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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Abstract Full text Figures/Tables Video References Cited by

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. 吳亞哲, 陳偉偉. 中國腦卒中流行概況. 心腦血管病防治, 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, 趙華玲, 等. 體質量指數與腦梗死的相關性研究. 山西醫藥雜志, 2018, 47(9): 987-990.
18. 許浩, 姜文凱. 對江蘇省成年人BMI指數的研究. 體育與科學, 2001, (6): 39-43.
19. 王麗娜, 李陽. 四種常用成年人體型評價指標與動脈硬化風險相關性研究. 新鄉: 2018年中國生理學會運動生理學專業委員會會議暨“科技創新與運動生理學”學術研討會, 2018.
20. 吳艷, 謝曉英, 傅芬. 聯合孕早中期空腹血糖、血脂水平及身體質量指數對妊娠期糖尿病發生風險預測的臨床價值. 實用中西醫結合臨床, 2021, 21(12): 39-40,99.
21. 楊晶瑩, 鐘妮娜, 高文靜, 等. 身體質量指數對結直腸癌患者術后近期死亡率影響的Meta分析. 武漢大學學報(醫學版), 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. 曾憲濤, 劉慧, 陳曦, 等. Meta分析系列之四: 觀察性研究的質量評價工具. 中國循證心血管醫學雜志, 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. 趙連成, 武陽豐, 周北凡, 等. 體質指數與冠心病, 腦卒中發病的前瞻性研究. 中華心血管病雜志, 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. 赫鵬, 孫文慧, 馬翠, 等. 中青年體質指數, 腰圍及腰臀比與腦卒中發生的相關性研究. 中國全科醫學, 2012, 15(17): 1924-1927,1931.
44. 姜立清, 孫兆青, 鄭黎強, 等. 遼寧農民體重指數腰圍與腦卒中患病關系的流行病學調查. 山西醫藥雜志, 2007, 36(10): 870-873.
45. 馬翠, 李巖, 李熙東, 等. 不同肥胖指標及糖尿病與缺血性腦卒中關系. 中國公共衛生, 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.
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Chinese Journal of Evidence-Based Medicine

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

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