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Erschienen in: European Journal of Nutrition 3/2015

01.04.2015 | Original Contribution

Association between different obesity measures and the risk of stroke in the EPIC Spanish cohort

verfasst von: Itziar Abete, Larraitz Arriola, Nerea Etxezarreta, Imanol Mozo, Conchi Moreno-Iribas, Pilar Amiano, Nerea Egüés, Estibaliz Goyenechea, Adolfo Lopez de Munain, Maite Martinez, Noemi Travier, Carmen Navarro, Maria-Dolores Chirlaque, Maria-Jose Tormo, Diana Gavrila, Jose Maria Huerta, María-José Sánchez, Esther Molina-Montes, Mar Requena, Maria-Dolores Jiménez-Hernández, Eva Ardanaz, Aurelio Barricarte, Jose Ramon Quiros, Laudina Rodriguez, Miren Dorronsoro

Erschienen in: European Journal of Nutrition | Ausgabe 3/2015

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Abstract

Introduction

There is still a scientific debate on the exact role played by obesity on stroke risk.

Objective

The aim of the study was to analyze the association between obesity, measured by different indices such as body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and a new one called A Body Shape Index (ABSI) and the risk of total and ischemic stroke.

Subjects/methods

A total of 41,020 subjects (15,490 men and 25,530 women) aged 29–69 years participated in the study. All participants were recruited between 1992 and 1996 and followed up until 2008 to ascertain incident cerebrovascular disease events. Cox proportional hazards models were designed to estimate the relative risk and 95 % CI between obesity and cerebrovascular disease incidence.

Results

After 13.8 years of follow-up, a total of 674 stroke cases (55.3 % in men) were registered (531 ischemic, 79 hemorrhagic, 42 subarachnoid hemorrhage and 22 unspecified). WC fourth quartile (HR 1.95; 95 % CI 1.20–3.19) and WHR fourth quartile (HR 1.58; 95 % CI 1.12–2.25) were positively associated with total stroke only in men. BMI was not associated with stroke incidence. The new index, ABSI, was significantly associated with total stroke incidence only in men (HR 1.54; 95 % CI 1.06–2.23).

Conclusions

Data from the Spanish EPIC cohort study show a strong association of WC and WHR with the relative risk of suffering a stroke only in men, while no associations were found for BMI. It supports the suggestion of other authors of using more than one obesity index in the study of stroke risk prediction.
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Literatur
1.
Zurück zum Zitat González Jiménez E (2011) Genes and obesity: a cause and effect relationship. Endocrinol Nutr 58:492–496CrossRef González Jiménez E (2011) Genes and obesity: a cause and effect relationship. Endocrinol Nutr 58:492–496CrossRef
2.
Zurück zum Zitat Hossain P, Kawar B, El Nahas M (2007) Obesity and diabetes in the developing world—a growing challenge. N Engl J Med 356:213–215CrossRef Hossain P, Kawar B, El Nahas M (2007) Obesity and diabetes in the developing world—a growing challenge. N Engl J Med 356:213–215CrossRef
3.
Zurück zum Zitat Berenson GS, Bogalusa Heart Study group (2012) Health consequences of obesity. Pediatr Blood Cancer 58:117–121CrossRef Berenson GS, Bogalusa Heart Study group (2012) Health consequences of obesity. Pediatr Blood Cancer 58:117–121CrossRef
4.
Zurück zum Zitat Hubert HB, Feinleib M, McNamara PM, Castelli WP (1983) Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation 67:968–977CrossRef Hubert HB, Feinleib M, McNamara PM, Castelli WP (1983) Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation 67:968–977CrossRef
5.
Zurück zum Zitat Zhang Y, Chapman AM, Plested M, Jackson D, Purroy F (2012) The incidence, prevalence, and mortality of stroke in France, Germany, Italy, Spain, the UK, and the US: a literature review. Stroke Res Treat 2012:436125 Zhang Y, Chapman AM, Plested M, Jackson D, Purroy F (2012) The incidence, prevalence, and mortality of stroke in France, Germany, Italy, Spain, the UK, and the US: a literature review. Stroke Res Treat 2012:436125
6.
Zurück zum Zitat Mukherjee D, Patil CG (2011) Epidemiology and the global burden of stroke. World Neurosurg 76:S85–S90CrossRef Mukherjee D, Patil CG (2011) Epidemiology and the global burden of stroke. World Neurosurg 76:S85–S90CrossRef
7.
Zurück zum Zitat Gómez-Ambrosi J, Silva C, Galofré JC, Escalada J, Santos S, Millán D et al (2012) Body mass index classification misses subjects with increased cardiometabolic risk factors related to elevated adiposity. Int J Obes (Lond) 36:286–294CrossRef Gómez-Ambrosi J, Silva C, Galofré JC, Escalada J, Santos S, Millán D et al (2012) Body mass index classification misses subjects with increased cardiometabolic risk factors related to elevated adiposity. Int J Obes (Lond) 36:286–294CrossRef
8.
Zurück zum Zitat Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J, Halsey J et al (2009) Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet 373:1083–1096CrossRef Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J, Halsey J et al (2009) Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet 373:1083–1096CrossRef
9.
Zurück zum Zitat Berrington de Gonzalez A, Hartge P, Cerhan JR, Flint AJ, Hannan L, MacInnis RJ et al (2010) Body-mass index and mortality among 1.46 million white adults. N Engl J Med 363:2211–2219CrossRef Berrington de Gonzalez A, Hartge P, Cerhan JR, Flint AJ, Hannan L, MacInnis RJ et al (2010) Body-mass index and mortality among 1.46 million white adults. N Engl J Med 363:2211–2219CrossRef
10.
Zurück zum Zitat Siren R, Eriksson JG, Vanhanen H (2012) Waist circumference a good indicator of future risk for type 2 diabetes and cardiovascular disease. BMC Public Health 12:631CrossRef Siren R, Eriksson JG, Vanhanen H (2012) Waist circumference a good indicator of future risk for type 2 diabetes and cardiovascular disease. BMC Public Health 12:631CrossRef
11.
Zurück zum Zitat Moore SC (2009) Waist versus weight: which matters more for mortality? Am J Clin Nutr 89:1003–1004CrossRef Moore SC (2009) Waist versus weight: which matters more for mortality? Am J Clin Nutr 89:1003–1004CrossRef
12.
Zurück zum Zitat Bodenant M, Kuulasmaa K, Wagner A, Kee F, Palmieri L, Ferrario MM et al (2011) Measures of abdominal adiposity and the risk of stroke: the MOnica Risk, Genetics, Archiving and Monograph (MORGAM) study. Stroke 42:2872–2877CrossRef Bodenant M, Kuulasmaa K, Wagner A, Kee F, Palmieri L, Ferrario MM et al (2011) Measures of abdominal adiposity and the risk of stroke: the MOnica Risk, Genetics, Archiving and Monograph (MORGAM) study. Stroke 42:2872–2877CrossRef
13.
Zurück zum Zitat Krakauer NY, Krakauer JC (2012) A new body shape index predicts mortality hazard independently of body mass index. PLoS ONE 7:e39504CrossRef Krakauer NY, Krakauer JC (2012) A new body shape index predicts mortality hazard independently of body mass index. PLoS ONE 7:e39504CrossRef
14.
Zurück zum Zitat Suk SH, Sacco RL, Boden-Albala B, Cheun JF, Pittman JG, Elkind MS et al (2003) Abdominal obesity and risk of ischemic stroke: the Northern Manhattan Stroke Study. Stroke 34:1586–1592CrossRef Suk SH, Sacco RL, Boden-Albala B, Cheun JF, Pittman JG, Elkind MS et al (2003) Abdominal obesity and risk of ischemic stroke: the Northern Manhattan Stroke Study. Stroke 34:1586–1592CrossRef
15.
Zurück zum Zitat Furukawa Y, Kokubo Y, Okamura T, Watanabe M, Higashiyama A, Ono Y et al (2010) The relationship between waist circumference and the risk of stroke and myocardial infarction in a Japanese urban cohort: the Suita study. Stroke 41:550–553CrossRef Furukawa Y, Kokubo Y, Okamura T, Watanabe M, Higashiyama A, Ono Y et al (2010) The relationship between waist circumference and the risk of stroke and myocardial infarction in a Japanese urban cohort: the Suita study. Stroke 41:550–553CrossRef
16.
Zurück zum Zitat Riboli E, Kaaks R (1997) The EPIC Project: rationale and study design. European Prospective Investigation into Cancer and Nutrition. Int J Epidemiol 26:S6–S14CrossRef Riboli E, Kaaks R (1997) The EPIC Project: rationale and study design. European Prospective Investigation into Cancer and Nutrition. Int J Epidemiol 26:S6–S14CrossRef
17.
Zurück zum Zitat Riboli E, Hunt KJ, Slimani N, Ferrari P, Norat T, Fahey M et al (2002) European Prospective Investigation into Cancer and Nutrition (EPIC): study populations and data collection. Public Health Nutr 5:1113–1124CrossRef Riboli E, Hunt KJ, Slimani N, Ferrari P, Norat T, Fahey M et al (2002) European Prospective Investigation into Cancer and Nutrition (EPIC): study populations and data collection. Public Health Nutr 5:1113–1124CrossRef
18.
Zurück zum Zitat EPIC Group of Spain (1997) Relative validity and reproducibility of a diet history questionnaire in Spain: I—foods: European Prospective Investigation into Cancer and Nutrition. Int J Epidemiol 26:S91–S99CrossRef EPIC Group of Spain (1997) Relative validity and reproducibility of a diet history questionnaire in Spain: I—foods: European Prospective Investigation into Cancer and Nutrition. Int J Epidemiol 26:S91–S99CrossRef
19.
Zurück zum Zitat EPIC Group of Spain (1997) Relative validity and reproducibility of a diet history questionnaire in Spain: II—nutrients: European Prospective Investigation into Cancer and Nutrition. Int J Epidemiol 26:S100–S109CrossRef EPIC Group of Spain (1997) Relative validity and reproducibility of a diet history questionnaire in Spain: II—nutrients: European Prospective Investigation into Cancer and Nutrition. Int J Epidemiol 26:S100–S109CrossRef
20.
Zurück zum Zitat Slimani N, Deharveng G, Unwin I, Southgate DA, Vignat J, Skeie G et al (2007) The EPIC nutrient database project (ENDB): a first attempt to standardize nutrient databases across the 10 European countries participating in the EPIC study. Eur J Clin Nutr 61:1037–1056CrossRef Slimani N, Deharveng G, Unwin I, Southgate DA, Vignat J, Skeie G et al (2007) The EPIC nutrient database project (ENDB): a first attempt to standardize nutrient databases across the 10 European countries participating in the EPIC study. Eur J Clin Nutr 61:1037–1056CrossRef
21.
Zurück zum Zitat InterAct Consortium (2012) Validity of a short questionnaire to assess physical activity in 10 European countries. Eur J Epidemiol 27:15–25CrossRef InterAct Consortium (2012) Validity of a short questionnaire to assess physical activity in 10 European countries. Eur J Epidemiol 27:15–25CrossRef
22.
Zurück zum Zitat InterAct Consortium, Langenberg C, Sharp S, Forouhi NG, Franks PW, Schulze MB, Kerrison N et al (2011) Design and cohort description of the InterAct Project: an examination of the interaction of genetic and lifestyle factors on the incidence of type 2 diabetes in the EPIC Study. Diabetologia 54:2272–2282 InterAct Consortium, Langenberg C, Sharp S, Forouhi NG, Franks PW, Schulze MB, Kerrison N et al (2011) Design and cohort description of the InterAct Project: an examination of the interaction of genetic and lifestyle factors on the incidence of type 2 diabetes in the EPIC Study. Diabetologia 54:2272–2282
23.
Zurück zum Zitat Diez-Tejedor E (2006) Guía para el diagnóstico y tratamiento del ictus. Guide for diagnosis and treatment of stroke. Prous Science, Barcelona Diez-Tejedor E (2006) Guía para el diagnóstico y tratamiento del ictus. Guide for diagnosis and treatment of stroke. Prous Science, Barcelona
24.
Zurück zum Zitat Grambsch P, Therneau T (1994) Proportional hazards tests and diagnostics based on weighted residuals. Biometrica 31:515–526CrossRef Grambsch P, Therneau T (1994) Proportional hazards tests and diagnostics based on weighted residuals. Biometrica 31:515–526CrossRef
25.
Zurück zum Zitat Romero-Corral A, Somers VK, Sierra-Johnson J, Korenfeld Y, Boarin S, Korinek J et al (2010) Normal weight obesity: a risk factor for cardiometabolic dysregulation and cardiovascular mortality. Eur Heart J 31:737–746CrossRef Romero-Corral A, Somers VK, Sierra-Johnson J, Korenfeld Y, Boarin S, Korinek J et al (2010) Normal weight obesity: a risk factor for cardiometabolic dysregulation and cardiovascular mortality. Eur Heart J 31:737–746CrossRef
26.
Zurück zum Zitat Toss F, Wiklund P, Franks PW, Eriksson M, Gustafson Y, Hallmans G et al (2011) Abdominal and gynoid adiposity and the risk of stroke. Int J Obes (Lond) 35:1427–1432CrossRef Toss F, Wiklund P, Franks PW, Eriksson M, Gustafson Y, Hallmans G et al (2011) Abdominal and gynoid adiposity and the risk of stroke. Int J Obes (Lond) 35:1427–1432CrossRef
27.
Zurück zum Zitat Saito I, Iso H, Kokubo Y, Inoue M, Tsugane S (2011) Body mass index, weight change and risk of stroke and stroke subtypes: the Japan Public Health Center-based prospective (JPHC) study. Int J Obes (Lond) 35:283–291CrossRef Saito I, Iso H, Kokubo Y, Inoue M, Tsugane S (2011) Body mass index, weight change and risk of stroke and stroke subtypes: the Japan Public Health Center-based prospective (JPHC) study. Int J Obes (Lond) 35:283–291CrossRef
28.
Zurück zum Zitat Bazzano LA, Gu D, Whelton MR, Wu X, Chen CS, Duan X et al (2010) Body mass index and risk of stroke among Chinese men and women. Ann Neurol 67:11–20CrossRef Bazzano LA, Gu D, Whelton MR, Wu X, Chen CS, Duan X et al (2010) Body mass index and risk of stroke among Chinese men and women. Ann Neurol 67:11–20CrossRef
29.
Zurück zum Zitat Wang C, Liu Y, Yang Q, Dai X, Wu S, Wang W et al (2013) Body mass index and risk of total and type-specific stroke in Chinese adults: results from a longitudinal study in China. Int J Stroke 8:245–250CrossRef Wang C, Liu Y, Yang Q, Dai X, Wu S, Wang W et al (2013) Body mass index and risk of total and type-specific stroke in Chinese adults: results from a longitudinal study in China. Int J Stroke 8:245–250CrossRef
30.
Zurück zum Zitat Kizer JR, Biggs ML, Ix JH, Mukamal KJ, Zieman SJ, de Boer IH et al (2011) Measures of adiposity and future risk of ischemic stroke and coronary heart disease in older men and women. Am J Epidemiol 173:10–25CrossRef Kizer JR, Biggs ML, Ix JH, Mukamal KJ, Zieman SJ, de Boer IH et al (2011) Measures of adiposity and future risk of ischemic stroke and coronary heart disease in older men and women. Am J Epidemiol 173:10–25CrossRef
31.
Zurück zum Zitat Wormser D, Kaptoge S, Di Angelantonio E, Wood AM, Pennells L, Thompson A et al (2011) Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: collaborative analysis of 58 prospective studies. Lancet 377:1085–1095CrossRef Wormser D, Kaptoge S, Di Angelantonio E, Wood AM, Pennells L, Thompson A et al (2011) Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: collaborative analysis of 58 prospective studies. Lancet 377:1085–1095CrossRef
32.
Zurück zum Zitat Kurth T, Gaziano JM, Rexrode KM, Kase CS, Cook NR, Manson JE et al (2005) Prospective study of body mass index and risk of stroke in apparently healthy women. Circulation 111:1992–1998CrossRef Kurth T, Gaziano JM, Rexrode KM, Kase CS, Cook NR, Manson JE et al (2005) Prospective study of body mass index and risk of stroke in apparently healthy women. Circulation 111:1992–1998CrossRef
33.
Zurück zum Zitat Rexrode KM, Hennekens CH, Willett WC, Colditz GA, Stampfer MJ, Rich-Edwards JW et al (1997) A prospective study of body mass index, weight change, and risk of stroke in women. JAMA 277:1539–1545CrossRef Rexrode KM, Hennekens CH, Willett WC, Colditz GA, Stampfer MJ, Rich-Edwards JW et al (1997) A prospective study of body mass index, weight change, and risk of stroke in women. JAMA 277:1539–1545CrossRef
34.
Zurück zum Zitat Hu G, Tuomilehto J, Silventoinen K, Sarti C, Männistö S, Jousilahti P (2007) Body mass index, waist circumference, and waist-hip ratio on the risk of total and type-specific stroke. Arch Intern Med 167:1420–1427CrossRef Hu G, Tuomilehto J, Silventoinen K, Sarti C, Männistö S, Jousilahti P (2007) Body mass index, waist circumference, and waist-hip ratio on the risk of total and type-specific stroke. Arch Intern Med 167:1420–1427CrossRef
35.
Zurück zum Zitat Nimmo MA, Leggate M, Viana JL, King JA (2013) The effect of physical activity on mediators of inflammation. Diabetes Obes Metab 15:51–60CrossRef Nimmo MA, Leggate M, Viana JL, King JA (2013) The effect of physical activity on mediators of inflammation. Diabetes Obes Metab 15:51–60CrossRef
36.
Zurück zum Zitat Huerta JM, Chirlaque MD, Tormo MJ, Gavrila D, Arriola L, Moreno-Iribas C et al (2013) Physical activity and risk of cerebrovascular disease in the European Prospective Investigation into Cancer and Nutrition-Spain study. Stroke 44:111–118CrossRef Huerta JM, Chirlaque MD, Tormo MJ, Gavrila D, Arriola L, Moreno-Iribas C et al (2013) Physical activity and risk of cerebrovascular disease in the European Prospective Investigation into Cancer and Nutrition-Spain study. Stroke 44:111–118CrossRef
37.
Zurück zum Zitat Yatsuya H, Folsom AR, Yamagishi K, North KE, Brancati FL, Stevens J (2010) Race- and sex-specific associations of obesity measures with ischemic stroke incidence in the Atherosclerosis Risk in Communities (ARIC) study. Stroke 41:417–425CrossRef Yatsuya H, Folsom AR, Yamagishi K, North KE, Brancati FL, Stevens J (2010) Race- and sex-specific associations of obesity measures with ischemic stroke incidence in the Atherosclerosis Risk in Communities (ARIC) study. Stroke 41:417–425CrossRef
38.
Zurück zum Zitat Song YM, Sung J, Davey Smith G, Ebrahim S (2004) Body mass index and ischemic and hemorrhagic stroke: a prospective study in Korean men. Stroke 35:831–836CrossRef Song YM, Sung J, Davey Smith G, Ebrahim S (2004) Body mass index and ischemic and hemorrhagic stroke: a prospective study in Korean men. Stroke 35:831–836CrossRef
39.
Zurück zum Zitat Koenig W, Pepys MB (2002) C-reactive protein risk prediction: low specificity, high sensitivity. Ann Intern Med 136:550–552CrossRef Koenig W, Pepys MB (2002) C-reactive protein risk prediction: low specificity, high sensitivity. Ann Intern Med 136:550–552CrossRef
40.
Zurück zum Zitat Ma SH, Park BY, Yang JJ, Jung EJ, Yeo Y, Whang Y et al (2012) Interaction of body mass index and diabetes as modifiers of cardiovascular mortality in a cohort study. J Prev Med Public Health 45:394–401CrossRef Ma SH, Park BY, Yang JJ, Jung EJ, Yeo Y, Whang Y et al (2012) Interaction of body mass index and diabetes as modifiers of cardiovascular mortality in a cohort study. J Prev Med Public Health 45:394–401CrossRef
41.
Zurück zum Zitat Nilsson G, Hedberg P, Öhrvik J (2011) Survival of the fattest: unexpected findings about hyperglycaemia and obesity in a population based study of 75-year-olds. BMJ Open 1:e000012CrossRef Nilsson G, Hedberg P, Öhrvik J (2011) Survival of the fattest: unexpected findings about hyperglycaemia and obesity in a population based study of 75-year-olds. BMJ Open 1:e000012CrossRef
Metadaten
Titel
Association between different obesity measures and the risk of stroke in the EPIC Spanish cohort
verfasst von
Itziar Abete
Larraitz Arriola
Nerea Etxezarreta
Imanol Mozo
Conchi Moreno-Iribas
Pilar Amiano
Nerea Egüés
Estibaliz Goyenechea
Adolfo Lopez de Munain
Maite Martinez
Noemi Travier
Carmen Navarro
Maria-Dolores Chirlaque
Maria-Jose Tormo
Diana Gavrila
Jose Maria Huerta
María-José Sánchez
Esther Molina-Montes
Mar Requena
Maria-Dolores Jiménez-Hernández
Eva Ardanaz
Aurelio Barricarte
Jose Ramon Quiros
Laudina Rodriguez
Miren Dorronsoro
Publikationsdatum
01.04.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Nutrition / Ausgabe 3/2015
Print ISSN: 1436-6207
Elektronische ISSN: 1436-6215
DOI
https://doi.org/10.1007/s00394-014-0716-x

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