Lancet Diabetes Endocrinol: 多队列观察研究证实,肥胖与多疾病负担相关!

2022-04-01 Naomi MedSci原创

近日,研究人员试图研究肥胖人群中普通健康状况的风险,确定肥胖相关疾病的出现之间的关联,以及描述肥胖在老年人复杂多发病率形成中的作用。肥胖与各种各样不断增加的疾病负担有关,这可能是疾病预防重要目标之一。

全世界的肥胖流行率和与肥胖相关的疾病负担正在增加。世界卫生组织估计,全球有超过6.5亿人患有肥胖症(bmi ≥30 kg/m2)。根据大型观察研究,肥胖与疾病/寿命减少3-8年有关,与体重正常的人相比,肥胖导致的过早死亡的风险大约高出13倍。此外,肥胖使人易患各种各样的临床疾病,包括2型糖尿病、心血管疾病、慢性肾脏疾病、部位特异性癌症、肌肉骨骼疾病和感染。然而,目前尚不清楚这些疾病是否分布在所有肥胖人群中,还是集中在与肥胖相关的多发病率较小的人群中。

有证据表明,肥胖增加疾病易感性,以及与健康相关的生活质量下降。在对120000名成年人的 IPD-work多队列研究中,轻度肥胖(BMI 30.0-34.9kg/m2)的人与正常体重的人相比,心血管代谢多发病率(心肌梗死、中风和2型糖尿病的2个或3个)增加了4倍以上。一项对超过11000名成年人的研究发现,超重或肥胖的参与者患有并发症的可能性是其他人的两倍,包括高血压、血脂异常、未指明的糖尿病和骨关节炎。对美国45至64岁的病人进行的一项研究发现,最常见的疾病群组包括体重正常人的高血压和背痛,以及超重或肥胖人士的关节紊乱、血脂异常、2型糖尿病、睡眠紊乱和慢性肾脏疾病。然而,很少有研究表明多种与肥胖有关的疾病会导致复杂的多发病率(四种或更多的共病)。

近日,研究人员试图研究肥胖人群中普通健康状况的风险,确定肥胖相关疾病的出现之间的关联,以及描述肥胖在老年人复杂多发病率形成中的作用。

研究人员进行了一个观察性研究,使用了来自两个芬兰队列研究(健康和社会支持研究和芬兰公共部门研究)的汇集的前瞻性数据,研究项目(1998-2013年)包括114657名16-78岁的成年人。来自英国生物库的499357名成年人(研究入口年龄在38-73岁之间; 2006-10年)在一个独立人群中进行了复制。在基线时评估体重指数和临床特征。BMI分为肥胖(≥300kg/m2)、超重(250-299kg/m2)、健康体重(185-249kg/m2)和体重不足(< 185kg/m2)。通过连接到国家健康记录,参与者对根据第10版(ICD-10)诊断的死亡和疾病进行跟踪国际疾病与相关健康问题统计分类。计算了体重指数和多发病率之间关联的95% 顺式和群体归因分数的危害比率(HRS)。

  • 芬兰队列的平均随访时间为 12·1 年 (SD 3·8),英国生物库队列的平均随访时间为 11·8 年 (1·7)。
  • 在 Bonferroni 多重测试调整和忽略小于 1.50 的 HR 后,肥胖与 21 种非重叠的心脏代谢、消化、呼吸、神经、肌肉骨骼和传染病相关。
  • 与健康体重相比,肥胖的混杂因素调整 HR 为 2·83(95% CI 2·74–2·93;PAF 19·9% [95% CI 19·3–20·5])至少 一种肥胖相关疾病,5.17 (4.84–5.53;34·4% [33.2–35.5]) 两种疾病,12.39 (9.26–16.58;55 ·2% [50.9–57.5]) 用于复杂的多发病。
  • 在55岁的肥胖参与者中,观察到75岁以前健康体重和复杂多发病率的参与者比例,肥胖程度与复杂多发病率呈剂量-反应关系。
  • 与肥胖相比,超重和复杂多发病率之间的关联更为适中(HR 267,95% CI 194-368; PAF 133% [95% CI 96-163])。在英国生物库中也观察到了同样的结果。

      肥胖与各种各样不断增加的疾病负担有关,这可能是避免多目标预防方案复杂性的多发病率预防的一个重要目标。

文献来源:

Kivimäki M, Strandberg T, Pentti J, et al. Body-mass index and risk of obesity-related complex multimorbidity: an observational multicohort study. Lancet Diabetes Endocrinol. 2022;10(4):253-263. doi:10.1016/S2213-8587(22)00033-X

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    2022-03-30 howi
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    2022-08-03 智慧医人
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    2022-04-01 仁术2021

    不错,学习了。

    0

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本文揭示了5种慢性病当前的流行和负担情况,为当地5种慢性病防控策略的调整制订提供了科学依据。

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泛发性脓疱型银屑病(GPP)是一种严重的、可能危及生命的皮肤病。但是很少有研究报道关于GPP的负担,尤其是在国家层面。

BMJ:1990-2019年间全球国家和地区慢阻肺疾病负担的系统分析

COPD的疾病负担不断减轻,但仍然是一个主要的公共卫生问题。

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