Cong X F, Zhao D H, Liu S B, Xu T L, Wang W J, Ma J X, Li J H
National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China.
Heilongjiang Provincial Center for Disease Control and Prevention, Harbin 150030, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2021 Sep 10;42(9):1586-1593. doi: 10.3760/cma.j.cn112338-20200714-00938.
To explore the relationship between body mass index (BMI), waist circumference (WC) and the risk for ischemic stroke in adults in China. A total of 36 632 adults were selected from 60 surveillance areas (25 urban surveillance areas and 35 rural surveillance areas) in China Chronic Disease Surveillance Project in 2010 for a follow up study from 2016 to 2017 based on the baseline data in 2010. The follow up was completed for 27 762 adults. Cox proportional hazard regression model was used to analyze the association of body mass index and waist circumference with the risk for ischemic stroke in different populations. The death and hypercholesterolemia cases were excluded by sensitivity analysis. A total of 26 907 adults were included in the analysis. During the follow up period, 1 128 ischemic stroke events were observed (491 in men and 637 in women). After adjusting the related confounding factors and taking normal BMI/normal WC group as the reference, the risk for ischemic stroke increased by 50% in normal BMI/abdominal obesity group (=1.50, 95%:1.07-2.08), 51% in overweight/abdominal obesity group (=1.51, 95%:1.20-1.91), 46% in obesity/abdominal obesity group (=1.46, 95%:1.09-1.96), and 63% in normal BMI/abdominal obesity group (=1.63, 95%:1.12-2.38), 56% in overweight/abdominal obesity group (=1.56, 95%: 1.20-2.03) and 45% in obesity/abdominal obesity group (=1.45, 95%: 1.05-2.01) respectively in men and in men with CVD risk factors. There was no increased risks in the overweight/normal WC group. The risk increased by 40% in overweight/abdominal obesity group (=1.40, 95%:1.15-1.72) and 46% in obesity/abdominal obesity group (=1.46, 95%:1.16-1.83), and 35% in overweight/abdominal obesity group (=1.35, 95%:1.08-1.69) and 30% in obesity/abdominal obesity group (=1.30, 95%:1.01-1.67) respectively in women and women with CVD risk factors. There were no risk increases in overweight/normal WC group and normal BMI/abdominal obesity group. Sensitivity analysis results showed no change. Overweight/obesity with abdominal obesity or abdominal obesity alone could increase the risk for stroke in men, and overweight/obesity with abdominal obesity could increase the risk for ischemic stroke in women; suggesting that BMI and WC should be used jointly to evaluate obesity in population for weight control to prevent ischemic stroke.
探索中国成年人身体质量指数（BMI）、腰围（WC）与缺血性中风风险之间的关系。2010年，从中国慢性病监测项目的60个监测地区（25个城市监测地区和35个农村监测地区）选取了36632名成年人，基于2010年的基线数据，于2016年至2017年进行随访研究。对27762名成年人完成了随访。采用Cox比例风险回归模型分析不同人群中身体质量指数和腰围与缺血性中风风险的关联。通过敏感性分析排除死亡和高胆固醇血症病例。共26907名成年人纳入分析。随访期间，观察到1128例缺血性中风事件（男性491例，女性637例）。调整相关混杂因素后，以正常BMI/正常WC组为参照，正常BMI/腹型肥胖组缺血性中风风险增加50%（风险比=1.50，95%置信区间：1.07 - 2.08），超重/腹型肥胖组增加51%（风险比=1.51，95%置信区间：1.20 - 1.91），肥胖/腹型肥胖组增加46%（风险比=1.46，95%置信区间：1.09 - 1.96）；在男性及有心血管疾病风险因素的男性中，正常BMI/腹型肥胖组缺血性中风风险增加63%（风险比=1.63，95%置信区间：1.12 - 2.38），超重/腹型肥胖组增加56%（风险比=1.56，95%置信区间：1.20 - 2.03），肥胖/腹型肥胖组增加45%（风险比=1.45，95%置信区间：1.05 - 2.01）。超重/正常WC组风险未增加。超重/腹型肥胖组风险增加40%（风险比=1.40，95%置信区间：1.15 - 1.72），肥胖/腹型肥胖组增加46%（风险比=1.46，95%置信区间：1.16 - 1.83）；在女性及有心血管疾病风险因素的女性中，超重/腹型肥胖组风险增加35%（风险比=1.35，95%置信区间：1.08 - 1.69），肥胖/腹型肥胖组增加30%（风险比=1.30，95%置信区间：1.01 - 1.67）。超重/正常WC组和正常BMI/腹型肥胖组风险未增加。敏感性分析结果无变化。超重/肥胖合并腹型肥胖或单独腹型肥胖均可增加男性中风风险，超重/肥胖合并腹型肥胖可增加女性缺血性中风风险；提示应联合使用BMI和WC评估人群肥胖情况以控制体重，预防缺血性中风。
