Association Between The Status Of Metabolism,Overweight/Obesity And The Risk Of Stroke

ObjectivesStroke is a chronic non-communicable disease that seriously endangers human health.Its prevention and control work has always received great attention.Overweight/obesity can cause metabolic disorders and increase the risk of stroke.However,Not all overweight/obese people have metabolic unhealthy,and not all metabolic unhealthy will develop obesity.According to the two attributes of metabolic status and overweight/obesity,the population can be divided into 4 phenotypes:metabolically healthy non-overweight/obesity(MHNO),metabolically healthy overweight/obesity(MHO),and metabolically unhealthy non-overweight/obe-sity(MUNO),and metabolically unhealthy overweight/obesity(MUO).Up to date,the conclusions of the association between MHO,MUNO phenotypes and the risk of cardiovascular are still inconsistent.The association between the phenotypes and the risk of stroke,as well as the population health management strategy related to each special phenotypes are still the focus of current research.So based on the survey data of the "National Screening and Intervention Project for High-risk Groups of Stroke" in 2014-2015,the objectives of this study was(1)to explore the related factors of metabolic unhealthy in non-overweight/obese population and overweight/obese population,respectively;(2)By taking stroke patients as cases as well as non-stroke/TIA subjects as controls,to explore the association between MHO,MUNO and MUO phenotypes and the risk of stroke,and to analyze whether metabolic abnormality and overweight/obesity interact in the occurrence of stroke.The main prupose of this study is to provide targeted recommendations for the first and secondary prevention of stroke.MethodsThis study was based on the cross-sectional survey data of "National Screening and Intervention Project for High-risk Groups of Stroke" during 2014 to 2015,which adopted a two-stage cluster sampling to survey 256 communities/towns from 31 provinces,municipalities and Xinjiang Production and Construction Corps in China.A total of 726451 residents aged 40 and over had been investigaed.We first analyzed the related factors of metabolic abnormalities in non-overweight/obese population and overweight/obese population using multifactor unconditional logistic regression model.Then,Taking patients with stroke as cases as well as non-stroke/TIA population as controls in this population,we explored the associations between the phenotypes of MHO,MUNO and MUO and the risk of stroke using multiple Logistic regression models and calculated odds ratios(OR)and 95%confidence intervals(CI).The robustness of the above analysis was verified by sensitivity analysis and subgroup analysis.The possible effects of metabolic abnormalities and overweight/obesity on stroke risk were analyzed using multiplication and addition interactions.In addition,the mediating effect of body mass index(BMI)between motor inactivity and stroke was investigated in normal and abnormal metabolic groups.Results1.The results of Logistic regression analysis including 123591 overweight/obese people showed that increasing age,living in central/eastern region,rural areas,smoking behavior,lack of exercise,WC-type obesity,history of atrial fibrillation(AF),and family history of stroke were associated with metabolic unhealthy.Simultaneously,the results of Logistic regression analysis including a total of 95060 non-overweight/obese people showed that increasing age,ethnic minorities,living in eastern residential areas,rural areas,smoking behavior,lack of exercise,WC obesity,AF and family history of stroke were associated with metabolic abnormalities.2.A total of 15778 stroke patients and 191154 controls were included in the case-control study.Taking MHNO phenotype as a reference,The ORs and 95%CIs of the MHO for stroke in the general population,male and female populations were 1.13(1.08,1.18)and 1.11(1.04,1.18)and 1.16(1.08,1.24)respectively after adjusting covariates;The ORs and 95%CIs of the MUNO phenotype and stroke risk were 1.41(1.34,1.50),1.38(1.28,1.49)and 1.46(1.35,1.58)respectively;The MUO phenotype were 1.77(1.69,1.85),1.66(1.56,1.77)and 1.92(1.80,2.04)respectively.The results of sensitivity analysis and subgroup analysis were consistent with the above results.3.The OR and 95%CI of multiplicative interaction between metabolic unhealthyities and overweight/obesity for stroke in the general population and female population were 1.12(1.04,1.20)and 1.15(1.04,1.27)respectively,all P<0.007.The index excess risk(RERI),attribution ratio(AP)and interaction index(S)of additive interaction in the general population,male and female populations were statistically significant.Moreover,the AP values were 12%,9%and 14%respectively.4.Both in the non-overweight/obesity popolation and in the the metabolic unhealthy populations,the mediating role of BMI between exercise deficiency and stroke were 1%,both P<0.05.Conclusions1.In the non-overweight/obesity population and overweight/obesity population,the factors are related to metabolic unhealthy are similar,including increasing age,living in eastern residential areas,rural areas,smoking,physical inactivity,WC-type obesity,history of atrial fibrillation,and family history of stroke.2.MHO,MUNO and MUO phenotypes are all related to stroke.Metabolic unhealthyities and overweight/obesity have a additive interaction(positive synergy)in the risk of stroke.Therefore,people should pay attention to the prevention of stroke in the MHO and MUNO populations,which means the population with MHO phenotype should carry out weight management as well as the population with MUNO phenotype also needs continuous monitoring and intervention management of metabolic related indicators in the primary prevention activity for stroke.3.BMI plays a partial mediating role between lack of exercise and stroke.