Objective: To perform a systematic review between all-cause mortality and body mass index (BMI) in Asian adults.
Method: Relevant prospective studies that reported the relative risks (RRs) of all-cause mortality for community-based adults in Asia were identified by a literature search.PubMed and CNKI electronic databases were searched from inception through September 30, 2014, with language restrictions of English and Chinese. Data were extracted by 1 reviewer and then reviewed by 3 independent reviewers. The overall effect of varied levels of BMI and all-cause mortality were then pooled and analyzed.Potential sources of heterogeneity were detected by stratification analyses and sensitivity analyses. Publication bias was detected by funnel plot, Egger's test and Begg's test.
Results: Seventeen studies met the inclusion criteria; these studies included 1 769 369 individuals with 104 888 deaths. Random-effects summary all-cause mortality RRs was calculated. With the use of a BMI (in kg/m²) of 18.5~22.9 as the reference, the summary RRs were 1.39(95% CI: 1.31~1.47) for BMI less than 18.5 kg/m² , 0.88 (95% CI: 0.85~0.92) for BMI of 23.0~29.9 kg/m² and 1.14 (95% CI: 1.05~1.23) for BMI more than 30.0 kg/m². The RRs tended to be higher when weight and height were self-reported rather than measured. The RRs were higher when papers were published before the year 2005 rather than after the year 2006. Also, the RRs were higher when the quality scores were higher. Potential sources of heterogeneity were gender, the method of obtaining weight and height, geography, publication year and quality scores. There was no publication bias (P>0.05) in this meta-analysis.
Conclusion: There was an increased risk of all-cause mortality for those both at the lower and higher level of BMI in Asian adults.
目的: 探讨亚洲地区成人不同水平体质量指数(Body mass index, BMI)与全因死亡率关系。
方法: 全面检索相关文献, 严格按照纳入标准筛选有关体质量指数和全因死亡率的前瞻性队列研究, 应用meta分析方法对各研究进行数据合并与分析。通过分层分析和敏感性分析寻找研究异质性来源, 利用漏斗图、Egger检验和Begg检验分析发表偏倚。
结果: 共纳入17篇文献, 累计研究对象1 769 369例, 死亡104 888例。BMI＜18.5 kg/m 2、23.0~29.9 kg/m 2、≥30.0 kg/m 2三组的合并RR分别为1.39(95% CI: 1.31~1.47)、0.88(95% CI: 0.85~0.92)、1.14(95% CI: 1.05~1.23)。分层分析结果提示, 人群性别、地域和患者身高体质量的获取方式、文献发表时间、文献质量是研究异质性的来源。Egger和Begg检验均未发现发表偏倚(均 P＞0.05)。
结论: BMI过低和BMI过高是亚洲人群全因死亡率的危险因素。