Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Department of Public Health, Zhejiang University School of Medicine, National Clinical Research Center for Children's Health, Hangzhou, Zhejiang 310058, China.
Chin Med J (Engl). 2024 May 20;137(10):1169-1178. doi: 10.1097/CM9.0000000000002970. Epub 2024 Jan 29.
Whether the dynamic weight change is an independent risk factor for mortality remains controversial. This study aimed to examine the association between weight change and risk of all-cause and cause-specific mortality based on the Linxian Nutrition Intervention Trial (NIT) cohort.
Body weight of 21,028 healthy residents of Linxian, Henan province, aged 40-69 years was measured two times from 1986 to 1991. Outcome events were prospectively collected up to 2016. Weight maintenance group (weight change <2 kg) or stable normal weight group was treated as the reference. Cox proportional hazard model was performed to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs) to estimate the risk of mortality.
A total of 21,028 subjects were included in the final analysis. Compared with the weight maintenance group, subjects with weight loss ≥2 kg had an increased risk of death from all-cause (HR All-cause = 1.14, 95% CI: 1.09-1.19, P <0.001), cancer (HR Cancer = 1.12, 95% CI: 1.03-1.21, P = 0.009), and heart disease (HR Heart diseases = 1.21, 95% CI: 1.11-1.31, P <0.001), whereas subjects with weight gain ≥5 kg had 11% (HR Cancer = 0.89, 95% CI: 0.79-0.99, P = 0.033) lower risk of cancer mortality and 23% higher risk of stroke mortality (HR Stroke = 1.23,95% CI: 1.12-1.34, P <0.001). For the change of weight status, both going from overweight to normal weight and becoming underweight within 5 years could increase the risk of total death (HR Overweight to normal = 1.18, 95% CI: 1.09-1.27; HR Becoming underweight = 1.35, 95% CI: 1.25-1.46) and cancer death (HR Overweight to normal = 1.20, 95% CI: 1.04-1.39; HR Becoming underweight = 1.44, 95% CI: 1.24-1.67), while stable overweight could increase the risk of total death (HR Stable overweight = 1.11, 95% CI: 1.05-1.17) and death from stroke (HR Stable overweight = 1.44, 95% CI: 1.33-1.56). Interaction effects were observed between age and weight change on cancer mortality, as well as between baseline BMI and weight change on all-cause, heart disease, and stroke mortality (all Pinteraction <0.01).
Weight loss was associated with an increased risk of all-cause, cancer, and heart disease mortality, whereas excessive weight gain and stable overweight were associated with a higher risk of stroke mortality. Efforts of weight management should be taken to improve health status.
https://classic.clinicaltrials.gov/ , NCT00342654.
体重变化是否是死亡的独立危险因素仍存在争议。本研究旨在根据林县营养干预试验（NIT）队列，检查体重变化与全因和病因特异性死亡率之间的关联。
河南省林县 21028 名 40-69 岁健康居民的体重在 1986 年至 1991 年期间测量了两次。前瞻性收集直至 2016 年的结局事件。体重维持组（体重变化<2kg）或稳定正常体重组作为参考。采用 Cox 比例风险模型计算风险比（HR）和 95%置信区间（95%CI），以估计死亡率的风险。
共纳入 21028 名受试者进行最终分析。与体重维持组相比，体重减轻≥2kg 的受试者全因死亡风险增加（HR 全因=1.14，95%CI：1.09-1.19，P<0.001）、癌症死亡风险增加（HR 癌症=1.12，95%CI：1.03-1.21，P=0.009）和心脏病死亡风险增加（HR 心脏病=1.21，95%CI：1.11-1.31，P<0.001），而体重增加≥5kg 的受试者癌症死亡风险降低 11%（HR 癌症=0.89，95%CI：0.79-0.99，P=0.033），中风死亡风险增加 23%（HR 中风=1.23，95%CI：1.12-1.34，P<0.001）。对于体重状况的变化，体重在 5 年内从超重变为正常体重或变得消瘦都会增加总死亡（HR 超重变为正常=1.18，95%CI：1.09-1.27；HR 消瘦=1.35，95%CI：1.25-1.46）和癌症死亡（HR 超重变为正常=1.20，95%CI：1.04-1.39；HR 消瘦=1.44，95%CI：1.24-1.67）的风险，而稳定的超重会增加总死亡（HR 稳定超重=1.11，95%CI：1.05-1.17）和中风死亡（HR 稳定超重=1.44，95%CI：1.33-1.56）的风险。年龄和体重变化之间以及基线 BMI 和体重变化之间在癌症死亡率上观察到交互作用效应，以及在全因、心脏病和中风死亡率上均观察到交互作用效应（所有 P交互<0.01）。
体重减轻与全因、癌症和心脏病死亡风险增加有关，而过度体重增加和稳定超重与中风死亡风险增加有关。应努力进行体重管理，以改善健康状况。
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