Weight, weight change, and coronary heart disease in women. Risk within the 'normal' weight range.
Weight, weight change, and coronary heart disease in women. Risk within the 'normal' weight range.
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DOI：
10.1001/jama.1995.03520300035033
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发表时间：
1995-02
期刊：
影响因子：
--
通讯作者：
W. Willett;J. Manson;M. Stampfer;G. Colditz;B. Rosner;F. Speizer;C. Hennekens
中科院分区：
文献类型：
--
作者：
W. Willett;J. Manson;M. Stampfer;G. Colditz;B. Rosner;F. Speizer;C. Hennekens
目的：评估1990年美国女性体重指南的有效性，该指南支持在35岁左右体重大幅增加，并推荐体重指数（BMI）（定义为体重（kg）除以身高（m）的平方）范围为21至27 kg/m2，以女性冠心病（CHD）风险为依据。设计--前瞻性队列研究。环境--美国注册护士。参与者--1976年，共有115，818名年龄在30至55岁之间、无既往CHD病史的女性。主要观察指标--冠心病的发生率，定义为非致死性心肌梗死或致死性冠心病。结果：在14年的随访中，共确诊冠心病1292例。在控制年龄、吸烟、绝经状态、绝经后激素使用和父母CHD病史后，以BMI小于21 kg/m2的女性作为参照，CHD的相对危险度（RR）和95%置信区间（CI）为1.19（0.97 - 1.44）BMI为21 - 22.9 kg/m2，1.46对于BMI为23至24.9kg/m2，其为2.06（1.72至2.48），对于BMI为25至28.9kg/m2，其为3.56（2.96至4.29），对于BMI为29 kg/m2或更高。在控制相同变量以及18岁时BMI的分析中，将18岁时体重增加的女性与体重稳定（+/- 5 kg）的女性进行比较。5- 7.9 kg增重的RR和CI为1.25（1.01 - 1.55），8- 10.9 kg增重的RR和CI为1.64（1.33 - 2.04），11- 19 kg增重的RR和CI为1.92（1.61 - 2.29），20 kg或以上增重的RR和CI为2.65（2.17 - 3.22）。在BMI范围为18至25 kg/m2的女性中，18岁后的体重增加仍然是CHD风险的强有力预测因素。结论：在“正常”范围内较高的体重水平，以及18岁后适度的体重增加，似乎增加了中年女性冠心病的风险。这些数据提供的证据表明，目前的美国体重指南可能会错误地让大部分年龄超过35岁的女性放心，这些女性在目前的指南范围内，但有潜在的可避免的冠心病风险。
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.