Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents

被引：1890

作者：

Di Angelantonio, Emanuele ^{[1
]}

Bhupathiraju, Shilpa N. ^{[2
]}

Wormser, David ^{[1
]}

Gao, Pei ^{[1
,3
]}

Kaptoge, Stephen ^{[1
]}

de Gonzalez, Amy Berrington ^{[4
]}

Cairns, Benjamin J. ^{[5
]}

Huxley, Rachel ^{[6
]}

Jackson, Chandra L. ^{[7
]}

Joshy, Grace ^{[8
]}

Lewington, Sarah ^{[5
]}

Manson, JoAnn E. ^{[9
]}

Murphy, Neil ^{[10
]}

Patel, Alpa V. ^{[11
]}

Samet, Jonathan M. ^{[12
]}

Woodward, Mark ^{[5
,13
,14
]}

Zheng, Wei ^{[15
]}

Zhou, Maigen ^{[16
]}

Bansal, Narinder ^{[1
]}

Barricarte, Aurelio ^{[17
]}

Carter, Brian ^{[11
]}

Cerhan, James R. ^{[18
]}

Collins, Rory ^{[5
]}

Smith, George Davey ^{[19
]}

Fang, Xianghua ^{[20
]}

Franco, Oscar H. ^{[21
]}

Green, Jane ^{[5
]}

Halsey, Jim ^{[5
]}

Hildebrand, Janet S. ^{[11
]}

Jung, Keum Ji ^{[22
]}

Korda, Rosemary J. ^{[23
]}

McLerran, Dale F. ^{[24
]}

Moore, Steven C. ^{[25
]}

O'Keeff, Linda M. ^{[1
]}

Paige, Ellie ^{[1
]}

Ramond, Anna ^{[1
]}

Reeves, Gillian K. ^{[5
]}

Rolland, Betsy ^{[25
]}

Sacerdote, Carlotta ^{[26
]}

Sattar, Naveed ^{[27
]}

Sofianopoulou, Eleni ^{[1
]}

Stevens, June ^{[28
]}

Thun, Michael ^{[11
]}

Ueshima, Hirotsugu ^{[29
]}

Yang, Ling ^{[5
]}

Yun, Young Duk ^{[30
]}

Willeit, Peter ^{[1
,31
]}

Banks, Emily ^{[32
]}

Beral, Valerie ^{[5
]}

Chen, Zhengming ^{[5
]}

机构：

[1] Univ Cambridge, Cambridge, England

[2] Harvard Univ, Harvard TH Chan Sch Publ Hlth, Boston, MA 02115 USA

[3] Peking Univ, Beijing 100871, Peoples R China

[4] Natl Canc Inst, Bethesda, MD USA

[5] Univ Oxford, S Parks Rd, Oxford, England

[6] Curtin Univ, Perth, WA 6845, Australia

[7] Harvard Univ, Sch Med, Boston, MA USA

[8] Australian Natl Univ, GPO Box 4, Canberra, ACT, Australia

[9] Harvard Univ, Sch Med, Harvard TH Chan Sch Publ Hlth, Boston, MA USA

[10] Imperial Coll London, London, England

[11] Amer Canc Soc, Atlanta, GA 30329 USA

[12] Univ So Calif, Los Angeles, CA USA

[13] Univ Sydney, Sydney, NSW, Australia

[14] Johns Hopkins Univ, Baltimore, MD USA

[15] Vanderbilt Univ Sch Med, Nashville, TN USA

[16] Chinese Ctr Dis Control & Prevent, Beijing, Peoples R China

[17] Consortium Biomed Res Epidemiol & Publ Hlth, Navarre Publ Hlth Inst, Pamplona, Spain

[18] Mayo Clin, Rochester, MN USA

[19] Univ Bristol, Bristol, Avon, England

[20] Capital Med Univ, Beijing, Peoples R China

[21] Univ Med Ctr Rotterdam, Rotterdam, Netherlands

[22] Yonsei Univ, Seoul 120749, South Korea

[23] Australian Natl Univ, GPO Box 4, Canberra, ACT, Australia

[24] Fred Hutchinson Canc Res Ctr, 1124 Columbia St, Seattle, WA 98104 USA

[25] Natl Canc Inst, Bethesda, MD USA

[26] Univ Turin, Ctr Canc Prevent, Turin, Italy

[27] Univ Glasgow, Glasgow, Lanark, Scotland

[28] Univ N Carolina, Chapel Hill, NC USA

[29] Shiga Univ Med Sci, Shiga, Japan

[30] Hlth Insurance Policy Res Inst, Seoul, South Korea

[31] Med Univ Innsbruck, A-6020 Innsbruck, Austria

[32] Australian Natl Univ Canberra, Canberra, ACT, Australia

[33] Int Agcy Res Canc, 150 Cours Albert Thomas, F-69372 Lyon, France

[34] Univ Hong Kong, Hong Kong, Peoples R China

[35] Massey Univ, Wellington, New Zealand

[36] Harvard Univ, Sch Med, Harvard TH Chan Sch Publ Hlth, Boston, MA USA

来源：

LANCET | 2016年 / 388卷 / 10046期

基金：

英国医学研究理事会; 美国国家卫生研究院;

关键词：

CARDIOVASCULAR-DISEASE; RISK-FACTORS; OBESITY; ASSOCIATION; OVERWEIGHT; ADIPOSITY; METHODOLOGY; POPULATION; DEATH;

D O I：

10.1016/S0140-6736(16)30175-1

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background Overweight and obesity are increasing worldwide. To help assess their relevance to mortality in different populations we conducted individual-participant data meta-analyses of prospective studies of body-mass index (BMI), limiting confounding and reverse causality by restricting analyses to never-smokers and excluding pre-existing disease and the first 5 years of follow-up. Methods Of 10 625 411 participants in Asia, Australia and New Zealand, Europe, and North America from 239 prospective studies (median follow-up 13.7 years, IQR 11.4-14.7), 3 951 455 people in 189 studies were never-smokers without chronic diseases at recruitment who survived 5 years, of whom 385 879 died. The primary analyses are of these deaths, and study, age, and sex adjusted hazard ratios (HRs), relative to BMI 22.5-<25.0 kg/m(2). Findings All-cause mortality was minimal at 20.0-25.0 kg/m(2) (HR 1.00, 95% CI 0.98-1.02 for BMI 20.0-<22.5 kg/m(2); 1.00, 0.99-1.01 for BMI 22.5-<25.0 kg/m(2)), and increased significantly both just below this range (1.13, 1.09-1.17 for BMI 18.5-<20.0 kg/m(2); 1.51, 1.43-1.59 for BMI 15.0-<18.5) and throughout the overweight range (1.07, 1.07-1.08 for BMI 25.0-<27.5 kg/m(2); 1.20, 1.18-1.22 for BMI 27.5-<30.0 kg/m(2)). The HR for obesity grade 1 (BMI 30.0-<35.0 kg/m(2)) was 1.45, 95% CI 1.41-1.48; the HR for obesity grade 2 (35.0-<40.0 kg/m(2)) was 1.94, 1.87-2.01; and the HR for obesity grade 3 (40.0-<60.0 kg/m(2)) was 2.76, 2.60-2.92. For BMI over 25.0 kg/m(2), mortality increased approximately log-linearly with BMI; the HR per 5 kg/m(2) units higher BMI was 1.39 (1.34-1.43) in Europe, 1.29 (1.26-1.32) in North America, 1.39 (1.34-1.44) in east Asia, and 1.31 (1.27-1.35) in Australia and New Zealand. This HR per 5 kg/m(2) units higher BMI (for BMI over 25 kg/m(2)) was greater in younger than older people (1.52, 95% CI 1.47-1.56, for BMI measured at 35-49 years vs 1.21, 1.17-1.25, for BMI measured at 70-89 years; p(heterogeneity) < 0.0001), greater in men than women (1.51, 1.46-1.56, vs 1.30, 1.26-1.33; p(heterogeneity) < 0.0001), but similar in studies with self-reported and measured BMI. Interpretation The associations of both overweight and obesity with higher all-cause mortality were broadly consistent in four continents. This finding supports strategies to combat the entire spectrum of excess adiposity in many populations.

引用

页码：776 / 786

页数：11

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