Zahn Karl, Linseisen Jakob, Heier Margit, Peters Annette, Thorand Barbara, Nairz Franziska, Meisinger Christa
Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology II, Neuherberg, Germany.
Institute for Medical Informatics, Biometry and Epidemiology (IBE), Munich, Germany.
PLoS One. 2018 Feb 5;13(2):e0191630. doi: 10.1371/journal.pone.0191630. eCollection 2018.
It remains controversial whether measures of general or abdominal adiposity are better risk predictors for ischemic stroke. Furthermore, so far it is unclear whether body fat mass index (BFMI) and fat free mass index (FFMI) are risk predictors for ischemic stroke. This study examined the sex-specific relevance of body mass index (BMI), BROCA Index, waist circumference (WC), waist-height ratio (WHtR), BFMI and FFMI for the development of ischemic stroke in a Caucasian population.
The prospective population-based cohort study was based on 1917 men and 1832 women (aged 50 to 74 years) who participated in the third (1994/95) or fourth (1999/2001) MONICA/KORA Augsburg survey. Subjects were free of stroke at baseline. Standardized anthropometric and bioelectric impedance measurements were obtained at baseline. Hazard ratios (HR) were estimated from Cox proportional hazard models.
During a median follow-up of 9.3 years 128 ischemic strokes occurred in men and 81 in women, respectively. Coded as quartiles WC and WHtR were significantly associated with incident stroke in multivariable analyses in women (comparing the 4th vs. the bottom quartile), but none of the adiposity measures was significantly associated with incident stroke in multivariable adjusted analyses in men. When anthropometric measures were used as continuous variables, these findings were confirmed. After multivariable adjustment the associations between obesity measures and incident ischemic stroke were statistically significant only for WC (HR 1.39, 95%CI 1.12-1.72) and WHtR in women (HR 1.39, 95%CI 1.12-1.73) per increase of 1 standard deviation. In both sexes the measures BFMI and FFMI were no independent predictors for incident ischemic stroke.
Abdominal obesity measures are independent predictors of incident ischemic stroke in women but not in men from the general adult population. Thus, it may be of particular importance for women to prevent central obesity in order to reduce their risk of ischemic stroke.
一般肥胖或腹部肥胖指标是否为缺血性中风更好的风险预测指标仍存在争议。此外，迄今为止尚不清楚体脂质量指数（BFMI）和去脂体重指数（FFMI）是否为缺血性中风的风险预测指标。本研究调查了体重指数（BMI）、布罗卡指数、腰围（WC）、腰高比（WHtR）、BFMI和FFMI在白种人群中对缺血性中风发生的性别特异性相关性。
这项基于人群的前瞻性队列研究基于1917名男性和1832名女性（年龄50至74岁），他们参与了第三次（1994/95年）或第四次（1999/2001年）奥格斯堡地区的莫妮卡/科拉研究。受试者在基线时无中风。在基线时进行标准化人体测量和生物电阻抗测量。风险比（HR）由Cox比例风险模型估计。
在中位随访9.3年期间，男性发生128例缺血性中风，女性发生81例。在多变量分析中，按四分位数编码的WC和WHtR与女性的中风事件显著相关（比较第4四分位数与最低四分位数），但在男性的多变量调整分析中，没有一项肥胖指标与中风事件显著相关。当将人体测量指标用作连续变量时，这些结果得到证实。多变量调整后，肥胖指标与缺血性中风事件之间的关联仅在女性中，WC每增加1个标准差时具有统计学意义（HR 1.39，95%CI 1.12-1.72），WHtR（HR 1.39，95%CI 1.12-1.73）。在两性中，BFMI和FFMI指标均不是缺血性中风事件的独立预测指标。
腹部肥胖指标是一般成年女性缺血性中风事件的独立预测指标，但不是男性的。因此，对女性而言，预防中心性肥胖对于降低其缺血性中风风险可能尤为重要。
