Gjærde Line K, Gamborg Michael, Ängquist Lars, Truelsen Thomas C, Sørensen Thorkild I A, Baker Jennifer L
Novo Nordisk Foundation Center for Basic Metabolic Research, Section for Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Department of Clinical Epidemiology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.
JAMA Neurol. 2017 Nov 1;74(11):1312-1318. doi: 10.1001/jamaneurol.2017.1627.
The incidence of ischemic stroke among young adults is rising and is potentially due to an increase in stroke risk factors occurring at younger ages, such as obesity.
To investigate whether childhood body mass index (BMI) and change in BMI are associated with adult ischemic stroke and to assess whether the associations are age dependent or influenced by birth weight.
DESIGN, SETTING, AND PARTICIPANTS: This investigation was a population-based cohort study of schoolchildren born from 1930 to 1987, with follow-up through national health registers from 1977 to 2012 in Denmark. Participants were 307 677 individuals (8899 ischemic stroke cases) with measured weight and height at ages 7 to 13 years. The dates of the analysis were September 1, 2015, to May 27, 2016.
Childhood BMI, change in BMI, and birth weight. Ischemic stroke events were divided into early (≤55 years) or late (>55 years) age at diagnosis.
The study cohort comprised 307 677 participants (approximately 49% female and 51% male). During the study period, 3529 women and 5370 men experienced an ischemic stroke. At all ages from 7 to 13 years, an above-average BMI z score was positively associated with early ischemic stroke. At age 13 years, a BMI z score of 1 was associated with hazard ratios (HRs) of 1.26 (95% CI, 1.11-1.43) in women and 1.21 (95% CI, 1.10-1.33) in men. No significant associations were found for below-average BMI z scores. Among children with above-average BMI z scores at age 7 years, a score increase of 0.5 from ages 7 to 13 years was positively associated with early ischemic stroke in women (HR, 1.10; 95% CI, 1.01-1.20) and in men (HR, 1.08; 95% CI, 1.00-1.16). Similarly, among children with below-average BMI z scores at age 7 years, a score increase of 0.5 from ages 7 to 13 years was positively associated with early ischemic stroke in women (HR, 1.14; 95% CI, 1.06-1.23) and in men (HR, 1.10; 95% CI, 1.04-1.18). Adjusting for birth weight minimally affected the associations.
Independent of birth weight, above-average childhood BMI and increases in BMI during childhood are positively associated with early adult ischemic stroke. To avoid the occurrence of early ischemic stroke associated with childhood overweight and obesity, these results suggest that all children should be helped to attain and maintain healthy weights.
年轻成年人缺血性中风的发病率正在上升，这可能是由于中风危险因素在更年轻的年龄段出现增加，比如肥胖。
调查儿童期体重指数（BMI）及BMI变化是否与成人缺血性中风相关，并评估这些关联是否存在年龄依赖性或受出生体重影响。
设计、背景和参与者：本研究是一项基于人群的队列研究，研究对象为1930年至1987年出生的学童，通过丹麦国家健康登记系统从1977年至2012年进行随访。参与者为307677名个体（8899例缺血性中风病例），在7至13岁时测量了体重和身高。分析日期为2015年9月1日至2016年5月27日。
儿童期BMI、BMI变化和出生体重。缺血性中风事件分为诊断时年龄较早（≤55岁）或较晚（>55岁）。
研究队列包括307677名参与者（约49%为女性，51%为男性）。在研究期间，3529名女性和5370名男性发生了缺血性中风。在7至13岁的所有年龄段，高于平均水平的BMI z评分与早期缺血性中风呈正相关。在13岁时，BMI z评分为1与女性的风险比（HR）为1.26（95%CI，1.11 - 1.43），男性为1.21（95%CI，1.10 - 1.33）。低于平均水平的BMI z评分未发现显著关联。在7岁时BMI z评分高于平均水平的儿童中，7至13岁时评分增加0.5与女性早期缺血性中风呈正相关（HR，1.10；95%CI，1.01 - 1.20），男性为（HR，l.08；95%CI，1.00 - 1.16）。同样，在7岁时BMI z评分低于平均水平的儿童中，7至13岁时评分增加0.5与女性早期缺血性中风呈正相关（HR，1.14；95%CI，1.06 - 1.23），男性为（HR，1.10；95%CI，1.04 - 1.18）。调整出生体重对这些关联影响极小。
独立于出生体重，儿童期高于平均水平的BMI以及儿童期BMI的增加与成人早期缺血性中风呈正相关。为避免与儿童超重和肥胖相关的早期缺血性中风的发生，这些结果表明应帮助所有儿童达到并维持健康体重。
