Shin Koh Eun, Lee Gyu Bae, Han Kyungdo, Son Ho-Sung, Jung Jae-Seung, Han Byoung Duck, Kim Yang-Hyun, Kim Hee Jung
Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea.
Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea.
J Cardiol. 2025 May 6. doi: 10.1016/j.jjcc.2025.04.014.
In general, obesity is associated with infectious diseases, however, the relationship between underweight and infectious disease is controversial. Moreover, the association between body mass index (BMI) and the incidence of infective endocarditis (IE) has not been studied to date. Therefore, we investigated the relationship between BMI and incidence of IE in the Korean population.
We analyzed 4,080,331 participants (mean age 47.12 ± 14.13 years) from the National Health Insurance health checkup database. Hazard ratios (HRs) and 95 % confidence intervals (CIs) for IE incidence according to five BMI levels were calculated using multivariable Cox proportional hazards models with or without IE risk.
During the 9-year follow-up, the incidence rate of IE was 3.244 persons per 100,000 person-years in the underweight group, 2.023 in normal weight, 2.105 in overweight, 2.133 in obesity stage I, and 3.294 in obesity stage II. After adjusting for all covariates, overall HR for the incidence of IE increased among participants with IE risk in all BMI levels compared to subjects without IE risk when the normal weight group without IE risk was designated as the reference group. An increase in the HR for the incidence of IE was observed only in underweight subjects in both the total and no IE risk groups [HR: 2.01 (95 % CI, 1.46-2.77); HR: 2.01 (95 % CI, 1.45-2.78)].
Underweight is associated with increased risk of developing IE, especially in subjects without IE risk. Considering increasing incidence of IE, clinicians should pay more attention to underweight patients with no IE risks.
一般而言，肥胖与传染病相关，然而，体重过轻与传染病之间的关系存在争议。此外，迄今为止，体重指数（BMI）与感染性心内膜炎（IE）发病率之间的关联尚未得到研究。因此，我们调查了韩国人群中BMI与IE发病率之间的关系。
我们分析了来自国民健康保险健康检查数据库的4,080,331名参与者（平均年龄47.12±14.13岁）。使用多变量Cox比例风险模型计算了根据五个BMI水平的IE发病率的风险比（HRs）和95%置信区间（CIs），模型考虑了有无IE风险。
在9年的随访期间，体重过轻组的IE发病率为每10万人年3.244人，正常体重组为2.023人，超重组为2.105人，肥胖I期为2.133人，肥胖II期为3.294人。在对所有协变量进行调整后，当将无IE风险的正常体重组指定为参考组时，与无IE风险的受试者相比，所有BMI水平中有IE风险的参与者中IE发病率的总体HR均增加。仅在总体组和无IE风险组的体重过轻受试者中观察到IE发病率的HR增加[HR：2.01（95%CI，1.46 - 2.77）；HR：2.01（95%CI，1.45 - 2.78）]。
体重过轻与发生IE的风险增加相关，尤其是在无IE风险的受试者中。考虑到IE发病率不断上升，临床医生应更加关注无IE风险的体重过轻患者。
