高 BMI 与低 ALS 风险相关：一项基于人群的研究。
High BMI is associated with low ALS risk: A population-based study.
机构信息
From the Institute of Clinical Medicine, Campus Ahus (O.N., T.H.), and Department of Community Medicine and Global Health, Institute of Health and Society (H.E.M., H.S.), University of Oslo; Department of Neurology (O.N., T.H.), Akershus University Hospital, Lørenskog; and Department of Chronic Diseases and Ageing (H.E.M., H.S.), Norwegian Institute of Public Health, Oslo, Norway.
出版信息
Neurology. 2019 Jul 30;93(5):e424-e432. doi: 10.1212/WNL.0000000000007861. Epub 2019 Jun 26.
OBJECTIVE
To investigate the temporal relationship among prediagnostic body mass index (BMI), weight change, and risk of amyotrophic lateral sclerosis (ALS).
METHODS
From the compulsory Norwegian tuberculosis screening program, we collected objectively measured BMI from 85% of all citizens (near 1.5 million) between 20 and 70 years of age living in 18 of 19 Norwegian counties between 1963 and 1975. For those who participated in later health surveys, we collected further information on weight change, lifestyle, and health. We identified ALS cases until September 2017 through national registries of diagnoses at death and at encounters with the specialist health service. Both Cox hazard models and flexible parametric survival models were fitted to address our research question.
RESULTS
We identified 2,968 ALS cases during a mean of 33 (maximum 54) years follow-up. High prediagnostic BMI was associated with low subsequent ALS risk across the typical ALS ages in both sexes. Overall, hazard ratio (HR) for ALS per 5-unit increase in prediagnostic BMI was 0.83 (95% confidence interval [CI] 0.79-0.88). After an initial increase during the first 10 years, it decreased almost linearly throughout the observation period and was 0.69 (95% CI 0.62-0.77) after 50 years. Those in the quartile with highest weight gain had lower ALS risk than those in the lowest quartile (HR 0.63, 95% CI 0.44-0.89).
CONCLUSION
High BMI and weight gain are associated with low ALS risk several decades later. The strength of the association between BMI and ALS risk increases up to 50 years after BMI measurement.
目的
研究诊断前体重指数（BMI）、体重变化与肌萎缩侧索硬化症（ALS）风险之间的时间关系。
方法
从强制性挪威结核病筛查计划中，我们收集了 1963 年至 1975 年间生活在挪威 19 个郡中 18 个郡的 18 至 70 岁之间的近 150 万公民的 BMI 进行了客观测量。对于那些参加了后来健康调查的人，我们收集了关于体重变化、生活方式和健康的进一步信息。我们通过全国死亡诊断和专科医疗服务就诊登记册，在 2017 年 9 月之前确定了 ALS 病例。我们使用 Cox 风险模型和灵活参数生存模型来回答我们的研究问题。
结果
在平均 33 年（最长 54 年）的随访中，我们确定了 2968 例 ALS 病例。在男女典型 ALS 年龄中，高诊断前 BMI 与较低的后续 ALS 风险相关。总体而言，每增加 5 个单位的 BMI ，ALS 的风险比为 0.83（95%置信区间 [CI] 0.79-0.88）。在最初的 10 年增加后，它几乎呈线性下降，在观察期结束时为 0.69（95% CI 0.62-0.77）。体重增加最多的四分位数比体重增加最少的四分位数的 ALS 风险低（HR 0.63，95% CI 0.44-0.89）。
结论
高 BMI 和体重增加与几十年后 ALS 风险较低有关。BMI 与 ALS 风险之间的关联强度在 BMI 测量后长达 50 年增加。
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