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1.
《Preventive medicine》2008,46(6):436-441
Objective.To determine how change in BMI over 8 years is associated with risk of subsequent cardiovascular disease (CVD) among middle aged men.Methods.Prospective cohort study among 13,230 healthy men (aged 51.6 ± 8.7 years) in the Physicians' Health Study. BMI was collected at baseline in 1982 and after 8 years, at which time follow-up began. Subsequent CVD events were collected and confirmed through March 31, 2005. Cox proportional hazards models evaluated BMI at 8 years and risk of CVD, 8-year change in BMI and risk of CVD, and whether change in BMI added prognostic information after the consideration of BMI at 8 years.Results.1308 major CVD events occurred over 13.5 years. A higher BMI at year 8 was associated with an increased risk of CVD. Compared to a stable BMI (± 0.5 kg/m2), a 0.5–2.0 kg/m2 increase had a multivariable-adjusted RR of 1.00 (0.86–1.16). A ≥ 2.0 kg/m2 increase had a multivariable-adjusted RR of 1.39 (1.16–1.68), however further adjustment for BMI reduced the RR to 1.00 (0.81–1.23). A decrease in BMI had a multivariable RR of 1.23 (1.07–1.42) which was unaffected by adjustment for BMI at 8 years.Conclusion.A higher BMI and a rising BMI were both associated with an increased risk of CVD, however an increasing BMI did not add prognostic information once current BMI was considered. In contrast, a declining BMI was associated with an increased risk of CVD independent of current BMI.  相似文献   

2.
CONTEXT: The benefit of weight reduction for cardiovascular disease (CVD) outcomes remains uncertain. OBJECTIVE: To examine the effects of baseline body mass index on major CVD outcomes and diabetes over a 20 year follow up, and of weight change in the first five years over the subsequent 15 years. DESIGN AND SETTING: A prospective study of British men followed up for 20 years. PARTICIPANTS: Men aged 40-59 years with no diagnosis of CVD or diabetes (n = 7176) of whom 6798 provided full information on weight change five years later. OUTCOME MEASURES: Major CVD events (fatal and non-fatal myocardial infarction and stroke, angina, "other" CVD deaths) and diabetes. RESULTS: During the 20 year follow up there were 1989 major CVD events and 449 incident cases of diabetes in the 7176 men. Risk of major CVD and diabetes increased significantly with increasing overweight and obesity. During the 15 year follow up, weight gain was associated with increased risk of CVD and diabetes. Weight loss was associated with lower risk of diabetes than the stable group irrespective of initial weight. No significant cardiovascular benefit was seen for weight loss in any men, except possibly in considerably overweight (BMI 27.5-29.9 kg/m(2)) younger middle aged men (RR = 0.42; 95% CI 0.22 to 0.81). CONCLUSION: Long term risk of CVD and diabetes increased significantly with increasing overweight and obesity. Weight loss was associated with significant reduction in risk of diabetes but not CVD, except possibly in considerably overweight younger men. Duration and severity of obesity seem to limit the cardiovascular benefits of weight reduction in older men.  相似文献   

3.
目的分析中国成年人体质指数(BMI)和腰围与肾结石住院风险的关联。方法本研究利用中国慢性病前瞻性研究的长期随访数据, 剔除基线自报患有慢性肾病、恶性肿瘤、BMI和腰围为极端值的研究对象, 最终纳入502 096人。采用Cox比例风险回归模型分析BMI和腰围与肾结石住院风险之间的关联。结果研究对象随访(10.7±2.2)年, 随访期间记录肾结石导致的首次住院共12 396例。调整潜在混杂因素后, 以BMI(kg/m2)20.5~22.4者为参照组, <18.5、18.5~20.4、22.5~23.9、24.0~25.9、26.0~27.9、28.0~29.9、≥30.0者的风险比(HR)(95%CI)依次为:0.96(0.87~1.05)、0.94(0.88~1.00)、1.11(1.05~1.17)、1.25(1.18~1.32)、1.29(1.21~1.37)、1.39(1.28~1.50)、1.54(1.40~1.71);BMI每增加1 kg/m2, 肾结石住院风险的HR值增加4%(HR=1.04, 95%CI:1.04~1.05)。与腰围(cm)75.0~79.9者相比, ...  相似文献   

4.
OBJECTIVES: In previous studies, we have shown that obesity is associated with increased cardiovascular disease (CVD) mortality in white women but not in black women. Earlier research suggests that body mass index (BMI) has a greater effect on CVD mortality in younger white females than older white females, whereas this relationship in black women is not as clear. This study examines the effect of age on the association of BMI to CVD in black and white women. METHODS: The Black Pooling Project includes data on 2,843 black women with 50,464 person-years of follow-up, and 12,739 white women with 214,606 person-years of follow-up. A Cox proportional hazards model was used to examine the association between BMI and CVD mortality for specific age/race groups. The younger group was < 60 years of age and the older group was > 60 years of age. RESULTS: In younger white women, the relative risk (95% confidence interval [CI]) for CVD mortality was significant in obese women (BMI > 30 kg/m2) vs. women of normal weight (BMI 18.5-24.9 kg/m2) (1.59 [CI 1.20, 2.09]). Similarly, in older white women, the relative risk for CVD mortality in obese women vs. women of normal weight was significant (1.21 [CI 1.04, 1.41]). There were no such associations for black women. Overweight (BMI 25-29.9 kg/m2) was not associated with increased risk in black or white women. CONCLUSION: These findings indicate that obesity is associated with a significantly greater risk of CVD mortality among white women, with the strongest association among white women < 60 years of age.  相似文献   

5.
The authors examined the association between waist circumference and mortality among 154,776 men and 90,757 women aged 51-72 years at baseline (1996-1997) in the NIH-AARP Diet and Health Study. Additionally, the combined effects of waist circumference and body mass index (BMI; weight (kg)/height (m)(2)) were examined. All-cause mortality was assessed over 9 years of follow-up (1996-2005). After adjustment for BMI and other covariates, a large waist circumference (fifth quintile vs. second) was associated with an approximately 25% increased mortality risk (men: hazard ratio (HR) = 1.22, 95% confidence interval (CI): 1.15, 1.29; women: HR = 1.28, 95% CI: 1.16, 1.41). The waist circumference-mortality association was found in persons with and without prevalent disease, in smokers and nonsmokers, and across different racial/ethnic groups (non-Hispanic Whites, non-Hispanic Blacks, Hispanics, and Asians). Compared with subjects with a combination of normal BMI (18.5-<25) and normal waist circumference, those in the normal-BMI group with a large waist circumference (men: > or =102 cm; women: > or =88 cm) had an approximately 20% higher mortality risk (men: HR = 1.23, 95% CI: 1.08, 1.39; women: HR = 1.22, 95% CI: 1.09, 1.36). The finding that persons with a normal BMI but a large waist circumference had a higher mortality risk in this study suggests that increased waist circumference should be considered a risk factor for mortality, in addition to BMI.  相似文献   

6.
BACKGROUND: Whereas obesity has been associated with an increased risk of colon cancer in men, a weak or no association has been observed in women. Results for rectal cancer have also been inconsistent. OBJECTIVE: The objective was to perform a meta-analysis to summarize the available evidence from prospective studies on the associations of overall and abdominal obesity with the risk of colon and rectal cancer. DESIGN: We searched MEDLINE (1966-April 2007) and the references of the retrieved articles. Study-specific relative risks (RRs) were pooled by using a random-effects model. RESULTS: Thirty prospective studies were included in the meta-analysis of body mass index (BMI; in kg/m(2)). Overall, a 5-unit increase in BMI was related to an increased risk of colon cancer in both men (RR: 1.30; 95% CI: 1.25, 1.35) and women (RR: 1.12; 95% CI: 1.07, 1.18), but the association was stronger in men (P < 0.001). BMI was positively associated with rectal cancer in men (RR: 1.12; 95% CI: 1.09, 1.16) but not in women (RR: 1.03; 95% CI: 0.99, 1.08). The difference in RRs between cancer sites was statistically significant (P < 0.001 in men and P = 0.04 in women). Colon cancer risk increased with increasing waist circumference (per 10-cm increase) in both men (RR: 1.33; 95% CI: 1.19, 1.49) and women (RR: 1.16; 95% CI: 1.09, 1.23) and with increasing waist-hip ratio (per 0.1-unit increase) in both men (RR: 1.43; 95% CI: 1.19, 1.71) and women (RR: 1.20; 95% CI: 1.08, 1.33). CONCLUSIONS: The association between obesity and colon and rectal cancer risk varies by sex and cancer site.  相似文献   

7.
BACKGROUND: The relevance of body mass index (BMI) to cause-specific mortality in old age is uncertain. OBJECTIVES: To examine cause-specific 5 year mortality in old age by BMI in old age and middle age (40-69 years). METHODS: Cox proportional hazards for mortality rates among 4862 former male civil servants in relation to quartiles of BMI measured when screened in 1968-70 and when resurveyed in 1997-98 (median age 76 years). RESULTS: The association between all-cause mortality after resurvey and BMI in old age was U-shaped with hazard ratios (HRs) of 1.3 (95% CI 1.1-1.5) for the lightest and heaviest categories relative to the middle two. Among 'healthy' men the lightest (<22.7 kg/m2) had greatest all-cause mortality. The heaviest men (>26.6 kg/m2) had increased risk of cardiovascular disease (CVD) mortality in the first two years or for the whole period if never-smokers. Respiratory mortality was inversely associated with BMI in old age [adjusted HR for trend per BMI category increase 0.6 (0.5-0.7)] but cancer mortality lacked a clear pattern. Net gain or loss of 10 kg or more between middle and old age was a strong predictor of all-cause and CVD mortality. CONCLUSIONS: The shape of the association between BMI in old age and mortality differs by cause of death. Major weight change over time is a warning signal for higher CVD mortality. Having BMI<22.7 kg/m2 in old age is associated with above-average mortality rates even if apparently healthy.  相似文献   

8.
目的探讨不同体重指数(BMI)和腰围水平对人群中其他心血管病危险因素聚集的影响.方法将1992~1994年和1998年在我国不同地区中年人群中进行的2次心血管病危险因素调查资料合并共30 561人,比较不同BMI和腰围分组的研究对象其他心血管病危险因素聚集率和聚集的相对危险,其中危险因素聚集定义为同一研究对象具有高血压、高血清总胆固醇、低高密度脂蛋白胆固醇或空腹血糖异常之中的任意2项或2项以上者.结果随着BMI和(或)腰围的增加,人群其他心血管病危险因素的聚集率呈明显上升趋势, 按BMI分层各组中,男女两性腰围与其他心血管病危险因素的聚集率均呈明显的线性上升趋势,同样在不同的腰围分组中,BMI均与其他心血管病危险因素的聚集率呈明显的线性趋势.男性和女性年龄调整心血管病危险因素聚集率在BMI<24 kg/m2、腰围(男/女)<85/80 cm组分别为11.1%和10.4%,BMI<24 kg/m2、腰围(男/女)85~95.9/80~89.9 cm组分别为24.2%和16.9%, BMI 24.0~27.9 kg/m2、腰围(男/女)<85/80 cm组分别为24.0%和17.0%,BMI 24~27.9 kg/m2、腰围(男/女)85~95.9 /80~89.9 cm组分别为34.3%和24.0%. BMI 24.0~27.9 kg/m2、腰围(男/女)≥95/90 cm组分别为40.8%和29.6%,BMI≥28 kg/m2、腰围(男/女)85~95.9/80~89.9 cm组分别为44.2%和29.9%,BMI≥28 kg/m2、腰围(男/女)≥95/90 cm组分别为54.7%和35.4%.结论 BMI和腰围水平均与其他心血管病危险因素的聚集有独立的正相关性.保持BMI和腰围均在正常范围对心血管健康是很重要的.  相似文献   

9.
The authors explored the relation of body mass index (BMI; weight (kg)/height (m)(2)) and weight change to all-cause mortality in the elderly, using data from a large, population-based California cohort study, the Leisure World Cohort Study. They estimated relative risks of mortality associated with self-reported BMI at study entry, BMI at age 21 years, and weight change between age 21 and study entry. Participants were categorized as underweight (BMI <18.5), normal weight (BMI 18.5-24.9), overweight (BMI 25-29.9), or obese (BMI >or=30). Of 13,451 participants aged 73 years (on average) at study entry (1981-1985), 11,203 died during 23 years of follow-up (1981-2004). Relative to normal weight, being underweight (relative risk (RR) = 1.51, 95% confidence interval (CI): 1.38, 1.65) or obese (RR = 1.25, 95% CI: 1.13, 1.38) at study entry was associated with increased mortality. People who were either overweight or obese at age 21 also had increased mortality (RR = 1.17, 95% CI: 1.09, 1.25). Participants who lost weight between age 21 and study entry had increased mortality regardless of their BMI category at age 21. Obesity was significantly associated with increased mortality only among persons under age 75 years and among never or past smokers. This study highlights the influence on older-age mortality risk of being overweight or obese in young adulthood and underweight or obese in later life.  相似文献   

10.
Increasing prevalence of overweight and obesity motivated this prospective examination of gestational diabetes mellitus in relation to self-reported adult height, weight, and weight fluctuation. Gestational diabetes was assessed by use of medical records in 1,644 women enrolled in Seattle and Tacoma, Washington, between 1996 and 2002. After adjustment, risk was inversely related to height and directly related to pregravid body mass index (p(trend) < 0.001). The relation with body mass index at age 18 years was J shaped, with higher risk among lean women (adjusted relative risk (RR) = 1.79, 95% confidence interval (CI): 1.01, 2.84) and obese women (RR = 4.53, 95% CI: 1.25, 16.43) versus normal-weight women. Weight gain between age 18 years and the study pregnancy was associated with increased risk independently of body mass index at 18 years and other confounders (>/=10-kg gain vs. <2.5-kg change: RR = 3.43, 95% CI: 1.60, 7.37). Weight cycling (loss and regain of >/=6.8 kg) was not associated after adjustment for body mass index at 18 years and adult weight change (>/=3 vs. zero cycles: RR = 1.23, 95% CI: 0.56, 2.73). Cycling was nonsignificantly related among women who gained 10 kg or more during adulthood (>/=3 vs. zero cycles: RR = 2.04, 95% CI: 0.83, 5.02). Efforts to prevent obesity and weight gain among young women may reduce gestational diabetes risk.  相似文献   

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