背景:老龄化标志,细胞老化的特征,在许多与年龄有关的疾病的病理生理学中发挥作用。我们检查了肥胖是否与发展此类标志相关疾病的风险增加有关。
方法:在这项多队列研究中,我们纳入了38-72岁的人的体重数据,高度,以及在2006年3月13日至2010年10月1日之间的基线临床检查期间从英国生物银行测量的腰围,随访至2021年11月12日。为了测试结果的可重复性(复制分析),我们使用了对研究调查做出回应的芬兰公共部门研究和芬兰健康与社会支持研究中包括的40岁或以上人群的数据,有BMI数据,并在2016年12月31日之前成功链接到国家登记册中的电子健康记录.在基线时评估肥胖和临床特征。通过与国家健康记录的联系,参与者接受了与9种衰老标志相关的83种疾病的随访(基因组不稳定,端粒磨耗,表观遗传改变,失去了蛋白质,放松营养感知,线粒体功能障碍,细胞衰老,干细胞衰竭,和改变的细胞间通讯)。结果是标志相关疾病的首例,除了同时发生三种或三种以上标志相关疾病和死亡率。
结果:496530名来自英国生物库的成年人(平均年龄57·0岁[SD8·1])被纳入主要分析,来自芬兰队列的83249名(平均年龄48·2岁[6·4])成年人被纳入复制分析。英国生物银行的中位随访时间为12·7年(IQR12·0-13·4),芬兰队列为14·0年(8·0-15·0)。在调整了人口统计特征后,生活方式因素,和抑郁症,英国生物银行肥胖(BMI≥30·0kg/m2)的参与者与健康体重(BMI18·5-24·9kg/m2)相比,首次标志相关疾病的风险比高出1·40(95%CI1·38-1·41)。三种共同发生的疾病的相应风险比为2·92(95%CI2·64-3·22),用于失调的营养感知,2·73(2·46-3·02)端粒磨耗,2·33(2·10-2·60)用于表观遗传改变,2·30(2·14-2·48)用于线粒体功能障碍,2·23(2·04-2·45)用于干细胞衰竭,2·02(1·89-2·16)用于改变的细胞间通信,2·01(1·89-2·15)用于细胞衰老,1·83(1·67-2·00),用于失去蛋白质停滞,和1·39(1·27-1·52)的基因组不稳定性。这些发现在芬兰队列中得到了重复。在两项研究中,其他风险因素之间的关联(低教育,不健康的饮食因素[仅在英国生物银行中可用],吸烟,高酒精消费,缺乏身体活动,和抑郁症)和与标志相关的疾病比肥胖的疾病要弱。肥胖人群中45-60%的超额死亡率归因于与标志相关的疾病。
结论:肥胖可能在细胞衰老相关疾病的发展中起重要作用。解决衰老机制可能有助于减少肥胖流行导致的疾病和死亡负担。
背景:惠康信托基金,英国医学研究委员会,美国国家老龄研究所,芬兰学院,和芬兰心血管研究基金会。
■有关摘要的德语和芬兰语翻译,请参见补充材料部分。
BACKGROUND: Ageing hallmarks, characterising features of cellular ageing, have a role in the pathophysiology of many age-related diseases. We examined whether obesity is associated with an increased risk of developing such hallmark-related diseases.
METHODS: In this multicohort
study, we included people aged 38-72 years with data on weight, height, and waist circumference measured during a clinical examination at baseline between March 13, 2006, and Oct 1, 2010, from the UK Biobank with follow-up until Nov 12, 2021. To test reproducibility of the findings (replication analysis), we used data from people aged 40 years or older included in the Finnish Public Sector
study and the Finnish Health and Social Support
study who responded to the
study surveys, had data on BMI, and were successfully linked to electronic health records from national registers up to Dec 31, 2016. Obesity and clinical characteristics were assessed at baseline. Via linkage to national health records, participants were followed up for 83 diseases related to nine ageing hallmarks (genomic instability, telomere attrition, epigenetic alterations, loss of proteostasis, deregulated nutrient sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion, and altered intercellular communication). Outcomes were the first instance of hallmark-related disease, in addition to co-occurrence of three or more hallmark-related diseases and mortality.
RESULTS: 496 530 adults (mean age 57·0 years [SD 8·1]) from the UK Biobank were included in the primary analysis, and 83 249 (mean age 48·2 years [6·4]) adults from the Finnish cohorts were included in the replication analysis. Median follow-up was 12·7 years (IQR 12·0-13·4) in the UK Biobank and 14·0 years (8·0-15·0) in the Finnish cohorts. After adjusting for demographic characteristics, lifestyle factors, and depression, UK Biobank participants with obesity (BMI ≥30·0 kg/m2) had a 1·40 (95% CI 1·38-1·41) times higher hazard ratio for the first hallmark-related disease than those with a healthy weight (BMI 18·5-24·9 kg/m2). The corresponding hazard ratios for three co-occurring diseases were 2·92 (95% CI 2·64-3·22) for deregulated nutrient sensing, 2·73 (2·46-3·02) for telomere attrition, 2·33 (2·10-2·60) for epigenetic alterations, 2·30 (2·14-2·48) for mitochondrial dysfunction, 2·23 (2·04-2·45) for stem cell exhaustion, 2·02 (1·89-2·16) for altered intercellular communication, 2·01 (1·89-2·15) for cellular senescence, 1·83 (1·67-2·00) for loss of proteostasis, and 1·39 (1·27-1·52) for genomic instability. These findings were replicated in the Finnish cohorts. In both studies, the associations between other risk factors (low education, unhealthy dietary factors [available only in the UK Biobank], smoking, high alcohol consumption, physical inactivity, and depression) and hallmark-related diseases were weaker than those with obesity. 45-60% of the excess mortality in people with obesity was attributable to hallmark-related diseases.
CONCLUSIONS: Obesity might have an important role in the development of diseases associated with cellular ageing. Tackling ageing mechanisms could potentially help to reduce the disease and mortality burden resulting from the obesity epidemic.
BACKGROUND: Wellcome Trust, UK Medical Research Council, US National Institute on Aging, Academy of Finland, and Finnish Foundation for Cardiovascular Research.
UNASSIGNED: For the German and Finnish translations of the abstract see Supplementary Materials section.