Yao Zhiqi, Tchang Beverly G, Albert Michael, Blumenthal Roger S, Nasir Khurram, Blaha Michael J
Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore.
Department of Internal Medicine, Division of Endocrinology, Weill Cornell Medical College, New York.
NEJM Evid. 2025 Apr;4(4):EVIDoa2400229. doi: 10.1056/EVIDoa2400229. Epub 2025 Mar 25.
The burden of obesity-related health conditions remains incompletely explored. Previous studies have been underpowered to study severe obesity, focused on a limited set of health outcomes, and lacked diversity in study populations.
We studied 270,657 participants from the All of Us research program with linked electronic health records and body mass index (the weight in kilograms divided by the square of the height in meters) greater than or equal to 18.5. We investigated the prevalence and incidence of 16 a priori-identified outcomes covering cardiovascular-kidney-metabolic syndrome and others: hypertension, type 2 diabetes mellitus, hyperlipidemia/dyslipidemia, heart failure, atrial fibrillation, atherosclerotic cardiovascular disease, chronic kidney disease, pulmonary embolism, deep vein thrombosis, gout, metabolic dysfunction-associated steatotic liver disease, biliary calculus, obstructive sleep apnea, asthma, gastroesophageal reflux disease, and osteoarthritis. Adjusted hazard ratios were calculated for each BMI category and compared with normal weight. The population-attributable fraction was calculated for different obesity classifications.
The included population was 62.0% women and 22.0% Black. Class I, II, and III obesity was observed in 21.2%, 11.3%, and 9.8% of participants, respectively. Obesity was strongly associated with all incident outcomes, with graded associations across higher classes of obesity. Class III obesity was most strongly associated with obstructive sleep apnea, type 2 diabetes mellitus, and metabolic dysfunction-associated steatotic liver disease (hazard ratio [95% confidence interval {CI}], 10.94 [9.97 to 12.00], 7.74 [7.03 to 8.53], and 6.72 [6.01 to 7.50], respectively), with weaker associations for asthma, osteoarthritis, and atherosclerotic cardiovascular disease (hazard ratio [95% CI], 2.14 [1.95 to 2.35], 2.06 [1.94 to 2.19], and 1.96 [1.70 to 2.25], respectively). Associations were consistent across sex and race. The obesity-related population-attributed fraction ranged from 14.0% (osteoarthritis) to 51.5% (obstructive sleep apnea) in this population.
Obesity, particularly severe obesity, was strongly associated with the incidence of 16 common health outcomes.
肥胖相关健康状况的负担仍未得到充分研究。以往的研究在研究重度肥胖方面能力不足，聚焦于有限的一组健康结局，且研究人群缺乏多样性。
我们研究了来自“我们所有人”研究项目的270,657名参与者，这些参与者均有电子健康记录且体重指数（体重千克数除以身高米数的平方）大于或等于18.5。我们调查了16种预先确定的结局的患病率和发病率，这些结局涵盖心血管-肾脏-代谢综合征及其他疾病：高血压、2型糖尿病、高脂血症/血脂异常、心力衰竭、心房颤动、动脉粥样硬化性心血管疾病、慢性肾脏病、肺栓塞、深静脉血栓形成、痛风、代谢功能障碍相关脂肪性肝病、胆结石、阻塞性睡眠呼吸暂停、哮喘、胃食管反流病和骨关节炎。计算了每个体重指数类别对应的校正风险比，并与正常体重者进行比较。计算了不同肥胖分类的人群归因分数。
纳入人群中女性占62.0%，黑人占22.0%。分别有21.2%、11.3%和9.8%的参与者存在I级、II级和III级肥胖。肥胖与所有发病结局均密切相关，且在更高等级的肥胖中存在分级关联。III级肥胖与阻塞性睡眠呼吸暂停、2型糖尿病和代谢功能障碍相关脂肪性肝病的关联最为密切（风险比[95%置信区间{CI}]分别为10.94[9.97至12.00]、7.74[第7.03至8.53]和6.72[6.01至7.50]），与哮喘、骨关节炎和动脉粥样硬化性心血管疾病的关联较弱（风险比[95%CI]分别为2.14[1.95至2.35]、2.06[1.94至2.19]和1.96[1.70至2.25]）。这些关联在性别和种族间是一致的。在该人群中，肥胖相关的人群归因分数范围为14.0%（骨关节炎）至51.5%（阻塞性睡眠呼吸暂停）。
肥胖，尤其是重度肥胖，与16种常见健康结局的发病率密切相关。
