Vaidya Anand, Curhan Gary C, Paik Julie M, Wang Molin, Taylor Eric N
Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
J Bone Miner Res. 2017 Sep;32(9):1900-1906. doi: 10.1002/jbmr.3168. Epub 2017 Jun 12.
Greater body weight and fat mass have been associated with higher serum parathyroid hormone levels and a higher prevalence of primary hyperparathyroidism (P-HPTH) in women. However, prospective studies to evaluate whether greater body size associates with a higher incidence of developing P-HPTH have not been reported. We investigated whether greater body size was independently associated with a higher risk for developing P-HPTH in women. We conducted a prospective cohort study of 85,013 female participants in the Nurses' Health Study I followed for up to 26 years. Body size was measured via multiple metrics: weight, body mass index (BMI), and waist circumference (WC). Weight and BMI were assessed every 2 years from 1986 to 2012, and WC was assessed in 1986, 1996, and 2000. Detailed dietary and demographic exposures were quantified via validated biennial questionnaires. Incident cases of P-HPTH were confirmed by individual medical record review. Cox proportional hazards models were used to evaluate whether WC, weight, and BMI were independent risk factors for developing P-HPTH. Models were adjusted for demographic variables, comorbidities, medications, intakes of calcium and vitamin D, and exposure to ultraviolet light. We confirmed 491 incident cases of P-HPTH during 2,128,068 person-years of follow-up. The multivariable-adjusted relative risks for incident P-HPTH increased across quartiles of WC: Q1, ref; Q2, 1.34 (0.97, 1.86); Q3, 1.70 (1.24, 2.31); Q4, 2.27 (1.63, 3.18); p trend < 0.001. Similarly, the multivariable-adjusted risks for incident P-HPTH increased across quartiles of weight: Q1, ref; Q2, 1.23 (0.92, 1.65); Q3, 1.63 (1.24, 2.14); Q4, 1.65 (1.24, 2.19); p trend < 0.001. A similar but statistically non-significant trend was observed across quartiles of BMI (p trend = 0.07). In summary, body size may be an independent and modifiable risk factor for developing P-HPTH in women. © 2017 American Society for Bone and Mineral Research.
女性体重和脂肪量增加与血清甲状旁腺激素水平升高及原发性甲状旁腺功能亢进症（P-HPTH）患病率较高有关。然而，尚未有前瞻性研究评估更大的体型是否与发生P-HPTH的更高发病率相关。我们调查了更大的体型是否与女性发生P-HPTH的更高风险独立相关。我们对护士健康研究I中的85,013名女性参与者进行了一项前瞻性队列研究，随访长达26年。通过多种指标测量体型：体重、体重指数（BMI）和腰围（WC）。从1986年到2012年，每2年评估一次体重和BMI，在1986年、1996年和2000年评估WC。通过经过验证的两年一次的问卷对详细的饮食和人口统计学暴露进行量化。P-HPTH的发病病例通过个人病历审查得到确认。使用Cox比例风险模型评估WC、体重和BMI是否是发生P-HPTH的独立危险因素。模型针对人口统计学变量、合并症、药物、钙和维生素D的摄入量以及紫外线暴露进行了调整。在2,128,068人年的随访期间，我们确认了491例P-HPTH发病病例。WC四分位数中P-HPTH发病的多变量调整相对风险增加：第一四分位数，参照；第二四分位数，1.34（0.97，1.86）；第三四分位数，1.70（1.24，2.31）；第四四分位数，2.27（1.63，3.18）；p趋势<0.001。同样，体重四分位数中P-HPTH发病的多变量调整风险增加：第一四分位数，参照；第二四分位数，1.23（0.92，1.65）；第三四分位数，1.63（1.24，2.14）；第四四分位数，1.65（1.24，2.19）；p趋势<0.001。在BMI四分位数中观察到类似但无统计学意义的趋势（p趋势 = 0.07）。总之，体型可能是女性发生P-HPTH的一个独立且可改变的危险因素。© 2017美国骨与矿物质研究学会。
