Department of Neurology, The Affiliated Kailuan General Hospital of North China Coal Medical, University, No. 57 East Xinhua Road, Tangshan 063000, Hebei, PR China.
Department of Neurology, The Affiliated Kailuan General Hospital of North China Coal Medical, University, No. 57 East Xinhua Road, Tangshan 063000, Hebei, PR China.
Obes Res Clin Pract. 2011 Jan-Mar;5(1):e1-e78. doi: 10.1016/j.orcp.2010.09.251.
The current studies have shown that overweight and obesity are possible risk factors for cerebral infarction, but variety of weight status in the role of the mechanism of cerebral infarction is not yet fully understood. In our research, a prospective cohort follow-up study of 8 years (2002-2009) was used to analyze the correlation of weight, cerebral infarction and other factors in 1170 Han retired employees from KaiLuan Group. The study included enrolling with questionnaire survey, medical examination, brain CT scan and so on, based on the changes in body mass index from the beginning to the end of the follow-up study, the subjects were divided into eight groups: stay normal weight group (n = 364), stay overweight group (n = 171), development from overweight into obesity group (n = 95), stay obesity group (n = 37), development from normal weight into overweight group (n = 365), development from normal weight into obesity group (n = 63), overweight improved group (n = 55) and obesity improved group (n = 20). We found that the incidence of cerebral infarction in the stay overweight group was higher than in the stay obese and stay normal weight groups (25.15%, 18.92%, 19.23%, P < 0.05) during the last medical examination in the end of follow-up study, and relative risk was 1.31, 0.98, 1, and population attributable risk was 0.10, -0.002, 0, respectively. But there was no difference of the incidence of cerebral infarction between stay obesity group and stay normal weight group (P > 0.05). The incidence of hypertension in the development of normal weight into obesity group and stay obesity group was higher than stay overweight group and stay normal weight group (63.49%, 56.76%, 48.54%, 36.54%, P < 0.05), while the aggregated incidence of risk factors in above mentioned four groups was 75%, 64%, 63%, 55% (P < 0.05), respectively. In logistic regression analysis of correlative factors to cerebral infarction, waist circumference in the last checkup, diabetes, development from normal weight to overweight status, etc were selected (P < 0.01), and odds ratio (OR) values were 0.98, 6.51, 4.13 (P < 0.05), respectively. The incidence of cerebral infarction in overweight improved and obesity improved groups were 29.09%, 45.00%, relative risk values were 1.51, 2.34, the aggregated incidence of risk factors were 48%, 65%. This study showed that Chinese aging population who has overweight with a significant overweight stable phase and with no overweight stable phase but progressing to obesity had different risks of diseases. The former was at high risk of cerebral infarction, the latter was susceptible to hypertension. In the aging population of overweight and obesity, the aggregated incidence of cerebral infarction related risk factors were significantly increased, and weight-loss treatment did not reduce the incidence of cerebral infarction. Thus, the aging patients with obesity should be actively treated to eliminate hypertension and other risk factors, rather than an appetite for weight-loss treatment.:
当前的研究表明，超重和肥胖是脑梗死的可能危险因素，但体重状况的多种机制在脑梗死中的作用尚不完全清楚。在我们的研究中，采用前瞻性队列随访研究 8 年（2002-2009 年），分析了 1170 名来自凯洛格集团的汉族退休员工的体重、脑梗死等因素的相关性。该研究包括问卷调查、体检、脑 CT 扫描等，根据随访研究结束时体重指数的变化，将受试者分为 8 组：保持正常体重组（n=364）、保持超重组（n=171）、从超重发展为肥胖组（n=95）、保持肥胖组（n=37）、从正常体重发展为超重组（n=365）、从正常体重发展为肥胖组（n=63）、超重改善组（n=55）和肥胖改善组（n=20）。我们发现，在最后一次随访结束时的体检中，超重组的脑梗死发病率高于肥胖组和保持正常体重组（25.15%、18.92%、19.23%，P<0.05），相对风险分别为 1.31、0.98、1，人群归因风险分别为 0.10、-0.002、0。但肥胖组与保持正常体重组的脑梗死发病率无差异（P>0.05）。从正常体重发展为肥胖组和肥胖组的高血压发病率高于超重组和保持正常体重组（63.49%、56.76%、48.54%、36.54%，P<0.05），而上述四组的综合危险因素发病率分别为 75%、64%、63%、55%（P<0.05）。在脑梗死相关因素的逻辑回归分析中，选择了最后一次检查的腰围、糖尿病、从正常体重到超重状态的发展等（P<0.01），比值比（OR）值分别为 0.98、6.51、4.13（P<0.05）。超重改善组和肥胖改善组的脑梗死发病率分别为 29.09%、45.00%，相对风险值分别为 1.51、2.34，综合危险因素发病率分别为 48%、65%。本研究表明，中国老龄化人口中，有明显超重稳定期且无超重稳定期但进展为肥胖的人群，其疾病风险不同。前者脑梗死风险较高，后者易患高血压。在超重和肥胖的老龄化人群中，与脑梗死相关的危险因素的综合发病率显著增加，减肥治疗并不能降低脑梗死的发病率。因此，肥胖的老年患者应积极治疗高血压等危险因素，而不是热衷于减肥治疗。
