Overweight, obesity, and risk of cardiometabolic multimorbidity: pooled analysis of individual-level data for 120 813 adults from 16 cohort studies from the USA and Europe.
Overweight, obesity, and risk of cardiometabolic multimorbidity: pooled analysis of individual-level data for 120 813 adults from 16 cohort studies from the USA and Europe.
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DOI：
10.1016/s2468-2667(17)30074-9
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发表时间：
2017-06
期刊：
影响因子：
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通讯作者：
Jokela M
中科院分区：
文献类型：
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作者：
Kivimäki M;Kuosma E;Ferrie JE;Luukkonen R;Nyberg ST;Alfredsson L;Batty GD;Brunner EJ;Fransson E;Goldberg M;Knutsson A;Koskenvuo M;Nordin M;Oksanen T;Pentti J;Rugulies R;Shipley MJ;Singh-Manoux A;Steptoe A;Suominen SB;Theorell T;Vahtera J;Virtanen M;Westerholm P;Westerlund H;Zins M;Hamer M;Bell JA;Tabak AG;Jokela M
尽管已经研究了超重和肥胖与个体心脏代谢疾病的关系，但人们对它们与心脏代谢多种疾病风险的关系知之甚少。在这里，我们的目的是确定超重和肥胖的成年人与健康体重的成年人相比，发生心脏代谢多种疾病（即至少两种疾病：2 型糖尿病、冠心病和中风）的风险。我们汇集了来自美国和欧洲 16 项前瞻性队列研究的个体参与者 BMI 和心脏代谢多重发病率数据。参与分析的参与者年龄为 35 岁或以上，并且拥有基线 BMI 以及基线和随访时 2 型糖尿病、冠心病和中风的可用数据。我们排除了在研究基线时或之前诊断为糖尿病、冠心病或中风的参与者。根据世界卫生组织的建议，我们将BMI分为健康（20·0–24·9 kg/m2）、超重（25·0–29·9 kg/m2）、I级（轻度）肥胖（30·0–34·9 kg/m2）和II级和III级（重度）肥胖（≥35·0 kg/m2）。我们使用了体重不足（<20 kg/m2）的包容性定义，以获得足够的病例数进行分析。主要结果是心脏代谢多发病（即至少发生两种疾病：2 型糖尿病、冠心病和中风）。通过重新调查或与电子病历（包括入院和死亡）的链接来确定事件心脏代谢多发病。我们使用逻辑回归分别分析每个队列的数据，然后使用随机效应荟萃分析汇总特定队列的估计值。参与者为 120 813 名成年人（平均年龄 51·4 岁，范围 35-103；71 445 名女性），在研究基线（1973-2012 年）时没有糖尿病、冠心病或中风。在平均 10·7 年（1995 年至 2014 年）的随访期间，我们发现了 1627 例多重发病病例。调整社会人口统计学和生活方式因素后，与体重健康的个体相比，超重个体发生心脏代谢多种疾病的风险高出两倍（比值比 [OR] 2·0，95% CI 1·7–2·4；p<0·0001），I 级肥胖个体的风险几乎高出五倍（4·5、3·5–5·8； p<0·0001)，而 II 级和 III 级肥胖者加起来几乎高出 15 倍 (14·5、10·1–21·0；p<0·0001)。这种关联在男性和女性、年轻人和老年人、白人和非白人参与者中都存在，并且不依赖于暴露评估或结果确定的方法。在对心脏代谢状况的不同组合进行分析时，仅血管疾病（冠心病或中风）与 II 级和 III 级肥胖相关的比值比为 2·2 (95% CI 1·9–2·6)，血管疾病随后是糖尿病的比值比为 12·0 (8·1–17·9)，糖尿病的比值比为 18·6 (16·6–20·9) 仅对于糖尿病，其次是血管疾病为 29·8 (21·7–40·8)。随着体重指数的增加，心脏代谢多种疾病的风险也会增加；与体重指数健康的人相比，超重者的两倍到严重肥胖者的十倍以上。我们的研究结果强调临床医生需要积极筛查患有血管疾病的超重和肥胖患者的糖尿病，并更加关注肥胖糖尿病患者血管疾病的预防。 NordForsk、医学研究委员会、英国癌症研究中心、芬兰工作环境基金会和芬兰科学院。
Although overweight and obesity have been studied in relation to individual cardiometabolic diseases, their association with risk of cardiometabolic multimorbidity is poorly understood. Here we aimed to establish the risk of incident cardiometabolic multimorbidity (ie, at least two from: type 2 diabetes, coronary heart disease, and stroke) in adults who are overweight and obese compared with those who are a healthy weight. We pooled individual-participant data for BMI and incident cardiometabolic multimorbidity from 16 prospective cohort studies from the USA and Europe. Participants included in the analyses were 35 years or older and had data available for BMI at baseline and for type 2 diabetes, coronary heart disease, and stroke at baseline and follow-up. We excluded participants with a diagnosis of diabetes, coronary heart disease, or stroke at or before study baseline. According to WHO recommendations, we classified BMI into categories of healthy (20·0–24·9 kg/m2), overweight (25·0–29·9 kg/m2), class I (mild) obesity (30·0–34·9 kg/m2), and class II and III (severe) obesity (≥35·0 kg/m2). We used an inclusive definition of underweight (<20 kg/m2) to achieve sufficient case numbers for analysis. The main outcome was cardiometabolic multimorbidity (ie, developing at least two from: type 2 diabetes, coronary heart disease, and stroke). Incident cardiometabolic multimorbidity was ascertained via resurvey or linkage to electronic medical records (including hospital admissions and death). We analysed data from each cohort separately using logistic regression and then pooled cohort-specific estimates using random-effects meta-analysis. Participants were 120 813 adults (mean age 51·4 years, range 35–103; 71 445 women) who did not have diabetes, coronary heart disease, or stroke at study baseline (1973–2012). During a mean follow-up of 10·7 years (1995–2014), we identified 1627 cases of multimorbidity. After adjustment for sociodemographic and lifestyle factors, compared with individuals with a healthy weight, the risk of developing cardiometabolic multimorbidity in overweight individuals was twice as high (odds ratio [OR] 2·0, 95% CI 1·7–2·4; p<0·0001), almost five times higher for individuals with class I obesity (4·5, 3·5–5·8; p<0·0001), and almost 15 times higher for individuals with classes II and III obesity combined (14·5, 10·1–21·0; p<0·0001). This association was noted in men and women, young and old, and white and non-white participants, and was not dependent on the method of exposure assessment or outcome ascertainment. In analyses of different combinations of cardiometabolic conditions, odds ratios associated with classes II and III obesity were 2·2 (95% CI 1·9–2·6) for vascular disease only (coronary heart disease or stroke), 12·0 (8·1–17·9) for vascular disease followed by diabetes, 18·6 (16·6–20·9) for diabetes only, and 29·8 (21·7–40·8) for diabetes followed by vascular disease. The risk of cardiometabolic multimorbidity increases as BMI increases; from double in overweight people to more than ten times in severely obese people compared with individuals with a healthy BMI. Our findings highlight the need for clinicians to actively screen for diabetes in overweight and obese patients with vascular disease, and pay increased attention to prevention of vascular disease in obese individuals with diabetes. NordForsk, Medical Research Council, Cancer Research UK, Finnish Work Environment Fund, and Academy of Finland.