韩国年轻人中肥胖或体重变化与冠心病的关系。

Association of Obesity or Weight Change With Coronary Heart Disease Among Young Adults in South Korea.

机构信息

Department of Biomedical Sciences, College of Medicine, Seoul National University, Seoul, South Korea.

Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea.

出版信息

JAMA Intern Med. 2018 Aug 1;178(8):1060-1068. doi: 10.1001/jamainternmed.2018.2310.

DOI:10.1001/jamainternmed.2018.2310

PMID:29913019

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6143106/

Abstract

IMPORTANCE

Previous studies have shown a U- or J-shaped association of body mass index (BMI) or change in BMI with coronary heart disease (CHD) among middle-aged and elderly adults. However, whether a similar association exists among young adults is unclear.

OBJECTIVE

To determine whether an association exists between BMI or BMI change with CHD among young adults.

DESIGN, SETTING, AND PARTICIPANTS: This population-based longitudinal study used data obtained by the Korean National Health Insurance Service from 2002 to 2015. The study population comprised 2 611 450 men and women aged between 20 and 39 years who underwent 2 health examinations, the first between 2002 and 2003 and the second between 2004 and 2005.

EXPOSURES

World Health Organization Western Pacific Region guideline BMI categories of underweight, normal weight, overweight, obese grade 1, and obese grade 2 derived during the first health examination and change in BMI calculated during the second health examination.

MAIN OUTCOMES AND MEASURES

Body mass index (calculated as weight in kilograms divided by height in meters squared). Absolute risks (ARs), adjusted hazard ratios (aHRs), and 95% CIs for acute myocardial infarction or CHD during follow-up from 2006 to 2015.

RESULTS

Data from 1 802 408 men with a mean (SD) age of 35.1 (4.8) years and 809 042 women with a mean (SD) age of 32.5 (6.3) years were included. The mean (SD) BMI was 23.2 (3.2) for the total population, 24.0 (3.0) for men, and 21.4 (2.9) for women. Compared with normal weight men, overweight (AR, 1.38%; aHR, 1.18 [95% CI, 1.14-1.22]), obese grade 1 (AR, 1.86%; aHR, 1.45 [95% CI, 1.41-1.50]), and obese grade 2 (AR, 2.69%; aHR, 1.97 [95% CI, 1.86-2.08]) men had an increased risk of CHD (P < .001 for trend). Similarly, compared with normal weight women, overweight (AR, 0.77%; aHR, 1.34 [95% CI, 1.24-1.46]), obese grade 1 (AR, 0.95%; aHR, 1.52 [95% CI, 1.39-1.66]), and obese grade 2 (AR, 1.01%; aHR, 1.64 [95% CI, 1.34-2.01]) women had an increased risk of CHD (P < .001 for trend). Compared with participants who maintained their weight at normal levels, those who became obese had elevated CHD risk among men (0.35% increase in AR; aHR, 1.35 [95% CI, 1.17-1.55]) and women (0.13% increase in AR; aHR, 1.31 [95% CI, 0.95-1.82]). Weight loss to normal levels among obese participants was associated with reduced CHD risk for men (0.58% decrease in AR; aHR, 0.77 [95% CI, 0.64-0.94]) and women (0.57% decrease in AR; aHR, 0.66 [95% CI, 0.45-0.98]).

CONCLUSIONS AND RELEVANCE

Obesity and weight gain were associated with elevated risk of CHD among young adults in this study. Studies that prospectively determine the association between weight change and CHD risk are needed to validate these findings.

摘要

重要性

先前的研究表明，在中年和老年人中，体重指数（BMI）或 BMI 变化与冠心病（CHD）之间呈 U 型或 J 型关联。然而，在年轻人中是否存在类似的关联尚不清楚。

目的

确定 BMI 或 BMI 变化与年轻人 CHD 之间是否存在关联。

设计、地点和参与者：这项基于人群的纵向研究使用了韩国国家健康保险服务公司 2002 年至 2015 年的数据。研究人群包括 2611450 名年龄在 20 至 39 岁之间的男女，他们接受了 2 次健康检查，第一次在 2002 年至 2003 年之间，第二次在 2004 年至 2005 年之间。

暴露因素

在第一次健康检查期间得出的世界卫生组织西太平洋地区体重指数类别，包括体重不足、正常体重、超重、肥胖 1 级和肥胖 2 级，以及在第二次健康检查期间计算的 BMI 变化。

主要结果和测量指标

体重指数（计算为体重千克数除以身高米数的平方）。随访期间急性心肌梗死或 CHD 的绝对风险（AR）、调整后的危险比（aHR）和 95%置信区间（2006 年至 2015 年）。

结果

纳入了 1802408 名男性，平均（SD）年龄为 35.1（4.8）岁，809042 名女性，平均（SD）年龄为 32.5（6.3）岁。总人群的平均（SD）BMI 为 23.2（3.2），男性为 24.0（3.0），女性为 21.4（2.9）。与正常体重男性相比，超重（AR，1.38%；aHR，1.18[95%CI，1.14-1.22]）、肥胖 1 级（AR，1.86%；aHR，1.45[95%CI，1.41-1.50]）和肥胖 2 级（AR，2.69%；aHR，1.97[95%CI，1.86-2.08]）男性发生 CHD 的风险增加（趋势 P<0.001）。同样，与正常体重女性相比，超重（AR，0.77%；aHR，1.34[95%CI，1.24-1.46]）、肥胖 1 级（AR，0.95%；aHR，1.52[95%CI，1.39-1.66]）和肥胖 2 级（AR，1.01%；aHR，1.64[95%CI，1.34-2.01]）女性发生 CHD 的风险增加（趋势 P<0.001）。与体重保持正常水平的参与者相比，体重增加的参与者患 CHD 的风险增加（男性 AR 增加 0.35%；aHR，1.35[95%CI，1.17-1.55]；女性 AR 增加 0.13%；aHR，1.31[95%CI，0.95-1.82]）。肥胖参与者体重降至正常水平与 CHD 风险降低相关（男性 AR 降低 0.58%；aHR，0.77[95%CI，0.64-0.94]；女性 AR 降低 0.57%；aHR，0.66[95%CI，0.45-0.98]）。