Metabolic mediators of the effects of body-mass index, overweight, and obesity on coronary heart disease and stroke: A pooled analysis of 97 prospective cohorts with 1·8 million participants

摘要: Background Body-mass index (BMI) and diabetes have increased worldwide, whereas global average blood pressure cholesterol decreased or remained unchanged in the past three decades. We quantified how much of effects BMI on coronary heart disease stroke are mediated through pressure, cholesterol, glucose, is independent these factors. Methods pooled data from 97 prospective cohort studies that collectively enrolled 1·8 million participants between 1948 2005, included 57 161 31 093 events. For each we excluded who were younger than 18 years, had a lower 20 kg/m2, history stroke. estimated hazard ratio (HR) with without adjustment for all possible combinations glucose. HRs random-effects model calculated attenuation excess risk after mediators. Findings The HR 5 kg/m2 higher was 1·27 (95% CI 1·23-1·31) 1·18 (1·14-1·22) confounders. Additional metabolic factors reduced to 1·15 (1·12-1·18) 1·04 (1·01-1·08) stroke, suggesting 46% 42-50) 76% (65-91) by Blood most important mediator, accounting 31% (28-35) 65% (56-75) percentage risks mediators did not differ significantly Asian western cohorts (North America, Europe, Australia, New Zealand). Both overweight (BMI ≥25 <30 kg/m2) obesity ≥30 associated compared normal weight ≥20 <25 kg/m2), 50% (44-58) 44% (41-48) selected percentages 98% (69-155) 69% (64-77) obesity. Interpretation Interventions reduce high glucose might address about half three-quarters BMI. Maintenance optimum bodyweight needed full benefits.