成人肥胖的评价方法、指标及标准在公共卫生中应用的研究进展

肥胖不仅本身是一种疾病,还是糖尿病、心血管疾病、某些恶性肿瘤等慢性病的重要的可改变的危险因素。如何评价肥胖成为公共卫生实践中首要解决的重要问题,包括如何监测人群肥胖流行状况和变化趋势,对于肥胖及相关疾病进行肥胖控制等。随着对肥胖研究的深入,越来越多的研究发现用不同的指标和评价标准来测量肥胖,与不同疾病的关联强度有较大差异。然而公共卫生实践及相关研究中,对评价肥胖的指标要求简单、经济、对人体无害、容易获得并具备较高的敏感性与特异性,从而能够准确、高效地识别高危人群,对其进行干预并评价干预的效果。因此,公共卫生中选择适宜的肥胖指标不仅关系到结果的准确性,而且符合成本效益原则。本文对肥胖测量的相关指标、判定标准及其研究进展予以综述,旨在为公共卫生实践和相关研究中如何选择正确的肥胖测量指标提供参考。     

我国胃癌发病主要危险因素的综合分析

胃癌是我国常见的恶性肿瘤，其病因尚无定论。多年来，国内外学者对影响胃癌发病的危险因素进行了大量的研究，认为胃癌主要与幽门螺杆菌（Heli-cobaeter pylori，HP）感染、居民的生活习惯、饮食、微量元素缺乏以及遗传等因素有关。2006年胡宏雷等同志所做的“幽门螺杆菌感染与胃癌关系的Meta分析”证实了HP感染与胃癌之间的关联具有统计学意义。本文主要从遗传和个人行为方面进行了Meta分析，以进一步探讨胃癌发病过程中可预防的病因，为制定相关预防和控制措施提供参考依据。     

云南省富源县2009年恶性肿瘤发病情况分析

目的分析研究2009年富源县恶性肿瘤的发病情况和流行特征,为富源县恶性肿瘤防治提供科学依据。方法对2009年富源县居民恶性肿瘤新发病例进行统计分析,计算发病率、发病顺位、构成比等指标。结果 2009年富源县居民恶性肿瘤新发病例638例,发病率89.94/10万。发病前5位为肺癌、胃癌、肝癌、颅内肿瘤、结直肠癌;男性恶性肿瘤发病率为100.82/10万,男性恶性肿瘤发病前5位为肺癌、肝癌、胃癌;颅内肿瘤、结直肠癌;女性恶性肿瘤发病率78.95/10万,女性恶性肿瘤发病率前5位为肺癌、胃癌、肝癌、颅内肿瘤、结直肠癌。恶性肿瘤的发病率随着年龄增加而升高。结论富源县居民恶性肿瘤的发病主要集中在中老年人群,恶性肿瘤构成比以肺癌为主,且不论男性女性,肺癌发病年龄明显提前,男女均以预防控制肺癌、胃癌、肝癌为重点,特别是女性肺癌。     

黑皮素4受体基因多态性与青少年肥胖的相关性研究

目的探讨黑皮素4受体(MC4R)基因V103I多态性与青少年肥胖、血脂的相关性,为控制肥胖提供理论依据。方法选择北京市东城区919名14~17岁初中生进行身体测量、血脂测定和V103I多态性检测。结果青少年各项血脂指标均表现为肥胖组>超重组>体重正常组(P<0.05),肥胖与血脂存在一定相关性;V103I等位基因突变率(G>A)为3.9%;体重正常、超重和肥胖组之间基因型构成和等位基因频率差异无统计学意义(P>0.05);男性超重组GG基因型的腰臀比(WHR)略低于GA/AA基因型(P<0.05);血脂指标TC,TG,LDL-C异常者与正常者相比,基因型构成和等位基因频率差异无统计学意义。结论中国青少年MC4R基因V103I多态性突变率与白种人接近,该多态性可能与男性超重有关,但与血脂异常没有显著关联。     

基线体质指数与男性胃癌发病关系的前瞻性队列研究

目的 研究基线BMI与男性胃癌发病风险之间的关联。方法 基于开滦队列（2006-2015年）男性人群,收集身高、体重等流行病学信息。每两年随访1次,收集胃癌发病结局资料;检索开滦附属医院医疗信息系统、开滦集团保险系统、唐山市医疗保险系统,补充收集随访过程中可能遗漏的胃癌新发病例。以体重正常（18.5 kg/m² ≤ BMI<24.0 kg/m²）人群为参照组,利用Cox风险比例模型分析基线BMI与男性胃癌发病风险的关联,计算发病风险比（HR）及其95% CI。结果 共纳入109 600名男性,共随访860 399.79人年,中位随访时间8.8年,收集胃癌新发病例272例。和正常体重人群相比,调整年龄、文化程度、吸烟状态、饮酒频率、粉尘暴露、食盐习惯、饮茶习惯等潜在的混杂因素后,体重过轻人群（BMI<18.5 kg/m²）胃癌发病风险升高（HR=2.11,95% CI：1.23~3.62）,超重/肥胖与胃癌发病风险无统计学关联。按照年龄、文化程度、吸烟、饮酒、饮茶、粉尘暴露等进行分层分析,结果显示,高年龄组、高文化程度、不吸烟、不饮酒、不饮茶、有粉尘暴露人群中,低体重与胃癌发病关联依然有统计学意义。结论 体重过轻可能增加男性胃癌发病风险,且该关联受年龄、文化程度、吸烟、饮酒、饮茶、粉尘暴露等因素影响。     

中心型肥胖与全因死亡风险的关联:72项前瞻性队列研究的系统综述和剂量-反应关系的荟萃分析

体重指数(BMI)不能反映身体的区域脂肪分布,中心性肥胖指标在估计肥胖时可能比BMI更准确b本研究应用系统综述和剂量反应荟萃分析,探究了中心型肥胖指标(包括腰围、臀围、大腿围、腰臀比、腰高比、腰股比、身体肥胖指数和体型指数)与全因死亡风险的关系,并阐明他们与全因死亡之间的剂量反应关系.     

成都城区3～6岁肥胖儿体格测量病例对照研究

[目的]比较肥胖和正常学龄前儿童身体测量指标的区别,为诊断儿童肥胖科学合理指标体系提供依据.[方法]选取成都市城区558名3～6岁儿童按照1:2比例进行病例对照研究.[结果]肥胖组儿童BMI、血压、体围和皮褶厚度在不同年龄、性别组基本上均高于对照组,两对照组之间未见差异.BMI与臀围、肩胛下、髂脊上皮褶厚度及SF4相关性均>0.7(P<0.01).[结论]通过体格测量可预测儿童肥胖发生及肥胖类型,监测相关指标是预防肥胖有效措施.     

体像不满在儿童肥胖与自尊关联中的间接效应

探讨体像不满在儿童超重/肥胖与自尊关联中的间接效应,为提高肥胖儿童自尊水平提供参考.方法 采用分层整群抽样方法抽取蚌埠市2所九年一贯制学校524名8~15岁儿童少年为研究对象,测量身高、体重等指标,采用Ma体形图调查儿童体像认知,采用Rosenberg自尊量表评定儿童自尊.结果 儿童超重/肥胖率为31.11%,体像不满率为80.73%,自尊总分为(29.58±5.49)分.在男生中,超重/肥胖与自尊的关联无统计学意义,但与体像不满有关(OR=8.94,P0.05).结论 男生超重/肥胖可能通过体像不满与低自尊有关,女生超重/肥胖可能直接与低自尊有关.     

身体形态指数ABSI和身体圆度指数BRI的发展与应用

目的 对身体形态指数(ABSI)和身体圆度指数(BRI)的发展进行介绍,并对其应用情况进行综述,为人体形态测量提供参考。方法 在Pubmed、中国知网等电子文献数据库中进行文献检索,详尽收录迄今ABSI与BRI对高血压、糖尿病、代谢综合征、心血管疾病等常见疾病的发病率以及全因死亡率预测的相关研究。结果 ABSI与BRI均对高血压、糖尿病、代谢综合征、心血管疾病发病呈现出一定的预测能力。其中,BRI在预测糖尿病、代谢综合征发病方面优于ABSI,但与身体质量指数、腰围、臀围、腰高比等传统测量指标相比,并未表现出显著的差异。ABSI对全因死亡率的预测能力则明显优于传统测量指标和BRI。结论 ABSI与BRI作为两项新的形态学指标,是BMI等传统身体指数测量的补充,对疾病发病具有一定的预测能力和应用性。今后的研究可以从两项指标对疾病的单独作用以及与传统指标的联合作用着手,同时探索其在不同社会人口学特征人群中的拟合情况,提供更有利的研究证据和科学积累。     

北京市成年人不同体重异常判断指标与血脂异常的相关性研究

目的探讨北京市成年人不同体重异常判断指标与血脂异常的相关及一致性。方法于2017年8至12月, 采用多阶段分层整群随机抽样方法对北京市5个区18～79岁常住居民进行问卷调查、体格测量和实验室检查。分析超重肥胖、身体脂肪率高、中心型肥胖、高腰高比者的血脂异常患病率。通过偏相关分析体重指数(BMI)、身体脂肪率、腰围、腰高比与血脂水平的相关性;采用复杂抽样logistic回归模型分析不同体重异常判断指标与血脂异常之间的关联。计算Kappa值分析不同体重异常判断指标的一致性。结果共纳入研究对象4 975例。血脂异常加权患病率为30.48%, 男性(40.16%)高于女性(20.52%), 差异有统计学意义(P<0.01)。超重肥胖、身体脂肪率高、中心型肥胖、高腰高比的加权率分别为56.65%、47.52%、42.48%和59.45%。BMI、身体脂肪率、腰围、腰高比与总胆固醇、甘油三酯、低密度脂蛋白胆固醇、非高密度脂蛋白胆固醇呈正相关, 与高密度脂蛋白胆固醇呈负相关。复杂抽样logistic回归分析结果显示, 身体脂肪率高(OR=1.67, 95%CI:1.35～2.07)、超重肥胖(...     

The Comparison of Different Obesity Indexes and the Risk of Lung Cancer: A Meta-Analysis of Prospective Cohort Studies

To evaluate the relationship between obesity, analyzed by different indicators, and lung cancer incidence, literature search was conducted in the PubMed, Web of Science, EBSCO, Ovid, and China National Knowledge Infrastructure databases for articles published until December 2018. Twenty-eight prospective cohort studies were identified, with 28 784,269 participants and 127,161 lung cancer cases were included in the analysis. The combined relative risks (RRs) with 95% CIs for the highest versus normal category of body mass index (BMI) were RR = 0.77 (95% CI: 0.72–0.82), but the inverse association disappeared for never smokers or small cell carcinoma after stratifying the smoking status or histological cancer types, respectively. Further analysis considered lag time and excluded the effects of preclinical cancer, there is no statistically significant inverse association between BMI and lung cancer risk, RR = 0.89 (95% CI: 0.66–1.19). In contrast, the combined RRs with 95% CIs for the highest versus lowest category of waist circumference (WC) were RR = 1.26 (95% CI: 1.14–1.39). Therefore, due to multiple confounders existed, BMI might not be an appropriate indicator for obesity when study lung cancer risk. The significantly positive relationship between WC and lung cancer risk indicated there might have an etiological connection between central obesity and lung cancer development.     

海南百岁老人12项肥胖相关指标与全因死亡的关联研究

目的描述和分析BMI、腰围、腰臀比、腰高比、小腿围、腰围小腿围比值(WCR)、脂质蓄积指数(LAP)、内脏脂肪指数(VAI)、中国内脏脂肪指数(CVAI)、身体形态指数、中国身体形态指数(CABSI)和身体圆度指数与海南百岁老人全因死亡间的关联。方法整群抽样方法抽取的海南百岁老人共1 002人。随访时间的M(Q1, Q3)为4.16(1.31, 5.04)年, 结局为全因死亡, 使用Cox比例风险回归分析各肥胖相关身体测量指标与全因死亡的关联, 并使用受试者工作特征曲线曲线下面积(AUC)进行比较。结果总人群中小腿围对全因死亡的判定能力最强, AUC为0.61(95%CI:0.57～0.64), 分性别结果与总人群一致(P<0.05)。WCR次之(AUC为0.58), 再次是BMI、LAP和腰围, AUC分别为0.55、0.55和0.54, 而CABSI、腰臀比和VAI的判定能力较弱, AUC分别为0.51、0.50和0.50。结论本研究比较了12项肥胖相关指标与海南百岁老人全因死亡间的关联, 发现小腿围的预测判定能力最好, 且呈剂量反应关系, 提示可作为长寿老人死亡风险预测的参...     

牙齿缺失与胃癌患者生存关系分析

目的探讨牙齿缺失与胃癌患者生存的关系,为胃癌的防治提供参考依据。方法采用多因素Cox回归分析方法,对河南省林县营养干预试验随访24年中发生原发性胃癌患者2 084例进行牙齿缺失与胃癌患者生存关系的分析。结果随访5年结果表明,调整年龄、吸烟、饮酒、体质指数、肿瘤家族史、饮食情况、临床分期和治疗方法后,男、女性牙齿缺失与胃癌患者死亡风险均无关(P>0.05);随访15年和24年结果表明,牙齿缺失与胃癌患者死亡风险均无关(P>0.05);对不同程度牙齿缺失情况进一步分级分析表明,牙齿缺失与胃癌患者死亡风险无关(P>0.05),牙齿缺失Ⅰ、Ⅱ、Ⅲ级胃癌患者5年生存率分别为26.79%、18.28%、17.61%,不同级别牙齿缺失胃癌患者生存率间差异有统计学意义(χ2=21.521,P<0.001)。结论男性牙齿缺失与胃癌生存无关,女性牙齿缺失同样与胃癌患者死亡风险无关。     

Dairy Consumption and Gastric Cancer Risk: A Meta-Analysis of Epidemiological Studies

Studies investigating the association of dairy consumption with gastric cancer risk have reported inconsistent findings. We conducted this systematic review and meta-analysis to review and summarize the epidemiologic evidence on the relation of total dairy and milk consumption with risk of gastric cancer. We summarized the available literature on this topic using meta-analysis of relative risks (RR) associated with total dairy and milk intake. The total of 17 case-control and 6 cohort studies (3256 cases) were eligible for inclusion. When comparing the highest with the lowest category of total dairy intake, the results of cohort studies indicated that increased consumption of total dairy food was associated with a reduced risk of gastric cancer (RR = 0.76; 95% CI: 0.64–0.91), whereas case-control studies provided no association. In subgroup analysis, significantly inverse associations between total diary food consumption and gastric cancer risk were observed in Europe subgroup (RR = 0.73; 95% CI: 0.54–0.99), U.S. subgroup (RR = 0.78; 95% CI: 0.63–0.98) but not in Asia subgroup. However, milk consumption was not associated with gastric cancer risk no matter in main or subgroup analysis. The results of cohort studies, but not case-control studies, suggested that total dairy might be related to the reduction of gastric cancer risk. Milk consumption was not associated with gastric cancer risk.     

维吾尔族糖尿病及糖调节受损患者体格生化指标分析

目的探讨维吾尔族糖尿病及糖调节受损患者体格、生化指标之间的差异。方法采用整群抽样的方法,横断面调查乌鲁木齐市6个维吾尔族居民较集中的社区40岁以上的常住居民529人,从中选择可疑人群191人,通过对其进行口服葡萄糖耐量试验将其分成两组,即2型糖尿病组和糖调节受损组,对其进行体格及生化指标的检测。结果本研究中维吾尔族糖尿病检出率为17.39%,糖调节受损检出率为7.56%。体格指标腰臀比、腹围、腰围在糖尿病男性组与糖调节受损男性组之间存在统计学差异,其余指标未见差异。糖尿病患者组与糖调节受损组之间的糖化血红蛋白值、血清胰岛素水平差异有统计学意义,血脂四项和肾功三项检测值均无统计学差异。结论此次研究发现维吾尔族糖尿病患者可能对与腹型肥胖有关的指标较为敏感;另外,维吾尔族糖尿病患者和糖调节受损患者对血糖的控制不佳,其并发症检出率也相对较高,因此,今后应在社区多开展对糖尿病高危人群的糖尿病筛查,更有效地开展健康知识宣教及行为干预.     

Risk of gastric cancer and peptic ulcers in relation to ABO blood type: a cohort study

Blood group A was found to be associated with gastric cancer in the 1950s. Strikingly, for peptic ulcers an increased risk has been shown for blood group O. However, previous investigations have generally been poorly conducted and have failed to take a unifying approach to these observations. Using the Scandinavian Donations and Transfusions (referred to as "SCANDAT") database, the authors established a cohort of Swedish and Danish blood donors with known blood type and followed these for the occurrence of gastric cancer and peptic ulcers through December 31, 2002. Cases were ascertained by using nationwide cancer and hospital registers. Altogether, 1,089,022 donors were followed for up to 35 years, during which 688 gastric cancer cases and 5,667 peptic ulcer cases accrued. Poisson regression analyses confirmed an increased risk of gastric cancer among individuals with blood group A (incidence rate ratio = 1.20, 95% confidence interval: 1.02, 1.42) and conversely that peptic ulcer risk was instead highest among those with blood group O. In this large, population-based cohort study, the authors have confirmed the association between blood group A and gastric cancer. In addition, they give further support to the notion that individuals with blood group O have a higher risk of peptic ulcers than those with other blood groups.     

Systematic review of the epidemiologic and trial evidence of an association between antidepressant medication and breast cancer

Biologic studies have suggested that antidepressant use may increase breast cancer risk. We conducted a systematic review of trials and controlled epidemiologic studies to assess this association. Pooled data from 31 primary efficacy drug company trials of fluoxetine suggested no increased risk but the short duration of these trials may have been insufficient to detect an association. In one prospective cohort study antidepressant use was associated with breast cancer, but this study was conducted among women attending for breast screening, and only limited data on antidepressant use were available. In a second large prospective drugs screening study no association was found between either amitriptyline or imipramine and breast cancer. In a large well-conducted retrospective cohort study there was no association between antidepressant use and breast cancer. A second retrospective cohort study was flawed, with exposure in those who developed breast cancer being measured over a shorter time period than in those who remained disease free. Two of four case-control studies found no association between antidepressant use and breast cancer after control for a number of potential confounding factors. We conclude that epidemiologic evidence does not support an association between antidepressant use and breast cancer.     

基于二胎政策下女性分娩次数与肥胖的关系

目的 高产次被认为是女性肥胖的危险因素。本研究探讨新疆墨玉县女性产次与全身性肥胖、中心性肥胖的相关性。方法 选取新疆和田墨玉县参与《新疆多民族自然人群队列建设研究》的35～74岁且有至少1次活产记录的女性为研究对象。使用体质指数（BMI）评估全身性肥胖,采用腰围（WC）和腰身比（WHtR）评估中心性肥胖。采用多元logistic回归模型分析产次与不同类型肥胖之间的关联。结果 共纳入6 987名研究对象。研究对象全身性肥胖患病率为56.9%（61.66 / 6 987）,通过WC和WHtR计算的中心性肥胖患病率分别为84.3%（5 897/6 987）和88.2%（3 977/6 987）。3种肥胖指标均值在产次为2中最低,WC和WHtR均值在不同产次中差异有统计学意义（P＜0.05）。调整潜在的混杂因素后,产次与3种肥胖指标均相关,BMI、WC、WHtR评估肥胖OR值分别为1.218（95%CI:1.033～1.436）、1.384（95%CI:1.130～1.695）和1.429（95%CI:1.144～1.785）。结论 高产次与肥胖风险,尤其是与中心性肥胖呈正相关。产次与3种中心性肥胖指标之间呈现V型趋势,生育2次可能是女性预防中心性肥胖最佳推荐值。     

Impact of overweight and obesity on medical care costs, all-cause mortality, and the risk of cancer in Japan

We conducted three prospective cohort studies that examined the association between body mass index (BMI) and health outcomes in Japan. Our studies found statistically significant relationships between excess body weight and increased medical costs, all-cause mortality, and risk of cancer incidence. There was a U-shaped association between BMI and mean total costs. The estimated excess costs attributable to overweight and obesity was 3.2% of the total costs. This 3.2% is within the range reported in studies in Western countries (0.7%-6.8%). We observed statistically significant elevations in mortality risk in obese (BMI> or = 30.0 kg/m(2)) women and lean (BMI<18.5 kg/m(2)) men and women. Our prospective cohort study found statistically significant relationships between excess weight and increased risk in women of all cancers. The population attributable fraction (PAF) of all incident cancers in this population that were attributable to overweight and obesity were 4.5% in women, which were within the range reported from Western populations, from 3.2% for US women to 8.8% for Spanish women. Our data suggests that excess body weight is a problem not only in Western countries but also in Japan.     

Body size at different periods of life and breast cancer risk

The inconclusive findings of past analytic epidemiologic studies on diet and breast cancer may have resulted from the inability of these studies to assess early dietary exposures. The role of macronutrient intake during early life can be indirectly studied, however, by examining past and present body size. The authors identified by computer linkage a population-based historical cohort of 38,084 women born between 1918 and 1943, on whom information about weight and height had been recorded in Hawaii in both 1942-1943 and 1972. Linkage of this cohort to the Hawaii Tumor Registry resulted in the identification of 607 incident cases of breast cancer for 1972-1983. An average of 4.4 cancer-free controls were matched to each case on year and month of birth and race of the parents. A matched case-control analysis, conducted in each five-year birth cohort, revealed a negative association of adolescent body mass to premenopausal breast cancer. This negative association was statistically significant in girls aged 10-14 years in 1942 (p for trend, 0.004), was present in all ethnic groups, and was strongest among overweight young women who remained overweight in adulthood. Early-age weight, height, and body surface area were not associated with either pre- or postmenopausal breast cancer. Adult weight and gain in body mass since 1942 were positively associated with postmenopausal breast cancer risk. Adjustment for age at first birth, parity and socioeconomic indicators for 1942 and 1972 did not modify the results. This study provides evidence for a protective role of adolescent obesity against premenopausal breast cancer, and for an enhancing role of a positive energy balance during adult life on postmenopausal breast cancer.