Bender R, Trautner C, Spraul M, Berger M
Department of Metabolic Diseases and Nutrition (WHO Collaborating Center for Diabetes), Heinrich Heine University of Düsseldorf, Germany.
Am J Epidemiol. 1998 Jan 1;147(1):42-8. doi: 10.1093/oxfordjournals.aje.a009365.
Quantification of the excess mortality from all causes associated with obesity remains controversial. In this paper, 6,193 obese patients, those with a body mass index (weight (kg)/height (m)2 (BMI)) range of 25-74 kg/m2, recruited from 1961 to 1994 in Düsseldorf, Germany, were followed for a mean time of 14 (standard deviation, 8.2) years, yielding 87,179 observed patient-years. During the study period, 1,028 patients (16.6%) died. The entire cohort was grouped into approximate quartiles according to BMI: group 1, BMI from 25 to < 32; group 2, BMI from 32 to < 36; group 3, BMI from 36 to < 40; group 4, BMI > or = 40 kg/m2. The following risk ratios were estimated by means of Cox proportional hazards models using the lowest BMI group as reference category: group 2 for men, 1.02 (95% confidence interval 0.76-1.37); for women, 1.23 (95% confidence interval 0.96-1.58); group 3 for men, 1.50 (95% confidence interval 1.09-2.06); for women, 1.33 (95% confidence interval 1.03-1.73); and group 4 for men, 2.10 (95% confidence interval 1.53-2.88); for women, 2.25 (95% confidence interval 1.78-2.84). The following standardized mortality ratios were calculated by using the respective geographic area (the Federal State of North Rhine Westphalia) as reference population: group 1 for men, 1.26 (95% confidence interval 0.98-1.61); for women, 1.00 (95% confidence interval 0.81-1.23); group 2 for men, 1.31 (95% confidence interval 1.09-1.57); for women, 1.20 (95% confidence interval 1.02-1.40); group 3 for men, 1.92 (95% confidence interval 1.53-2.38); for women, 1.27 (95% confidence interval 1.07-1.50); and group 4 for men, 3.05 (95% confidence interval 2.47-3.73); for women, 2.31 (95% confidence interval 2.04-2.60). In addition to age, sex, and BMI, Cox proportional hazards models revealed systolic blood pressure, glucose intolerance, diabetes, and smoking as significant independent mortality risk factors, whereas cholesterol was not significant. In this prospective study of a large cohort of obese persons, morbid obesity (BMI of > or = 40 kg/m2) was a strong predictor of premature death. Excess mortality risks associated with gross obesity (BMI from 32 to < 40 kg/m2) were considerably lower than hitherto assumed; moderate degrees of obesity (BMI from 25 to < 32 kg/m2) were not significantly associated with excess mortality.
对与肥胖相关的所有原因导致的超额死亡率进行量化仍存在争议。在本文中，对1961年至1994年期间在德国杜塞尔多夫招募的6193名肥胖患者（体重指数（体重（千克）/身高（米）²（BMI））范围为25 - 74千克/米²）进行了平均14年（标准差为8.2年）的随访，产生了87179个观察患者年。在研究期间，1028名患者（16.6%）死亡。整个队列根据BMI大致分为四分位数：第1组，BMI为25至<32；第2组，BMI为32至<36；第3组，BMI为36至<40；第4组，BMI≥40千克/米²。以下风险比通过Cox比例风险模型估计，以最低BMI组作为参考类别：第2组男性为1.02（95%置信区间0.76 - 1.37）；女性为1.23（95%置信区间0.96 - 1.58）；第3组男性为1.50（%置信区间1.09 - 2.06）；女性为1.33（95%置信区间1.03 - 1.73）；第4组男性为2.10（95%置信区间1.53 - 2.88）；女性为2.25（95%置信区间1.78 - 2.84）。通过将各自的地理区域（北莱茵 - 威斯特法伦州）作为参考人群计算了以下标准化死亡率：第1组男性为1.26（95%置信区间0.98 - 1.61）；女性为1.00（95%置信区间0.81 - 1.23）；第2组男性为1.31（95%置信区间1.09 - 1.57）；女性为1.20（95%置信区间1.02 - 1.40）；第3组男性为1.92（95%置信区间1.53 - 2.38）；女性为1.27（95%置信区间1.07 - 1.50）；第4组男性为3.05（95%置信区间2.47 - 3.73）；女性为2.31（95%置信区间2.04 - 2.60）。除年龄、性别和BMI外，Cox比例风险模型显示收缩压、葡萄糖耐量异常、糖尿病和吸烟是显著的独立死亡风险因素，而胆固醇不显著。在这项对大量肥胖人群的前瞻性研究中，病态肥胖（BMI≥40千克/米²）是过早死亡的有力预测因素。与严重肥胖（BMI为32至<40千克/米²）相关的超额死亡风险远低于迄今的假设；中度肥胖（BMI为25至<32千克/米²）与超额死亡率无显著关联。
