Johnson William, Norris Tom, Pearson Natalie, Petherick Emily S, King James A, Willis Scott A, Hardy Rebecca, Paudel Susan, Haycraft Emma, Baker Jennifer L, Hamer Mark, Stensel David J, Tilling Kate, Richardson Tom G
School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, University Hospitals of Leicester National Health Service (NHS) Trust and the University of Leicester, Leicester, UK.
Int J Obes (Lond). 2025 Jan 23. doi: 10.1038/s41366-025-01718-4.
Adults living with overweight or obesity do not represent a single homogenous group in terms of mortality and disease risks. The aim of our study was to evaluate how the associations of adulthood overweight and obesity with mortality and incident disease are modified by (i.e., differ according to) self-reported childhood body weight categories.
The sample comprised 191,181 men and 242,806 women aged 40-69 years (in 2006-2010) in the UK Biobank. The outcomes were all-cause mortality, incident cardiovascular disease (CVD), and incident obesity-related cancer. Cox proportional hazards regression models were used to estimate how the associations with the outcomes of adulthood weight status (normal weight, overweight, obesity) differed according to perceived body weight at age 10 years (about average, thinner, plumper). To triangulate results using an approach that better accounts for confounding, analyses were repeated using previously developed and validated polygenic risk scores (PRSs) for childhood body weight and adulthood BMI, categorised into three-tier variables using the same proportions as in the observational variables.
In both sexes, adulthood obesity was associated with higher hazards of all outcomes. However, the associations of obesity with all-cause mortality and incident CVD were stronger in adults who reported being thinner at 10 years. For example, obesity was associated with a 1.28 (1.21, 1.35) times higher hazard of all-cause mortality in men who reported being an average weight child, but among men who reported being a thinner child this estimate was 1.63 (1.53, 1.75). The ratio between these two estimates was 1.28 (1.17, 1.40). There was also some evidence that the associations of obesity with all-cause mortality and incident CVD were stronger in adults who reported being plumper at 10 years. In genetic analyses, however, there was no evidence that the association of obesity (according to the adult PRS) with mortality or incident CVD differed according to childhood body size (according to the child PRS). For incident obesity-related cancer, the evidence for effect modification was limited and inconsistent between the observational and genetic analyses.
Greater risks for all-cause mortality and incident CVD in adults with obesity who perceive themselves to have been a thinner or plumper than average child may be due to confounding and/or recall bias.
就死亡率和疾病风险而言，超重或肥胖的成年人群并非一个单一的同质群体。我们研究的目的是评估成年期超重和肥胖与死亡率及新发疾病之间的关联如何因自我报告的儿童期体重类别而有所不同（即存在差异）。
样本包括英国生物银行中年龄在40 - 69岁（2006 - 2010年）的191,181名男性和242,806名女性。结局指标为全因死亡率、新发心血管疾病（CVD）和新发肥胖相关癌症。采用Cox比例风险回归模型来估计成年期体重状况（正常体重、超重、肥胖）与结局之间的关联如何因10岁时感知的体重（约为平均水平、较瘦、较胖）而有所不同。为了使用一种能更好地解释混杂因素的方法来验证结果，我们使用先前开发并验证的儿童期体重和成年期BMI的多基因风险评分（PRSs）重复进行分析，并按照与观察变量相同的比例将其分类为三层变量。
在男性和女性中，成年期肥胖都与所有结局的更高风险相关。然而，对于那些报告10岁时较瘦的成年人，肥胖与全因死亡率和新发CVD之间的关联更强。例如，对于报告儿童期体重为平均水平的男性，肥胖与全因死亡率的风险比为1.28（1.21, 1.35），但对于报告儿童期较瘦的男性，这一估计值为1.63（1.53, 1.75）。这两个估计值之间的比值为1.28（1.17, 1.40）。也有一些证据表明，对于那些报告10岁时较胖的成年人，肥胖与全因死亡率和新发CVD之间的关联更强。然而，在基因分析中，没有证据表明肥胖（根据成年期PRS）与死亡率或新发CVD之间的关联因儿童期体型（根据儿童期PRS）而有所不同。对于新发肥胖相关癌症，观察性分析和基因分析之间效应修正的证据有限且不一致。
那些认为自己儿童期体重比平均水平更瘦或更胖的肥胖成年人，其全因死亡率和新发CVD的风险更高，这可能是由于混杂因素和/或回忆偏倚所致。
