Krüger Anja, Willems van Dijk Ko, van Heemst Diana, Noordam Raymond
Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands.
Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands; Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands; Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, the Netherlands.
Atherosclerosis. 2025 Apr;403:119135. doi: 10.1016/j.atherosclerosis.2025.119135. Epub 2025 Feb 20.
Most epidemiological studies ignore long-term burden, gain and variability in body weight in assessing cardiometabolic disease risk. We investigated the associations of body mass index (BMI) trajectories measured by general practitioners with incident type 2 diabetes (T2D) and coronary artery disease (CAD).
We used electronic healthcare data from 111,615 European-ancestry participants from UK Biobank (57.1 (SD 7.8) years, 59.6 % women) with at least three BMI measurements (median trajectory period: 14.9 [interquartile range 9.5, 20.1] years). We calculated six variables capturing different long-term aspects, including i.e. burden (long-term average, area under the curve), gain (slope) and variability (standard deviation, average of the [absolute] consecutive BMI differences). The variables were used in principal component (PC) analyses and k-means clustering. Newly-derived dimensions and subgroups were used as exposures in cox-proportional hazard models.
The BMI-trajectory indices were captured in two PCs reflecting BMI burden and BMI gain. The BMI-burden PC associated with higher T2D (hazard ratio [95 % confidence interval] per SD higher PC: 1.57 [1.55,1.60]) and CAD (1.17 [1.15,1.19]) risks, while weak or no associations were observed with the BMI-gain PC (T2D: 1.03 [1.01,1.05]; CAD: 1.01 [0.98,1.03]). Participants with the highest BMI burden, compared to those with lowest BMI burden without significant gain, had highest T2D (6.96 [6.41,7.55]) and CAD (1.57 [1.45,1.69]) risks. Both methods to capture BMI burden, gain and variability showed superior model fit compared to a single baseline BMI assessment.
Long-term high BMI burden, irrespective of BMI gain, was a risk factor for cardiometabolic disease.
大多数流行病学研究在评估心血管代谢疾病风险时忽略了体重的长期负担、增加量及变异性。我们调查了全科医生测量的体重指数（BMI）轨迹与2型糖尿病（T2D）和冠状动脉疾病（CAD）发病之间的关联。
我们使用了来自英国生物银行的111615名欧洲血统参与者的电子医疗数据（年龄57.1[标准差7.8]岁，女性占59.6%），这些参与者至少有三次BMI测量值（中位轨迹期：14.9[四分位间距9.5，20.1]年）。我们计算了六个变量，以反映不同的长期情况，包括负担（长期平均值、曲线下面积）、增加量（斜率）和变异性（标准差、[绝对]连续BMI差值的平均值）。这些变量用于主成分（PC）分析和k均值聚类。新得出的维度和亚组用作Cox比例风险模型中的暴露因素。
BMI轨迹指数在反映BMI负担和BMI增加量的两个主成分中得以体现。BMI负担主成分与更高的T2D风险（每标准差更高的主成分的风险比[95%置信区间]：1.57[1.55，1.60]）和CAD风险（1.17[1.15，1.19]）相关，而与BMI增加量主成分的关联较弱或无关联（T2D：1.03[1.01，1.05]；CAD：1.01[0.98，1.03]）。与BMI负担最低且无显著增加的参与者相比，BMI负担最高的参与者患T2D（6.96[6.41，7.55]）和CAD（1.57[1.45，1.69]）的风险最高。与单一的基线BMI评估相比，两种捕捉BMI负担、增加量和变异性的方法均显示出更好的模型拟合度。
无论BMI增加情况如何，长期高BMI负担都是心血管代谢疾病的一个危险因素。
