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年轻时体重较低而中年时体重增加，与成人疾病发生风险的相关性尚不明确。 2019年12月13日，《美国医学会杂志》网络开放版在线发表美国范德堡大学、中国上海市肿瘤研究所的研究报告，调查了中国人群年轻时体重较低而中年时体重增加，与成人主要健康结局的相关性。 该人群队列研究于2017年9月1日～2018年4月30日对两项中国前瞻队列研究入组时年龄40～59岁4万8377例女性（平均年龄47.8±5.3岁）和3万5989例男性（平均年龄49.6±5.1岁）数据进行分析：
主要分析20岁至40～59岁的体重增加，与癌症以及其他慢性疾病死亡和发生的相关性。 结果发现，对于中年体重指数≥23的成人，年轻至中年时体重每增加5公斤：
体重增加≥20公斤与<20公斤相比：
对于体重指数18.5～22.9的成人，未见上述相关性。 无论体重指数如何，体重增加≥20公斤与<20公斤相比，二型糖尿病、高血压、脂肪肝、卒中、痛风、胆结石发生风险显著较高，尤其：
因此，该研究结果表明，年轻至中年时体重增加，与疾病发生风险和晚年死亡风险存在显著相关性。中年时体重指数可以改变体重增加与死亡和癌症发生的相关性，不过并未改变其他主要慢性疾病发生风险。 JAMA Netw Open. 2019 Dec 13;2(12):e1917371. Association of Adult Weight Gain With Major Health Outcomes Among Middle-aged Chinese Persons With Low Body Weight in Early Adulthood. Guochong Jia; Xiao-Ou Shu; Ying Liu; Hong-Lan Li; Hui Cai; Jing Gao; Yu-Tang Gao; Wanqing Wen; Yong-Bing Xiang; Wei Zheng. Vanderbilt University Medical Center, Nashville, Tennessee; Shanghai Cancer Institute, Shanghai, China. QUESTION: What is the association between weight gain from early to middle adulthood and major health outcomes in later life given the body mass index at middle adulthood? FINDINGS: In this population-based cohort study of 2 Chinese cohorts of 48377 women and 35989 men, weight gain from early to middle adulthood was associated with elevated total and major cause-specific mortality as well as incidence of multiple obesity-related cancers in later life only among those who reached a body mass index of 23 or higher at middle adulthood. Positive associations of weight gain with risk of type 2 diabetes, hypertension, fatty liver disease, stroke, gout, and gallstones were found regardless of body mass index level (≥23 or <23) in middle adulthood. MEANING: A moderate weight gain from early to middle adulthood may be associated with elevated risk of some chronic diseases in later life. IMPORTANCE: The association of weight gain from early to middle adulthood with disease risk has not been adequately studied. OBJECTIVE: To investigate the association of adult weight gain with major health outcomes in a Chinese population with low body weight in early adulthood. DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study assessed data from 48377 women and 35989 men aged 40 to 59 years at recruitment in 2 prospective cohort studies in China. The Shanghai Women's Health Study recruited 74941 women, aged 40 to 70 years, from January 1, 1996, to December 31, 2000, and the Shanghai Men's Health Study recruited 61482 men, aged 40 to 74 years, from January 1, 2002, to December 31, 2006. This analysis was conducted from September 1, 2017, to April 30, 2018. EXPOSURES: Weight gain from 20 years of age to 40 to 59 years of age. MAIN OUTCOMES AND MEASURES: Mortality and incidence of cancers and other chronic diseases. RESULTS: This analysis included 48377 women (mean [SD] age, 47.8 [5.3] years) and 35989 men (mean [SD] age, 49.6 [5.1] years). Per 5-kg weight gain from early to middle adulthood was associated with an approximately 10% (hazard ratio [HR], 1.09; 95% CI, 1.04-1.14 for men; HR, 1.14; 95% CI, 1.11-1.19 for women) elevated all-cause mortality and a greater than 20% (HR, 1.26; 95% CI, 1.16-1.38 for men; HR, 1.23; 95% CI, 1.14-1.33 for women) cardiovascular disease-related mortality in later life among individuals who reached a body mass index (BMI) of 23 or higher at middle adulthood. Body mass index at middle adulthood also modified the association of weight gain with risk of obesity-related cancers, with weight gain of 20 kg or more associated with increased risks both for men (HR, 1.34; 95% CI, 1.07-1.67) and for women (HR 1.45; 95% CI, 1.24-1.68). No similar associations were found for individuals with a BMI of 18.5 to 22.9. Regardless of BMI, weight gain was associated with elevated risks of type 2 diabetes, hypertension, fatty liver disease, stroke, gout, and gallstones, particularly for type 2 diabetes (HR, 7.87; 95% CI, 6.91-8.97 for women; HR, 4.95; 95% CI, 4.23-5.79 for men) and fatty liver disease (HR, 3.68; 95% CI, 3.42-3.95 for women; HR, 2.83, 95% CI, 2.56-3.13 for men) in individuals with weight gain of 20 kg or more compared with those with a healthy weight. CONCLUSIONS AND RELEVANCE: This study found that weight gain from early to middle adulthood was associated with disease incidence and mortality in later life. The BMI at middle adulthood modified the association of weight gain with mortality and cancer incidence but not risk of other major chronic diseases. DOI: 10.1001/jamanetworkopen.2019.17371
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