Ni Mhurchu C, Rodgers A, Pan WH, Gu DF, Woodward M. Body mass index and cardiovascular disease in the Asia-Pacific Region: an overview of 33 cohorts involving 310 000 participants. Int J Epidemiol 33, 751-758

Clinical Trials Research Unit, Faculty of Medicine and Health Sciences, Asia Pacific Cohort Studies Collaboration, University of Auckland, Auckland, New Zealand.
International Journal of Epidemiology (Impact Factor: 9.18). 09/2004; 33(4):751-8. DOI: 10.1093/ije/dyh163
Source: PubMed


Few prospective data from the Asia-Pacific region are available relating body mass index (BMI) to the risks of stroke and ischaemic heart disease (IHD). Our objective was to assess the age-, sex-, and region-specific associations of BMI with cardiovascular disease using individual participant data from prospective studies in the Asia-Pacific region.
Studies were identified from literature searches, proceedings of meetings, and personal communication. All studies had at least 5000 person-years of follow-up. Hazard ratios were calculated from Cox models, stratified by sex and cohort, and adjusted for age at risk and smoking. The first 3 years of follow-up were excluded in order to reduce confounding due to disease at baseline.
A total of 33 cohort studies, including 310 283 participants, contributed 2 148 354 person-years of follow-up, during which 3332 stroke and 2073 IHD events were observed. There were continuous positive associations between baseline BMI and the risks of ischaemic stroke, haemorrhagic stroke, and IHD, with each 2 kg/m(2) lower BMI associated a 12% (95% CI: 9, 15%) lower risk of ischaemic stroke, 8% (95% CI: 4, 12%) lower risk in haemorrhagic stroke, and 11% (95% CI: 9, 13%) lower risk of IHD. The strengths of all associations were strongly age dependent, and there was no significant difference between Asian and Australasian cohorts.
This overview provides the most reliable estimates to date of the associations between BMI and cardiovascular disease in the Asia-Pacific region, and the first direct comparisons within the region. Continuous relationships of approximately equal strength are evident in both Asian and Australasian populations. These results indicate considerable potential for cardiovascular disease reduction with population-wide lowering of BMI.

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    • "Methods APCSC is an overview, using individual participant data, of prospective cohort studies from the Asia-Pacific region. APCSC's design and methods have been previously described in detail (Ni Mhurchu et al., 2004; Zhang et al., 2003; Woodward et al., 2007; Patel et al., 2004). All studies had 5000+ person-years of follow-up. "
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    ABSTRACT: Objective: To assess whether body mass index (BMI) modifies the associations of lipids with coronary heart disease (CHD). Methods: In the Asia Pacific Cohort Studies Collaboration, total cholesterol (TC), high density lipoprotein cholesterol (HDLC) and triglycerides (TG) were measured for 333,297, 71,777 and 84,015 participants, respectively. All participants had measured BMI, categorized into underweight, normal, high-normal, overweight and obese, using standard definitions. For each BMI subgroup the effects of lipids on CHD were estimated per 1 standard deviation (SD) increase using Cox proportional hazard models, stratified by study and sex, adjusted for age and smoking. They were compared across the BMI groups, testing for interactions. Results: In the analyses for TC, HDLC and TG, there were 3121, 714 and 808 CHD events during a mean follow-up of 6.7 years. The risk of CHD increased monotonically with increasing TC and decreasing HDLC in all BMI subgroups without evidence of heterogeneity (p for interaction > 0.4). In contrast, the hazard ratio for CHD for a one SD increase in log-transformed TG increased from 1.07 (95%CI 0.72-1.59) in underweight, 1.26 (1.10-1.44) in normal weight, 1.27 (1.08-1.49) in high-normal weight, 1.37 (1.22-1.55) in overweight, to 1.61(1.30-1.99) in obesity (p = 0.01 for interaction trend). These associations were attenuated (p = 0.07 for interaction) but remained significant in the overweight and obese after further adjustment for TC and HDLC. Conclusions: Greater excess body weight exacerbated the effects of TG, but not TC or HDLC, on CHD, suggesting that additional effort is required to reduce TG in the overweight and obese.
    Full-text · Article · Jun 2016
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    • "Thus, our findings provide evidence for the importance of greater adiposity in the occurrence of a CHD event. In other studies that investigated the association between BMI and incident CHD [9,12-15,17,37], results were broadly similar to those found here, but generally lacked power to describe reliably the relation between BMI and incident CHD across a wide range of values and important subgroups in the population. "
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    ABSTRACT: Background A high body mass index (BMI) is associated with an increased risk of mortality from coronary heart disease (CHD); however, a low BMI may also be associated with an increased mortality risk. There is limited information on the relation of incident CHD risk across a wide range of BMI, particularly in women. We examined the relation between BMI and incident CHD overall and across different risk factors of the disease in the Million Women Study. Methods 1.2 million women (mean age = 56 years) participants without heart disease, stroke, or cancer (except non-melanoma skin cancer) at baseline (1996 to 2001) were followed prospectively for 9 years on average. Adjusted relative risks and 20-year cumulative incidence from age 55 to 74 years were calculated for CHD using Cox regression. Results After excluding the first 4 years of follow-up, we found that 32,465 women had a first coronary event (hospitalization or death) during follow-up. The adjusted relative risk for incident CHD per 5 kg/m2 increase in BMI was 1.23 (95% confidence interval (CI) 1.22 to 1.25). The cumulative incidence of CHD from age 55 to 74 years increased progressively with BMI, from 1 in 11 (95% CI 1 in10 to 12) for BMI of 20 kg/m2, to 1 in 6(95% CI 1 in 5 to 7) for BMI of 34 kg/m2. A 10 kg/m2 increase in BMI conferred a similar risk to a 5-year increment in chronological age. The 20 year cumulative incidence increased with BMI in smokers and non-smokers, alcohol drinkers and non-drinkers, physically active and inactive, and in the upper and lower socioeconomic classes. In contrast to incident disease, the relation between BMI and CHD mortality (n = 2,431) was J-shaped. For the less than 20 kg/m2 and ≥35 kg/m2 BMI categories, the respective relative risks were 1.27 (95% CI 1.06 to 1.53) and 2.84 (95% CI 2.51 to 3.21) for CHD deaths, and 0.89 (95% CI 0.83 to 0.94) and 1.85 (95% CI 1.78 to 1.92) for incident CHD. Conclusions CHD incidence in women increases progressively with BMI, an association consistently seen in different subgroups. The shape of the relation with BMI differs for incident and fatal disease.
    Full-text · Article · Apr 2013 · BMC Medicine
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    • "Obesity and being overweight are serious public health problems; obesity has a direct relationship with physical health and psychological health and is a potential risk factor for many diseases, including cardiovascular diseases, stroke, ischemic heart disease, diabetes, and cancer [2, 5–8]. Therefore, it is important to recognize when patients are overweight or obese, and many studies have been performed about the relationship of obesity, as determined by body mass index (BMI), and disease [4, 6, 7, 9–11]. BMI, proposed by Lambert Adolphe Jacques Quetelet, is a measurement criterion presenting the relationship between body weight and height [3] and a commonly used public health method for classifying underweight, normal, overweight, and obese patients. "
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    ABSTRACT: Obesity is a serious public health problem because of the risk factors for diseases and psychological problems. The focus of this study is to diagnose the patient BMI (body mass index) status without weight and height measurements for the use in future clinical applications. In this paper, we first propose a method for classifying the normal and the overweight using only speech signals. Also, we perform a statistical analysis of the features from speech signals. Based on 1830 subjects, the accuracy and AUC (area under the ROC curve) of age- and gender-specific classifications ranged from 60.4 to 73.8% and from 0.628 to 0.738, respectively. We identified several features that were significantly different between normal and overweight subjects ( P < 0.05 ). Also, we found compact and discriminatory feature subsets for building models for diagnosing normal or overweight individuals through wrapper-based feature subset selection. Our results showed that predicting BMI status is possible using a combination of speech features, even though significant features are rare and weak in age- and gender-specific groups and that the classification accuracy with feature selection was higher than that without feature selection. Our method has the potential to be used in future clinical applications such as automatic BMI diagnosis in telemedicine or remote healthcare.
    Full-text · Article · Mar 2013 · Evidence-based Complementary and Alternative Medicine
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