体质量指数、腰围与高血压的关系

目的探讨体质量指数(BMI)、腰围与高血压发病的关系。方法以金昌队列为研究平台,共纳入8183例研究对象进行分析。计算基线BMI、腰围不同组别高血压的发病率;采用Cox比例风险模型,以基线正常BMI、腰围作为参照,分析不同BMI、腰围水平高血压发病风险(HR)及95%CI,进一步分层分析不同性别BMI与腰围对高血压发病影响的交互作用。结果研究对象平均随访2.29年,8183例随访对象中新发高血压1158例,累积发病率为14.2%,标化累积发病率为14.5%,发病密度为8.10/100人年;以正常BMI、腰围作为参照,调整混杂因素后,在男性中超重、肥胖以及中心型肥胖者发生高血压的HR值(95%CI)分别为1.52(1.26～1.82),2.30(1.80～2.94),1.30(1.07～1.57);在女性中,分别为1.43(1.13～1.81),1.61(1.14～2.29),1.34(1.06～1.70);交互作用分析结果显示,调整混杂因素后,BMI、腰围与高血压发病存在正向相乘模型的交互作用(P0.01)。当BMI正常合并中心型肥胖时,男女高血压发病风险分别为两者均正常的1.30倍(95%CI 1.01～1.68)和1.44倍(95%CI1.05～1.97);当BMI肥胖合并中心型肥胖时,男女高血压发病风险分别为两者均正常的3.12倍(95%CI 2.35～4.14)和2.08倍(95%CI1.44～3.00)。结论 BMI与腰围同时增加会提高人群高血压的发病风险,其联合作用大于两者的单独作用。     

不同基线血压水平对40岁以下青年人群早发心脏病的影响

目的：探讨不同基线血压水平对40岁以下青年人群早发心脏病（发病年龄<55岁）的影响。方法：采用前瞻性队列研究方法,选取2006～2012年度首次参加开滦集团职工健康体检、40岁以下且血压资料完整、既往无心脏病病史者共35 993例,以新发心脏病（包括冠心病、心房颤动及心力衰竭）为终点事件,随访至2021年年底。根据2018年中国高血压防治指南血压分级标准将受试者分为四组：正常血压组（n=13 208）、血压正常高值组（n=16 576）、高血压1级组（n=4 357）、高血压2～3级组（n=1 852）。采用Kaplan-Meier法计算不同基线血压水平分组的早发心脏病累积发病率,并采用log-rank检验进行组间比较。采用多因素Cox比例风险回归模型分析不同基线血压水平对早发心脏病的影响。结果：平均随访（12.5±2.6）年时,正常血压组、血压正常高值组、高血压1级组、高血压2～3级组的早发心脏病累积发病率分别为0.47%、0.97%、3.56%和4.42%(log-rank P<0.01)。Cox回归分析结果显示,校正年龄、性别等混杂因素后,与正常血压组相比,血压正常高...     

中青年原发性高血压患者糖代谢异常与动态血压相关指标变化特征分析

目的:探讨中青年原发性高血压患者糖代谢异常与动态血压相关指标变化特征。方法: 对119 例既往无糖尿病史的高血压患者行空腹血糖( FPG)、2 h血糖( PPG)和24 小时动态血压监测,根据 FPG和PPG水平分为糖耐量正常组(B组 NGT)、糖调节受损组(C组 IGR) 和新诊断Ⅱ型糖尿病组(D组 T2DM),另选31例血压及血糖均正常的健康体检者作为正常对照组（A组）。结果: 从NGT至IGR至T2DM,24 h收缩压平均值、24 h脉压值、血压晨峰值逐渐升高(P<0.05或P<0.01),异常血压负荷值发生率、异常血压晨峰发生率、非杓型血压发生率逐渐增高(P<0.05或P<0.01)。多因素Linear regerssion分析发现:BMI、高血压病程、脉压、血压晨峰值、血压昼夜节律与血糖水平呈正相关(P<0.05或P<0.01)。结论: 中青年高血压患者易出现糖代谢异常;中青年高血压并发糖代谢异常患者,血糖水平与BMI、高血压病程、脉压、血压晨峰值、血压昼夜节律密切相关。     

社区人群超重和肥胖对血压的影响与干预对策

目的分析体质指数(BMI)对高血压发病率的影响,对超重和肥胖人群实施行为干预指导。方法对深圳市上梅林社区30～59岁居民1256人进行BMI、血压测量及问卷调查。结果 BMI正常组的高血压发病率最低,男约17.55%,女约13.06%。BMI超重组高血压发病率男性约35.44%,女性约29.05%,BMI肥胖组高血压发病率男约67.71%,女约52.34%。BMI超重组、肥胖组与正常组之间的差异有显著性意义。结论随着体质指数的增加,高血压的发病率升高,二者呈显著正相关,加强对超重、肥胖人群实施健康教育与行为干预,保持BMI在正常范围是预防高血压病发生的有效措施。     

体质量指数与腔隙性脑梗死患者预后的关系研究

目的探讨体质量指数(BMI)与腔隙性脑梗死患者预后的关系。方法纳入中国脑卒中管理质量评估登记研究(China Quality Evaluation of Stroke Care and Treatment)数据库中TOAST分型为腔隙性脑梗死的患者3410例,其中低体质量组(BMI18.5kg/m~2)182例、正常体质量组(BMI 18.5~23.9kg/m~2)1639例、超重组(BMI24.0~27.9kg/m~2)1212例和肥胖组(BMI≥28.0kg/m~2)377例。终点事件包括12个月时全因死亡、死亡或严重残疾、感染并发症和脑卒中复发。结果与正常体质量组比较,低体质量组12个月时累计全因死亡率升高(19.1%vs 6.7%,P0.01),超重组和肥胖组变化无显著差异(6.0%和3.8%vs 6.7%,P0.05)。多因素分析显示,以正常体质量组为参照,低体质量组12个月累计全因死亡(HR=1.91,95%CI:1.22~2.98,P=0.004)、12个月时死亡或严重残疾(OR=1.50,95%CI:1.05~2.14,P=0.026)及感染并发症(OR=1.92,95%CI:1.21~3.06,P=0.006)的风险更高,脑卒中复发风险无显著差异;超重组和肥胖组患者发生上述终点事件的风险无显著差异。结论腔隙性脑梗死患者中,低体质量伴随脑卒中预后不良风险升高,但脑卒中复发的风险无显著改变。     

18～30岁人群体质量指数与高血压发病的关系

目的探讨18~30岁人群体质量指数与高血压发病的关系。方法采用前瞻性队列研究,以参加2006年7月至2007年10月开滦集团健康体检的18~30岁人群为研究对象,排除既往高血压病史、妊娠者及资料不全,排除2008-2009,2010-2011或2012-2013年均未参加查体者,最终纳入统计分析的4765人,观察不同体质量指数分组人群高血压发病情况,并分析进展至不同亚型高血压的情况。采用寿命表法计算高血压累积发病率,Cox比例风险回归模型分析体质量指数与高血压发病的关系。结果中位随访5.8年,期间共发生高血压999例,其中单纯收缩期高血压(ISH)占14%,单纯舒张期高血压(IDH)占62%,收缩舒张期高血压(SDH)占24%。低体质量组、正常体质量组、超重组和肥胖组累积高血压发病率分别为9.90%、18.28%、34.97%和61.13%,发病密度分别为12.19人/千人年、24.86人/千人年、51.14人/千人年、103.75人/千人年,组间比较差异有统计学意义(P0.05)。校正年龄、性别、吸烟、饮酒、体育锻炼、教育程度、基线收缩压、低密度脂蛋白胆固醇及高血压家族史等混杂因素后,超重组和肥胖组发生高血压的风险分别为体质量正常组的1.60(95%CI 1.36~1.87)和2.88(2.44~3.39)倍。结论在18~30岁人群中,高血压发病以IDH为主。随体质量指数增加,高血压发病率及发病风险增加。超重和肥胖对青年人群IDH和SDH发病的影响更大。     

血压正常高值人群动脉硬度、左室结构和功能的相关性研究

应用震荡法测定理想血压组、血压正常高值组、高血压组的踝臂脉搏波速度（baPWV）值;应用彩色超声心动图检测其左心室结构和功能。结果理想血压组、血压正常高值组、高血压组baPWV、左室质量（LVM）、左室质量指数（LVMI）、左心室舒张早期二尖瓣最大血流速度（E）/舒张晚期二尖瓣最大血流速度（A）两两比较均有统计学差异（P〈0.01,〈0.05）;与血压正常高值组、理想血压组比较,高血压组的相对室壁厚度（RWT）升高,左室射血分数（EF）降低（P〈0.01,〈0.05）;baPWV与年龄、收缩压（SBP）、舒张压（DBP）、脉压（PP）、LVMI、舒张末主动脉内径（AO）、RWT呈正相关（r=0.37、0.52、0.22、0.28、0.22、0.20、0.24,P〈0.01、〈0.05）、与E值、E/A比值呈负相关（r=-0.14、-0.45,P〈0.01）。年龄、SBP和体质量指数对baPWV有独立的影响作用;baPWV、SBP、PP、AO、体质量指数是影响LVMI的主要因素;baPWV、年龄、DBP、AO是E/A的重要影响因素。提示血压正常高值者已经存在动脉硬度增加,与左室肥厚及舒张功能减退密切相关。     

血压联合体质量指数与新发慢性肾脏病的关系

目的探讨成人群体中血压联合体质量指数(BMI)对新发慢性肾脏病(CKD)的影响。方法采用回顾性队列研究的方法,以参加2006-2007年健康体检的开滦研究人群作为研究队列,其中符合入选标准的研究对象共84 671人。依据血压[高血压:收缩压≥140和(或)舒张压≥90 mm Hg或有明确诊断的高血压病史或正在服用降压药;正常血压:收缩压140和舒张压90 mm Hg且无明确诊断的高血压病史和未服用降压药]和BMI(超重肥胖:BMI≥24 kg/m~2;非超重肥胖:BMI24 kg/m~2)将观察对象分为4组:正常血压非超重肥胖组、正常血压超重肥胖组、高血压非超重肥胖组和高血压超重肥胖组;CKD定义为:至少2次体检出现估算的肾小球滤过率(eGFR)下降或者蛋白尿;用Kaplan-Meier法计算各组新发CKD的累积发生率,并用Log-rank检验比较不同组别累积发生率的差异;采用Cox比例风险模型探讨不同组别对新发CKD的影响。结果符合入选标准的84 671名基线非CKD人群,在平均随访(8.77±1.41)年期间,共新发CKD 3 625例,累积发生率达4.28%;正常血压非超重肥胖组、正常血压超重肥胖组、高血压非超重肥胖组、高血压超重肥胖组新发CKD的累积发生率分别为2.63%、3.26%、4.47%、6.63%;并且各组间比较差异有统计学意义(P0.05)。多因素Cox回归分析显示,在校正多种混杂因素后,与正常血压非超重肥胖组相比,正常血压超重肥胖组、高血压非超重肥胖组和高血压超重肥胖组新发CKD的风险均增加,对应的HR(95%CI)分别为1.23(1.10～1.37)、1.53(1.35～1.73)、2.23(2.02～2.47)。此外,分别除外糖尿病、吸烟及服用降压药人群后进行了敏感性分析,结果与主要研究结果趋势一致。结论高血压和超重肥胖与新发CKD相关,同时合并高血压及超重肥胖新发CKD风险高于单独高血压或者超重肥胖者。     

秦皇岛市7～12岁学龄儿童高血压现状及危险因素分析

目的探讨秦皇岛市7～12岁学龄儿童高血压流行现状及其危险因素。方法通过分层整群随机抽样,抽取秦皇岛市5所小学7～12岁儿童1507人进行问卷调查及身高、体质量、血压等指标测量。结果共检出正常高值血压和高血压儿童182例(12.1%),高血压检出率6.1%,男童6.7%,女童5.5%。高血压检出率均随年龄增长而增加(P<0.01)。超重组和肥胖组收缩压和舒张压水平均明显高于体质量指数(BMI)正常组,正常BMI儿童高血压检出率为2.6%,超重儿童高血压检出率5.0%,肥胖儿童高血压检出率16.0%。Logistic回归分析显示,年龄和肥胖是儿童高血压的独立危险因素(OR1.684,95%CI1.435～1.976;OR7.731,95%CI4.647～12.860,均P<0.01)。结论秦皇岛市儿童高血压检出率6.1%,年龄和肥胖是儿童高血压的独立危险因素。     

糖尿病合并高血压体检人群体重指数与血脂、脂肪肝的关联性分析及健康生活方式指导

目的探讨糖尿病合并高血压体检人群体重指数(BMI)与血脂、脂肪肝的关联性分析及健康生活方式指导。方法回顾性分析2019年1月—2021年1月在该单位参加健康体检的人群,选取70例糖尿病合并高血压的体检人群,根据BMI分为正常组(15例)、超重组(32例)、肥胖组(23例),分析糖尿病合并高血压体检人群BMI与血脂、脂肪肝的关联性。结果肥胖组的TC、TG、LDL-C明显高于超重组与正常组,肥胖组的HDL-C明显低于超重组与正常组,3组比较差异有统计学意义(P0.05)。肥胖组的血压、空腹血糖及餐后2 h血糖明显高于超重组和正常组,3组比较差异有统计学意义(P0.05)。在对3组糖尿病合并高血压体检人群空腹B超的分析中发现,正常组有5例脂肪肝的患者,占33.33%,超重组有19例脂肪肝患者,占59.38%,肥胖组有18例脂肪肝患者,占78.26%,3组比较差异有统计学意义(χ2=7.645,P=0.022)。BMI指数与TC、TG、LDL-C、脂肪肝呈正相关(r=0.222、0.335、0.344、0.439,95%CI=0.027、0.148、0.159、0.265,P0.05),BMI指数与HDL-C呈负相关(r=-0.690,95%CI=-0.784,P0.05)。结论糖尿病合并高血压体检人群体BMI越高,血脂的水平越高,脂肪肝的发病率越高,对于糖尿病合并高血压的患者要控制饮食,减轻体质量,对控制血糖、血脂和脂肪肝的发展与发生有重大意义。     

青中年时期体重状态变化与中老年时期高血压的关系

目的探讨青年及中年时期超重后的体重状态变化及减重比与中老年高血压患病风险的关系。方法选取中国糖尿病和代谢紊乱研究中年龄40~79岁的人群。减重比定义为(最大体重-目前体重)/最大体重。采用多因素logistic回归分析,分别探讨青年及中年超重后的体重状态变化及减重比与高血压的关系。结果共19823人纳人分析,共7623人诊断为高血压。(1)与正常体重组[最大体重指数(MAXBMI)及体重指数(BMI)均在18.5~23.9 kg/m²]相比,青年时期持续超重(MAXBMI及BML≥24.0 kg/m2,18岁≤最大体重年龄<40岁)及中年时期持续超重(MAXBMI及BMI≥24.0 kg/m²,40岁≤最大体重年龄<60岁)高血压患病风险的OR(95%CI)分别为2.66(2.38~2.96)和2.79(2.56~3.03),青年时期既往超重(MAXBMI≥24.0 kg/m²,18.5 ke/m²≤BMI<24.0kg/m²,18岁≤最大体重年龄<40岁)及中年时期既往超重(MAXBMI≥24.0 kg/m²,18.5 kg/m²≤BMI<24.0 kg/m²,40岁≤最大体重年龄<60岁)高血压患病风险的OR(95%CI)分别为1.20(1.04~1.37)和1.58(1.40~1.78)。(2)正常体重(18.5 kg/m²≤MAXBMI<24.0 kg/m²)及超重(MAXBMI≥24.0kg/m²)人群中,与减重比<5%相比,减重比≥5%与高血压患病风险降低相关。结论青年及中年时期的超重与中老年高血压的患病风险增加密切相关,与目前BMI不相关。最大体重减轻≥5%与高血压患病风险降低密切相关,与MAXBMI不相关。     

湖北地区居民腰围和体质量指数与高血压的相关性研究

目的探讨湖北地区居民腰围及体质量指数(BMI)与高血压之间的相关性。方法采用分层多阶段随机抽样的方法,于2013年1月至2014年1月对湖北地区5个城区及5个乡村年龄15岁居民20 539例进行调查研究。通过体格检查、问卷调查的方式收集调查对象的个人基本情况及腰围等资料。结果男性及女性在高血压发病情况上差异有统计学意义(P0.05)。≥60岁3个不同年龄组(60~69,70~79,80~89岁)研究对象在高血压发病率上随年龄增加而逐渐升高,且差异有统计学意义(P0.05)。高血压组超重、肥胖、腹型肥胖、超重伴腹型肥胖发生率均高于非高血压组。两组人群在超重、肥胖、腹型肥胖、超重伴腹型肥胖发生率上差异有统计学意义(P0.05)。收缩压、年龄、基础代谢、身体脂肪率、内脏脂肪指数、性别均为BMI的危险因素;对于男性,舒张压、基础代谢、身体脂肪率、内脏脂肪指数为中心性肥胖的危险因素,年龄为中心性肥胖的保护因素;对于女性,舒张压、年龄、基础代谢、身体脂肪率、内脏脂肪指数为中心性肥胖的危险因素。结论湖北地区居民超重及肥胖形势严峻,腰围及BMI与高血压关系密切。     

高血压患者体重指数与脂肪肝相关性探讨

目的　探讨高血压患者体重指数与脂肪肝、血脂及血压之间的关系。方法　对 13 5例高血压患者按体重指数(BMI)分为 3组 :正常体重组 (BMI=2 0～ 2 3 ) ,超重组 (BMI=2 4～ 2 7) ,肥胖组 (BMI≥ 2 8) ,所有患者均测血脂、血压 ,并行腹部 B超检查。结果　肥胖组较正常组总胆固醇 (TC)、三酰甘油 (TG)、低密度脂蛋白 (L DL )有明显差异(P<0 .0 5 ) ;肥胖组与超重组比较 ,仅 TC有差异 (P<0 .0 5 )。 BMI与脂肪肝的发生率呈正相关 (rs=0 .911,P<0 .0 1) ,且肥胖组中中、重度脂肪肝的发生率较正常组明显增多 (P<0 .0 1)。收缩压 (SBP)及舒张压 (DBP)均随着BMI的增加而明显增高 :肥胖组高于超重组 ,超重组高于正常组 ,差异有显著性 (P<0 .0 0 1及 P<0 .0 5 )。结论　合并超重的高血压患者应积极减重 ,并控制在正常范围 ,对降低血压、预防冠心病及脂肪肝均有重要意义     

青年和中年时期体重状态变化及最大体重减重程度与其中老年时期2型糖尿病的关系

目的探讨青年及中年时期人群,发生超重和肥胖后的体重状态变化以及最大体重减重程度与其中老年期发生T2DM的关系。方法基于中国糖尿病和代谢紊乱研究库,选取19878名年龄≥40岁的中老年人群,采用多因素Logistic回归分析既往超重及肥胖[最大BMI(BMIMax)≥24.0 kg/m^2]发生在青年及中年时期人群的体重状态变化及最大体重减重程度与T2DM患病风险的关系。结果与正常体重组(BMIMax及BMI 18.5~23.9 kg/m^2)相比,青年时期持续超重组(BMIMax及BMI≥24.0 kg/m^2)、青年时期既往超重组(BMIMax≥24.0 kg/m^2,BMI 18.5~23.9 kg/m^2)、中年时期持续超重组(BMIMax及BMI≥24.0 kg/m^2)、中年时期既往超重组(BMIMax≥24.0 kg/m^2,BMI 18.5~23.9 kg/m^2)的T2DM患病风险均不同程度增加,以青年时期持续超重组最高(OR 2.57,95%CI 2.21~2.99)。超重人群(BMIMax≥24.0 kg/m^2)中,与减重<5%人群相比,减重≥5%人群T2DM患病风险增高,以减重≥15%人群风险最高(OR 3.58,95%CI 3.07~4.17)。结论无论目前体重正常或超重,青年及中年时期人群发生超重及肥胖均增加其中老年时期T2DM患病风险。超重人群最大体重减重≥5%时,中老年T2DM患病风险增加。     

体质量指数与老年阻塞性睡眠呼吸暂停低通气综合征严重程度的相关性

目的探讨体质量指数(BMI)与老年阻塞性睡眠呼吸暂停低通气综合征(OSAHS)严重程度的相关性。方法回顾性分析2015年1月至2017年10月在解放军总医院、北京大学国际医院和甘肃中医药大学附属医院经标准多导睡眠监测诊断为OSAHS的609例老年患者(≥60岁)的病例资料。按BMI水平将研究对象分为体重正常组(n=154)、超重组(n=228)和肥胖组(n=227),比较组间多导睡眠监测指标的差异。采用SPSS 25.0软件进行数据分析。采用Spearman秩相关分析BMI与多导睡眠监测主要指标的相关性,采用多因素logistic回归分析不同BMI水平与重度OSAHS的相关性。结果3组患者呼吸暂停低通气指数(AHI)、血氧饱和度(SaO2)<90%的时间、氧减指数(ODI)、平均暂停时间、最低氧饱和度、平均氧饱和度与SaO2<90%的时间占总监测时间比例(T90)比较,差异均有统计学意义(均P<0.05);老年OSAHS患者的BMI与AHI、最长暂停时间、ODI、T90、SaO2<90%的时间呈正相关(r=0.294、0.113、0.313、0.413、0.411,均P<0.05),与平均氧饱和度、最低氧饱和度呈负相关(r=-0.173、-0.229,均P<0.05);超重组罹患重度OSAHS的风险是正常体重组的1.690倍(OR=1.690),肥胖组罹患重度OSAHS的风险更高(OR=3.685)。分层分析(高血压和无高血压)发现,肥胖与重度OSAHS的相关性在高血压和非高血压人群中均存在,但在非高血压人群中,肥胖与重度OSAHS的相关性更强。结论老年人BMI越大,OSAHS病情越严重。非高血压人群中BMI和老年OSAHS的严重程度相关性更强。     

The impact of obesity on the short-term and long-term outcomes after percutaneous coronary intervention: the obesity paradox?

OBJECTIVES: The purpose of this study was to assess the impact of body mass index (BMI) on the short- and long-term outcomes after percutaneous coronary intervention (PCI). BACKGROUND: Obesity is associated with advanced coronary artery disease (CAD). However, the relation between BMI and outcome after PCI remains controversial. METHODS: We studied 9,633 consecutive patients who underwent PCI between January 1994 and December 1999. Patients were divided into three groups according to BMI: normal, BMI between 18.5 and 24.9 (n = 1,923); overweight, BMI between 25 and 30 (n = 4,813); and obese, BMI >30 (n = 2,897). RESULTS: Obese patients were significantly younger and had consistently worse baseline clinical characteristics than normal or overweight patients, with a higher incidence of hypertension, diabetes, hypercholesterolemia and smoking history (p < 0.0001). Despite similar angiographic success rates among the three groups, normal BMI patients had a higher incidence of major in-hospital complications, including cardiac death (p = 0.001). At one-year follow-up, overall mortality rates were significantly higher for normal BMI patients compared with overweight or obese patients (p < 0.0001). Myocardial infarction and revascularization rates did not differ among the three groups. By multivariate Cox regression analysis, diabetes, hypertension, age, BMI and left ventricular function were independent predictors of long-term mortality. CONCLUSIONS: In patients with known CAD who undergo PCI, very lean patients (BMI <18.5) and those with BMI within the normal range are at the highest risk for in-hospital complications and cardiac death and for increased one-year mortality.     

A retrospective study of maternal and neonatal outcomes in overweight and obese women with gestational diabetes mellitus

In pregnant women, obesity is a risk factor for multiple adverse pregnancy outcomes, including gestational diabetes mellitus (GDM), preeclampsia, and preterm birth. The aim of this study was to determine the effects of pre-pregnancy body mass index (BMI) on maternal and neonatal outcomes in women with GDM. A retrospective study of 5010 patients with GDM in 11 provinces in China was performed in 2011. Participants were divided into three groups based on BMI as follows: a normal weight group (BMI 18.5–23.9 kg/m²), an overweight group (BMI 24–27.9 kg/m²), and an obese group (BMI ≥28.0 kg/m²). Maternal baseline characteristics and pregnancy and neonatal outcomes were compared between the groups. Multiple logistic regression analysis was used to explore the relationships between BMI and the risk of adverse outcomes. Of the 5010 GDM patients, 2879 subjects were from north China and 2131 were from south China. Women in the normal weight group gained more weight during pregnancy compared with the overweight and obese GDM patients. Women in the overweight and obese groups had increased odds of hypertension during pregnancy (adjusted odds ratio (AOR)?=?1.50, 95 % confidence interval (CI)?=?1.31–1.76 and AOR?=?2.12, 95 % CI?=?1.84–3.16). The AORs for macrosomia in the overweight and obese groups were 1.46 (95 % CI?=?1.16–1.69) and 1.94 (95 % CI?=?1.31–2.98), respectively. The relative risk of delivering a baby with an Apgar score <7 at 5 min was significantly higher in women who were obese (AOR?=?2.11, 95 % CI?=?1.26–2.85) before pregnancy compared with normal weight women. Compared with the normal weight subjects, the incidence of cesarean section and emergency cesarean section among overweight and obese women with GDM was significantly higher (P?<?0.001). Overall, overweight and obese women with GDM have an increased risk of adverse outcomes, including hypertension during pregnancy, macrosomic infants, infants with low Apgar scores, and the need for an emergency cesarean section. More attention should be paid to GDM women who are obese because they are at risk for multiple adverse outcomes.     

Short-term predictors of overweight in early adolescence

OBJECTIVE: To identify short-term predictors of risk for overweight in early adolescence in a sample of Caucasian origin subjects, in Cyprus. SUBJECTS: A total of 357 subjects (178 males) with baseline age 11.5+/-0.4 y were re-evaluated after a mean of 1.6+/-0.5 y. MEASUREMENTS: Body weight and height, calculated body mass index (BMI), and blood pressure at baseline and follow-up. Serum lipids were determined at baseline. Obesity and overweight were defined at baseline and follow-up, according to the International Obesity Task Force data set. Socioeconomic class was determined. Self-reported parental weight and height were used to calculate the parental BMI. BMI tracking and changes in BMI categories were calculated (with 95% confidence interval (CI)). The future risk of overweight in baseline normal weight subjects was predicted using logistic regression analyses, where only normal weight subjects at baseline were included. RESULTS: More males remained in the overweight or obese category than females: 86.7% (95% CI: 73.2, 94.9) vs 71.8% (95% CI: 55.1, 85.0), respectively, P=0.03. The identified predictors for future overweight were paternal obesity, odds ratio (OR): 7.1 (95% CI: 1.3, 38.0), systolic blood pressure >95th percentile, OR: 8.9 (95% CI: 1.9, 41.7), high triglyceride levels, OR: 4.2 (95% CI: 1.0, 16.9) and low HDL-cholesterol levels, OR: 7.6 (95% CI: 1.7, 34.3). CONCLUSIONS: Triglycerides and HDL-cholesterol levels have been proved predictors for overweight in early adolescence for the first time. The different sex pattern in BMI tracking observed, and also the different environmental influences on future overweight risk compared to other studies, indicate that local circumstances should be considered when implementing national intervention strategies for the prevention of obesity.     

The obesity paradox: body mass index and outcomes in patients with heart failure

BACKGROUND: In the general population, obesity is associated with increased risk of adverse outcomes. However, studies of patients with chronic disease suggest that overweight and obese patients may paradoxically have better outcomes than lean patients. We sought to examine the association of body mass index (BMI) and outcomes in stable outpatients with heart failure (HF). METHODS: We analyzed data from 7767 patients with stable HF enrolled in the Digitalis Investigation Group trial. Patients were categorized using baseline BMI (calculated as weight in kilograms divided by the square of height in meters) as underweight (BMI <18.5), healthy weight (BMI, 18.5-24.9, overweight (BMI, 25.0-29.9), and obese (BMI > or =30.0). Risks associated with BMI groups were evaluated using multivariable Cox proportional hazards models over a mean follow-up of 37 months. RESULTS: Crude all-cause mortality rates decreased in a near linear fashion across successively higher BMI groups, from 45.0% in the underweight group to 28.4% in the obese group (P for trend <.001). After multivariable adjustment, overweight and obese patients were at lower risk for death (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.80-0.96, and HR, 0.81; 95% CI, 0.72-0.92, respectively), compared with patients at a healthy weight (referent). In contrast, underweight patients with stable HF were at increased risk for death (HR 1.21; 95% CI, 0.95-1.53). CONCLUSIONS: In a cohort of outpatients with established HF, higher BMIs were associated with lower mortality risks; overweight and obese patients had lower risk of death compared with those at a healthy weight. Understanding the mechanisms and impact of the "obesity paradox" in patients with HF is necessary before recommendations are made concerning weight and weight control in this population.     

体质量指数与食管裂孔疝及反流性食管炎关系的研究

目的探讨体质量指数（BMI）与食管裂孔疝（HH）及反流性食管炎（RE）的关系。方法具有典型反酸、烧心等症状的227例胃食管反流病（GERD）患者,根据BMI（单位：kg／m^2）将患者分为3组,正常组（18．5≤BMI〈24）、超重组（24≤BMI〈28）、肥胖组（BMI≥28）。胃镜诊断RE、非糜烂性反流病（NERD）及HH。pH监测DeMeester积分≥15提示存在病理性酸反流。Logistic回归分析BMI与HH及RE的关系。结果RE检出率为30．0％（68／227）,HH检出率为5．7％（13／227）;HH中76．9％（10／13）存在RE。RE及HH检出率随BMI增加而升高（P均〈0．05）,且正常组、超重组和肥胖组中B级及以上RE所占比例也随BMI增加而升高（6．4％、16．9％、31．6％,P=0．003）;pH监测DeMeester积分在上述3组分别为15．9、19．8和36．9,3组间差异有统计学意义（P〈0．05）,超重组患者下午、夜间及24h食管内平均pH值均明显低于正常组（P均〈0．01）。多因素分析显示,肥胖是HH的危险因素,OR值为7．058（95％可信区间1．294～38．488,P=0．024）。男性、超重、肥胖及HH是RE的危险因素,OR值分别为2．537（95％可信区间1．350～4．766,P=0．004）、1．921（95％可信区间1．005-3．670,P=0．048）、3．305（95％可信区间1．123～9．724,P=0．030）及6．879（95％可信区间1．695～27．913,P=0．007）。结论BMI与HH、RE及其严重程度显著相关,肥胖是HH及RE的共同危险因素,HH可促进RE的发生。