Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden.
Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.
Clin Nutr. 2021 Nov;40(11):5467-5474. doi: 10.1016/j.clnu.2021.09.030. Epub 2021 Sep 29.
BACKGROUND & AIMS: The association between higher body mass index (BMI) and cardiometabolic diseases (CMDs, including type 2 diabetes and cardiovascular diseases) is not well understood. We aimed to examine the association of BMI and its long-term changes with cardiometabolic diseases (CMDs) and explore the role of familial background and healthy lifestyle in this association. METHODS: Within the Swedish Twin Registry, 36 622 CMD-free individuals aged ≥40 were followed for up to 16 years. BMI data was collected at baseline and 25-35 years prior to baseline. Healthy lifestyle (non-smoking, no/mild alcohol consumption, and regular physical activity) was assessed as unfavourable (none or only one of these factors) vs. favourable (two or three). Incident CMDs were identified by linkage with the Swedish National Patient Registry. Two strategies were followed: 1) Cox models in all twin individuals; 2) stratified Cox models in CMD-discordant twin pairs. RESULTS: At baseline, 16 195 (44.2%) study participants had overweight/obesity (BMI ≥ 25 kg/m) and 11 202 (30.6%) developed CMDs over follow-up. Among all participants, the hazard ratio (HR) and 95% confidence interval (CI) of developing any CMD was 1.52 (1.45-1.58) for people with overweight/obesity compared to normal BMI (20-25 kg/m). Compared to stable normal BMI, HRs (95% CIs) of CMDs were 1.28 (1.02-1.59) and 1.33 (1.24-1.43) for only earlier life or only later life overweight/obesity, respectively, and 1.69 (1.55-1.85) for overweight/obesity both in earlier and later life. In stratified Cox analyses conducted among all CMD-discordant twin pairs, overweight/obesity was associated with greater risk of CMDs (1.37, 95% CI 1.18-1.61). In joint effect analysis, the risk of CMDs related to overweight/obesity was diminished 32% among people with a favourable lifestyle (1.51, 95% CI 1.44-1.58) compared to those with overweight/obesity and an unfavourable lifestyle (2.20, 95% CI 2.03-2.38). CONCLUSIONS: Overweight/obesity is associated with an increased risk of CMDs, and shared genetic and early-life environmental factors might not account for this association. However, a favourable lifestyle could attenuate the risk of high BMI-related CMDs.
背景与目的：较高的体重指数（BMI）与心血管代谢疾病（CMD，包括 2 型糖尿病和心血管疾病）之间的关联尚未得到充分理解。我们旨在研究 BMI 及其长期变化与心血管代谢疾病（CMD）之间的关联，并探讨家族背景和健康生活方式在这种关联中的作用。
方法：在瑞典双胞胎登记处，对 36622 名年龄≥40 岁且无 CMD 的个体进行了长达 16 年的随访。在基线和基线前 25-35 年收集 BMI 数据。健康的生活方式（不吸烟、不饮酒或轻度饮酒、定期进行身体活动）被评估为不利（无或只有一个因素）与有利（两个或三个因素）。通过与瑞典国家患者登记处的链接确定新发 CMD。遵循了两种策略：1）所有双胞胎个体的 Cox 模型；2）CMD 不一致双胞胎对的分层 Cox 模型。
结果：在基线时，16195 名（44.2%）研究参与者超重/肥胖（BMI≥25kg/m），11202 名（30.6%）在随访期间发生 CMD。在所有参与者中，与正常 BMI（20-25kg/m）相比，超重/肥胖者发生任何 CMD 的风险比（HR）和 95%置信区间（CI）为 1.52（1.45-1.58）。与稳定的正常 BMI 相比，仅早生期或仅晚生期超重/肥胖者发生 CMD 的 HR（95%CI）分别为 1.28（1.02-1.59）和 1.33（1.24-1.43），而早生期和晚生期均超重/肥胖者的 HR 为 1.69（1.55-1.85）。在对所有 CMD 不一致双胞胎对进行的分层 Cox 分析中，超重/肥胖与 CMDs 风险增加相关（1.37，95%CI 1.18-1.61）。在联合效应分析中，与超重/肥胖相关的 CMDs 风险在生活方式良好的人群中降低了 32%（1.51，95%CI 1.44-1.58），而在超重/肥胖且生活方式不良的人群中则降低了 32%（2.20，95%CI 2.03-2.38）。
结论：超重/肥胖与 CMDs 风险增加相关，共同的遗传和早期环境因素可能无法解释这种关联。然而，健康的生活方式可以减轻 BMI 相关 CMDs 的风险。
Eur Heart J. 2023-2-14
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