Department of Emergency, Hechi People's Hospital, Hechi, Guangxi Zhuang Autonomous Region, China.
Department of Rehabilitation, Shenzhen Dapeng New District Nan'ao People's Hospital, Shenzhen, Guangdong, China.
Front Endocrinol (Lausanne). 2023 Jul 5;14:1203896. doi: 10.3389/fendo.2023.1203896. eCollection 2023.
Body mass index (BMI) and stroke risk have been linked, but these findings are still debated. This study investigated the relationship between BMI and stroke risk in a middle-aged and elderly Chinese population.
This study used four waves of CHARLS data (2011, 2013, 2015, and 2018), including 12,161 participants. The CHARLS sample was obtained by multi-stage probability sampling and all participants were assessed by one-to-one interviews using a standardized questionnaire. We used a Cox proportional-hazards regression model to examine the relationship between BMI and stroke risk. We used Cox proportional hazards regression with cubic spline functions and smooth curve fitting to identify the non-linear relationship between them. A series of sensitivity analyses were also conducted.
The multivariate Cox proportional hazards regression model identified a positive association between BMI and stroke risk (HR=1.025, 95% CI: 1.010-1.040). We also found a non-linear relationship between BMI and stroke incidence, with an inflection point at 26.63 kg/m for BMI. Each 1 kg/m increase in BMI to the left of the inflection point was related to a 4.4% increase in stroke risk (HR=1.044, 95% CI: 1.019-1.069). We stratified individuals by gender to further investigate their association and found a particular non-linear relationship and saturation effect between BMI and stroke risk in men, with the inflection point at 25.94 kg/m. Each 1 kg/m increase in BMI to the left of the inflection point was related to a 7.6% increase in stroke risk (HR=1.076, 95% CI 1.034-1.119). The association was linear in women, with each 1 kg/m increase in BMI associated with a 2.1% increase in stroke risk (HR=1.021, 95% CI 1.002, 1.040).
In men, there was a specific non-linear association and saturation effect of BMI with stroke (inflection point of 25.94 kg/m), while in women, there was none. When males had a BMI below 25.94 kg/m, the risk of stroke was significantly and positively associated with BMI. By controlling BMI below 25.94 kg/m in men, a further decrease in BMI may promote a significant reduction in stroke risk.
体重指数（BMI）与中风风险之间存在关联，但这些发现仍存在争议。本研究旨在调查中年和老年中国人群中 BMI 与中风风险之间的关系。
本研究使用了 CHARLS 数据的四个波次（2011 年、2013 年、2015 年和 2018 年），共包括 12161 名参与者。CHARLS 样本通过多阶段概率抽样获得，所有参与者均通过一对一访谈使用标准化问卷进行评估。我们使用 Cox 比例风险回归模型来检验 BMI 与中风风险之间的关系。我们使用 Cox 比例风险回归和三次样条函数以及平滑曲线拟合来识别它们之间的非线性关系。还进行了一系列敏感性分析。
多变量 Cox 比例风险回归模型确定 BMI 与中风风险之间存在正相关关系（HR=1.025，95%CI：1.010-1.040）。我们还发现 BMI 与中风发病率之间存在非线性关系，BMI 的拐点为 26.63kg/m。BMI 每增加 1kg/m 到拐点左侧，中风风险增加 4.4%（HR=1.044，95%CI：1.019-1.069）。我们按性别对个体进行分层，以进一步探讨其相关性，发现男性 BMI 与中风风险之间存在特定的非线性关系和饱和效应，BMI 的拐点为 25.94kg/m。BMI 每增加 1kg/m 到拐点左侧，中风风险增加 7.6%（HR=1.076，95%CI 1.034-1.119）。在女性中，这种关联是线性的，BMI 每增加 1kg/m，中风风险增加 2.1%（HR=1.021，95%CI 1.002，1.040）。
在男性中，BMI 与中风（拐点为 25.94kg/m）之间存在特定的非线性关联和饱和效应，而在女性中则没有。当男性 BMI 低于 25.94kg/m 时，中风风险与 BMI 呈显著正相关。通过控制男性 BMI 低于 25.94kg/m，可以进一步降低 BMI，从而显著降低中风风险。
