目的 分析中国成年人BMI与主要慢性病发病及全死因死亡风险的关联.方法 本研究基于中国慢性病前瞻性研究,基线时测量研究对象的身高、体重和腰围.分析中剔除基线现患冠心病、脑卒中、恶性肿瘤、COPD和糖尿病者,纳入428 113名研究对象.使用Cox比例风险回归模型分析BMI和腰围与主要慢性病(包括心血管疾病、恶性肿瘤、COPD、2型糖尿病)发病及全死因死亡的关联.结果 在平均10年随访期间,共有131 454人发生≥1种上述慢性病,26 892人死亡.主要慢性病发病风险随BMI增加而升高,与正常体重(18.5≤BMI＜24.0 kg/m2)者相比,超重(24.0≤BMI＜28.0 kg/m2)和肥胖(BMI＞28.0 kg/m2)者的风险比分别为1.26(95％CI:1.24 ～ 1.27)和1.59(95％CI:1.57～ 1.62).BMI过低或过高均与全死因死亡风险升高有关.腰围与主要慢性病发病及全死因死亡风险呈正向关联.按照中国人群体重标准,将体重控制在正常范围可以减少约12％主要慢性病发病.结论 一般性肥胖和中心性肥胖是中国成年人主要慢性病发病的危险因素.

Objective To examine the association of BMI with major chronic diseases morbidity and all-cause mortality in Chinese adults.Methods This study is based on China Kadoorie Biobank.Anthropometric indexes were objectively measured at the baseline survey during 2004-2008.After excluding participants with heart disease,stroke,cancer,COPD and diabetes,428 113 participants aged 30 to 79 years were included in the analysis.Cox regression models were used to investigate the associations of BMI and waist circumference with incidence of major chronic diseases (including cardiovascular disease,cancer,COPD,and type 2 diabetes) and all-cause mortality.Results Over an average of 10 years,131 454 participants developed any one of major chronic diseases.A total of 26 892 all-cause deaths were reported.The risk of major chronic diseases increased with BMI.Compared with normal BMI (18.5-24.0 kg/m2),the HR (95％ CI) of overweight (BMI 24.0-28.0 kg/m2) and obesity (BMI≥28.0 kg/m2) were 1.26 (95％CI:1.24-1.27) and 1.59 (95％CI:1.57-1.62) respectively.Underweight and obesity were both associated with risk of all-cause mortality.Waist circumference was positively associated with risk of major chronic diseases and all-cause mortality.According to recommended cut-off points of BMI and waist circumference for Chinese adults,maintaining a healthy body weight would prevent 12％ incident cases of major chronic diseases.Conclusion General and central obesity were risk factors for major chronic disease among Chinese adults.