Body mass index, weight change and risk of stroke and stroke subtypes: the Japan Public Health Center-based prospective (JPHC) study

Saito, Isao; Iso, Hiroyasu; Kokubo, Yoshihiro; Inoue, Manami; Tsugane, Shoichiro

doi:10.1038/ijo.2010.131

Cited by 45 publications

(39 citation statements)

References 21 publications

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“…The Hisayama study reported that high BMI was associated with a high incidence of cerebral infarction in men, but not in women 25 . The Japan Public Health Center-Based Prospective (JPHC) Study reported that higher BMI was associated with an increased risk of stroke in women, but not in men 23 . Females in the Hisayama study were more likely to be current smokers than those in our study.…”

Section: Discussioncontrasting

confidence: 44%

Body mass index and stroke incidence in Japanese community residents: The Jichi Medical School (JMS) Cohort Study

Kawate

Kayaba

Hara

et al. 2017

Journal of Epidemiology

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BackgroundHigh body mass index (BMI) has been reported as a risk factor for cardiovascular events in Western countries, while low BMI has been reported as a risk factor for cardiovascular death in Asian countries, including Japan. Although stroke is a major cause of death and disability in Japan, few cohort studies have examined the association between BMI and stroke incidence in Japan. This study aimed to examine the association between BMI and stroke incidence using prospective data from Japanese community residents.MethodsData were analyzed from 12,490 participants in the Jichi Medical School Cohort Study. Participants were categorized into five BMI groups: ≤18.5, 18.6–21.9, 22.0–24.9, 25.0–29.9, and ≥30.0 kg/m2. Multivariate-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using the Cox proportional hazard model. The group with a BMI of 22.0–24.9 kg/m2 was used as the reference category.ResultsDuring mean follow-up of 10.8 years, 395 participants (207 men and 188 women) experienced stroke, including 249 cerebral infarctions and 92 cerebral hemorrhages. Men with a BMI ≤18.5 kg/m2 (HR 2.11; 95% CI, 1.17–3.82) and women with a BMI ≥30.0 kg/m2 (HR 2.25; 95% CI, 1.28–5.08) were at significantly higher risk for all-stroke. Men with a BMI ≤18.5 kg/m2 were at significantly higher risk for cerebral infarction (HR 2.15; 95% CI, 1.07–4.33).ConclusionsThe association between BMI and stroke incidence observed in this population was different than those previously reported: low BMI was a risk factor for all-stroke and cerebral infarction in men, while high BMI was a risk factor for all-stroke in women.

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Section: Discussioncontrasting

confidence: 44%

Body mass index and stroke incidence in Japanese community residents: The Jichi Medical School (JMS) Cohort Study

Kawate

Kayaba

Hara

et al. 2017

Journal of Epidemiology

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“…Studies have revealed a graded association between BMI and stroke risk; the risk of total stroke or IS rises linearly with increasing BMI and in a stepwise fashion for higher BMI categories. [297][298][299] Obesity affects stroke risk in both men and women, even after adjustment for factors such as age, physical activity, smoking, alcohol consumption, and comorbid conditions such as hypertension and diabetes mellitus [297][298][299][300][301][302][303][304][305][306][307] (Table 10). There is no clear evidence that obesity has a stronger impact on stroke risk in women than in men (Table 10).…”

Section: Association Between Obesity and Abdominal Adiposity And Stromentioning

confidence: 99%

Guidelines for the Prevention of Stroke in Women

Bushnell¹,

McCullough²,

Awad³

et al. 2014

Stroke

772

414

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1545Purpose-The aim of this statement is to summarize data on stroke risk factors that are unique to and more common in women than men and to expand on the data provided in prior stroke guidelines and cardiovascular prevention guidelines for women. This guideline focuses on the risk factors unique to women, such as reproductive factors, and those that are more common in women, including migraine with aura, obesity, metabolic syndrome, and atrial fibrillation. Results-We provide current evidence, research gaps, and recommendations on risk of stroke related to preeclampsia, oral contraceptives, menopause, and hormone replacement, as well as those risk factors more common in women, such as obesity/metabolic syndrome, atrial fibrillation, and migraine with aura. Conclusions-To more accurately reflect the risk of stroke in women across the lifespan, as well as the clear gaps in current risk scores, we believe a female-specific stroke risk score is warranted. (Stroke. 2014;45:1545-1588.)

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“…4 Considering the results of the present study as well as previous studies, the effect of obesity or weight gain on death appears to be considerably smaller in Japanese than Caucasian subjects. In contrast, recent large Japanese prospective studies demonstrated that overweight or obesity assessed using BMI raised the risk of incident stroke only in women, 5 and that of incident coronary heart disease only in men. 17 Another meta-analysis in Japan also found that increased BMI was associated with a higher risk of incident stroke in both men and women, but a higher risk of coronary heart disease only in men.…”

Section: Discussionmentioning

confidence: 87%

Prospective Study on Waist Circumference and Risk of All-Cause and Cardiovascular Mortality

Saito

Kokubo

Kiyohara

et al. 2012

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp ecently, a prospective study in more than 1 million Asian subjects has confirmed that there is a U-shaped association between body mass index (BMI) and the risk of death from cancer, cardiovascular disease (CVD), and other causes. 1 But previous epidemiological studies in Japan suggested that increased BMI was unlikely to influence mortality risk, 2,3 whereas a lower BMI or weight loss markedly raised this risk. 4 In contrast, it has been reported that Japanese overweight or obese subjects have an increased risk for incident coronary heart disease or ischemic stroke. 5, 6 The Hisayama study in Japan documented that increased BMI was associated with an increased risk of stroke in women, but not in men. 7 An enhanced risk for incident CVD and stroke associated with increased waist circumference was also found only in women in the Suita study. 8 Taken together, these findings indicate that overweight or obesity has an impact on incident CVD in Japanese men and women, except for stroke in men.A large European prospective study documented that abdominal obesity, as indexed by waist circumference, had a Jshaped association with mortality risk. 9 That study showed that overweight or obesity, assessed by BMI or waist circumference, was associated closely with increased risk of CVD mortality in Caucasian subjects. Compared with indices of adiposity, a waist circumference signifying central obesity was a stronger marker for predicting CVD mortality than BMI. 10 A recent meta-analysis in Caucasian subjects found increased all-cause and CVD mortality risks for elderly people (65-74 years old) with an increased waist circumference across BMI categories and for underweight elderly people. 11 The association of waist circumference levels with CVD mortality risk, however, remains to be determined in Japanese adults. Therefore, to better Background: The aim of the present study was to clarify the association between waist circumference and all-cause and cardiovascular disease (CVD) mortality risk in relatively lean Japanese subjects.

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Body mass index, weight change and risk of stroke and stroke subtypes: the Japan Public Health Center-based prospective (JPHC) study

Cited by 45 publications

References 21 publications

Body mass index and stroke incidence in Japanese community residents: The Jichi Medical School (JMS) Cohort Study

Body mass index and stroke incidence in Japanese community residents: The Jichi Medical School (JMS) Cohort Study

Guidelines for the Prevention of Stroke in Women

Prospective Study on Waist Circumference and Risk of All-Cause and Cardiovascular Mortality

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