N.E. Marchand, ScD, J.A. Sparks, MD, MMSc, S.K. Tedeschi, MD, MPH, S. Malspeis, K.H. Costenbader, MD, MPH, E.W. Karlson, MD, B. Lu, MD, DrPH, Division of Rheumatology, Inflammation and Immunity, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
J Rheumatol. 2021 Feb;48(2):165-173. doi: 10.3899/jrheum.200056. Epub 2020 Jul 15.
Being overweight or obese increases rheumatoid arthritis (RA) risk among women, particularly among those diagnosed at a younger age. Abdominal obesity may contribute to systemic inflammation more than general obesity; thus, we investigated whether abdominal obesity, compared to general obesity, predicted RA risk in 2 prospective cohorts: the Nurses' Health Study (NHS) and NHS II.
We followed 50,682 women (1986-2014) in NHS and 47,597 women (1993-2015) in NHS II, without RA at baseline. Waist circumference (WC), BMI, health outcomes, and covariate data were collected through biennial questionnaires. Incident RA cases and serologic status were identified by chart review. We examined the associations of WC and BMI with RA risk using time-varying Cox proportional hazards models. We repeated analyses restricted to age ≤ 55 years.
During 28 years of follow-up, we identified 844 incident RA cases (527 NHS, 317 NHS II). Women with WC > 88 cm (35 in) had increased RA risk (HR 1.22, 95% CI 1.06-1.41). A similar association was observed for seropositive RA, which was stronger among young and middle-aged women. Further adjustment for BMI attenuated the association to null. In contrast, BMI was associated with RA (HR 1.33, 95% CI 1.05-1.68) and seropositive RA, even after adjusting for WC, and, as in WC analyses, this association was stronger among young and middle-aged women.
Abdominal obesity was associated with increased RA risk, particularly for seropositive RA, among young and middle-aged women; however, it did not independently contribute to RA risk beyond general obesity.
超重或肥胖会增加女性患类风湿关节炎（RA）的风险，尤其是在年龄较小被诊断出的女性。腹部肥胖比一般肥胖更容易导致全身炎症；因此，我们在两个前瞻性队列研究中调查了腹部肥胖与一般肥胖相比是否能预测 RA 风险：护士健康研究（NHS）和 NHS II。
我们随访了 50682 名女性（1986-2014 年），她们在 NHS 中没有 RA 病史，47597 名女性（1993-2015 年）在 NHS II 中没有 RA 病史。通过每两年一次的问卷收集腰围（WC）、BMI、健康结果和协变量数据。通过病历审查确定 RA 病例和血清学状态。我们使用时间依赖性 Cox 比例风险模型检查了 WC 和 BMI 与 RA 风险的关系。我们重复了年龄≤55 岁的分析。
在 28 年的随访期间，我们发现了 844 例新发 RA 病例（527 例 NHS，317 例 NHS II）。WC＞88cm（35 英寸）的女性 RA 风险增加（HR 1.22，95%CI 1.06-1.41）。对于血清阳性 RA，也观察到了类似的关联，而且这种关联在年轻和中年女性中更强。进一步调整 BMI 后，这种关联减弱到无统计学意义。相比之下，BMI 与 RA（HR 1.33，95%CI 1.05-1.68）和血清阳性 RA 相关，即使在调整 WC 后也是如此，而且与 WC 分析一样，这种关联在年轻和中年女性中更强。
腹部肥胖与年轻和中年女性的 RA 风险增加相关，尤其是与血清阳性 RA 相关；然而，它与一般肥胖相比，对 RA 风险的独立贡献不大。
