瑞典的健康结果及其与体重大幅减轻后体重恢复的关系：一项前瞻性队列研究

IF 13.6 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Europe Pub Date : 2025-03-13 DOI:10.1016/j.lanepe.2025.101261

Lena M.S. Carlsson , Ida Arnetorp , Johanna C. Andersson-Assarsson , Peter Jacobson , Per-Arne Svensson , Magdalena Taube , Sofie Ahlin , Felipe M. Kristensson , Kristjan Karason , Ingrid Larsson , Cecilia Karlsson , Kirsi H. Pietiläinen , Ingmar Näslund , Björn Carlsson , Markku Peltonen , Kajsa Sjöholm

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引用次数: 0

摘要

背景：减肥后体重反弹的临床意义仍不确定。我们分析了体重显著减轻的个体的死亡率、心血管事件、癌症和微血管疾病，并比较了维持体重者和恢复体重者。方法采用前瞻性队列设计，我们分析了1987-2001年招募的1346名瑞典肥胖受试者（SOS）研究中接受减肥手术的参与者，年龄37-60岁，BMI≥34（男性）或≥38（女性）。4年后体重恢复≥20%的个体（恢复组）与体重恢复较少的个体（维持组）进行比较。该研究于2020年12月31日结束，中位随访时间为27年，死亡率追踪率为99.9% （ClinicalTrials.gov NCT01479452）。恢复组和维持组1年后平均体重减轻29.3±11.7 kg和31.9±13.8 kg， 1 - 4年平均体重变化分别为+12.7±6.6 kg和- 0.6±7.3 kg。在随访期间，恢复组和维持组的总死亡率和癌症发生率相似，分别为12.4 （95% CI: 10.9-14.2）和12.4 (10.7-14.3),p = 0.740, 11.3 （95% CI: 9.7-13.0）和10.4(8.8-12.2)/ 1000人年（p = 0.308）。然而，恢复组的微血管疾病发病率更高，11.0 (95% CI: 9.5-12.8) vs 8.7(7.3-10.4) / 1000人年（p = 0.024），虽然没有统计学意义，但主要不良心血管事件（心肌梗死、中风和心力衰竭）的发生率也更高，15.7 (95% CI: 13.8-17.8) vs 13.0(11.2-15.1) / 1000人年（p = 0.055）。体重反弹与血管疾病风险增加有关，但我们无法证明其与预期寿命的关联。资助：瑞典研究委员会、瑞典国家根据瑞典政府与县议会之间的协议、卫生和卫生；该地区医疗保健委员会Västra Götaland、Adlerbert研究基金会、Wilhelm和Martina Lundgren基金会、哥德堡皇家艺术与科学学会、芬兰科学院、芬兰医学基金会、Gyllenberg基金会、Novo Nordisk基金会、芬兰糖尿病研究基金会、Paulo基金会和Sigrid Juselius基金会。

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Health outcomes and their association with weight regain after substantial weight loss in Sweden: a prospective cohort study

Background

The clinical implications of weight regain following weight loss remain uncertain. We analysed mortality, cardiovascular events, cancer, and microvascular disease in individuals with significant weight loss, comparing maintainers to regainers.

Methods

Using a prospective cohort design, we analysed 1346 participants who underwent bariatric surgery in the Swedish Obese Subjects (SOS) study, aged 37–60 years with BMI ≥34 (men) or ≥38 (women), recruited 1987–2001. Individuals who regained ≥20% of their 1-year weight loss after 4 years (regain group) were compared to those who regained less (maintenance group). The study was closed on December 31, 2020 with median follow-up of 27 years and 99.9% mortality tracking (ClinicalTrials.gov NCT01479452).

Findings

Average weight loss after 1 year was 29.3 ± 11.7 kg and 31.9 ± 13.8 kg and average weight change from year 1 to year 4 was +12.7 ± 6.6 kg and −0.6 ± 7.3 kg in the regain and maintenance groups, respectively. During follow-up, regain and maintenance groups showed similar rates of total mortality and cancer, 12.4 (95% CI: 10.9–14.2) vs 12.4 (10.7–14.3), p = 0.740, and 11.3 (95% CI: 9.7–13.0) vs 10.4 (8.8–12.2) per 1000 person-years (p = 0.308), respectively. The regain group had, however, higher incidence of microvascular disease, 11.0 (95% CI: 9.5–12.8) vs 8.7 (7.3–10.4) per 1000 person-years (p = 0.024), and while not statistically significant, also higher incidence of major adverse cardiovascular events (myocardial infarction, stroke, and heart failure) 15.7 (95% CI: 13.8–17.8) vs 13.0 (11.2–15.1) per 1000 person-years (p = 0.055).

Interpretation

Weight regain was linked to increased vascular disease risk but we could not demonstrate an association with life expectancy.

Funding

The Swedish Research Council, the Swedish State under the agreement between the Swedish Government and the county councils, the Health & Medical Care Committee of the Region Västra Götaland, the Adlerbert Research Foundation, the Wilhelm and Martina Lundgren Foundation, the Royal Society of Arts and Sciences in Gothenburg, Academy of Finland, Finnish Medical Foundation, Gyllenberg Foundation, Novo Nordisk Foundation, Finnish Diabetes Research Foundation, Paulo Foundation and Sigrid Juselius Foundation.

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来源期刊

Lancet Regional Health-Europe Multiple-

CiteScore

19.90

自引率

1.40%

发文量

260

审稿时长

9 weeks

期刊介绍： The Lancet Regional Health – Europe, a gold open access journal, is part of The Lancet's global effort to promote healthcare quality and accessibility worldwide. It focuses on advancing clinical practice and health policy in the European region to enhance health outcomes. The journal publishes high-quality original research advocating changes in clinical practice and health policy. It also includes reviews, commentaries, and opinion pieces on regional health topics, such as infection and disease prevention, healthy aging, and reducing health disparities.