伊朗德黑兰医科大学Sakineh Shab-Bidar团队研究了中心肥胖与全因死亡风险的相关性。2020年9月23日，该研究发表在《英国医学杂志》上。

为了量化中心肥胖指数与普通人群死亡风险的相关性，包括腰围、臀围、大腿围、腰臀比、腰围身高比、腰围大腿比、身体肥胖指数和A体形指数，并阐明剂量反应关系的形状，研究组在PubMed和Scopus数据库中检索从成立到2019年7月的相关文献，即至少评估了三类中心肥胖指数中全因死亡风险的前瞻性队列研究，并进行系统回顾和荟萃分析。

在筛选的98745项研究中，研究组对1950篇文献进行了全文审查以确认其资格。最终分析包括72项前瞻性队列研究，共2528297名参与者。总体风险比如下：腰围增加10厘米，风险比为1.11；臀围增加10厘米，风险比为0.90；大腿围增加5厘米，风险比为0.82；腰臀比增加0.1个单位，风险比为1.20；腰围身高比增加0.1个单位，风险比为1.24；腰围大腿比增加0.1个单位，风险比为1.21；身体肥胖指数增加10％，风险比为1.17；A体形指数增加0.005单位，风险比为1.15。

在考虑了体重指数后，正相关仍然存在。腰围和腰围身高比与男女全因死亡风险之间的关系几乎呈J形。腰臀比和A体形指数与全因死亡风险单调正相关。身体肥胖指数与全因死亡风险的关系呈U形。

研究结果表明，与总体肥胖无关，中心肥胖指数，包括腰围、腰臀比、腰围身高比、腰围大腿比、身体肥胖指数和A体型指数，与更高的全因死亡率呈显著正相关。较大的臀围和大腿围，全因死亡风险较低。

附：英文原文

Title: Central fatness and risk of all cause mortality: systematic review and dose-response meta-analysis of 72 prospective cohort studies

Author: Ahmad Jayedi, Sepideh Soltani, Mahdieh Sadat Zargar, Tauseef Ahmad Khan, Sakineh Shab-Bidar

Issue&Volume: 2020/09/23

Abstract:

Objective To quantify the association of indices of central obesity, including waist circumference, hip circumference, thigh circumference, waist-to-hip ratio, waist-to-height ratio, waist-to-thigh ratio, body adiposity index, and A body shape index, with the risk of all cause mortality in the general population, and to clarify the shape of the dose-response relations.

Design Systematic review and meta-analysis.

Data sources PubMed and Scopus from inception to July 2019, and the reference lists of all related articles and reviews.

Eligibility criteria for selecting studies Prospective cohort studies reporting the risk estimates of all cause mortality across at least three categories of indices of central fatness. Studies that reported continuous estimation of the associations were also included.

Data synthesis A random effects dose-response meta-analysis was conducted to assess linear trend estimations. A one stage linear mixed effects meta-analysis was used for estimating dose-response curves.

Results Of 98745 studies screened, 1950 full texts were fully reviewed for eligibility. The final analyses consisted of 72 prospective cohort studies with 2528297 participants. The summary hazard ratios were as follows: waist circumference (10 cm, 3.94 inch increase): 1.11 (95% confidence interval 1.08 to 1.13, I2=88%, n=50); hip circumference (10 cm, 3.94 inch increase): 0.90 (0.81 to 0.99, I2=95%, n=9); thigh circumference (5 cm, 1.97 inch increase): 0.82 (0.75 to 0.89, I2=54%, n=3); waist-to-hip ratio (0.1 unit increase): 1.20 (1.15 to 1.25, I2=90%, n=31); waist-to-height ratio (0.1 unit increase): 1.24 (1.12 to 1.36, I2=94%, n=11); waist-to-thigh ratio (0.1 unit increase): 1.21 (1.03 to 1.39, I2=97%, n=2); body adiposity index (10% increase): 1.17 (1.00 to 1.33, I2=75%, n=4); and A body shape index (0.005 unit increase): 1.15 (1.10 to 1.20, I2=87%, n=9). Positive associations persisted after accounting for body mass index. A nearly J shaped association was found between waist circumference and waist-to-height ratio and the risk of all cause mortality in men and women. A positive monotonic association was observed for waist-to-hip ratio and A body shape index. The association was U shaped for body adiposity index.

Conclusions Indices of central fatness including waist circumference, waist-to-hip ratio, waist-to-height ratio, waist-to-thigh ratio, body adiposity index, and A body shape index, independent of overall adiposity, were positively and significantly associated with a higher all cause mortality risk. Larger hip circumference and thigh circumference were associated with a lower risk. The results suggest that measures of central adiposity could be used with body mass index as a supplementary approach to determine the risk of premature death.

DOI: 10.1136/bmj.m3324

Source: https://www.bmj.com/content/370/bmj.m3324