The Israel Defense Forces Medical Corps, Tel Hashomer, Ramat Gan, Israel.
The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Cardiovasc Diabetol. 2018 Jun 5;17(1):80. doi: 10.1186/s12933-018-0727-7.
Most studies linking long-term consequences of adolescent underweight and obesity are limited to men.
To assess the sex-specific association of adolescent BMI with cardiovascular- and non-cardiovascular-related mortality in young adulthood and midlife.
A nationwide cohort.
927,868 women, 1,366,271 men.
Medical examination data at age 17, including BMI, were linked to the national death registry.
Death attributed to cardiovascular (CVD) and non-CVD causes.
During 17,346,230 women-years and 28,367,431 men-years of follow-up, there were 451 and 3208 CVD deaths, respectively, and 6235 and 22,223 non-CVD deaths, respectively. Compared to low-normal BMI (18.5-22.0 kg/m), underweight women had a lower adjusted risk for CVD mortality (Cox hazard ratio (HR) = 0.68; 95% CI 0.46-0.98) in contrast to underweight men (HR = 0.99; 0.88-1.13). The latter were at higher risk for non-CVD mortality (HR = 1.04; 1.00-1.09), unlike underweight women (HR = 1.01; 0.93-1.10). Findings, which persisted when the study sample was limited to those with unimpaired health, were accentuated for the obese with ≥ 30 years follow-up. Both sexes exhibited similarly higher risk estimates already in the high-normal BMI range (22.0 ≤ BMI < 25.0 kg/m) with overall no interaction between sex and BMI (p = 0.62). Adjusted spline models suggested lower BMI values for minimal mortality risk among women (16.8 and 18.2 kg/m) than men (18.8 and 20.0 kg/m), for CVD and non-CVD death, respectively.
Underweight adolescent females have favorable cardiovascular outcomes in adulthood. Otherwise the risk patterns were similar between the sexes. The optimal BMI value for women and men with respect to future CVD outcomes is within or below the currently accepted low-normal BMI range.
大多数将青少年体重不足和肥胖与长期后果联系起来的研究仅限于男性。
评估青少年 BMI 与年轻人和中年期心血管和非心血管相关死亡率之间的性别特异性关联。
全国性队列研究。
927868 名女性，1366271 名男性。
17 岁时的体检数据，包括 BMI，与国家死亡登记处相关联。
归因于心血管疾病（CVD）和非 CVD 原因的死亡。
在 17346230 名女性年和 28367431 名男性年的随访中，分别有 451 例和 3208 例 CVD 死亡，分别有 6235 例和 22223 例非 CVD 死亡。与低正常 BMI（18.5-22.0 kg/m）相比，体重不足的女性患 CVD 死亡率的调整风险较低（Cox 风险比（HR）=0.68；95%CI 0.46-0.98），而体重不足的男性（HR=0.99；0.88-1.13）则相反。后者的非 CVD 死亡率风险更高（HR=1.04；1.00-1.09），而体重不足的女性则不然（HR=1.01；0.93-1.10）。当研究样本仅限于健康状况不受影响的人群时，这些发现仍然存在，并且在随访时间≥30 年的肥胖人群中更为明显。在高正常 BMI 范围（22.0 kg/m≤BMI<25.0 kg/m）中，两种性别都表现出更高的风险估计值，而且性别和 BMI 之间没有相互作用（p=0.62）。调整后的样条模型表明，女性（CVD 和非 CVD 死亡的分别为 16.8 和 18.2 kg/m）的 BMI 值低于男性（18.8 和 20.0 kg/m）的最小死亡率风险。
青少年女性体重不足时，成年后患心血管疾病的风险较低。否则，两性之间的风险模式相似。对于女性和男性来说，未来 CVD 结局的最佳 BMI 值在目前接受的低正常 BMI 范围内或以下。
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