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一般和中心性肥胖在心血管代谢性多种疾病中的作用:使用多状态模型重新探讨肥胖悖论。

Roles of general and central adiposity in cardiometabolic multimorbidity: revisiting the obesity paradox using a multistate model.

机构信息

Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

出版信息

Obesity (Silver Spring). 2024 Apr;32(4):810-821. doi: 10.1002/oby.23980. Epub 2024 Jan 28.

Abstract

OBJECTIVE

The objective of this study was to evaluate the associations of general and central obesity with risk of first cardiometabolic disease (FCMD), cardiometabolic multimorbidity (CMM), and death.

METHODS

A total of 86,169 participants who were CMD-free were included from the Kailuan cohort and categorized into four groups by quartiles of BMI, waist to hip ratio (WHR), weight-adjusted waist index, and waist to height ratio. We defined FCMD as the first onset of diabetes, stroke, or myocardial infarction and CMM as co-occurrence of at least two CMDs. Multistate models were used to estimate hazard ratios and 95% CI.

RESULTS

A total of 18,461 participants developed FCMD, of whom 1476 progressed to CMM, and 10,009 died during follow-ups. Both general and central adiposity indices increased the risk of transition from baseline to FCMD and from FCMD to CMM. However, compared with the first quartile, the hazard ratio (95% CI) of the fourth quartile of BMI was 0.86 (95% CI: 0.80-0.91) for transition from health to death and 0.66 (95% CI: 0.59-0.74) from FCMD to death, whereas the corresponding estimates of WHR were 1.22 (95% CI: 1.14-1.31) and 1.16 (95% CI: 1.02-1.32), respectively.

CONCLUSIONS

Central adiposity indices such as WHR were associated with an increased risk of CMD and mortality, showing no evidence for the obesity paradox and thereby supporting a shift of public focus from BMI only to both general obesity and adiposity distribution.

摘要

目的

本研究旨在评估全身肥胖和中心型肥胖与首发心血管代谢疾病(FCMD)、心血管代谢性多种疾病(CMM)和死亡风险的相关性。

方法

本研究共纳入了来自开滦队列的 86169 名无心血管代谢疾病的参与者,并根据 BMI、腰围臀围比(WHR)、体重校正腰围指数和腰围身高比的四分位数将其分为四组。我们将 FCMD 定义为糖尿病、中风或心肌梗死的首次发病,CMM 定义为至少两种心血管代谢疾病的同时发生。多状态模型用于估计风险比和 95%置信区间。

结果

共有 18461 名参与者发生了 FCMD,其中 1476 名进展为 CMM,10009 名在随访期间死亡。全身和中心型肥胖指标均增加了从基线到 FCMD 和从 FCMD 到 CMM 的风险转变。然而,与第一四分位相比,BMI 第四四分位的风险比(95%置信区间)从健康到死亡为 0.86(95%置信区间:0.80-0.91),从 FCMD 到死亡为 0.66(95%置信区间:0.59-0.74),而 WHR 的相应估计值分别为 1.22(95%置信区间:1.14-1.31)和 1.16(95%置信区间:1.02-1.32)。

结论

中心型肥胖指标如 WHR 与心血管代谢疾病和死亡率的风险增加相关,这表明肥胖悖论不存在,因此支持将公众关注点从 BMI 转变为全身肥胖和肥胖分布。

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