Willett W C, Manson J E, Stampfer M J, Colditz G A, Rosner B, Speizer F E, Hennekens C H
Channing Laboratory, Brigham and Women's Hospital, Boston, MA.
JAMA. 1995 Feb 8;273(6):461-5. doi: 10.1001/jama.1995.03520300035033.
OBJECTIVE--To assess the validity of the 1990 US weight guidelines for women that support a substantial gain in weight at approximately 35 years of age and recommend a range of body mass index (BMI) (defined as weight in kilograms divided by the square of height in meters) from 21 to 27 kg/m2, in terms of coronary heart disease (CHD) risk in women. DESIGN--Prospective cohort study. SETTING--Female registered nurses in the United States. PARTICIPANTS--A total of 115,818 women aged 30 to 55 years in 1976 and without a history of previous CHD. MAIN OUTCOME MEASURE--Incidence of CHD defined as nonfatal myocardial infarction or fatal CHD. RESULTS--During 14 years of follow-up, 1292 cases of CHD were ascertained. After controlling for age, smoking, menopausal status, postmenopausal hormone use, and parental history of CHD and using as a reference women with a BMI of less than 21 kg/m2, relative risks (RRs) and 95% confidence intervals (CIs) for CHD were 1.19 (0.97 to 1.44) for a BMI of 21 to 22.9 kg/m2, 1.46 (1.20 to 1.77) for a BMI of 23 to 24.9 kg/m2, 2.06 (1.72 to 2.48) for a BMI of 25 to 28.9 kg/m2, and 3.56 (2.96 to 4.29) for a BMI of 29 kg/m2 or more. Women who gained weight from 18 years of age were compared with those with stable weight (+/- 5 kg) in analyses that controlled for the same variables as well as BMI at 18 years of age. The RRs and CIs were 1.25 (1.01 to 1.55) for a 5- to 7.9-kg gain, 1.64 (1.33 to 2.04) for an 8- to 10.9-kg gain, 1.92 (1.61 to 2.29) for an 11- to 19-kg gain, and 2.65 (2.17 to 3.22) for a gain of 20 kg or more. Among women with the BMI range of 18 to 25 kg/m2, weight gain after 18 years of age remained a strong predictor of CHD risk. CONCLUSIONS--Higher levels of body weight within the "normal" range, as well as modest weight gains after 18 years of age, appear to increase risks of CHD in middle-aged women. These data provide evidence that current US weight guidelines may be falsely reassuring to the large proportion of women older than 35 years who are within the current guidelines but have potentially avoidable risks of CHD.
目的——评估1990年美国女性体重指南的有效性，该指南支持大约35岁时大幅增加体重，并建议体重指数（BMI，定义为体重千克数除以身高米数的平方）范围为21至27kg/m²，从女性冠心病（CHD）风险方面进行评估。
设计——前瞻性队列研究。
地点——美国注册女护士。
参与者——1976年共有115818名年龄在30至55岁之间且无既往冠心病病史的女性。
主要结局指标——冠心病发病率定义为非致命性心肌梗死或致命性冠心病。
结果——在14年的随访期间，确诊了1292例冠心病病例。在控制了年龄、吸烟、绝经状态、绝经后激素使用以及冠心病家族史后，以BMI小于21kg/m²的女性为参照，BMI为21至22.9kg/m²时冠心病的相对风险（RRs）及95%置信区间（CIs）为1.19（0.97至1.44），BMI为23至24.9kg/m²时为1.46（1.20至1.77），BMI为25至28.9kg/m²时为2.06（1.72至2.48），BMI为29kg/m²及以上时为3.56（2.96至4.29）。在控制相同变量以及18岁时BMI的分析中，将18岁后体重增加的女性与体重稳定（±5kg）的女性进行比较。体重增加5至7.9kg时RRs及CIs为1.25（1.01至1.55），体重增加8至10.9kg时为1.64（1.33至2.04），体重增加11至19kg时为1.92（1.61至2.29），体重增加20kg及以上时为2.65（2.17至3.22）。在BMI范围为18至25kg/m²的女性中，18岁后体重增加仍然是冠心病风险的有力预测因素。
结论——“正常”范围内较高的体重水平，以及18岁后适度的体重增加，似乎会增加中年女性患冠心病的风险。这些数据表明，当前美国的体重指南可能会让很大一部分年龄超过35岁且处于当前指南范围内但有潜在可避免冠心病风险的女性产生错误的安心感。
