Hodge A M, Dowse G K, Collins V R, Zimmet P Z
International Diabetes Institute, Melbourne, Australia.
Am J Epidemiol. 1996 Mar 1;143(5):442-55. doi: 10.1093/oxfordjournals.aje.a008764.
The association of obesity with mortality was investigated in population-based samples of Micronesian Nauruans (n = 1,400), Melanesian Fijians (n = 1,279), and Indian Fijians (n = 1,182), over 10 years from 1982 in Nauru, and 11 years from 1980 in Fiji. At the end of follow-up, vital status was known for all Nauruans and all but 3.5% of Fijians. Mortality rates were higher in Nauru than Fiji, and in Melanesians than Indians. The mean body mass index of decedents was similar to or less than (Nauruan men, p < 0.001) that of survivors in each sex-ethnic group. Crude mortality rates showed an inverse relation with body mass index in Nauruan men, with inconsistent relations in other sex-ethnic groups. After stratification by diabetes status, there was no relation between mortality and obesity in nondiabetic subjects, but an inverse relation was observed among diabetic subjects in each population. These findings persisted even after the exclusion of subjects who died within the first 2 years of follow-up. After controlling for age, smoking, and diabetes status in Cox proportional hazard models, body mass index (as a continuous variable) was not related to mortality in any sex/ethnic group and tended to be negatively associated with mortality risk. Interactions of body mass index with age, smoking, and diabetes status were not significant. Mortality risk was significantly increased in older subjects and in diabetic subjects, and cigarette smoking also increased risk in some groups. Stratification of analyses according to cigarette smoking did not alter the nature of the results. The association of mortality and body mass index categorized by quartiles was also investigated. After adjusting for age alone, or age, smoking, and diabetes status, the lower quartiles of body mass index were consistently associated with the highest relative risk for mortality. Quadratic terms for body mass index did not improve Cox models in subjects with normal glucose tolerance. Relations with cardiovascular disease mortality were also assessed and results were inconsistent, although positive trends were observed in Nauruan women (p = 0.02) and Melanesian men (p = 0.06). Overall, there was little evidence to suggest that obesity was a risk factor for total or cardiovascular mortality in these populations. However, obesity is clearly associated with a high risk of diabetes and other morbid conditions and at least on this basis it would seem desirable to prevent obesity in these and other Pacific populations.
在1982年起的10年里，对瑙鲁的1400名密克罗尼西亚瑙鲁人、1980年起的11年里，对斐济的1279名美拉尼西亚斐济人和1182名印度斐济人进行了基于人群样本的肥胖与死亡率关联研究。随访结束时，所有瑙鲁人以及除3.5%以外的所有斐济人的生命状态已知。瑙鲁的死亡率高于斐济，美拉尼西亚人的死亡率高于印度人。各性别-种族组中，死者的平均体重指数与幸存者的相似或更低（瑙鲁男性，p<0.001）。粗死亡率在瑙鲁男性中与体重指数呈负相关，在其他性别-种族组中关系不一致。按糖尿病状态分层后，非糖尿病受试者的死亡率与肥胖无关，但在各人群的糖尿病受试者中观察到负相关。即使排除随访头两年内死亡的受试者，这些发现仍然存在。在Cox比例风险模型中控制年龄、吸烟和糖尿病状态后，体重指数（作为连续变量）在任何性别/种族组中均与死亡率无关，且倾向于与死亡风险呈负相关。体重指数与年龄、吸烟和糖尿病状态的交互作用不显著。老年受试者和糖尿病受试者的死亡风险显著增加，吸烟在某些组中也增加了风险。根据吸烟情况对分析进行分层并未改变结果的性质。还研究了按四分位数分类的死亡率与体重指数的关联。仅调整年龄，或调整年龄、吸烟和糖尿病状态后，体重指数的较低四分位数始终与最高的相对死亡风险相关。体重指数的二次项在糖耐量正常的受试者中并未改善Cox模型。还评估了与心血管疾病死亡率的关系，结果不一致，尽管在瑙鲁女性（p = 0.02）和美拉尼西亚男性（p = 0.06）中观察到了正趋势。总体而言，几乎没有证据表明肥胖是这些人群全因或心血管疾病死亡的危险因素。然而，肥胖显然与糖尿病和其他疾病的高风险相关，至少在此基础上，在这些及其他太平洋人群中预防肥胖似乎是可取的。
