天津市农村人群体质指数与脑卒中发病关系的前瞻性队列研究

目的探讨天津市农村人群体质指数(BMI)与脑卒中发病的关系。方法以整群随机抽样的方法,于1991年9月在天津市蓟县某镇选取6个自然村15岁及以上常住人口4796人为基线研究对象,进行流行病学问卷调查,测量血压、身高、体重。用前瞻性队列研究的方法,每年随访队列人群的脑卒中事件,并进行全死因登记,至2009年9月共随访18年。分析不同BMI水平脑卒中发病的相对危险度(RR)。结果脑卒中发病与BMI水平明显有关,与正常体重组比较,体重过低组、超重组、肥胖组发生出血性卒中的RR值分别为2.7,1.9和3.5,缺血性卒中的发病危险在超重组和肥胖组明显增加,RR值分别为1.4和2.4;60岁以下人群体重过低组出血性卒中的发病风险最高(RR=10);60岁以上人群仅显示肥胖组有较高的缺血性卒中发病危险。结论农村肥胖人群有较高的脑卒中发病风险,特别是60岁以下人群,体重过低者易患出血性卒中。     

我国成年人自评健康状况与脑卒中发病风险的前瞻性研究

目的分析我国成年人自评健康状况与脑卒中发病风险的关联。方法将2010年中国慢性病及其危险因素监测数据作为基线数据,从2010年监测点中选取11个省60个监测点(城市监测点25个、农村监测点35个)作为随访点,排除基线心血管病者,共36195人进入随访队列。2016-2017年进行随访调查,完成随访27441人。采用Cox比例风险回归模型分析自评健康状况与脑卒中发病风险比(HR),并按年龄、性别等基线特征进行亚组分析,剔除死亡者和基线糖尿病者进行敏感性分析。结果共纳入26699名研究对象进入分析,平均随访6.4年(共171431.1人年),随访期间共观察到脑卒中1332例(蛛网膜下腔出血32例,脑内出血197例,缺血性卒中1149例),发病密度为7.77/1000人年。多因素调整相关因素后,以自评健康非常好者为参照,自评健康差者脑卒中发病风险增加68%(HR=1.68,95%CI:1.22~2.32),缺血性卒中发病风险增加47%(HR=1.47,95%CI:1.05~2.05)。亚组分析发现年龄和BMI对自评健康与脑卒中发病风险间的关联存在效应修饰作用,年龄和血脂异常对自评健康与缺血性卒中发病存在修饰作用(交互P<0.05)。敏感性分析结果与全人群结果一致。结论自评健康状况差的人群发生脑卒中和缺血性卒中的风险增加,应将该人群,尤其是自评健康差的超重/肥胖、年龄<60岁或血脂异常人群作为重点干预对象。     

西宁地区40岁以上人群肥胖与高血压发病风险队列研究

目的探讨西宁地区40岁以上人群肥胖与高血压发病风险的队列研究。方法采用前瞻性队列研究法,在青海省心脑血管病专科医院行健康体检的1 149名40岁以上人群作为基线资料,并于2015年8月至2017年8月开展统一健康状况随访。按照体质指数(BMI)将研究对象分为A1、A2、A3、A4组,计算各组高血压发病率。以A2组为参照,用Log-binomial回归方法,校正变量,计算A1、A3、A4组高血压发病风险与95%置信区间。根据性别、年龄分层计算肥胖对高血压发病人群的归因危险度百分比。结果 919例受试者中BMI18.5kg/m~2 53例、BMI 18.5～23.9kg/m~2 546例、BMI (24.0～27.9)kg/m~2 256例、BMI27.9kg/m~2 64例;A4组受试者高血压发病率及发病风险明显高于A3、A2、A1组[χ~2值_(发病率)=31.698,U值_(发病风险)=3.075(模型1)、3.572(模型2)、3.634(模型3)、3.505(模型4),均P=0.000];在总例数中,模型1、2、3、4基线体重正常-随访超重/肥胖组、基线超重/肥胖-随访体重正常组、基线-随访超重/肥胖组高血压发病风险增加52.00%、26.00%、74.00%,52.00%、29.00%、75.00%,49.00%、28.00%、68.00%,30.00%、8.00%、35.00%;40～65岁、≥66岁超重/肥胖者的高血压发病风险增加为19.00%、9.00%,归因危险度百分比6.70%、3.40%。结论西宁地区40岁以上人群肥胖导致高血压的发病风险呈上升趋势,且中年人群体重增长是高血压发病的危险因素。应建议加大对中年超重或肥胖人群的生活干预,有助于高血压发病率下降。     

社区居民肥胖、中心性肥胖与冠心病发病风险的前瞻性队列研究

目的 探索肥胖、中心性肥胖与冠心病发病风险的关系。方法 2013年在上海市浦东新区社区居民中采用多阶段分层随机抽样选取人群开展基线调查,收集6685名队列研究对象的人口学特征、暴露因素、身体测量指标等信息。随访观察中位时间3.00年,记录队列人群的冠心病发病情况。单因素分析采用t检验、Kruskal-Wallis检验和卡方检验,多因素分析采用COX比例风险模型。结果 队列总计观察人年数为19759.93人年,共有260人发生冠心病,男性101例,女性159例。队列人群总体发病率3.89%,发病密度13.16/千人年。冠心病发病率随BMI升高呈上升趋势（〖XC小五号.EPS;P〗趋势=6.761,P=0.009）。中心性肥胖人群发病风险是正常人群的1.39倍(P =0.019, 95%CI: 1.06-1.82),中心性肥胖合并高血压患者发生冠心病的风险是正常人群的1.77倍(P=0.001, 95%CI:1.26-2.49)。结论 中心性肥胖是冠心病发病的重要危险因素。     

军队男性中老年人脑卒中发病和死亡的队列研究

目的：前瞻性探讨军队男性中老年人脑卒中发病及死亡的危险因素。方法：采用队列研究设计。研究对象为居住西安市22个军队干休所的1268名男性军队离退休干部。1987年基线调查的主要内容包括：年龄、体重指数(BMI)、血压、血脂、吸烟、饮酒、既往病史及家族史等。终点指标为新发脑卒中、脑卒中死亡和总死亡。结果：随访至2001年6月，观察人年为15 546。新发脑卒中113例，调整发病率为727／10万人年；脑卒中死亡45例，调整死亡率为289／10万人年。调整了年龄、血脂、吸烟、饮酒、既往心脑血管病病史及家族史等主要危险因素后，基线血压水平、BMI和既往冠心病和高脂血症病史是影响该人群脑卒中发病和死亡的主要危险因素。结论：军队男性中老年人群的脑卒中发病率和死亡率低于一般同龄人群，中老年人体重和血压水平进行监测和控制对预防中老年人群的脑卒中发病和死亡有重要意义。     

BMI与恶性肿瘤发病风险的前瞻性队列研究

目的利用大规模人群队列研究,探讨BMI与恶性肿瘤发病的关联性及其强度。方法采用2006年开滦集团体检人群队列(收集基线调查时人口学、生活方式和身高、体重等测量指标信息).通过主动和被动随访相结合方式,收集肿瘤发病、死亡等结局信息。排除随访时问<1年的新发病例后,采用多因素Cox比例风险回归模型分析低体重、超重和肥胖与肿瘤发病的风险比(HR)和95%CI,调整变量包括年龄、受教育程度、吸烟、饮酒和HBsAg(仅在肝癌中调整)：对男性肺癌、肝癌和女性乳腺癌分别按吸烟、HBsAg和绝经状态分层后纳入模型重新分析。结果至2011年12月31 Et,随访人群纳入队列133 273人,其中男性106 630人(80.0l%)、女性26 643人(19.99%),共随访570 531.02人年,平均随访时间为4.28年。男性低体重(BMI<18.5kg／m2)2 387人(2.24%),正常体重(BMI 18.5～23.9 kg／m2)45 090人(42.29%),超重(BMI 24.0-27.9 kg／m2)43 774人(41.05%),肥胖(BMI≥28.0 kg／m2)15 379人(14.42%);女性低体重858人(3.22%),正常体重14 037人(52.69%),超重8 507人(31.93%),肥胖3 241人(12.16%)。共收集肿瘤新发病例1 647例,其中男性1 348例,女性299例。多因素Cox比例风险回归模型分析表明,与正常体重者相比,男性低体重者胃癌(a／／R=3.82,95%CI：1.97。7.38)和肝癌(棚月=3.00,95%C1：1.36～6.65)的发病风险增加;男性肥胖(aHR=2.75,95%C1：1.25.6.06)和超重(a／／R=1.98,95%CI：1.03,3.82)者结肠癌发病风险增加;男性膀胱癌病例中,超重为保护性因素(aHR=0.44,95%CI：0.23-0,84);男性肺癌病例中,超重和肥胖均为保护性因素(超重：aHR=0.59,95%Cl：O.46一O.76;肥胖：aHR=0.64,95%CI：O.44。O.92)。而较之体重正常女性,女性肥胖者乳腺癌(aHR=1.86,95%C1：1.05～3.31)的发病风险增加：分层分析显示：刘‘于男性肺癌,超重对不吸烟者和吸烟者均起保护作用(小吸烟者：aHR=0.50,95%C1：O.35-0.72;吸烟者：aHR=0.70,95%CI：0.50一O.98),肥胖仅对男性不吸烟者起保护作用(a／／R=0 57,95%CI：O.33～O.97),而男性吸烟者与肺癌发病风险不存在相关性(aHR=0.72,95%C1：0.43～1.21)。按女性绝经状态分层后,肥胖增加了绝经后乳腺癌的发病风险(aHR=1.97,95%CI：1.01～3.82),而与绝经前乳腺癌的发病风险之间的关联无统计学意义：结论BMI与恶性肿瘤发病风险的相关性因肿瘤不同而存在差异。低体重与男性胃癌和肝癌的发病风险存在相关性,肥胖与男性结肠癌、女性绝经后乳腺癌和卵巢癌的发病风险存在相关性,而超重可能刘‘于男性肺癌和膀胱癌发病起到保护作用,肥胖可能对于非吸烟男性肺癌发病起到保护作用。     

肥胖与缺血性脑卒中发病率关系的回顾性队列研究

目的:探索肥胖与缺血性脑卒中发病率之间的关系,为脑卒中科学防治提供理论指导。方法:采用回顾性队列研究方法,于2017年6月随机抽取上海市嘉定区社区居民,并按照体质指数(BMI)分成两组,调查所有研究对象一般情况、生活习惯等基线资料后,采用多因素logistic回归分析肥胖对缺血性脑卒中发病的影响。结果:共有8 659例研究对象纳入队列,非肥胖组6 672例,肥胖组1 987例,队列中共有71例研究对象新发脑卒中,累计发病率为8.20‰,经年龄、喝茶等因素矫正后,肥胖组发病风险是非肥胖组1.934(1.191～3.140)倍。结论:肥胖是缺血性脑卒中的独立危险因素,应把监测和控制BMI提升到更高的地位,早期发现高危人群,及时予以干预,降低缺血性脑卒中发生风险。     

老年人群体质指数与心血管疾病危险因素相关性分析

目的探究老年人群体质指数(BMI)与心血管疾病危险因素发病风险之间的关系,为老年人体重管理和肥胖干预提供参考依据。方法选取2015年1-7月在温州医科大学附属第一医院进行体检的1 140名老年人为研究对象,男性511名,女性629名,年龄60岁,进行1年的跟踪随访。对调查对象进行问卷调查(人口学特征、生活方式及既往病史等)、体格检查,并测定空腹血糖、血脂。患有糖尿病、高血压及血脂异常3种疾病中的1种及以上定义为有心血管疾病危险因素。按照世界卫生组织推荐的亚洲人群BMI分类标准,将调查对象分为低体重(BMI18.5 kg/m_2),体重正常(18.5kg/m_2≤BMI≤22.9 kg/m_2),超重(23.0 kg/m_2≤BMI≤24.9 kg/m_2),肥胖I级(25.0 kg/m_2≤BMI≤29.9 kg/m_2)和肥胖II级(BMI≥30.0 kg/m_2)。用SPSS 19.0软件进行t检验,χ2检验。BMI与心血管疾病危险因素之间关系采用多因素logistic回归分析。结果在老年人群中,男性、女性至少有1种心血管疾病危险因素的检出率分别为62.8%和73.9%。logistic回归分析结果显示,在调整年龄、肌力、吸烟、饮酒、运动锻炼、肝脏疾病和肾脏疾病后,与正常体重者相比,低体重者心血管疾病危险因素发病风险OR值为1.57(95%CI:1.09~2.26),超重、肥胖I级和肥胖II级老年人心血管疾病危险因素发病风险OR值分别为1.49(95%CI:0.94~2.02)、3.21(95%CI:2.28~4.52)和4.12(95%CI:2.23~7.60)。结论老年人群BMI与心血管疾病危险因素的发病风险之间存在"U"形关系。低体重的老年人患心血管疾病的危险性增加。随着肥胖程度的增加,老年人患心血管疾病的危险性上升。     

山西营养与慢性病家庭队列人群体质指数与死亡率的关系

目的 分析山西营养与慢性病家庭队列人群BMI与总死亡率的关系。方法 以"2002年中国居民营养与健康状况调查"山西省调查人群为基线建立队列，于2015年12月至2016年3月对研究对象进行随访调查，对逝者进行死因回顾调查。2002年基线信息完整的≥ 18岁研究对象7 007人，随访到5 360人，随访率为76.5%。将研究对象按BMI分为8组，计算死亡率，以死亡率最低组作为参照，采用Cox比例风险回归模型估计全人群、分性别、年龄（≥ 60岁、<60岁）的各组死亡风险比（HR）及95% CI，模型调整基线年龄、性别、吸烟、饮酒、文化程度等因素，并进行敏感性分析。结果 共随访67 129人年，平均随访12.5年，死亡615人，队列总死亡率为916/10万人年。BMI为26.0~27.9 kg/m²组死亡率最低，以该组为参照组，多因素调整后，BMI<18.5、18.5~19.9、22.0~23.9和≥ 30.0 kg/m²组的死亡风险明显升高，调整HR值（95% CI）分别为1.90（1.26~2.86）、1.68（1.15~2.45）、1.49（1.08~2.06）和1.72（1.07~2.76）。对于≥ 60岁老年人，BMI<18.5 kg/m²组的死亡风险明显升高，调整HR值（95% CI）为1.94（1.20~3.15）。结论 BMI ≤ 19.9、22.0~23.9及≥ 30.0 kg/m²均会增加全因死亡风险。除关注肥胖外，低体重营养不良造成的老年人高死亡风险应特别引起重视。     

我国成人体重指数和腰围对相关疾病危险因素异常的预测价值:适宜体重指数和腰围切点的研究

目的：确定我国成人适宜的体重指数（BMI）范围和超重肥胖的划分界限。国际生命科学学会中国办事处中国肥胖问题工作组，对国内现有体量指标和相关疾病危险因素的研究数据组织了汇总分析。方法：有13项1990年以后的调查资料人选，共计20－70岁以上成人23972人，有腰围数据者111411人，有血脂和血糖化验数据者8万余人。数据进入分析的人群分布于大陆21个省市、自治区儿台湾。汇总方法是由各负责单位根据统一制定的表格和标准提供数据，汇总分析中心进行核对、汇总和统计分析。结果；高血压、糖尿病、血清总胆固醇升高、高密度脂蛋白胆固醇过低、甘油三酯升高和危险因素聚集（一个人具有2个及以上危险因素）的现患率均随BMI或腰围的增高而上升。通过不同BMI和腰围切点对于检出各项危险因素异常的敏感度和特异度分析，提出敏感度特异度较好、假阳性率较低的BMI切24为中国成人超重的界限，特异度达90％的BMI切点28为肥胖的界限；男性腰围≥85cm，女性≥80cm为腹部脂肪蓄积的界限。结论：切点以上的人群归因危险度百分比显示：将BMI控制到24以下，可能防止人群中45％－50％的危险因素聚集。对BMI在28及以上者药物控制到此点以下，可能防止15％－17％的危险因素聚集，从而降低心血管病和糖尿病的发病危险。男性腰围控制在85cm以下，女性腰围控制到80cm以下， 可能防止约47％－58％的解除因素聚集。根据以上分析结果，提出了对中国成人超重和肥胖界限的建议。     

体重指数与死亡的前瞻性研究

目的：探讨不同体重指数（BMI）水平与总死亡及不同死因死亡的关系。方法;1982－1985年在我国不同地区的10组人群中（年龄35－39岁）进行心血管病危险因素调查,并对研究对象中无脑卒中、无心肌梗死及无恶性肿瘤史的30560人（男性15723人,女性14837人）,随访至1999－2000年,登记各种死亡的发生情况。结果：在平均15．2年的随访中,共死亡3212例,其中冠心病和脑卒中共死亡676例,恶性肿瘤死亡1281例,其他原因死亡1255例。用Cox比例风险回归模型（调整年龄、性别0估计低BMI组（BMI＜18．5）、正常BMI组（BMI为18．5－23．9）、超重组（BMI为24－27．9）和肥胖组（BMI≥28）总死亡的相对危险分别为1．21,1．00,0．901,1．12,呈“U”形关系,当同时剔除前5年死亡病例及吸烟者后,低BMI组死亡的相对危险降低,而肥胖组增加,正常BMI组的相对危险最小。 随着BMI水平的上升,冠心病和脑卒中死亡的相对危险增加,恶性肿瘤死亡的相对危险降低,其他原因死亡的相对危险与BMI水平呈“U”形关系,当剔除早期死亡病例及吸烟者后,这些趋势依然存在。结论：BMI在正常范围内,总死亡的相对危险较低,且冠心病和脑卒中死亡,恶性肿瘤死亡及其它原因死亡的 综合风险也处于相对较低水平,有着重要的公共卫生学意义。     

2型糖尿病患者体重指数与死亡风险的前瞻性研究

  目的  探讨体重指数（body mass index,BMI）与2型糖尿病患者全死因死亡风险的关联。  方法  研究对象为江苏省苏南、苏北地区纳入国家基本公共卫生服务管理的17 638名2型糖尿病患者,应用Cox比例风险回归模型计算基线时不同BMI组人群在随访期间的全死因死亡风险（hazard ratio,HR）值及95%置信区间（confidence interval,CI）。  结果  研究对象累计随访77 451人年,平均随访4.39年,随访期间共死亡1 274人,低体重组BMI < 18.5 kg/m2、正常体重组（18.5 kg/m2 ≤ BMI < 24.0 kg/m2）、超重组（24.0 kg/m2 ≤ BMI < 28.0 kg/m2）、肥胖组（BMI ≥ 28.0 kg/m2）死亡人数分别为39人、575人、484人和176人,相应的死亡率分别为15.6%、9.5%、6.2%、5.1%。调整混杂因素后,以正常体重组为参照,低体重组、超重组、肥胖组死亡风险的HR值（95%CI）分别为1.66（95%CI:1.20~2.30）,0.68（95%CI:0.61~0.77）,0.58（95%CI:0.48~0.68）。  结论  在2型糖尿病患者中,与正常体重人群相比,低体重人群的全死因死亡风险最高,超重和肥胖人群的死亡风险较低,超重和肥胖可以降低2型糖尿病患者死亡风险。     

Underweight and overweight in relation to mortality among men aged 40-59 and 50-69 years: the Seven Countries Study

This study investigated the relation between body mass index (BMI) and the all-cause mortality rate among 7,985 European men. Starting around 1960, when all men were aged 40-59 years, mortality was followed for 15 years (1960-1975); starting around 1970, the survivors were followed for an additional 15 years (1970-1985). For the first and second follow-up periods, a BMI of 18.5-25 kg/m2 around 1960 and 1970, respectively, was considered the reference category. The authors found that the hazard ratios of mortality for a BMI of <18.5 kg/m2 was 2.1 (95% confidence interval (CI): 1.5, 2.8) for the first follow-up period and 1.7 (95% CI: 1.3, 2.2) for the second. A BMI of 25-30 kg/m2 was not related to increased mortality. Among never smokers, the hazard ratios for a BMI of >30 kg/m2 were 1.8 (95% CI: 1.2, 2.8) for the 1960-1975 follow-up period and 1.4 (95% CI: 1.0, 1.9) for the 1970-1985 follow-up period. A BMI of >30 kg/m2 was not related to increased mortality among current smokers. When mortality was followed for more than 15 years, the hazard ratio for a BMI of <18.5 kg/m2 declined and the hazard ratios for a BMI of >30 kg/m2 did not change. Underweight among those in all smoking categories and severe overweight in never smokers remained predictors of increased mortality when middle-aged men became older.     

The mortality risk of smoking and obesity combined

BACKGROUND: Both smoking and obesity have been linked to increased mortality, but evaluating the joint effect has been limited. This nationwide, prospective mortality study of U.S. radiologic technologists was designed to evaluate the combined mortality risks of obesity and smoking. METHODS: Mortality risk was investigated in 64,120 women and 18,760 men who completed a baseline questionnaire (1983 to 1989). Body mass index (BMI) (weight adjusted for height, or kilograms divided by meters squared) was calculated from self-reported weight and height at baseline, with five categories: less than 18.5 (underweight), 18.5 to 24.9 (normal), 25.0 to 29.9 (overweight), 30.0 to 34.9 (moderately obese), and 35.0 and higher (very obese). Participants were followed from the questionnaire until the date of death or through 2002, whichever occurred first. The combined association among BMI and smoking and all-cause, cancer, and circulatory disease mortality by gender and attained age (less than 65 years, 65 years and older) was examined using Cox proportional hazards regression analyses (conducted in 2005). Person-years at risk averaged 16 years (women aged less than 65), 6 years (women aged 65 and older), 15 years (men aged less than 65), and 7 years (men aged 65 and older), totaling 1.35 million person-years. RESULTS: In all gender/age groups, both obesity and smoking, particularly current smoking, contributed substantially to all-cause mortality, with 3.5- to 5-fold risks for very obese, current smokers compared to normal weight, never smokers. Current smoking was the predominant risk factor for cancer mortality. Combining obesity with current smoking increased circulatory disease mortality by 6- to 11-fold for people aged less than 65 years, compared to normal weight, never smokers. Obese former smokers (less than 65 years) had notably lower risks. CONCLUSIONS: Obese smokers (aged less than 65 years) had strikingly high mortality risks, particularly from circulatory disease mortality.     

The relationship of physical activity and body weight with all-cause mortality: results from the Puerto Rico Heart Health Program

PURPOSE: To study the relationship of physical activity and obesity with all-cause mortality in Puerto Rican Men.

METHODS: The Puerto Rico Heart Health Program collected physical activity and anthropometric measurements in 9,824 men between 1962 and 1965. After excluding those with known coronary heart disease at baseline, and those who died within the first three years of the study we analyzed the data for the relationship between physical activity and overweight status to all-cause mortality in 9,136 men.We stratified our participants by quartiles of physical activity. Participants were classified into four categories of body weight: underweight (BMI < 18.5), healthy weight (BMI =18.5–24.9), overweight (BMI = 25–29.9), and obese (BMI = 30+).

RESULTS: After adjusting for age, education, smoking status, hypertension status, hypercholesterolemic status, urban/rural residence, and overweight status, physical activity was independently related to all-cause mortality. All-cause mortality was lower in those in quartile 2 (OR = 0.68, CI = 0.58–0.79) than quartile 1 (reference, sedentary group). Mortality among those in quartile 3 and 4 (0.63, CI = 0.54–0.75; and 0.55, CI = 0.46–0.65, respectively) were also significantly lower than those observed in quartile 1, but not significantly lower than those observed in quartile 2. Furthermore, within every category of body weight, those who were most active had significantly lower odds ratio of all-cause mortality.

CONCLUSION: Our findings support the current recommendation that some physical activity is better than none, in protecting against all-cause mortality. The benefits of an active lifestyle are independent of body weight and that overweight and obese Puerto Rican men who are physically active experienced significant reductions in all-cause mortality compared with their sedentary counterparts.     

Association of Body Mass Index with Ischemic and Hemorrhagic Stroke

Data on the association between body mass index (BMI) and stroke are scarce. We aimed to examine the association between BMI and incident stroke (ischemic or hemorrhagic) and to clarify the relationship between underweight, overweight, and obesity and stroke risk stratified by sex. We analyzed the JMDC Claims Database between January 2005 and April 2020 including 2,740,778 healthy individuals (Median (interquartile) age, 45 (38–53) years; 56.2% men; median (interquartile) BMI, 22.3 (20.2–24.8) kg/m²). None of the participants had a history of cardiovascular disease. Each participant was categorized as underweight (BMI <18.5 kg/m²), normal weight (BMI 18.5–24.9 kg/m²), overweight (BMI 25.0–29.9 kg/m²), or obese (BMI ≥ 30 kg/m²). We investigated the association of BMI with incidence stroke in men and women using the Cox regression model. We used restricted cubic spline (RCS) functions to identify the association of BMI as a continuous parameter with incident stroke. The incidence (95% confidence interval) of total stroke, ischemic stroke, and hemorrhagic stroke was 32.5 (32.0–32.9), 28.1 (27.6–28.5), and 5.5 (5.3–5.7) per 10,000 person-years in men, whereas 25.7 (25.1–26.2), 22.5 (22.0–23.0), and 4.0 (3.8–4.2) per 10,000 person-years in women, respectively. Multivariable Cox regression analysis showed that overweight and obesity were associated with a higher incidence of total and ischemic stroke in both men and women. Underweight, overweight, and obesity were associated with a higher hemorrhagic stroke incidence in men, but not in women. Restricted cubic spline showed that the risk of ischemic stroke increased in a BMI dose-dependent manner in both men and women, whereas there was a U-shaped relationship between BMI and the hemorrhagic stroke risk in men. In conclusion, overweight and obesity were associated with a greater incidence of stroke and ischemic stroke in both men and women. Furthermore, underweight, overweight, and obesity were associated with a higher hemorrhagic stroke risk in men. Our results would help in the risk stratification of future stroke based on BMI.     

Lifestyle factors,cardiovascular disease and all-cause mortality in middle-aged and elderly women: a systematic review and meta-analysis

Cardiovascular disease (CVD) risk factors, incidence and death increases from around the time of menopause comparing to women in reproductive age. A healthy lifestyle can prevent CVD, but it is unclear which lifestyle factors may help maintain and improve cardiovascular health for women after menopausal transition. We conducted a systematic review and meta-analysis of prospective cohort studies to evaluate the association between modifiable lifestyle factors (specifically smoking, physical activity, alcohol intake, and obesity), with CVD and mortality in middle-aged and elderly women. Pubmed, Embase, among other databases and reference lists were searched until February 29th, 2016. Study specific relative risks (RR) were meta-analyzed using random effect models. We included 59 studies involving 5,358,902 women. Comparing current versus never smokers, pooled RR were 3.12 (95% CI 2.15–4.52) for CHD incidence, 2.09 (95% CI 1.51–2.89) for stroke incidence, 2.76 (95% CI 1.62–4.71) for CVD mortality and 2.22 (95% CI 1.92–2.57) for all-cause mortality. Physical activity was associated with a decreased risk of 0.74 (95% CI 0.67–0.80) for overall CVD, 0.71 (95% CI 0.67–0.75) for CHD, 0.77 (95% CI 0.70–0.85) for stroke, 0.70 (95% CI 0.58–0.84) for CVD mortality and 0.71 (95% CI 0.65–0.78) for all-cause mortality. Comparing moderate drinkers versus non-drinkers, the RR was 0.72 (95% CI 0.56–0.91) for CHD, 0.63 (95% CI 0.57–0.71) for CVD mortality and 0.80 (95% CI 0.76–0.84) for all-cause mortality. For women with BMI 30–35 kg/m² the risk was 1.67 (95% CI 1.24–2.25) for CHD and 2.3 (95% CI 1.56–3.40) for CVD mortality, compared to normal weight. Each 5 kg/m² increase in BMI was associated with 24% (95% CI 16–33%) higher risk for all-cause mortality. This meta-analysis suggests that physical activity and moderate alcohol intake were associated with a reduced risk for CVD and mortality. Smoking and higher BMI were associated with an increased risk of these endpoints. Adherence to a healthy lifestyle may substantially lower the burden of CVD and reduce the risk of mortality among middle-aged and elderly women. However, this review highlights important gaps, as lack of standardized methods in assessing lifestyle factors and lack of accurate information on menopause status, which should be addressed by future studies in order to understand the role of menopause on the association between lifestyle factors and cardiovascular events.     

Apolipoprotein E gene is related to mortality only in normal weight individuals: The Rotterdam study

Objective To investigate the relationship between the apolipoprotein E (APOE) gene and the risk of mortality in normal weight, overweight and obese individuals. Methods and Results In a population-based study of 7,983 individuals aged 55 years and older, we compared the risks of all-cause and coronary heart disease (CHD) mortality by APOE genotype, both overall and in subgroups defined by body mass index (BMI). We found significant evidence for interaction between APOE and BMI in relation to total cholesterol (p = 0.04) and HDL cholesterol (p < 0.001). Overall, APOE*2 carriers showed a decreased risk of all-cause mortality. Analyses within BMI strata showed a beneficial effect of APOE*2 only in normal weight persons (adjusted hazard ratio (HR) 0.7[95% CI 0.5–0.9]). APOE*2 was not associated with a lower risk of all-cause mortality in overweight or obese persons. The effect of APOE*2 in normal weight individuals tended to be due to the risk of CHD mortality (adjusted HR 0.5 [95% CI 0.2–1.2]). Conclusion The APOE*2 allele confers a lower risk of all-cause mortality only to normal weight individuals.     

Underweight, overweight and obesity as risk factors for mortality and hospitalization

AIMS: The prevalence of overweight and obesity is increasing in many countries. We aimed to investigate differences in mortality and severe morbidity between underweight people (body mass index (BMI)<18.5), overweight people (BMI 25 to <30), obese people (BMI> or =30), and those with normal weights (BMI 18.5 to <25). METHODS: Random samples of the Swedish population aged 16-74 years in 1980-81 and 1988-89 were followed for 12 years with regard to all-cause mortality and mortality from circulatory diseases, all inpatient care, and inpatient care for circulatory and musculoskeletal diseases. Relative risks (RRs) for different levels of BMI were adjusted for age, longstanding illness, smoking, and educational level at baseline. In addition, analyses were made with delayed entry until the fourth-year after interview. RESULTS: Obesity and underweight, but not overweight, was associated with higher all-cause mortality. Among underweight men, the adjusted RR for all-cause mortality was 2.4 (95% confidence interval 1.6-3.6), and among underweight women it was 2.0 (1.5-2.7), but population attributable risks (PARs) were small, at 1.2% and 2.7%, respectively. Overweight was associated with increased risks for inpatient care for circulatory diseases, with PARs being 13.4% among men and 8.1% among women, and musculoskeletal diseases (PARs were 12.7% and 12.9%, respectively). Obese men and women had about 50% higher risks of all-cause mortality than normal-weight people, PARs being 3.2% and 3.8% respectively. CONCLUSIONS: This study supports the findings of other studies, in that overweight seems to be an exaggerated risk factor for all-cause mortality, but is related to other chronic disease. Underweight and obesity generally implies greater increases of RRs, but avoidance of overweight may have greater effect on the population level with regard to reduced cardiovascular and locomotor disease.