Zhuo Yulin, Liu Jiangmei, Hu Jianxiong, Qi Jinlei, He Guanhao, Yin Peng, Liu Tao, Liu Yingyin, Lin Yi, Guo Mengen, Jing Fengrui, Lin Ziqiang, You Jinling, Ma Wenjun, Zhou Maigeng
Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China.
The National Center for Chronic and Noncommunicable Disease Control and Prevention, Beijing, China.
Am J Clin Nutr. 2025 Aug;122(2):441-449. doi: 10.1016/j.ajcnut.2025.06.002. Epub 2025 Jun 6.
In the context of global warming, the health effects of non-optimum temperatures have attracted increasing attention. Studies have shown that high temperatures increase risk of hospitalization for protein-energy malnutrition (PEM), yet the impact of non-optimum temperatures on PEM mortality is unknown.
This study aims to quantitatively assess risk and burden of PEM-related mortality associated with short-term temperature exposure across 31 provinces in China.
We collected mortality and meteorological data from 1 January, 2013, to 31 December, 2022, in 31 provinces of mainland China. Based on time-stratified case-crossover design, we integrated logistic model with distributed lag nonlinear model to assess the association between non-optimum temperatures and PEM-related mortality. Subgroup analyses were performed by age, sex, type of PEM, and province to identify vulnerable populations.
A total of 197,406 PEM-related deaths were recorded during 2013-2022. The exposure-response curves were inversely J-shaped with higher effect for low temperature than high temperature. Nationally, we estimated that 17.03% [95% empirical confidence intervals (eCI): 14.59%, 19.17%] of PEM mortality was attributable to non-optimum temperatures. Subgroup analyses suggested that the attributable fraction of PEM mortality resulting from non-optimum temperatures was more prominent in males (17.69%; 95% eCI: 13.57%, 21.48%), the older adults ≥65 y (17.44%; 95% eCI: 14.84%, 19.80%), and non-severe PEM (17.45%; 95% eCI: 14.30%, 20.56%). In terms of spatial disparities, the top provinces with higher AFs were Anhui (27.63%; 95% eCI: 20.31%, 33.80%), Xinjiang (22.73%; 95% eCI: -0.14%, 39.55%), and Hubei (22.05%; 95% eCI: 12.36%, 29.87%).
Findings from this nationwide study suggest that both heat and cold are associated with increased risks and burden of PEM-related deaths. These findings underscore the necessity of targeted interventions to reduce the PEM-related mortality burden associated with ambient temperature.
在全球变暖的背景下，非适宜温度对健康的影响日益受到关注。研究表明，高温会增加蛋白质 - 能量营养不良（PEM）的住院风险，但非适宜温度对PEM死亡率的影响尚不清楚。
本研究旨在定量评估中国31个省份短期温度暴露与PEM相关死亡率的风险和负担。
我们收集了中国大陆31个省份2013年1月1日至2022年12月31日的死亡率和气象数据。基于时间分层病例交叉设计，我们将逻辑模型与分布滞后非线性模型相结合，以评估非适宜温度与PEM相关死亡率之间的关联。通过年龄、性别、PEM类型和省份进行亚组分析，以确定脆弱人群。
2013 - 2022年期间共记录了197,406例与PEM相关的死亡。暴露 - 反应曲线呈倒J形，低温的影响高于高温。在全国范围内，我们估计17.03%[95%经验置信区间（eCI）：14.59%，19.17%]的PEM死亡率可归因于非适宜温度。亚组分析表明，非适宜温度导致的PEM死亡率归因比例在男性（17.69%；95% eCI：13.57%，21.48%）、65岁及以上老年人（17.44%；95% eCI：14.84%，19.80%）和非重度PEM（17.45%；95% eCI：14.30%，20.56%）中更为突出。在空间差异方面，归因比例较高的省份有安徽（27.63%；95% eCI：20.31%，33.80%）、新疆（22.73%；95% eCI： - 0.14%，39.55%）和湖北（22.05%；95% eCI：12.36%，29.87%）。
这项全国性研究的结果表明，炎热和寒冷均与PEM相关死亡的风险和负担增加有关。这些发现强调了采取有针对性干预措施以减轻与环境温度相关的PEM相关死亡负担的必要性。
