A prospective study of body mass index, weight change, and risk of stroke in women.
A prospective study of body mass index, weight change, and risk of stroke in women.
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DOI：
10.1001/jama.1997.03540430051032
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发表时间：
1997-05
期刊：
影响因子：
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通讯作者：
K. Rexrode;C. Hennekens;W. Willett;G. Colditz;M. Stampfer;J. Rich-Edwards;F. Speizer;J. Manson
中科院分区：
文献类型：
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作者：
K. Rexrode;C. Hennekens;W. Willett;G. Colditz;M. Stampfer;J. Rich-Edwards;F. Speizer;J. Manson
目的探讨女性体重指数（BMI）和体重变化与脑卒中风险的关系。背景与设计：对参加护士健康研究的美国女性注册护士进行前瞻性队列研究。研究对象：1976年，年龄30 ~ 55岁，无冠心病、中风和癌症的女性共116759例。主要观察指标缺血性卒中、出血性卒中（蛛网膜下腔或脑实质内出血）和总卒中的发生率。结果在16年的随访中，共记录了866例卒中（包括403例缺血性卒中和269例出血性卒中）。在多变量分析中，调整了年龄、吸烟、绝经后激素使用和绝经状态，（≥ 27 kg/m2）的患者发生缺血性卒中的风险显著增加，相对风险（RR）为1.75（95%置信区间[CI]，1.17-2.59），BMI为27 - 28.9 kg/m2; 1.90与BMI小于21 kg/m2的患者相比，BMI为29至31.9 kg/m2的患者的平均风险为2.37（95% CI，1.28-2.82）; BMI为32 kg/m2或更高的患者的平均风险为2.37（95% CI，1.60-3.50）（趋势P <.001）。对于出血性中风，肥胖和出血性中风之间没有显著的负相关关系，在BMI最瘦的女性中风险最高（趋势P = 0.20）。与缺血性卒中相比，总卒中的RR有所减弱，但BMI较高的女性RR仍较高（趋势P <0.001）。在校正了18岁时BMI的多变量分析中，从18岁到1976年的体重增加与缺血性卒中的RR为1.69相关（95% CI，1.26-2.29），增重11 - 19.9 kg和2.52（95%CI，1.80-3.52）增加20公斤或更多（P趋势<0.001），与保持稳定体重（损失或增加<5公斤）的妇女相比。虽然体重变化与出血性卒中风险无关（趋势P = 0.20），但体重增加与总卒中风险之间存在直接关系（趋势P <0.001）。结论：这些前瞻性数据表明，女性肥胖和体重增加是缺血性和完全性卒中的重要危险因素，但不是出血性卒中的危险因素。肥胖与总卒中之间的关系取决于人群中卒中亚型的分布。
OBJECTIVE To examine the associations of body mass index (BMI) and weight change with risk of stroke in women. SETTING AND DESIGN Prospective cohort study among US female registered nurses participating in the Nurses' Health Study. PARTICIPANTS A total of 116759 women aged 30 to 55 years in 1976 who were free from diagnosed coronary heart disease, stroke, and cancer. MAIN OUTCOME MEASURE Incidence of ischemic stroke, hemorrhagic stroke (subarachnoid or intraparenchymal hemorrhage), and total stroke. RESULTS During 16 years of follow-up, 866 total strokes (including 403 ischemic strokes and 269 hemorrhagic strokes) were documented. In multivariate analyses adjusted for age, smoking, postmenopausal hormone use, and menopausal status, women with increased BMI (> or =27 kg/m2) had significantly increased risk of ischemic stroke, with relative risks (RRs) of 1.75 (95% confidence interval [CI], 1.17-2.59) for BMI of 27 to 28.9 kg/m2; 1.90 (95% CI, 1.28-2.82) for BMI of 29 to 31.9 kg/m2; and 2.37 (95% CI, 1.60-3.50) for BMI of 32 kg/m2 or more (P for trend<.001), as compared with those with a BMI of less than 21 kg/m2. For hemorrhagic stroke there was a nonsignificant inverse relation between obesity and hemorrhagic stroke, with the highest risk among women in the leanest BMI category (P for trend=.20). For total stroke the RRs were somewhat attenuated compared with those for ischemic stroke but remained elevated for women with higher BMI (P for trend<.001). In multivariate analyses that also adjusted for BMI at age 18 years, weight gain from age 18 years until 1976 was associated with an RR for ischemic stroke of 1.69 (95% CI, 1.26-2.29) for a gain of 11 to 19.9 kg and 2.52 (95% CI, 1.80-3.52) for a gain of 20 kg or more (P for trend<.001), as compared with women who maintained stable weight (loss or gain <5 kg). Although weight change was not related to risk of hemorrhagic stroke (P for trend=.20), a direct relationship was observed between weight gain and total stroke risk (P for trend<.001). CONCLUSIONS These prospective data indicate that both obesity and weight gain in women are important risk factors for ischemic and total stroke but not hemorrhagic stroke. The relationship between obesity and total stroke depends on the distribution of stroke subtypes in the population.