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目的采用Meta分析方法定量综合国内外前瞻性研究中不同水平体质指数(body mass index,BMI)与总死亡率关系。方法以“体质指数”、“超重”、“肥胖”、“死亡率”、“队列研究”、“前瞻性研究”及“随访研究”为主题词和关键词联合检索PubMed和中国期刊网全文数据库(CNKI),查找相关文献。合格的文献限定于探讨普通人群BMI与总死亡率关系的前瞻性研究,BMI分组数≥6,且报道了各组死亡的相对危险度(RR)及95%可信区间(95%CI)。结果共纳入32篇文献,含54个队列研究(总人数:7 910 932人,死亡数:1 376 997人)。男女合并发现,BMI和总死亡风险呈“U”形关系,总死亡风险最低时的BMI为23.0~24.9 kg/m2。与此对照,其他BMI组总死亡风险RR(95%CI)分别为:<18.5 kg/m2:1.53(1.49~1.57);18.5~20.9 kg/m2:1.09(1.07~1.11);21.0~22.9 kg/m2:1.06(1.04~1.08);25.0~26.9 kg/m2:1.01(1.00~1.03);27.0~29.9 kg/m2:1.11(1.10~1.12);30.0~34.9 kg/m2:1.25(1.23~1.28);≥35.0 kg/m2:1.59(1.53~1.65)。男性和女性死亡风险最低时的BMI为23.0~26.9 kg/m2和21.0~24.9 kg/m2。按照是否校正混杂因素、随访年限、自报与实测身高体重、地区分层分析,“U”形关系无明显改变。结论 BMI过低或过高均是总死亡率增加的危险因素。
Objective To quantitatively synthesize the relationship between body mass index (BMI) and total mortality in prospective studies at home and abroad by Meta analysis. Methods The patients were divided into two groups according to their body mass index, overweight, obesity, mortality, cohort study, prospective study and follow-up study. Keywords and keywords jointly PubMed and China Journal Full-text Database (CNKI), find the relevant literature. The qualified literature is limited to a prospective study to investigate the relationship between BMI and total mortality in the general population, with a BMI score of 6 or greater and reported relative risk of death (RR) and 95% confidence interval (95% CI) for each group. Results A total of 32 articles were included, including 54 cohort studies (total population: 7,910,932 and number of deaths: 1,376,997). The co-existence of men and women found that the BMI was associated with a “U” shape of overall risk of death with a BMI of 23.0-24.9 kg / m2 at the lowest total risk of death. In contrast, the overall risk of death RR (95% CI) for the other BMI groups was <18.5 kg / m2: 1.53 (1.49-1.57), 18.5-20.9 kg / m2: 1.09 (1.07-1.11), and 21.0-22.9 kg /M2:1.06(1.04~1.08).25.0~26.9 kg / m2: 1.01 (1.00~1.03); 27.0~29.9 kg / m2: 1.11 (1.10~1.12); 30.0~34.9 kg / m2: 1.25 (1.23~1.28) ); ≥35.0 kg / m2: 1.59 (1.53 ~ 1.65). The BMI at the lowest risk of death for males and females ranged from 23.0 to 26.9 kg / m2 and from 21.0 to 24.9 kg / m2. According to whether the correction of confounding factors, follow-up period, self-reported and measured height, weight, regional stratification analysis, “U ” shape no significant change. Conclusion BMI is too low or too high are the risk factors of increased total mortality.