BMI and risk of stroke: a dose-response meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Xinyu ¹ , SU Wenli ¹ , HUANG Yanan ¹ , CHEN Yanru ¹ , CHEN Xiaoli ^1,2 , CHONG Haiyan ¹ , YAN Fanghong ¹ , HAN Lin ^1,2 ,  MA Yuxia ^1,3

1. Evidence-Based Nursing Center, School of Nursing of Lanzhou University, Lanzhou 730000, P. R. China;
2. Department of Nursing, Gansu Provincial Hospital, Lanzhou 730000, P. R. China;
3. First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, P. R. China;

Corresponding author：

MA Yuxia, Email: yuxiama@lzu.edu.cn

Keywords：

Body mass index; Stroke; Meta-analysis; Systematic review; Dose-response relationship

DOI：

10.7507/1672-2531.202205032

Video：

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Objective To systematically review the dose-response relationship between body mass index (BMI) and the risk of stroke. Methods PubMed, EMbase, Web of Science, The Cochrane Library, CBM, VIP, WanFang Data and CNKI databases were electronically searched to collect studies on BMI and the risk of stroke from inception to December 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; then, meta-analysis was performed by using Stata 16.0 software, and the dose-response relationship between BMI and risk of stroke was analyzed by using restricted cubic spline function and generalized least squares estimation (GLST). Results A total of 19 studies involving 3 689 589 patients were included. The results of meta-analysis showed that compared with normal BMI, overweight (RR=1.28, 95%CI 1.19 to 1.39, P<0.01) and obesity (RR=1.41, 95%CI 1.15 to 1.72, P<0.01) had a higher risk of stroke. Dose-response meta-analysis suggested that there was no significant non-linear relationship between BMI and stroke risk (nonlinear test P=0.318), and linear trend showed that the risk of stroke increased by 4% for each unit increase in BMI (RR=1.04, 95%CI 1.03 to 1.05, P<0.01). Conclusion Current evidence suggests that increased BMI is associated with an increased risk of stroke. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.

Citation： WANG Xinyu, SU Wenli, HUANG Yanan, CHEN Yanru, CHEN Xiaoli, CHONG Haiyan, YAN Fanghong, HAN Lin, MA Yuxia. BMI and risk of stroke: a dose-response meta-analysis. Chinese Journal of Evidence-Based Medicine, 2022, 22(11): 1330-1338. doi: 10.7507/1672-2531.202205032 Copy

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1. Benjamin EJ, Virani SS, Callaway CW, et al. Heart disease and stroke statistics-2018 update: a report from the American heart association. irculation, 2018, 137(12): e67-e492.
2. Medin J, Nordlund A, Ekberg K, et al. Increasing stroke incidence in Sweden between 1989 and 2000 among persons aged 30 to 65 years: evidence from the Swedish Hospital Discharge Register. Stroke, 2004, 35(5): 1047-1051.
3. Mahon S, Parmar P, Barker-Collo S, et al. Determinants, prevalence, and trajectory of long-term post-stroke cognitive impairment: results from a 4-year follow-up of the ARCOS-IV study. Neuroepidemiology, 2017, 49(3-4): 129-134.
4. GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020, 396(10258): 1204-1222.
5. Struijs JN, van Genugten ML, Evers SM, et al. Future costs of stroke in the Netherlands: the impact of stroke services. Int J Technol Assess Health Care, 2006, 22(4): 518-524.
6. Heidenreich PA, Albert NM, Allen LA, et al. Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circ Heart Fail, 2013, 6(3): 606-619.
7. Zhou M, Wang H, Zeng X, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet, 2019, 394(10204): 1145-1158.
8. 吴亚哲, 陈伟伟. 中国脑卒中流行概况. 心脑血管病防治, 2016, 16(6): 410-414.
9. Feigin VL, Roth GA, Naghavi M, et al. Global burden of stroke and risk factors in 188 countries, during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet Neurol, 2016, 15(9): 913-924.
10. Maruvada P, Leone V, Kaplan LM, et al. The human microbiome and obesity: moving beyond associations. Cell Host Microbe, 2017, 22(5): 589-599.
11. Abenavoli L, Scarpellini E, Colica C, et al. Gut microbiota and obesity: a role for probiotics. Nutrients, 2019, 11(11): 2690.
12. Gadde KM, Martin CK, Berthoud HR, et al. Obesity: pathophysiology and management. J Am Coll Cardiol, 2018, 71(1): 69-84.
13. Guo Y, Yue XJ, Li HH, et al. Overweight and obesity in young adulthood and the risk of stroke: a meta-analysis. J Stroke Cerebrovasc Dis, 2016, 25(12): 2995-3004.
14. Abdullah A, Peeters A, de Courten M, et al. The magnitude of association between overweight and obesity and the risk of diabetes: a meta-analysis of prospective cohort studies. Diabetes Res Clin Pract, 2010, 89(3): 309-319.
15. Zhou Y, Zhang Y, Shi K, et al. Body mass index and risk of diabetic retinopathy: a meta-analysis and systematic review. Medicine (Baltimore), 2017, 96(22): e6754.
16. Luczyński W, Szypowska A, Bossowski A, et al. Overweight, obesity and metabolic syndrome in children with type 1 diabetes melllitus. Pediatr Endocrinol Diabetes Metab, 2010, 16(2): 83-88.
17. 皇甫春梅, 于俊杏, 赵华玲, 等. 体质量指数与脑梗死的相关性研究. 山西医药杂志, 2018, 47(9): 987-990.
18. 许浩, 姜文凯. 对江苏省成年人BMI指数的研究. 体育与科学, 2001, (6): 39-43.
19. 王丽娜, 李阳. 四种常用成年人体型评价指标与动脉硬化风险相关性研究. 新乡: 2018年中国生理学会运动生理学专业委员会会议暨“科技创新与运动生理学”学术研讨会, 2018.
20. 吴艳, 谢晓英, 傅芬. 联合孕早中期空腹血糖、血脂水平及身体质量指数对妊娠期糖尿病发生风险预测的临床价值. 实用中西医结合临床, 2021, 21(12): 39-40,99.
21. 杨晶莹, 钟妮娜, 高文静, 等. 身体质量指数对结直肠癌患者术后近期死亡率影响的Meta分析. 武汉大学学报(医学版), 2020, 41(2): 249-254.
22. Abete I, Arriola L, Etxezarreta N, et al. Association between different obesity measures and the risk of stroke in the EPIC Spanish cohort. Eur J Nutr, 2015, 54(3): 365-375.
23. Ohlsson C, Bygdell M, Sondén A, et al. BMI increase through puberty and adolescence is associated with risk of adult stroke. Neurology, 2017, 89(4): 363-369.
24. Yao Y, Lin J, Xu K. Effects of BMI on ischaemic stroke in hospital patients with essential hypertension. Heart, 2010, 96: A185-A186.
25. Bardugo A, Fishman B, Libruder C, et al. Body mass index in 1. 9 million adolescents and stroke in young adulthood. Stroke, 2021, 52(6): 2043-2052.
26. Jood K, Jern C, Wilhelmsen L, et al. Body mass index in mid-life is associated with a first stroke in men: a prospective population study over 28 years. Stroke, 2004, 35(12): 2764-2769.
27. Bazzano LA, Gu D, Whelton MR, et al. Body mass index and risk of stroke among Chinese men and women. Ann Neurol, 2010, 67(1): 11-20.
28. Song YM, Sung J, Davey Smith G, et al. Body mass index and ischemic and hemorrhagic stroke: a prospective study in Korean men. Stroke, 2004, 35(4): 831-836.
29. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
30. 曾宪涛, 刘慧, 陈曦, 等. Meta分析系列之四: 观察性研究的质量评价工具. 中国循证心血管医学杂志, 2012, 4(4): 297-299.
31. Andersen KK, Olsen TS. The obesity paradox in stroke: lower mortality and lower risk of readmission for recurrent stroke in obese stroke patients. Int J Stroke, 2015, 10(1): 99-104.
32. Falkstedt D, Hemmingsson T, Rasmussen F, et al. Body mass index in late adolescence and its association with coronary heart disease and stroke in middle age among Swedish men. Int J Obes (Lond), 2007, 31(5): 777-783.
33. Hu G, Tuomilehto J, Silventoinen K, et al. Body mass index, waist circumference, and waist-hip ratio on the risk of total and type-specific stroke. Arch Intern Med, 2007, 167(13): 1420-1427.
34. Kawate N, Kayaba K, Hara M, et al. Body mass index and stroke incidence in Japanese community residents: The Jichi Medical School (JMS) Cohort Study. J Epidemiol, 2017, 27(7): 325-330.
35. Kurth T, Gaziano JM, Berger K, et al. Body mass index and the risk of stroke in men. Arch Intern Med, 2002, 162(22): 2557-2562.
36. Kurth T, Gaziano JM, Rexrode KM, et al. Prospective study of body mass index and risk of stroke in apparently healthy women. Circulation, 2005, 111(15): 1992-1998.
37. Wang C, Liu Y, Yang Q, et al. Body mass index and risk of total and type-specific stroke in Chinese adults: results from a longitudinal study in China. Int J Stroke, 2013, 8(4): 245-250.
38. Yonemoto K, Doi Y, Hata J, et al. Body mass index and stroke incidence in a Japanese community: the Hisayama study. Hypertens Res, 2011, 34(2): 274-279.
39. 赵连成, 武阳丰, 周北凡, 等. 体质指数与冠心病, 脑卒中发病的前瞻性研究. 中华心血管病杂志, 2002, (7): 49-52.
40. He J, Gu DF, Reynolds K, et al. Overweight and risk of stroke in China: A prospective study of 169 871 men and women. Circulation, 2006, 113(8): E314-E318.
41. Chen W, Pan Y, Jing J, et al. Association of body mass index and risk of stroke after acute minor stroke or tia: a post hoc analysis of a randomized controlled trial. Neurotox Res, 2019, 36(4): 836-843.
42. Wannamethee SG, Shaper AG, Whincup PH, et al. Adiposity, adipokines, and risk of incident stroke in older men. Stroke, 2013, 44(1): 3-8.
43. 赫鹏, 孙文慧, 马翠, 等. 中青年体质指数, 腰围及腰臀比与脑卒中发生的相关性研究. 中国全科医学, 2012, 15(17): 1924-1927,1931.
44. 姜立清, 孙兆青, 郑黎强, 等. 辽宁农民体重指数腰围与脑卒中患病关系的流行病学调查. 山西医药杂志, 2007, 36(10): 870-873.
45. 马翠, 李岩, 李熙东, 等. 不同肥胖指标及糖尿病与缺血性脑卒中关系. 中国公共卫生, 2013, 29(10): 1502-1505.
46. Shiozawa M, Kaneko H, Itoh H, et al. Association of body mass index with ischemic and hemorrhagic stroke. Nutrients, 2021, 13(7): 2343.
47. Lu M, Ye W, Adami HO, et al. Prospective study of body size and risk for stroke amongst women below age 60. J Intern Med, 2006, 260(5): 442-450.
48. Yatsuya H, Folsom AR, Yamagishi K, et al. Race- and sex-specific associations of obesity measures with ischemic stroke incidence in the atherosclerosis risk in communities (ARIC) study. Stroke, 2010, 41(3): 417-425.
49. Cui C, Wu Z, Shi Y, et al. Sex-specific association of BMI change with stroke in middle-aged and older adults with type 2 diabetes. Nutr Metab Cardiovasc Dis, 2021, 31(11): 3095-3102.
50. Policardo L, Seghieri G, Francesconi P, et al. Gender difference in diabetes-associated risk of first-ever and recurrent ischemic stroke. J Diabetes Complications, 2015, 29(5): 713-717.
51. Zhao W, Katzmarzyk PT, Horswell R, et al. Sex differences in the risk of stroke and HbA(1c) among diabetic patients. Diabetologia, 2014, 57(5): 918-926.
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Chinese Journal of Evidence-Based Medicine

BMI and risk of stroke: a dose-response meta-analysis

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