Conventional and genetic associations of BMI with major vascular and non-vascular disease incidence and mortality in a relatively lean Chinese population: U-shaped relationship revisited.

IF 6.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH International journal of epidemiology Pub Date : 2024-08-14 DOI:10.1093/ije/dyae125
Andri Iona, Fiona Bragg, Zammy Fairhurst-Hunter, Iona Y Millwood, Neil Wright, Kuang Lin, Ling Yang, Huaidong Du, Yiping Chen, Pei Pei, Liang Cheng, Dan Schmidt, Daniel Avery, Canqing Yu, Jun Lv, Robert Clarke, Robin Walters, Liming Li, Sarah Parish, Zhengming Chen
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Abstract

Background: Higher body mass index (BMI) is associated with higher incidence of cardiovascular and some non-cardiovascular diseases (CVDs/non-CVDs). However, uncertainty remains about its associations with mortality, particularly at lower BMI levels.

Methods: The prospective China Kadoorie Biobank recruited >512 000 adults aged 30-79 years in 2004-08 and genotyped a random subset of 76 000 participants. In conventional and Mendelian randomization (MR) analyses, Cox regression yielded adjusted hazard ratios (HRs) associating measured and genetically predicted BMI levels with incident risks of major vascular events (MVEs; conventional/MR 68 431/23 621), ischaemic heart disease (IHD; 50 698/12 177), ischaemic stroke (IS; 42 427/11 897) and intracerebral haemorrhage (ICH; 7644/4712), and with mortality risks of CVD (15 427/6781), non-CVD (26 915/4355) and all causes (42 342/6784), recorded during ∼12 years of follow-up.

Results: Overall, the mean BMI was 23.8 (standard deviation: 3.2) kg/m2 and 13% had BMIs of <20 kg/m2. Measured and genetically predicted BMI showed positive log-linear associations with MVE, IHD and IS, but a shallower positive association with ICH in conventional analyses. Adjusted HRs per 5 kg/m2 higher genetically predicted BMI were 1.50 (95% CI 1.41-1.58), 1.49 (1.38-1.61), 1.42 (1.31-1.54) and 1.64 (1.58-1.69) for MVE, IHD, IS and ICH, respectively. These were stronger than associations in conventional analyses [1.21 (1.20-1.23), 1.28 (1.26-1.29), 1.31 (1.29-1.33) and 1.14 (1.10-1.18), respectively]. At BMIs of ≥20 kg/m2, there were stronger positive log-linear associations of BMI with CVD, non-CVD and all-cause mortality in MR than in conventional analyses.

Conclusions: Among relatively lean Chinese adults, higher genetically predicted BMI was associated with higher risks of incident CVDs. Excess mortality risks at lower BMI in conventional analyses are likely not causal and may reflect residual reverse causality.

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在相对瘦弱的中国人群中,体重指数与主要血管和非血管疾病的发病率和死亡率之间的传统和遗传关系:U型关系再探。
背景:体重指数(BMI)越高,心血管疾病和某些非心血管疾病(CVDs/non-CVDs)的发病率就越高。然而,体重指数与死亡率的关系仍存在不确定性,尤其是在体重指数较低的情况下:方法:前瞻性的中国嘉道理生物数据库在 2004-08 年间招募了超过 512 000 名年龄在 30-79 岁之间的成年人,并对其中的 76 000 名参与者进行了随机基因分型。在常规和孟德尔随机(MR)分析中,Cox 回归得出了测量和基因预测的 BMI 水平与重大血管事件(MVEs;常规/MR 68 431/23 621)、缺血性心脏病(IHD;50 698/12 177)、缺血性中风(IS;42727/11 897)和脑内出血(ICH;7644/4712),以及心血管疾病(15 427/6781)、非心血管疾病(26 915/4355)和所有原因(42342/6784)的死亡风险。结果显示总体而言,平均体重指数为 23.8(标准差:3.2)千克/平方米,13% 的人的体重指数达到结论水平:在相对瘦弱的中国成年人中,基因预测的体重指数越高,发生心血管疾病的风险越高。在传统分析中,较低体重指数下的过高死亡风险很可能不是因果关系,可能反映了残留的反向因果关系。
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来源期刊
International journal of epidemiology
International journal of epidemiology 医学-公共卫生、环境卫生与职业卫生
CiteScore
13.60
自引率
2.60%
发文量
226
审稿时长
3 months
期刊介绍: The International Journal of Epidemiology is a vital resource for individuals seeking to stay updated on the latest advancements and emerging trends in the field of epidemiology worldwide. The journal fosters communication among researchers, educators, and practitioners involved in the study, teaching, and application of epidemiology pertaining to both communicable and non-communicable diseases. It also includes research on health services and medical care. Furthermore, the journal presents new methodologies in epidemiology and statistics, catering to professionals working in social and preventive medicine. Published six times a year, the International Journal of Epidemiology provides a comprehensive platform for the analysis of data. Overall, this journal is an indispensable tool for staying informed and connected within the dynamic realm of epidemiology.
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