体质指数对2型糖尿病患者心血管危险因素的影响

目的分析体质指数(BM I)对2型糖尿病(DM)患者心血管危险因素的影响。方法随机选取天津医科大学代谢病医院2型DM患者832例,根据BM I分为体重不足组、体重正常组、超重组、肥胖Ⅰ期组、肥胖Ⅱ期组。检测、比较5组收缩压(SBP)、舒张压(DBP)及空腹血浆甘油三酯(TG)、高密度脂蛋白胆固醇(H DL-C)、血清尿酸(UA)、血浆纤维蛋白原(FIB)、空腹血糖(FPG)、胰岛素(INS),H om a-m odel公式计算胰岛素抵抗指数(IRI)。结果不同BM I的2型DM患者SBP、DBP、TG、H DL-C、UA、FIB和IRI有统计学意义(P<0.01),随着BM I的增加高血压、血脂紊乱、高尿酸血症、高纤维蛋白原血症患者(率)显著增加,有统计学意义(P<0.01～0.05)。Pearson相关分析显示,BM I与IRI、SBP、D BP、TG、U A呈正相关,与H DL-C呈负相关,与FIB无相关性。多元逐步回归分析显示,IRI、SBP、D BP、TG与BM I呈显著正相关,H D L-C与BM I呈显著负相关。结论BM I升高导致2型D M患者多种代谢紊乱加重,心血管疾病的危险性增加。     

Assessment of Body Mass Index and Association with Adolescent Preventive Care in U.S. Outpatient Settings

Using data from the latest National Ambulatory Care Surveys, this study finds that the importance of assessment of overweight and obesity and preventive counseling in adolescents is underappreciated in outpatient practices throughout the United States. The room for improvement remains considerable, and interventions to promote quality preventive care are needed for all adolescents.     

杭州某高校教师体质指数与心血管病危险因素的关系

[目的]分析杭州某高校教师心血管病危险因素随体质指数(body mass index,BMI)增加的变化情况,为杭州高校教工预防心血管疾病提供理论依据。[方法]将436名教师分为体重未超标组(264人)、超重组(135人)、肥胖组(37人);比较各组血压、血糖、血脂、同型半胱氨酸(homocysteine,Hcy)、脂蛋白(a)[liporotein(a),LP(a)]、胱抑素C(cystatin,Cys-C)、超敏C反应蛋白(high sensitivity C reactive protein,hs CRP)的差异;并统计各体重组教工BMI和Hcy、LP(a)、Cys-C、hs CRP的相关性。[结果]与体重未超标组比较,超重组和肥胖组教工的血压、血糖、血脂、Hcy、LP(a)、hs CRP均升高(P<0.05);与超重组比较,肥胖组教工的血压、血糖、LP(a)升高(P<0.05);超重组和肥胖组教师的BMI和Hcy、LP(a)、hs CRP具有正相关关系(P<0.05)。[结论]超重及肥胖与其他心血管危险因素存在聚集现象,对于高校教师中超重、肥胖者,应注意检查和发现多重心血管病危险因素的并存。     

Body Mass Index and Risk of Death in Asian Americans

Objectives. We investigated the association between body mass index (BMI) and mortality among Asian Americans.Methods. We pooled data from prospective cohort studies with 20 672 Asian American adults with no baseline cancer or heart disease history. We estimated hazard ratios and 95% confidence intervals (CIs) with Cox proportional hazards models.Results. A high, but not low, BMI was associated with increased risk of total mortality among individuals aged 35 to 69 years. The BMI was not related to total mortality among individuals aged 70 years and older. With a BMI 22.5 to < 25 as the reference category among never-smokers aged 35 to 69 years, the hazard ratios for total mortality were 0.83 (95% CI = 0.47, 1.47) for BMI 15 to < 18.5; 0.91 (95% CI = 0.62, 1.32) for BMI 18.5 to < 20; 1.08 (95% CI = 0.86, 1.36) for BMI 20 to < 22.5; 1.14 (95% CI = 0.90, 1.44) for BMI 25 to < 27.5; 1.13 (95% CI = 0.79, 1.62) for BMI 27.5 to < 30; 1.82 (95% CI = 1.25, 2.64) for BMI 30 to < 35; and 2.09 (95% CI = 1.06, 4.11) for BMI 35 to 50. Higher BMI was also related to increased cardiovascular disease and cancer mortality.Conclusions. High BMI is associated with increased mortality risk among Asian Americans.During the past 30 years the prevalence of obesity, defined as a body mass index (BMI, defined as weight in kilograms divided by the square of height in meters) of 30 or greater, increased in all racial or ethnic groups in the United States. Historically, obesity has been uncommon among Asian Americans compared with other racial or ethnic groups in the United States, but the prevalence of obesity in this population is rising. Between 1991 and 2008, the prevalence of obesity increased from 13.9% to 28.7% among US-born Asians and from 9.5% to 20.7% among Asian immigrants.1Substantial epidemiological data have defined the dose–response association between BMI and mortality among Whites in the United States,2 and to a lesser degree among US Blacks.3 However, data for Asian Americans, a fast-growing racial group in the United States, are sparse.4 Recently, a pooled analysis among East Asians residing in Asia, including Chinese, Japanese, and Koreans, showed that the association between BMI and total mortality was nonlinear, in that BMIs greater than 25 and less than 22.6 were both associated with increased mortality.5 It was interesting that the increased mortality associated with a high BMI in East Asians was not observed among Indians and Bangladeshis in Asia.5Asian Americans share an environment with US Whites and Blacks, which differs markedly from that of their counterparts in Asia. It is unclear whether this change in context results in different susceptibility to obesity and obesity-related diseases between Asian Americans and Asians residing in Asia, or whether a shared genetic background contributes to a similar association between obesity and disease. To investigate the association between BMI and risk of mortality among Asian Americans in the largest sample to date, we pooled data from 10 prospective cohort studies in the United States.6–15     

体质指数与脑卒中发病率关系的研究进展

脑卒中在我国的许多城市和地区都已经成为第1和第2位死因及首位致残原因,而我国肥胖人群的不断增加,更加重了脑卒中的危害。因此,研究脑卒中发病的影响因素,探求肥胖对脑卒中发病的作用机制,是目前预防脑卒中发病的主要课题之一。对体质指数(BMI)与脑卒中及其亚型发病率的关系进行了综述,为开展积极有效的危险因素干预研究,降低脑卒中发病率提供科学依据。     

Impact of Missing Data for Body Mass Index in an Epidemiologic Study

Maternal and Child Health Journal - Objective To assess the potential impact of missing data on body mass index (BMI) on the association between prepregnancy obesity and specific birth defects....     

体质指数对血压、血糖、血脂的影响

目的 探讨超重、肥胖对血压、血糖、血脂的影响.方法 对2009年医院体检中心1017名健康体检人群的体质指数(BMI)、血压、血糖、血脂等结果 进行统计分析.结果 超重检出率31.37%,肥胖检出率4.92%;随BMI升高,高密度脂蛋白胆固醇水平减低,收缩压、舒张压、空腹血糖、总胆固醇、甘油三酯、低密度脂蛋白胆固醇水平逐渐升高,高血压、高血糖、高血脂检出率亦增高.结论 健康体检人群超重、肥胖率较高,超重、肥胖与高血压、高血糖、高血脂关系密切,需采取早期有效措施控制超重和肥胖倾向.     

Body Mass Index,Waist-circumference and Cardiovascular Disease Risk Factors in Iranian Adults: Isfahan Healthy Heart Program

Considering the main effect of obesity on chronic non-communicable diseases, this study was performed to assess the association between body mass index (BMI), waist-circumference (WC), cardiometabolic risk factors and to corroborate whether either or both BMI and WC are independently associated with the risk factors in a sample of Iranian adults. This cross-sectional study was performed on data from baseline survey of Isfahan Healthy Heart Program (IHHP). The study was done on 12,514 randomly-selected adults in Isfahan, Najafabad and Arak counties in 2000-2001. Ages of the subjects were recorded. Fasting blood glucose (FBG), 2-hour post-load glucose (2hpp), serum lipids, systolic and diastolic blood pressure (SBP and DBP), BMI, WC, smoking status, and total daily physical activity were determined. Increase in BMI and WC had a significant positive relation with the mean of FBG, 2hpp, SBP, DBP, serum lipids, except for HDL-C (p<0.001 for all). After adjustment for age, smoking, physical activity, socioeconomic status (SES), and BMI, the highest odds ratio (OR) (95% CI) for diabetes mellitus (DM) according to WC was 3.13 (1.93-5.08) and 1.99 (1.15-3.44) in women and men respectively. Moreover, the highest ORs based on BMI with adjustment for age, smoking, physical activity, SES, and WC were for dyslipidaemia (DLP) [1.97 (1.58-2.45) in women and 2.96 (2.41-3.63) in men]. The use of BMI or WC alone in the models caused to enhance all ORs. When both BMI and WC were entered in the model, the ORs for all risk factors, in men, according to BMI, were more compared to WC. However, in women, ORs for DM and hypertension (HTN) in WC quartiles were more than in BMI quartiles. BMI is the better predictor of DM, HTN, and DLP in men compared to WC. Conversely, in women, WC is a superior predictor than BMI, particularly for DM and HTN. Furthermore, the measurement of both WC and BMI in Iranian adults may be a better predictor of traditional risk factors of CVDs compared to BMI or WC alone.Key words: Body mass index, Diabetes mellitus, Dyslipidaemia, Hypertension, Obesity, Risk Factor, Waist-circumference, Iran     

The Modifying Effect of Social Class on the Relationship Between Body Mass Index and Breast Cancer Incidence

Objectives. We sought to determine whether social class modifies the effect of BMI on breast cancer incidence.Methods. Participants included 5642 postmenopausal White women recruited in 1989 to CLUE II, a prospective cohort study in Washington County, Maryland. We obtained exposure data from CLUE II and the 1990 US Census. We used survival and random-effects Cox proportional hazards analyses to determine the association of social class and BMI with breast cancer incidence.Results. Education was independently associated with increased risk of breast cancer incidence (hazard ratio [HR] = 1.06; 95% confidence interval [CI] = 1.01, 1.11; P < .05); contextual measures of social class were not. Education modified the effect of BMI at age 21 years (HR = 0.98; 95% CI = 0.97, 0.99); area-level social class modified the effect of BMI at baseline (HR = 0.97; 95% CI = 0.94, 0.99) and BMI change (HR = 0.98; 95% CI = 0.95, 1.00). Subpopulation analyses that were adjusted for hormone use, parity, and breast-feeding found similar effects.Conclusions. Social class moderates the influence of body size on breast cancer incidence. Public health efforts, therefore, should advocate for policies that improve social conditions to decrease the burden of breast cancer.Higher social class and heavier body size are established independent risk factors for postmenopausal breast cancer. Their interaction, however, has not been well studied in relation to breast cancer incidence. Breast cancer incidence is higher among women of higher social class, in part because of class-based differences in reproductive behavior.^1–3 Women of higher social class are more likely to be older at first birth, have fewer total births, and to be older at menopause (all risk factors for breast cancer^1–3). Heavier body size, measured by body mass index (BMI), and weight gain increase postmenopausal breast cancer risk because high levels of adiposity result in the production of excess levels of circulating endogenous estrogens, which in turn promote mammary carcinogenesis.^4,5 Because social class in general has been found to be inversely associated with body size, there is an expectation that this association would lead to higher rates of breast cancer incidence among women of low social class. No previous studies have examined the dual effects of social class and body size on breast cancer incidence. Furthermore, only a few studies^4,6–8 have examined both static measures and measures of change over time in body size.To date, breast cancer research has not fully explored both individual and contextual indicators of social class. Individual-level indicators alone may not fully capture the sociostructural and economic conditions that influence the distribution of disease. Utilization of both area- and individual-level indicators of social class may therefore contribute to a better understanding of the effects of social class on breast cancer incidence. We examined the joint association of social class and body size with breast cancer incidence among a cohort of postmenopausal women and tested whether area-based measures of social class provided distinct social effects on breast cancer incidence apart from individual-based measures of social class. Our analyses focused on postmenopausal women, for whom heavier body size increases breast cancer risk (rather than premenopausal obesity, which has a protective effect).     

Ethnic Disparities in the Association of Body Mass Index with the Risk of Hypertension and Diabetes

Despite having lower body mass index (BMI) compared to other ethnic groups, Asians continue to develop significant metabolic diseases such as hypertension and diabetes. To evaluate the disparate association of BMI and risk of hypertension and diabetes in Asians. We retrospectively studied 150,753 adults from the 1985–2011 California Behavioral Risk Factor Survey. Trends in prevalence of obesity, hypertension, and diabetes were stratified by ethnicity. Multivariate logistic regression models evaluated the incremental effect of one unit BMI increase on risk of hypertension and diabetes and the disparate risks of hypertension and diabetes at different BMI thresholds. Asians had the lowest BMI among all groups. However, the impact of increasing BMI on risk of hypertension and diabetes was significantly greater in Asians. For each one unit increase in BMI, Asians were significantly more likely to have hypertension (OR 1.15; 95 % CI 1.13–1.18) compared to non-Hispanic whites, blacks, and Hispanics. Similar trends were seen for diabetes (Asians: OR 1.15; 95 % CI 1.13–1.18). The risk of hypertension in Asians with BMI ≥ 22 was similar to non-Hispanic whites with BMI ≥ 27 and blacks with BMI ≥ 28. The risk of diabetes in Asians with BMI ≥ 28 was similar to non-Hispanic whites with BMI ≥ 30. Despite lower overall BMI compared to other groups, weight gain in Asians is associated with significantly higher risks of hypertension and diabetes. Compared to other ethnic groups, similar risks of hypertension and diabetes are seen in Asians at much lower BMI.     

Body Mass Index and the Risk of Atrial Fibrillation: A Mendelian Randomization Study

Although observational studies have shown positive associations between body mass index (BMI) and the risk of atrial fibrillation (AF), the causal relationship is still uncertain owing to the susceptibility to confounding and reverse causation. This study aimed to examine the potential causality of BMI on AF by conducting a two-sample Mendelian randomization (TSMR) study. Methods: The independent genetic variants associated with BMI (n = 303) at the genome-wide significant level were derived as instrumental variables (IV) from the Genetic Investigation of Anthropometric Traits (GIANT) consortium consisting of 681,275 individuals of European ancestry. We then derived the outcome data from a GWAS meta-analysis comprised of 60,620 cases and 970,216 controls of European ancestry. The TSMR analyses were performed in five methods, namely inverse variance weighted (IVW) method, MR-Egger regression, the weighted median estimator (WME), the generalized summary data-based Mendelian randomization (GSMR), and the robust adjusted profile score (RAPS), to investigate whether BMI was causally associated with the risk of AF. Results: We found a genetically determined 1–standard deviation (SD) increment of BMI causally increased a 42.5% risk of AF (OR = 1.425; 95% CI, 1.346 to 1.509) based on the IVW method, which was consistent with the results of MR-Egger regression, WME, GSMR, as well as RAPS. The Mendelian randomization assumptions did not seem to be violated. Conclusion: This study provides evidence that higher BMI causally increased the risk of AF, suggesting control of BMI and obesity for prevention of AF.     

Use of Body Mass Index and Percentage Overweight Cutoffs to Screen Japanese Children and Adolescents for Obesity-Related Risk Factors

Background

Cutoffs based on percentage overweight (POW) are used for screening students in Japan; however, body mass index (BMI) is more common in the rest of the world. To screen for risk factors related to obesity among Japanese primary and secondary school students, we compared fasting and postprandial values, and the receiver operating characteristic (ROC) curves for the POW and BMI criteria.

Methods

The subjects were students aged 10 and 13 years living in Shunan City, Japan between 2006 and 2008 (n = 6566). POW and International Obesity Taskforce (IOTF) BMI criteria were used to screen for obesity-related risk factors. The lower (20%, 18-year-old equivalent: 25 kg/m²) and higher (50%, 18-year-old equivalent: 30 kg/m²) cutoffs were examined, and ROC curves were drawn.

Results

Fasting cholesterol levels were higher than postprandial levels. The prevalences of overweight/obesity were 6.6% to 10.0% using the lower cutoff and 0.6% to 5.0% using the higher cutoff. Among overweight subjects under fasting conditions, dyslipidemia was present in 12% to 52%, hypertriglyceridemia in 29% to 54%, hyperglycemia in 11% to 21%, and hypertension in 15% to 40%. Although the use of the lower and higher POW cutoffs resulted in lower sensitivity and the higher specificity, the POW and BMI ROC curves largely overlapped. However, for girls aged 10 years, the POW curve for ≥3 risks factors was lower than that of the latter (P = 0.013).

Conclusions

For Japanese aged 10 and 13 years, both BMI and POW are useful for risk factor screening. However, subjects may be misclassified with dyscholesterolemia if postprandial blood samples are used.Key words: body mass index, Japanese, risk factors, percentage overweight, ROC curve     

Intrauterine Exposure to Environmental Pollutants and Body Mass Index during the First 3 Years of Life

Objective

We investigated the association between body mass index (BMI) standard deviation score (SDS) and prenatal exposure to hexachlorobenzene, dichlorodiphenyldichloroethylene (DDE), dioxin-like compounds, and polychlorinated biphenyls (PCBs).

Methods

In this prospective birth cohort study, we assessed a random sample of mother–infant pairs (n = 138) living in Flanders, Belgium, with follow-up until the children were 3 years of age. We measured body mass index as standard deviation scores (BMI SDS) of children 1–3 years of age as well as pollutants measured in cord blood.

Results

DDE correlated with BMI SDS, with effect modification by maternal smoking and the child’s age. At 1 year, children of smoking mothers had higher BMI SDS than did children of nonsmoking mothers. At 3 years, this difference was reduced because of the faster rate of decline in BMI SDS in the former group. This relationship held except for children with high levels of DDE. DDE had a small effect on BMI SDS at 3 years of age in children of nonsmoking mothers (difference in BMI SDS for DDE concentrations between the 90th and 10th percentiles = 0.13). On the other hand, smoking enhanced the relation between DDE and BMI SDS at 3 years (difference in BMI SDS for DDE concentrations between the 90th and 10th percentiles = 0.76). Increasing concentrations of PCBs were associated with higher BMI SDS values at all ages (parameter estimate = 0.003 ± 0.001; p = 0.03).

Conclusion

In this study we demonstrated that intrauterine exposure to DDE and PCBs is associated with BMI during early childhood. Future studies are warranted to confirm our findings and to assess possible mechanisms by which these pollutants could alter energy metabolism.     

Effect of Individual or Neighborhood Disadvantage on the Association Between Neighborhood Walkability and Body Mass Index

Objectives. We sought to test whether the association between walkable environments and lower body mass index (BMI) was stronger within disadvantaged groups that may be particularly sensitive to environmental constraints.Methods. We measured height and weight in a diverse sample of 13 102 adults living throughout New York City from 2000–2002. Each participant''s home address was geocoded and surrounded by a circular buffer with a 1-km radius. The composition and built environment characteristics of these areas were used to predict BMI through the use of generalized estimating equations. Indicators of individual or area disadvantage included low educational attainment, low household income, Black race, and Hispanic ethnicity.Results. Higher population density, more mixed land use, and greater transit access were most consistently associated with a lower BMI among those with more education or higher incomes and among non-Hispanic Whites. Significant interactions were observed for education, income, race, and ethnicity.Conclusions. Contrary to expectations, built environment characteristics were less consistently associated with BMI among disadvantaged groups. This pattern may be explained by other barriers to maintaining a healthy weight encountered by disadvantaged groups.Urban environments have recently been studied for their effects on diet, physical activity, obesity, and obesity-related health conditions.^1–4 Metropolitan areas and counties characterized as compact, rather than sprawling, may facilitate walking for transportation and may curb obesity.^5,6 Yet, metropolitan areas are far from homogeneous, and neighborhood-level measures of the built environment have also been associated with obesity.¹ Within New York City, for example, higher population density, more mixed land uses, and access to public transit near the home were associated with lower body mass index (BMI).⁷Neighborhood socioeconomic disadvantage and racial or ethnic composition have also been examined as predictors of obesity⁸ and as potential confounders in studies of other environmental features. Research on the built environment and obesity has recently begun to consider whether population characteristics might modify the effect of built environment characteristics on obesity and related behaviors.^9–11 Speculation as to which populations would be most sensitive to the obesity-related effects of the built environment has yielded competing hypotheses. Several authors have posited that poor or disadvantaged groups would be most likely to respond to their residential environment, lacking means to go elsewhere.^1,8 On the other hand, some disadvantaged individuals may be “captive walkers” who rely on walking for transportation,¹² thus being unable to respond to the local environment by retreating into their vehicles. Meanwhile, the often discussed problem of “self-selection” could bias observational studies of neighborhoods and health¹³ and could imply that relatively affluent and advantaged individuals will have the strongest (albeit noncausal) associations between their neighborhood environment and obesity because more resources facilitate the selection of an environment to fit one''s preferred lifestyle. Finally, measurement error or unmeasured environmental characteristics may differ depending on the characteristics of the population studied. Ostensibly “walkable” neighborhoods may be less safe or attractive in more deprived areas.^14–17 Also, the use of paid gyms and the norms related to food or activity may differ by population,¹⁸ and the culturally mediated response to environmental features may differ as well.^19,20We report stratified analyses from a large, diverse population in New York City to shed light on these ideas. We a priori identified 4 population characteristics that identify disadvantaged individuals and neighborhoods: low educational attainment, low household income, Black race, and Hispanic ethnicity. Competing hypotheses from the published literature predict stronger or weaker associations for disadvantaged populations.     

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。