背景:不同的减肥策略对健康的影响差异很大,以及减肥策略之间的关系,特别是多种策略的组合,死亡仍不清楚。我们旨在研究各种数量和组合的减肥策略与全因死亡率和特定原因死亡率的关联,并进一步评估不同总体重减轻量与死亡率的关联。
方法:使用来自NHANES(1999-2018)的48,430名20岁及以上参与者的数据,我们收集了14项自我报告的减肥策略,并使用潜在类别分析确定了5个集群.使用Cox比例风险模型来检查体重减轻策略的数量和集群与死亡率之间的关联。
结果:在48,430名参与者的平均9.1年随访中,记录了7,539例死亡(包括1,941例心血管疾病和1,714例癌症)。采用2、3-4和≥5种减肥策略的参与者全因死亡率风险较低,HR为0.88(95%CI,0.81至0.97),0.89(95%CI,0.81至0.96)和0.71(95%CI,0.61至0.82)。无论减肥或体重增加的类别,随着减重策略数量的增加,死亡率有显著下降趋势(P趋势<0.05).采用第1组(四项战略)的与会者,第2组(五种策略)和第3组(三种策略)的全因死亡率风险明显降低,HR为0.71(95%CI,0.60至0.84),0.70(95%CI,0.55至0.89)和0.81(95%CI,0.70至0.94)。其中,集群1和集群2的特征都是少吃食物,锻炼,多喝水,降低卡路里和少吃脂肪。相反,集群4(五种策略)和集群5(四种策略)的影响不显著,他们都有更高的实际总能量摄入量。对于CVD和癌症死亡率观察到类似的关联。
结论:采用两种或两种以上的减肥策略可以降低死亡风险,即使是那些体重增加的人。少吃食物,锻炼,多喝水,降低卡路里和少吃脂肪是更好的组合策略。在此基础上,限制总能量的实际摄入是必要的。
BACKGROUND: The health effects of different weight loss strategies vary greatly, and the relationship between weight loss strategies, especially the combination of multiple strategies, and death is still unclear. We aimed to examine the associations of various numbers and combinations of weight loss strategies with all-cause and specific-cause mortality and to further evaluate the associations of different total weight loss volumes with mortality.
METHODS: Using data from NHANES (1999-2018) with 48,430 participants aged 20 and above, we collected fourteen self-reported weight loss strategies and identified five clusters using latent class analysis. Cox proportional hazards models were used to examine the association between the amounts and clusters of weight loss strategies and mortality.
RESULTS: During a median follow-up of 9.1 years of 48,430 participants, 7,539 deaths were recorded (including 1,941 CVDs and 1,714 cancer). Participants who adopted 2, 3-4, and ≥ 5 weight loss strategies had a lower risk of all-cause mortality, with HRs of 0.88 (95% CI, 0.81 to 0.97), 0.89 (95% CI, 0.81 to 0.96) and 0.71 (95% CI, 0.61 to 0.82). Regardless of weight loss or weight gain categories, there was a significant trend toward reduced mortality as the number of weight loss strategies increased (P trend < 0.05). Participants who adopted cluster-1 (four strategies), cluster-2 (five strategies) and cluster-3 (three strategies) had a significantly lower risk of all-cause mortality, with HRs of 0.71 (95% CI, 0.60 to 0.84), 0.70 (95% CI, 0.55 to 0.89) and 0.81 (95% CI, 0.70 to 0.94). Among them, cluster-1 and cluster-2 are both characterized by eating less food, exercising, drinking plenty of water, lowering calories and eating less fat. Conversely, cluster-4 (five strategies) and cluster-5 (four strategies) had marginally significant effects, and they both had actual higher total energy intakes. Similar associations were observed for CVDs and cancer mortality.
CONCLUSIONS: Employing two or more weight loss strategies was associated with a lower risk of death, even among those who gained weight. Eating less food, exercising, drinking plenty of water, lowering calories and eating less fat is a better combination of strategies. On this basis, limiting the actual intake of total energy is necessary.