needed to develop and validate these risk equations, specifically in non-European cohorts and that distinguish between BMI class II and III obesity. New data or adjustment of the current risk equations by calibration would allow for more accurate decision making at an individual and population level.
肥胖和超重是多种慢性疾病的主要危险因素。对于预测发生肥胖或超重相关并发症可能性的风险方程，系统评价有限。预测未来风险对于卫生经济建模至关重要。未来治疗方法的可用性取决于模型为临床和决策机构提供信息的能力。本系统文献综述旨在识别报告以下内容的研究：（1）计算肥胖个体或患有体重相关并发症的超重个体（OWRC）发生其他并发症（即2型糖尿病、心血管（CV）疾病（CVD）、急性冠状动脉综合征、中风、肌肉骨骼疾病、膝关节置换/关节成形术或阻塞性睡眠呼吸暂停）风险的方程；（2）严重肥胖、肥胖或OWRC个体发生2型糖尿病、CV事件或膝关节手术、中风或急性CV事件导致的死亡的绝对或比例风险。
检索数据库（MEDLINE和Embase），查找2011年1月1日至2021年3月29日期间在澳大利亚、加拿大、欧洲、英国和美国进行的基于人群队列分析或大规模研究的英文报告。使用纽卡斯尔渥太华量表的改编版对纳入报告进行质量评估。
在纳入的60项研究中，大多数使用欧洲队列。29项报告了发生其他并发症的风险预测方程。最常见的风险预测方程是逻辑回归模型，该模型未区分体重指数（BMI）组（特别是高于40kg/m²）且缺乏外部验证。其余纳入研究（31项研究）报告了死亡的绝对或比例风险（29项研究），或肥胖且患有糖尿病前期或正常糖耐量（NGT）人群发生2型糖尿病的风险（3项研究），或严重肥胖且患有NGT或2型糖尿病人群发生CV事件的风险（3项研究）。大多数报告的是比例风险,主要是风险比。
需要开展更多工作来开发和验证这些风险方程，特别是在非欧洲队列中，并区分II类和III类肥胖的BMI。新数据或通过校准调整当前风险方程将有助于在个体和人群层面做出更准确的决策。
