Meng Miaomiao, Guo Yixin, Kuang Zhuoran, Liu Lingling, Cai Yefeng, Ni Xiaojia
The Second Clinical School, Guangzhou University of Chinese Medicine, Guangzhou, China.
Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China.
Front Cardiovasc Med. 2022 Apr 25;9:844550. doi: 10.3389/fcvm.2022.844550. eCollection 2022.
Overweight/obesity is a modified risk factor for stroke. This systematic review and meta-analysis aimed to assess the impact of different obesity phenotypes on stroke risk in adults.
The PubMed, Embase, and Cochrane Library databases were searched from their inception to 7 March 2021 to identify the prospective cohort studies investigating stroke risk among different metabolic overweight/obesity phenotypes. The methodological quality of the included studies was evaluated using the Newcastle-Ottawa Scale. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using a random-effects model.
A total of eleven prospective cohorts ( = 5,609,945 participants) were included in the systematic review, nine of which were included in the meta-analysis. All metabolically unhealthy phenotypes had a higher risk of stroke than the metabolically healthy normal-weight phenotypes, including metabolically unhealthy normal weight (HR = 1.63, 95% CI: 1.41-1.89, = 89.74%, = 7 cohort studies, 1,042,542 participants), metabolically unhealthy overweight (HR = 1.94, 95% CI: 1.58-2.40, = 91.17%, = 4 cohort studies, 676,166 participants), and metabolically unhealthy obese (HR = 1.99, 95% CI: 1.66-2.40, = 93.49%, = 6 cohort studies, 1,035,420 participants) phenotypes. However, no risk of stroke was observed in the populations with metabolically healthy overweight (MHOW) (HR = 1.07, 95% CI: 1.00-1.14, = 69.50%, = 5 studies, 4,171,943 participants) and metabolically healthy obese (MHO) (HR = 1.07, 95% CI: 0.99-1.16, = 54.82%, = 8 studies, 5,333,485 participants) phenotypes. The subgroup analyses for the MHO studies suggested that the risk of stroke increased only when the MHO participants were mainly females, from North America, and when the World Health Organization standard was applied to define obesity. In the subgroup analysis of the risk of stroke in MHOW, a longer follow-up duration was also associated with a higher risk of stroke.
The risk of stroke increase for all metabolically unhealthy phenotypes irrespective of the body mass index (BMI). The associated risk of stroke with metabolic health but high BMI shows substantial heterogeneity, which requires future research considering the impact of sex and transition of the metabolic status on the risk of stroke.
The study protocol was prospectively registered in PROSPERO (No. CRD42021251021).
超重/肥胖是中风的一个可改变的风险因素。本系统评价和荟萃分析旨在评估不同肥胖表型对成年人中风风险的影响。
检索PubMed、Embase和Cochrane图书馆数据库自建库至2021年3月7日的文献，以确定调查不同代谢性超重/肥胖表型中风风险的前瞻性队列研究。使用纽卡斯尔-渥太华量表评估纳入研究的方法学质量。采用随机效应模型计算合并风险比（HR）及95%置信区间（CI）。
系统评价共纳入11项前瞻性队列研究（n = 5,609,945名参与者），其中9项纳入荟萃分析。所有代谢不健康表型的中风风险均高于代谢健康的正常体重表型，包括代谢不健康的正常体重（HR = 1.63，95% CI：1.41 - 1.89，I² = 89.74%，7项队列研究，1,042,542名参与者）、代谢不健康的超重（HR = 1.94，95% CI：1.58 - 2.40，I² = 91.17%，4项队列研究，676,166名参与者）和代谢不健康的肥胖（HR = 1.99，95% CI：1.66 - 2.40，I² = 93.49%，6项队列研究，1,035,420名参与者）表型。然而，在代谢健康的超重（MHOW）人群（HR = 1.07，95% CI：1.00 - 1.14，I² = 69.50%，5项研究，4,171,943名参与者）和代谢健康的肥胖（MHO）人群（HR = 1.07，95% CI：0.99 - 1.16，I² = 54.82%，8项研究，5,333,485名参与者）中未观察到中风风险增加。MHO研究的亚组分析表明，仅当MHO参与者主要为女性、来自北美且采用世界卫生组织标准定义肥胖时，中风风险才会增加。在MHOW中风风险的亚组分析中，较长的随访时间也与较高的中风风险相关。
所有代谢不健康表型的中风风险均增加，与体重指数（BMI）无关。代谢健康但BMI高的相关中风风险存在显著异质性，这需要未来研究考虑性别和代谢状态转变对中风风险的影响。
该研究方案已在PROSPERO前瞻性注册（编号CRD42021251021）。
