Zhang Huan, Zhao Junlong, Wang Chenchen, Zhang Jing, Zhu Xiaojing, Li Danxi, Han Zheyi, Shang Lei, Shi Yongquan
Air Force Medical Center, Department of Gastroenterology, Air Force Medical University, Beijing, China.
State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Air Force Medical University, Xi'an, 710032, China.
Arch Public Health. 2025 Apr 7;83(1):94. doi: 10.1186/s13690-025-01576-6.
This study aimed to assess the association of past obesity and past BMI trajectories with cancer mortality in National Health and Nutrition Examination Survey.
Past obesity was identified based on past maximum body weight, and trajectories of past BMI change were determined by latent class trajectory modeling (LCTM). Cox regression was used to assess the association of past obesity and past BMI trajectories with cancer mortality.
A total of 4,058 cancer patients participated in this study, of which 46.3% were past obesity, resulting in a significantly lower risk of cancer mortality compared to participants who were not past obesity (HR = 0.92, 95% CI: 0.92-0.93, P < 0.01). The LCTM identified five trajectories of past BMI, and compared with participants whose BMI remained in the normal range, the risk of death was 17% and 23% lower for participants in the "Long-term overweight" and "Long-term obesity" trajectory groups, respectively. In contrast, participants in the "Recent weight gain" and "Recent weight loss" trajectory groups had an increased risk of cancer death of 19% and 40%, respectively.
This study found that past obesity is consistent with the "obesity paradox." In furtherance, a moderately elevated and stable BMI might be associated with lower cancer mortality.
本研究旨在评估美国国家健康与营养检查调查中既往肥胖及既往体重指数（BMI）轨迹与癌症死亡率之间的关联。
根据既往最高体重确定既往肥胖情况，并通过潜在类别轨迹模型（LCTM）确定既往BMI变化轨迹。采用Cox回归评估既往肥胖及既往BMI轨迹与癌症死亡率之间的关联。
共有4058名癌症患者参与本研究，其中46.3%为既往肥胖患者，与非既往肥胖参与者相比，其癌症死亡风险显著降低（风险比[HR]=0.92，95%置信区间[CI]：0.92 - 0.93，P<0.01）。LCTM确定了既往BMI的五种轨迹，与BMI保持在正常范围内的参与者相比，“长期超重”和“长期肥胖”轨迹组的参与者死亡风险分别降低了17%和23%。相比之下，“近期体重增加”和“近期体重减轻”轨迹组的参与者癌症死亡风险分别增加了19%和40%。
本研究发现既往肥胖与“肥胖悖论”相符。此外，适度升高且稳定的BMI可能与较低的癌症死亡率相关。
