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中国成人BMI和腹型肥胖与急性心肌梗死发病关系的前瞻性研究

张鑫 王文绢 张润 由晓庆 李剑虹

张鑫, 王文绢, 张润, 由晓庆, 李剑虹. 中国成人BMI和腹型肥胖与急性心肌梗死发病关系的前瞻性研究[J]. 中华疾病控制杂志, 2022, 26(7): 750-755. doi: 10.16462/j.cnki.zhjbkz.2022.07.002
引用本文: 张鑫, 王文绢, 张润, 由晓庆, 李剑虹. 中国成人BMI和腹型肥胖与急性心肌梗死发病关系的前瞻性研究[J]. 中华疾病控制杂志, 2022, 26(7): 750-755. doi: 10.16462/j.cnki.zhjbkz.2022.07.002
ZHANG Xin, WANG Wen-juan, ZHANG Run, YOU Xiao-qing, LI Jian-hong. Relationship between BMI, abdominal obesity and the incidence of acute myocardial infarction in Chinese adults: a prospective study[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2022, 26(7): 750-755. doi: 10.16462/j.cnki.zhjbkz.2022.07.002
Citation: ZHANG Xin, WANG Wen-juan, ZHANG Run, YOU Xiao-qing, LI Jian-hong. Relationship between BMI, abdominal obesity and the incidence of acute myocardial infarction in Chinese adults: a prospective study[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2022, 26(7): 750-755. doi: 10.16462/j.cnki.zhjbkz.2022.07.002

中国成人BMI和腹型肥胖与急性心肌梗死发病关系的前瞻性研究

doi: 10.16462/j.cnki.zhjbkz.2022.07.002
基金项目: 

国家重点研发计划 2018YFC1313904

详细信息
    通讯作者:

    李剑虹,E-mail: lijianhong@ncncd.chinacdc.cn

  • 中图分类号: R181.3+8

Relationship between BMI, abdominal obesity and the incidence of acute myocardial infarction in Chinese adults: a prospective study

Funds: 

National Key Research and Development Program of China 2018YFC1313904

More Information
  • 摘要:   目的  了解中国成人BMI和腹型肥胖与急性心肌梗死(acute myocardial infarction, AMI)的发病关系。  方法  从2010年中国慢性病及危险因素监测中抽取11个省(市),再从中选择60个监测点作为随访点,并于2016―2017年进行随访调查,共随访到27 604人,数据清理后共26 794名调查对象纳入分析。采用Cox比例风险回归模型分析BMI和腹型肥胖与AMI发病的关系。  结果  26 794名调查对象,平均随访6.0年,随访期间共观察到256例AMI事件。在调整相关混杂因素后,与腰围(waist circumference, WC)正常、BMI < 24 kg/m2组相比,腹型肥胖、BMI < 24 kg/m2组AMI的发病风险增加85%(HR=1.85, 95% CI: 1.14~3.01),腹型肥胖、BMI≥24 kg/m2组AMI的发病风险增加56%(HR=1.56, 95% CI: 1.11~2.18),而WC正常、BMI≥24 kg/m2组与AMI的发病风险无相关(HR=0.85, 95% CI: 0.49~1.47)。  结论  无论BMI值为多少,腹型肥胖都是AMI发病的重要危险因素。
  • 图  1  不同BMI和腹型肥胖分组与AMI发病关系亚组分析

    注:a以WC正常、BMI < 24 kg/m2者为参照,报告腹型肥胖、BMI < 24 kg/m2者发生AMI风险效应值;模型调整年龄、性别、城乡、高血压、血脂异常、糖尿病、身体活动不足、吸烟、饮酒,不包括分层因素。

    Figure  1.  Subgroup analysis of the relationship between different BMI and abdominal obesity groups and the incidence of AMI

    表  1  2010年中国11省市研究对象基线特征[n(%)]

    Table  1.   Baseline characteristics of subjects in 11 Provinces and Cities of China in 2010 [n(%)]

    变量 WC正常BMI < 24 kg/m2(n=12 350) WC正常BMI≥24 kg/m2(n=3 085) 腹型肥胖BMI < 24 kg/m2(n=1 931) 腹型肥胖BMI≥24 kg/m2(n=9 428) P
    年龄(x±s, 岁) 46.07±14.52 46.62±12.35 51.14±13.69 49.53±12.59 < 0.001
    年龄组(岁) < 0.001
      18~ < 45 5 867 (47.51) 1 408 (45.64) 627 (32.47) 3 336 (35.38)
      45~ < 60 4 097 (33.17) 1 184 (38.38) 783 (40.55) 4 040 (42.85)
      ≥60 2 386 (19.32) 493 (15.98) 521 (26.98) 2 052 (21.76)
    5 919 (47.93) 1 473 (47.75) 700 (36.25) 3 927 (41.66) < 0.001
    文化程度 < 0.001
      小学以下 5 657 (45.81) 1 285 (41.65) 1 001 (51.84) 4 330 (45.93)
      小学 4 118 (33.34) 1 121 (36.34) 583 (30.19) 3 090 (32.77)
      初中 1 679 (13.59) 469 (15.20) 257 (13.31) 1 394 (14.79)
      高中及以上 896 (7.26) 210 (6.81) 90 (4.66) 614 (6.51)
    婚姻状况a < 0.001
      未婚 1 054 (8.55) 143 (4.65) 59 (3.06) 256 (2.72)
      已婚/同居 10 056 (81.61) 2 668 (86.79) 1 640 (85.06) 8 210 (87.28)
      丧偶/离婚/分居 1 213 (9.84) 263 (8.56) 229 (11.88) 941 (10.00)
    家庭年总收入(元) 0.054
       < 10 000 4 135 (33.48) 975 (31.60) 631 (32.68) 2 970 (31.50)
      10 000~ < 20 000 2 784 (22.54) 746 (24.18) 447 (23.15) 2 142 (22.72)
      20 000~ < 30 000 1 926 (15.60) 509 (16.50) 296 (15.32) 1 577 (16.73)
      ≥30 000 3 505 (28.38) 855 (27.72) 557 (28.85) 2 739 (29.05)
    城市 4 446 (36.00) 1 188 (38.51) 738 (38.22) 4 133 (43.84) < 0.001
    吸烟状况 < 0.001
      当前吸烟 3 529 (28.58) 716 (23.21) 407 (21.05) 1 996 (21.17)
      以前吸烟 326 (2.64) 115 (3.73) 39 (2.05) 255 (2.70)
      从不吸烟 8 493 (68.78) 2 254 (73.06) 1 485 (76.90) 7 177 (76.13)
    当前饮酒 4 665 (37.78) 1 147 (37.18) 659 (34.13) 3 279 (34.78) < 0.001
    糖尿病 429 (3.47) 148 (4.80) 145 (7.51) 1 065 (11.30) < 0.001
    血脂异常 4 913 (39.78) 1 695 (54.94) 980 (50.75) 6 284 (66.65) < 0.001
    蔬果摄入不足 6 723 (54.44) 1 631 (52.87) 1 127 (58.36) 5 341 (56.65) < 0.001
    身体活动不足 2 088 (16.91) 558 (18.09) 391 (20.25) 1 806 (19.16) < 0.001
    红肉摄入过多 1 629 (13.19) 404 (13.10) 179 (9.27) 1 163 (12.34) < 0.001
    高血压 3 398 (27.51) 1 288 (41.75) 789 (40.86) 5 321 (56.44) < 0.001
    SBP (x±s, mmHg) 128.39±20.12 135.09±20.88 135.82±21.51 141.31±22.19 0.012
    DBP (x±s, mmHg) 77.86±10.63 82.81±11.18 81.65±10.58 86.34±11.49 < 0.001
    TG (x±s, mmol/L) 1.16±1.03 1.49±1.43 1.46±1.28 1.85±1.63 < 0.001
    TC (x±s, mmol/L) 3.92±1.00 4.12±1.15 4.18±1.05 4.30±1.13 < 0.001
    HDL-C (x±s, mmol/L) 1.19±0.33 1.09±0.29 1.12±0.30 1.04±0.28 < 0.001
    LDL-C (x±s, mmol/L) 2.14±0.72 2.35±0.81 2.36±0.77 2.50±0.79 < 0.001
    FPG (x±s, mmol/L) 5.32±1.16 5.48±1.18 5.68±1.69 5.79±1.56 < 0.001
    OGTT-2h (x±s, mmol/L) 6.01±21.18 6.27±2.51 6.62±2.97 6.89±2.84 0.519
    注:a缺失62例;口服糖耐量试验(oral glucose tolerance test, OGTT)。
    下载: 导出CSV

    表  2  2010年中国11省市随访人群与失访人群特征分析[n(%)]

    Table  2.   Analysis of the characteristics of follow-up population and lost follow-up population in 11 Provinces and Cities of China in 2010 [n(%)]

    变量 随访人群 失访人群 χ2/t P
    人数 27 604 (75.78) 8 822 (24.22)
    年龄(x±s, 岁) 48.22 ±14.15 44.12 ±17.07 22.50 < 0.001
    12 485 (45.23) 4 165 (47.21) 10.59 0.001
    城市 10 772 (39.02) 4 395 (49.82) 320.61 < 0.001
    吸烟 6 894 (24.98) 1 987 (22.53) 24.70 < 0.001
    饮酒 10 018 (36.30) 3 315 (37.58) 4.73 0.030
    超重肥胖 14 796 (53.60) 5 043 (57.16) 34.22 < 0.001
    腹型肥胖 11 677 (42.30) 3 505 (39.73) 18.19 < 0.001
    糖尿病 2 856 (10.35) 943 (10.69) 0.84 0.359
    血脂异常 14 298 (51.80) 4 690 (53.16) 5.00 0.025
    蔬果摄入不足 15 331 (55.54) 5 011 (56.80) 4.32 0.038
    身体活动不足 5 073 (18.38) 1 903 (21.57) 44.03 < 0.001
    红肉摄入过多 3 449 (12.49) 1 133 (12.84) 0.74 0.390
    高血压 11 277 (40.67) 3 104 (35.18) 84.34 < 0.001
    SBP (x±s, mmHg) 134.50 ±21.97 132.00 ±22.10 9.07 < 0.001
    DBP (x±s, mmHg) 81.73 ±11.68 80.47 ±11.76 8.72 < 0.001
    TG (x±s, mmol/L) 1.46 ±1.36 1.41 ±1.40 3.03 0.002
    TC (x±s, mmol/L) 4.10 ±1.08 4.03 ±1.10 4.88 < 0.001
    HDL-C (x±s, mmol/L) 1.12 ±0.31 1.11 ±0.31 3.27 0.001
    LDL-C (x±s, mmol/L) 2.30 ±0.78 2.28 ±0.80 1.84 0.065
    FPG (x±s, mmol/L) 5.54 ±1.39 5.53 ±1.51 0.20 0.843
    OGTT-2h (x±s, mmol/L) 6.40 ±14.48 6.34 ±2.68 0.40 0.692
    下载: 导出CSV

    表  3  不同BMI和腹型肥胖分组与AMI发病的关系

    Table  3.   Relationship between different BMI and abdominal obesity groups and the incidence of acute myocardial infarction

    变量 WC正常BMI < 24 kg/m2(n=12 350) WC正常BMI≥24 kg/m2(n=3 085) 腹型肥胖BMI < 24 kg/m2(n=1 931) 腹型肥胖BMI≥24 kg/m2(n=9 428)
    AMI
      发病人数 75 26 25 130
      随访人年 73 992.35 18 448.90 11 552.43 56 366.27
      发病密度(/10万人年) 101.36 140.93 216.41 230.63
    HR(95% CI)值
      模型1 1.00 0.96(0.56~1.64) 2.04(1.26~3.30) 2.01(1.47~2.74)
      模型2 1.00 0.85(0.50~1.46) 1.82(1.12~2.95) 1.52(1.10~2.12)
      模型3 1.00 0.85(0.49~1.47) 1.85(1.14~3.01) 1.56(1.11~2.18)
    注:模型1:调整年龄、性别;模型2:在模型1基础上调整高血压、血脂异常、糖尿病;模型3:在模型2基础上调整文化程度、收入、婚姻状况、吸烟、饮酒、身体活动不足、蔬果摄入不足、红肉摄入过多。
    下载: 导出CSV
  • [1] Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018)[J]. J Am Coll Cardiol, 2018, 72(18): 2231-2264. DOI: 10.1016/j.jacc.2018.08.1038.
    [2] Anderson JL, Morrow DA. Acute myocardial infarction[J]. N Engl J Med, 2017, 376(21): 2053-2064. DOI: 10.1056/NEJMra1606915.
    [3] 中国心血管健康与疾病报告编写组. 中国心血管健康与疾病报告2020概要[J]. 中国循环杂志, 2021, 36(6): 521-545. DOI: 10.3969/j.issn.1000-3614.2021.06.001.

    The Writing Committee of the Report on Cardiovascular Health and Diseases in China. Report on cardiovascular health and diseases burden in China: an updated summary of 2020[J]. Chin Circ J, 2021, 36(6): 521-545. DOI: 10.3969/j.issn.1000-3614.2021.06.001.
    [4] Teng RL, Wang H, Sun BC, et al. Interaction between lipoprotein (a) levels and body mass index in first incident acute myocardial infarction[J]. BMC Cardiovasc Disord, 2020, 20(1): 350. DOI: 10.1186/s12872-020-01626-7.
    [5] Stegger JG, Schmidt EB, Obel T, et al. Body composition and body fat distribution in relation to later risk of acute myocardial infarction: a Danish follow-up study[J]. Int J Obes (Lond), 2011, 35(11): 1433-1441. DOI: 10.1038/ijo.2010.278.
    [6] Dikaiou P, Björck L, Adiels M, et al. Obesity, overweight and risk for cardiovascular disease and mortality in young women[J]. Eur J Prev Cardiol, 2021, 28(12): 1351-1359. DOI: 10.1177/2047487320908983.
    [7] Yusuf S, Hawken S, Ounpuu S, et al. Obesity and the risk of myocardial infarction in 27, 000 participants from 52 countries: a case-control study[J]. Lancet, 2005, 366(9497): 1640-1649. DOI: 10.1016/S0140-6736(05)67663-5.
    [8] 陈春明, 孔灵芝. 中国成人超重和肥胖症预防控制指南[M]. 北京: 人民卫生出版社, 2006.

    Chen CM, Kong LZ. Guidelines for the prevention and control of overweight and obesity in Chinese adults[M]. Beijing: People's Medical Publishing House, 2006.
    [9] Parikh NI, Gona P, Larson MG, et al. Long-term trends in myocardial infarction incidence and case fatality in the National Heart, Lung, and Blood Institute's Framingham Heart study[J]. Circulation, 2009, 119(9): 1203-1210. DOI: 10.1161/CIRCULATIONAHA.108.825364.
    [10] 中国肥胖问题工作组. 中国成人超重和肥胖症预防与控制指南(节录)[J]. 营养学报, 2004, 26(1): 1-4. DOI: 10.13325/j.cnki.acta.nutr.sin.2004.01.001.

    China Working Group on Obesity. Guidelines for the prevention and control of overweight and obesity in Chinese adults (excerpt)[J]. Acta Nutrimenta Sinica, 2004, 26(1): 1-4. DOI: 10.13325/j.cnki.acta.nutr.sin.2004.01.001.
    [11] Marbou WJT, Kuete V. Prevalence of metabolic syndrome and its components in bamboutos division's adults, west region of Cameroon[J]. Biomed Res Int, 2019, 2019: 9676984. DOI: 10.1155/2019/9676984.
    [12] Wadolowska L, Hamulka J, Kowalkowska J, et al. Changes in sedentary and active lifestyle, diet quality and body composition nine months after an education program in Polish students aged 11-12 years: report from the ABC of healthy eating study[J]. Nutrients, 2019, 11(2): E331. DOI: 10.3390/nu11020331.
    [13] Chatelan A, Castetbon K, Pasquier J, et al. Association between breakfast composition and abdominal obesity in the Swiss adult population eating breakfast regularly[J]. Int J Behav Nutr Phys Act, 2018, 15(1): 115. DOI: 10.1186/s12966-018-0752-7.
    [14] Pan XF, Wang LW, Pan A. Epidemiology and determinants of obesity in China[J]. Lancet Diabetes Endocrinol, 2021, 9(6): 373-392. DOI: 10.1016/S2213-8587(21)00045-0.
    [15] Kim DH, Nam GE, Han K, et al. Variabilities in weight and waist circumference and risk of myocardial infarction, stroke, and mortality: a nationwide cohort study[J]. Endocrinol Metab (Seoul), 2020, 35(4): 933-942. DOI: 10.3803/EnM.2020.871.
    [16] Sharma S, Batsis JA, Coutinho T, et al. Normal-weight central obesity and mortality risk in older adults with coronary artery disease[J]. Mayo Clin Proc, 2016, 91(3): 343-351. DOI: 10.1016/j.mayocp.2015.12.007.
    [17] Mourmoura E, Chaté V, Couturier K, et al. Body adiposity dictates different mechanisms of increased coronary reactivity related to improved in vivo cardiac function[J]. Cardiovasc Diabetol, 2014, 13: 54. DOI: 10.1186/1475-2840-13-54.
    [18] Piché ME, Tchernof A, Després JP. Obesity phenotypes, diabetes, and cardiovascular diseases[J]. Circ Res, 2020, 126(11): 1477-1500. DOI: 10.1161/CIRCRESAHA.120.316101.
    [19] Mørkedal B, Vatten LJ, Romundstad PR, et al. Risk of myocardial infarction and heart failure among metabolically healthy but obese individuals: hunt (Nord-Trøndelag Health Study), Norway[J]. J Am Coll Cardiol, 2014, 63(11): 1071-1078. DOI: 10.1016/j.jacc.2013.11.035.
    [20] Emerging Risk Factors Collaboration, Wormser D, Kaptoge S, et al. Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: collaborative analysis of 58 prospective studies[J]. Lancet, 2011, 377(9771): 1085-1095. DOI: 10.1016/S0140-6736(11)60105-0.
    [21] Kachur S, Lavie CJ, de Schutter A, et al. Obesity and cardiovascular diseases[J]. Minerva Med, 2017, 108(3): 212-228. DOI: 10.23736/S0026-4806.17.05022-4.
    [22] Elagizi A, Kachur S, Carbone S, et al. A review of obesity, physical activity, and cardiovascular disease[J]. Curr Obes Rep, 2020, 9(4): 571-581. DOI: 10.1007/s13679-020-00403-z.
    [23] Zhang P, Wang R, Gao CS, et al. Prevalence of central obesity among adults with normal BMI and its association with metabolic diseases in northeast China[J]. PLoS One, 2016, 11(7): e0160402. DOI: 10.1371/journal.pone.0160402.
    [24] Artham SM, Lavie CJ, Milani RV, et al. Value of weight reduction in patients with cardiovascular disease[J]. Curr Treat Options Cardiovasc Med, 2010, 12(1): 21-35. DOI: 10.1007/s11936-009-0056-y.
    [25] Ortega FB, Lavie CJ, Blair SN. Obesity and cardiovascular disease[J]. Circ Res, 2016, 118(11): 1752-1770. DOI: 10.1161/CIRCRESAHA.115.306883.
    [26] Swift DL, Johannsen NM, Lavie CJ, et al. Effects of clinically significant weight loss with exercise training on insulin resistance and cardiometabolic adaptations[J]. Obesity (Silver Spring), 2016, 24(4): 812-819. DOI: 10.1002/oby.21404.
    [27] Wells JCK. Commentary: The paradox of body mass index in obesity assessment: not a good index of adiposity, but not a bad index of cardio-metabolic risk[J]. Int J Epidemiol, 2014, 43(3): 672-674. DOI: 10.1093/ije/dyu060.
    [28] Taylor AE, Ebrahim S, Ben-Shlomo Y, et al. Comparison of the associations of body mass index and measures of central adiposity and fat mass with coronary heart disease, diabetes, and all-cause mortality: a study using data from 4 UK cohorts[J]. Am J Clin Nutr, 2010, 91(3): 547-556. DOI: 10.3945/ajcn.2009.28757.
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  • 收稿日期:  2021-12-20
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