Objective: To investigate the association between metabolically healthy obesity and the incident risk of stroke in people aged ≥40 years from rural areas of Henan Province. Methods: During 2007 to 2008, 20 194 residents aged ≥18 years were selected for baseline examination by random cluster sampling and 17 265 participants were followed up during 2013 to 2014. According to the aim of current study, a total of 11 864 eligible subjects were included in this post-hoc analysis. Depending on body mass index and metabolic status, subjects were divided into four groups: metabolically healthy normal weight, metabolically healthy obesity, metabolically abnormal normal weight and metabolically abnormal obesity. Multivariate logistic regression model was used to analyze the relationship between metabolically healthy obesity and the risk of stroke. Results: The median (Q1, Q3) age of study participants was 54(46, 61) years, and 4 526 participants were men. During the mean follow-up of 6 years, the cumulative incidence of stroke was 7.16%. The incidence of stroke in metabolically healthy normal weight, metabolically healthy obesity, metabolically abnormal normal weight, and metabolically abnormal obesity were 3.73%, 4.61%, 8.99% and 9.38%, respectively (χ²=117.458, P<0.001). After adjusting possible confounding factors, compared with metabolically healthy normal weight, the risk of stroke was significantly increased in the metabolically healthy obesity group, metabolically abnormal normal weight group and metabolically abnormal obesity group with the odds ratio (OR) and 95% confidence interval (CI) of 1.52(1.10-2.12), 2.11(1.61-2.77) and 2.78(2.18-3.55), respectively. Stratified analysis showed that the risk of stroke was significantly higher in metabolically healthy obesity people aged 40-59 years compared with metabolically healthy normal weight group (OR=2.12, 95%CI: 1.36-3.30). Conclusion: Metabolically healthy obesity, metabolically abnormal normal weight and metabolically abnormal obesity are positively associated with the risk of stroke.
目的： 探讨河南农村地区40岁及以上人群中代谢健康肥胖与脑卒中发病的关系。 方法： 采用整群随机抽样方法，选择20 194名河南省新安县≥18岁的农村常住居民于2007至2008年进行基线调查；随访调查于2013至2014年开展，共随访到17 265人。本研究为事后分析，根据研究目的最终共纳入11 864名研究对象进行统计学分析。根据基线体质指数和代谢状况将研究对象分为代谢健康体重正常、代谢健康肥胖、代谢异常体重正常和代谢异常肥胖四组。运用多因素logistic回归模型分析不同肥胖和代谢状态与脑卒中发病风险的关系。 结果： 研究对象的年龄中位数（四分位间距）为54（46，61）岁，其中男性4 529人。经过平均6年的随访，脑卒中的累积发病率为7.16%。代谢健康体重正常、代谢健康肥胖、代谢异常体重正常和代谢异常肥胖组脑卒中的发病率分别为3.73%、4.61%、8.99%和9.38%，差异有统计学意义（χ²=117.458，P<0.001）。控制可能存在的混杂因素后，以代谢健康体重正常组为参照，代谢健康肥胖、代谢异常体重正常和代谢异常肥胖组脑卒中发病风险的比值比（odds ratio，OR）与95%置信区间（confidence interval，CI）分别为1.52（1.10~2.12）、2.11（1.61~2.77）和2.78（2.18~3.55）。亚组分析表明，40~59岁人群中代谢健康肥胖表型显著增加脑卒中的发病风险（OR=2.12，95%CI：1.36~3.30）。 结论： 代谢健康肥胖、代谢异常体重正常和代谢异常肥胖均是影响脑卒中发病的危险因素。.