• 沒有找到結果。

Overweight and Obesity-related Metabolic Disorders in Hospital Employees

N/A
N/A
Protected

Academic year: 2021

Share "Overweight and Obesity-related Metabolic Disorders in Hospital Employees"

Copied!
8
0
0

加載中.... (立即查看全文)

全文

(1)

Background: Obesity is associated with metabolic disorders and cardiovascular diseases. This study investigated the relationship between overweight and obese status and the incidence of type 2 diabetes, hypertension, hyperlipidemia and hyperuricemia.

Methods: This prospective cohort study comprised 1749 hospital employees who received baseline health check-ups in 1993. Data from the 1027 participants (832 women, 195 men; mean age, 36 ± 7 years) who repeated check-ups in 2003 were used in the analysis. Relative risks (RRs) for development of metabolic disorders during follow-up associated with different body mass index (BMI) categories at baseline as defined by Asia-Pacific recommendations and the Department of Health in Taiwan were calculated after adjustment for covariates.

Results: The prevalence of overweight and obesity at baseline check-up were 17.6% and 14.5%, respectively. Obese subjects with baseline BMI ≥ 25 kg/m2 had a significant multivariate-adjusted RR of 2.7 for hypertension, 14.8 for type 2 diabetes, 3.2 for hypertriglyceridemia, and 2.8 for hyperuricemia, compared to subjects with baseline BMI < 23.0 kg/m2. RR for diabetes was higher in women than in men, but RR for hypertriglyceridemia was higher in men. The risks of hypertension and hyperuricemia significantly increased for subjects with baseline BMI ≥ 23 kg/m2, while RRs for type 2 diabetes increased significantly for baseline BMI ≥ 24 kg/m2 and hypertriglyceridemia increased for baseline BMI ≥ 25 kg/m2

. The risks attributable to obesity (baseline BMI ≥ 25 kg/m2) were 23.0% for hypertension, 70.8% for diabetes, 27.9% for hypertriglyceridemia, and 24.1% for hyperuricemia.

Conclusion: This study revealed that a high prevalence of overweight and obesity was associated with significantly increased risk of development of type 2 diabetes, hypertension, hypertriglyceridemia and hyperuricemia in hospital employees, suggesting the need for programs to improve weight management. [J Formos Med Assoc 2006;105(1):56–63]

Key Words: body mass index, hypercholesterolemia, hypertension, hypertriglyceridemia, hyperuricemia, type 2 diabetes

○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

Department of Family Medicine, 1Division of Cardiology, Department of Medicine, Mackay Memorial Hospital, 2Graduate Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan, R.O.C.

Received: February 25, 2005 Revised: March 21, 2005 Accepted: June 7, 2005

Obesity, an epidemic in the industrialized world,1–3 is also a growing problem in Taiwan, with nearly one quarter of the adult population currently over-weight or obese.4 Obesity is generally recognized as a major risk factor for the development of met-abolic disorders, such as type 2 diabetes, hyper-tension, hyperlipidemia, and hyperuricemia. As

*Correspondence to: Dr. Lee-Ching Hwang, Department of Family Medicine, Mackay Memorial Hospital, 92, Section 2, Chungshan North Road, Taipei, Taiwan, R.O.C.

E-mail: mmh75@ms2.mmh.org.tw

body mass index (BMI) rises, the relative risk (RR) of type 2 diabetes also increases.5–10 Willett et al7 reported that for BMI > 26 kg/m2 compared to BMI < 21 kg/m2, the risk of diabetes was four times high-er in males in the Health Professionals Follow-up Study,6

and eight times higher in women in the Nurses’ Health Study.8 According to a World Health

Overweight and Obesity-related Metabolic

Disorders in Hospital Employees

Lee-Ching Hwang,* Cheng-Ho Tsai,1

Tony Hsiu-Hsi Chen2

(2)

Physical check-up

The baseline health examination in 1993 consist-ed of history taking, physical examination, anthro-pometric measurements (height, body weight), and measurements of blood pressure, fasting plasma glucose, total cholesterol, triglyceride and uric acid. BMI was calculated as weight in kilograms divided by the square of the height in meters. According to the BMI cutoffs suggested for Asians,19 subjects were classified into normal (BMI < 23 kg/m2), over-weight (25 > BMI ≥ 23) or obese (BMI ≥ 25) categories. We also adopted the BMI cutoffs sug-gested by the Department of Health (DOH) in Tai-wan in order to compare results obtained using these two definitions of excess weight. According-ly, subjects were also classified into normal (BMI < 24), overweight (27 > BMI ≥ 24) or obese (BMI ≥ 27) categories. Venous blood was drawn after an overnight fast and analyzed at a central laboratory in a medical center. The health examination was repeated in 2003.

Definitions of hypertension, type 2 diabetes, hypercholesterolemia, hypertriglyceridemia and hyperuricemia

Hypertension was defined according to The Sev-enth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7), i.e. systolic blood pressure ≥ 140 mmHg and/or diastolic blood pres-sure ≥ 90 mmHg, or physician-diagnosed hyper-tension.

Diabetes was defined according to the Ameri-can Diabetes Association criteria. Medical charts were reviewed and a diagnosis of incident dia-betes was confirmed if the subject met any one of the following criteria: (1) fasting plasma glu-cose level of at least 126 mg/dL and 2-hour post-prandial plasma glucose level of at least 200 mg/dL; (2) elevated fasting plasma glucose level (≥ 126 mg/dL) on at least two different occasions; (3) treatment with hypoglycemic medication.

Hyperlipidemia was defined as serum total cho-lesterol ≥ 240 mg/dL and/or triglyceride ≥ 200 mg/ dL. Hyperuricemia was defined as serum uric acid ≥ 7.5 mg/dL for men and ≥ 6.5 mg/dL for women. Organization report, the risks for type 2 diabetes

and dyslipidemia are greatly increased in obese subjects, with RR > 3.0.10

Previous studies have demonstrated that the prevalence of hypertension increases with the de-gree of overweight.11,12 Prospective investigation revealed an association between BMI > 20 kg/m2 and increased incidence of hypertension in Japanese men.13 The Finnish Heart Study found that higher BMI increased the risk of coronary mortality that was mediated through the link be-tween body weight and blood pressure.14 Obesity is also associated with hypertriglyceridemia. Further, abdominal obesity and high serum triglyceride levels are associated, a phenotypic characteristic known as the hypertriglyceridemic waist.15 Positive cross-sectional associations be-tween hyperuricemia and overweight have also been demonstrated for adult males in Taiwan and Japan.16–18

There has been a lack of prospective investi-gation exploring the relationship between obes-ity and the incidence of metabolic disorders related to cardiovascular diseases in Taiwan. The present study examined a cohort of hospital employees to determine the association between BMI and incidence of obesity-related metabolic disorders.

Methods

Subjects

Participants were employees of a teaching hos-pital in Taipei, Taiwan. In 1993, 1749 employees (> 20 years old) who had regular physical check-ups were recruited. Subjects who were pregnant at baseline, or who left work during the follow-up period, were excluded. A total of 1027 employees who worked full-time at the hospital throughout the 10.5-year study period (9.7–10.7) completed both the baseline check-up in 1993 and follow-up check-up in 2003. There were no significant dif-ferences at baseline between the study group and those with loss of follow-up in age, sex, BMI and prevalence of metabolic disorders.

(3)

Statistical analysis

SAS software (SAS Institute Inc, Cary, NC, USA) was used for all statistical analyses. The demograph-ic characteristdemograph-ics of subjects were compared at the baseline health check-ups in 1993 and at the fol-low-up health check-ups in 2003 using the paired

t test. In addition, for all incident analyses,

preva-lent cases of the specific outcome were excluded (e.g. cases of diabetes in 1993 were excluded from analyses of the incidence of diabetes). Differences in proportion data were assessed using the chi-square test. Multiple logistic regression was used to derive the RRs and 95% confidence intervals (CIs) to determine the 10-year risk of overweight and obesity for developing high cholesterol and/ or triglyceride levels, hypertension, type 2 diabetes, and hyperuricemia. All logistic regression models were adjusted for age, sex, smoking status, alcohol intake and BMI change. The population attributa-ble risk (PAR) was calculated using Levin’s formula: PAR = P0(RR – 1)/P0(RR – 1) + 1; where P0 is the

proportion of the exposed population. All p val-ues are 2-sided, with p less than 0.05 considered

to be statistically significant. Means are presented with standard deviations.

Results

Table 1 summarizes the clinical characteristics at the start of this study in 1993 and at the end of the study in 2003 for the 1027 subjects with complete follow-up. At the time of the baseline health check-ups in 1993, mean age was 33.5 ± 7.2 years (range, 21–56 years). Mean BMI was 23.8 kg/m2 for men and 21.6 kg/m2 for women. The baseline preva-lence of type 2 diabetes, hypertension, hyper-cholesterolemia, triglyceridemia and hyperuri-cemia was 1.0%, 12.9%, 3.2%, 3.5% and 5.9% in 1993, respectively, and all were more common in men than in women.

At the follow-up health check-ups in 2003, fast-ing plasma glucose, systolic blood pressure, serum cholesterol and triglyceride levels, but not diastol-ic blood pressure, were increased signifdiastol-icantly, as determined by paired t test. A diagnosis of high

Table 1. Clinical characteristics of subjects (n = 1027) at baseline and 10.5 years later

Baseline (1993) 10.5 years later (2003)

Total Women Men Total Women Men

Age (yr) 33.5 ± 7.2 32.6 ± 7.1 37.3 ± 6.4 44.0 ± 7.1 43.1 ± 7.0 47.7 ± 6.3

Fasting plasma glucose (mg/dL) 090.0 ± 14.8 089.0 ± 14.2 094.2 ± 16.2 093.8 ± 19.2 092.9 ± 19.6 097.7 ± 16.8 BMI (kg/m2) 22.0 ± 2.9 21.6 ± 2.8 23.8 ± 2.9 23.1 ± 3.4 22.7 ± 3.4 24.8 ± 2.9

Systolic blood pressure (mmHg) 114.1 ± 14.1 112.7 ± 14.2 119.8 ± 11.9 121.9 ± 18.5 120.1 ± 18.7 129.9 ± 14.9 Diastolic blood pressure (mmHg) 76.0 ± 9.4 75.1 ± 9.4 80.2 ± 8.3 071.9 ± 11.7 070.3 ± 11.3 078.9 ± 10.7 Total cholesterol (mg/dL) 181.9 ± 32.5 178.9 ± 31.3 190.0 ± 34.4 186.1 ± 32.5 183.9 ± 32.5 195.7 ± 30.8 Triglyceride (mg/dL) 090.2 ± 59.2 088.9 ± 44.9 125.0 ± 77.9 090.6 ± 84.7 080.5 ± 76.3 0133.8 ± 103.6 Uric acid (mg/dL) 05.1 ± 1.5 04.7 ± 1.3 6.4 ± 1.4 05.6 ± 1.5 05.3 ± 1.3 07.2 ± 1.4 Prevalence Type 2 diabetes (%) 1.0 1.0 1.0 3.3 2.9 4.6 Hypertension (%) 12.90 10.70 22.10 20.40 17.20 33.90 Hypercholesterolemia (%) 3.2 2.2 7.7 6.4 5.1 12.30 Hypertriglyceridemia (%) 3.5 1.2 11.80 6.7 4.6 16.40 Hyperuricemia (%) 5.9 3.3 17.40 20.30 15.40 41.00 Overweight (%), 25 > BMI ≥ 23 17.60 14.40 31.30 19.80 17.20 30.80 Obesity (%), BMI ≥ 25 14.50 11.10 29.20 24.70 20.20 44.10 Overweight (%), 27 > BMI ≥ 24 16.60 12.40 34.40 21.10 17.40 36.90 Obesity (%), BMI ≥ 27 6.1 5.1 10.80 12.50 10.60 20.50

(4)

blood pressure was made in more than one fifth of subjects. Type 2 diabetes developed in approxi-mately 2.3% of subjects. Among them, 90.9% (30/33) used hypoglycemia medications. Among subjects with hypertension, 54.1% (112/207) used antihypertensive medications in 2003. The pre-valence of hypercholesterolemia and triglyceri-demia had doubled at the follow-up health check-ups. Hyperuricemia was also significantly more prevalent at the follow-up in 2003 (5.9% vs. 20.3%).

Mean baseline BMI was 22.0 ± 2.9, with 67.9% of the subjects in the normal range, 17.6% over-weight, and 14.5% obese according to Asia-Pacific

recommendations, and 16.6% overweight and 6.1% obese according to DOH Taiwan criteria. Ex-cessive weight was more common in men than in women. At the 10.5-year follow-up, the prevalence of overweight had increased by 2.2–4.5% and the prevalence of obesity had doubled. Further, the prevalence of BMI ≥ 30 rose from 1.5% to 4.7%.

The cumulative incidence of type 2 diabetes, hypertension, hypertriglyceridemia and hyper-uricemia, but not hypercholesterolemia, increased progressively with higher baseline BMI (Table 2) as defined by either the Asia-Pacific or DOH criteria. Most metabolic disorders, such as type 2

Table 2. Cumulative incidence of obesity-related metabolic disorders at the 10.5-year follow-up by baseline body mass index (BMI) categories

Baseline BMI categories (kg/m2) by Asian criteria Baseline BMI categories (kg/m2) by DOH

< 23 23–24.9 ≥ 25 p < 24 24–26.9 ≥ 27 p Total n (%) 697 (67.9) 181 (17.6) 149 (14.5) 794 (77.3) 170 (16.6) 63 (6.1) Type 2 diabetes (%) 00.7 01.7 11.0 * 00.8 03.6 20.0 * Hypertension (%) 10.2 25.4 31.4 * 12.0 25.2 40.5 * Hypercholesterolemia (%) 04.1 08.4 07.1 † 04.8 07.1 06.9 Hypertriglyceridemia (%) 03.3 07.1 13.1 * 03.7 07.8 20.4 * Hyperuricemia (%) 12.4 24.6 33.3 * 13.6 30.6 31.3 *

Any one of the above (%) 25.9 45.2 60.0 * 27.5 50.8 60.6 *

Any two or more of the above (%) 5.1 14.7 22.9 * 08.5 25.9 45.8 *

Men n (%) 77 (39.5) 61 (31.3) 57 (29.2) 107 (54.9) 67 (34.4) 21 (10.8) Type 2 diabetes (%) 1.33 03.3 07.1 † 01.9 03.0 15.0 * Hypertension (%) 21.4 30.9 40.0 † 23.7 35.6 42.9 † Hypercholesterolemia (%) 08.1 14.3 08.0 09.6 10.2 11.8 Hypertriglyceridemia (%) 06.6 10.0 23.9 † 07.0 14.3 37.5 † Hyperuricemia (%) 23.3 40.8 43.6 † 28.6 44.9 28.6

Any one of the above (%) 46.4 63.4 70.0 † 50.6 67.5 66.7

Any two or more of the above (%) 24.5 40.0 57.1 * 26.2 53.6 50.0 †

Women n (%) 620 (74.5) 120 (14.4) 92 (11.1) 687 (82.6) 103 (12.4) 42 (5.1) Type 2 diabetes (%) 00.7 00.8 13.5 * 00.6 03.9 22.5 * Hypertension (%) 08.8 23.0 26.2 * 10.3 19.5 39.1 * Hypercholesterolemia (%) 03.6 05.5 06.6 4.0 05.2 04.9 Hypertriglyceridemia (%) 02.9 05.9 07.1 † 03.2 04.1 13.2 † Hyperuricemia (%) 11.1 17.8 28.4 * 11.4 23.5 32.4 *

Any one of the above (%) 22.9 35.6 54.6 * 24.3 42.7 58.3 *

Any two or more of the above (%) 05.0 16.7 26.8 * 06.5 11.3 44.4 *

(5)

diabetes, hypertension, hypertriglyceridemia and hyperuricemia (except hypercholesterolemia), oc-curred in parallel with increasing baseline BMI in both genders. The incidences of these metabolic disorders were significantly higher in men than in women. Subjects with BMI < 23 at baseline had the lowest rates of metabolic disorders at follow-up. In contrast, nearly 60% of subjects who were obese at baseline developed more than one meta-bolic disorder. The cumulative follow-up incidence of type 2 diabetes, hypertension, hypercholes-terolemia, hypertriglyceridemia and hyperurice-mia in subjects who were obese at baseline accord-ing to the Asia-Pacific criteria was 11.0%, 31.4%,

7.1%, 13.1% and 33.3%, respectively. Two or more metabolic disorders were found in 22.9% of subjects who were obese at baseline, but in only 5.1% of subjects with normal weight.

Multivariate analysis with adjustment for age, sex, smoking, alcohol intake and BMI change demonstrated that obese subjects were at signifi-cantly increased risk of developing type 2 diabetes, hypertension, hypertriglyceridemia and hyper-uricemia, compared to subjects with normal BMI (Table 3). The odds ratio for type 2 diabetes was higher in women, but the odds ratio for hyper-triglyceridemia was higher in men. The population attributable proportion (PAP) for obesity was

Table 3. Effect of baseline body mass index (BMI) categories on risk of subsequent metabolic disorders*

Baseline BMI categories (kg/m2) by Asian criteria Baseline BMI categories (kg/m2) by DOH

< 23 23–24.9 ≥ 25 < 24 24–26.9 ≥ 27

RR PAR RR PAR RR PAR RR PAR

RR

(95% CI) (%) (95% CI) (%) RR (95% CI) (%) (95% CI) (%)

Total Type 2 diabetes 1 2.2 (0.5–9.4) 19.8 14.8 (5.0–43.6) 70.8 1 03.9 (1.2–13.0) 32.4 27.9 (9.7–80.3) 61.3 Hypertension 1 2.4 (1.5–3.9) 22.4 2.7 (1.6–4.5) 23.0 1 1.6 (1.0–2.6) 07.9 4.0 (1.9–8.4) 11.0 Hypercholesterolemia 1 1.7 (0.8–3.9) 12.6 1.4 (0.6–3.1) 06.6 1 1.1 (0.5–2.3) 01.5 1.2 (0.4–3.4) 01.1 Hypertriglyceridemia 1 1.8 (0.9–3.8) 14.2 3.2 (1.6–6.5) 27.9 1 1.5 (0.7–3.2) 07.2 05.5 (2.5–11.9) 19.8 Hyperuricemia 1 1.8 (1.2–2.8) 14.2 2.8 (1.7–4.5) 24.1 1 2.1 (1.4–3.3) 14.3 2.4 (1.2–4.8) 06.5 Any one of the above 1 1.7 (1.2–2.6) – 3.0 (1.9–4.9) – 1 1.9 (1.2–2.8) – 3.8 (1.7–8.1) – Any two or more of the above 1 2.7 (1.5–5.0) – 5.0 (2.6–9.9) – 1 2.1 (1.1–4.1) – 08.2 (3.1–21.4) – Men Type 2 diabetes 1 02.4 (0.2–28.1) 30.3 04.2 (0.4–42.9) 48.1 1 01.3 (0.2–10.1) 09.3 06.7 (0.9–49.2) 37.1 Hypertension 1 1.6 (0.7–3.9) 14.2 2.4 (1.1–5.8) 26.9 1 1.8 (0.8–3.9) 19.2 2.5 (0.7–8.5) 12.1 Hypercholesterolemia 1 2.1 (0.6–6.7) 25.5 1.0 (0.2–3.2) 00.0 1 1.0 (0.3–3.2) 00.0 0.7 (0.1–4.2) 02.9 Hypertriglyceridemia 1 1.7 (0.5–6.2) 16.9 05.1 (1.6–16.3) 52.3 1 2.5 (0.8–7.4) 32.8 ..8.9 (2.4–33.8) 42.3 Hyperuricemia 1 2.2 (1.0–4.9) 26.7 2.9 (1.2–6.8) 31.5 1 2.3 (1.1–4.9) 28.3 1.2 (0.3–4.4) 01.7 Any one of the above 1 1.9 (0.9–4.3) – 2.6 (1.1–6.6) – 1 2.0 (0.9–4.5) – 1.9 (0.4–8.1) – Any two or more of the above 1 2.1 (0.7–5.9) – 04.1 (1.4–12.2) – 1 3.3 (1.3–8.5) – 02.8 (0.5–15.5) – Women Type 2 diabetes 1 01.2 (0.2–10.5) 02.8 19.1 (5.7–63.7) 66.1 1 05.5 (1.3–23.0) 35.7 040.4 (11.5–143). 65.6 Hypertension 1 2.9 (1.7–5.2) 20.3 2.4 (1.2–4.6) 10.9 1 1.5 (0.8–2.8) 05.2 04.5 (1.7–11.6) 09.8 Hypercholesterolemia 1 1.4 (0.5–3.5) 05.1 1.5 (0.6–3.9) 05.2 1 1.0 (0.4–2.8) 00.0 1.0 (0.3–4.3) 00.0 Hypertriglyceridemia 1 1.9 (0.8–4.6) 11.5 2.0 (0.7–5.4) 09.3 1 1.1 (0.3–3.2) 01.2 03.6 (1.2–10.6) 10.8 Hyperuricemia 1 1.6 (0.9–2.7) 08.1 2.5 (1.4–4.4) 13.1 1 1.9 (1.1–3.4) 09.9 3.0 (1.4–6.7) 07.8 Any one of the above 1 1.6 (1.0–2.6) – 3.1 (1.8–5.4) – 1 1.7 (1.1–2.9) – 04.4 (1.8–10.9) – Any two or more of the above 1 2.9 (1.4–6.3) – 04.9 (2.0–11.6) – 1 1.3 (0.5–3.4) – 10.8 (3.4–34.7) – *Multiple logistic regression model: adjusted for age, gender, smoking status, alcohol intake and BMI change over the 10.5-year period. DOH = Department of Health, Taiwan; RR = relative risk; CI = confidence interval; PAR = population attributable risk.

(6)

70.8% for type 2 diabetes, 23.0% for hypertension, 27.9% for hypertriglyceridemia, and 24.1% for hyperuricemia.

Subjects who were overweight at baseline as defined by the Asia-Pacific criteria were at signifi-cantly increased risk for hypertension (RR = 2.4) and hyperuricemia (RR = 1.8) during follow-up. Overweight subjects as defined by DOH criteria were also at increased risk for type 2 diabetes. No relationship was found between baseline BMI cat-egories and incidence of hypercholesterolemia at follow-up in the multivariate analysis.

During the follow-up period, risk of develop-ment of any one or two of the metabolic disorders increased significantly with higher baseline BMI categories.

Discussion

This 10.5-year follow-up study has confirmed that the risk of metabolic disorders related to car-diovascular diseases increases progressively with higher baseline BMI regardless of whether Asia-Pacific or DOH criteria are used to define BMI categories. Further, the risks of hypertension and hyperuricemia were significantly increased for baseline BMI ≥ 23, while risk of type 2 diabetes increased significantly for baseline BMI ≥ 24, and risk of hypertriglyceridemia increased for baseline BMI ≥ 25.

As BMI increases, the RR of developing diabe-tes increases for both genders in many ethnic groups.5–10 The risk was lowest when BMI was < 22 and 24 in the Nurses’ Health Study8 and the Health Professionals Follow-Up Study, respectively.6 Tai et al found that the risk for diabetes in Chinese men with BMI > 25.3 was 2.9 times higher than for those with BMI < 21.3.9 Our findings showing a strong relationship between obesity in adult-hood and subsequent risk for type 2 diabetes over a 10.5-year period are consistent with previous research. The lowest risk for diabetes in this study was for subjects with BMI < 23, who had a 14-fold lower risk relative to their counterparts with BMI ≥ 25. Using DOH criteria, the risk of diabetes was

significantly increased in overweight subjects with BMI 24–26.9.

As BMI increases, the RR of hypertension also progressively increases.11,12 Previous study in a cohort of Japanese men revealed that, for BMI above 20 kg/m2, increased BMI was associated with an increased risk for hypertension.13 The Finnish Heart Study, a 15-year follow-up study performed in a cohort of 8373 Finnish women aged 30–59 years, found that for each increase in body weight of approximately 1 kg, the risk of coronary mortality increased by 1–1.5% that was mediated through the link between body weight and blood pressure.14 This study demon-strated that, for BMI above 23 kg/m2, an increase in baseline BMI was associated with increased risk of hypertension, a BMI threshold lower than that for diabetes. Development of hypertension was attributable to overweight or obesity in 45% of cases. Obesity is also associated with hyper-triglyceridemia.15,20,21 In this study, obesity was as-sociated with an increased risk of developing hy-pertriglyceridemia in subjects with normal base-line triglyceride levels.

Positive cross-sectional associations have been demonstrated between hyperuricemia and over-weight in adult males from Taiwan and Japan.16–18 Hyperinsulinemia induced by insulin resistance reduces uric acid clearance, leading to hyperuri-cemia, with accumulation of visceral fat exacerbat-ing the problem by increasexacerbat-ing uric acid synthesis through the activation of triglyceride synthesis.18 This study has shown that, for BMI > 23 kg/m2, increased BMI is associated with increased hyper-uricemia risk in subjects who had normal serum uric acid levels 10 years previously. Compared with subjects who had baseline BMI < 23, subjects who were overweight at baseline had a 1.8-fold in-creased risk of hyperuricemia, and obese subjects had a 2.8-fold increased risk at the 10.5-year fol-low-up. Further, 38.3% of hyperuricemia develop-ment was attributable to overweight or obese status at baseline.

The mechanisms leading to metabolic disor-ders associated with cardiovascular disease in obese persons are not completely known. It has

(7)

been hypothesized, however, that increased in-sulin resistance and hyperinin-sulinemia are contri-butors,22,23 and both of these are reversible with weight loss.24 Obesity affects metabolic disorders by the increased secretion of free fatty acids from fat and reduced production of adiponectin, which induce the insulin-resistant state, hyperinsuline-mia, and diabetes and/or development of other metabolic disorders.25 Hypertension may also de-velop due to sympathetic nervous system hyper-activity, and renal sodium reabsorption mediated by hyperinsulinemia. Hyperinsulinemia increases hepatic very low density lipoprotein, and trigly-ceride synthesis and secretion, which are associat-ed with hypertriglyceridemia.

The optimal weight for avoidance of cardiovas-cular disease and prolongation of life remains con-troversial. In the Framingham Heart Study, each standard deviation increment in relative weight was associated with 15% and 22% increases in cardiovascular events in men and women, respec-tively, during 26 years of follow-up.26 Kannel et al suggested that the optimal weight for avoidance of cardiovascular disease and prolonging life cor-responds to a BMI of 22.6 for men and 21.1 for women. Analyzing data from the Nurses’ Health Study8 and the Health Professionals Follow-up Study,6 Field et al demonstrated that adults in the healthy weight range (BMI 22–24.9) incurred an increased risk for non-communicable chronic dis-eases.27 They suggested that adults should try to maintain a BMI between 18.5 and 21.9. A study from Japan found that the BMI associated with the lowest morbidity was 22.2 in men and 21.9 in women.28 In this study, increased risks of develop-ing metabolic disorders were found for subjects with baseline BMI > 23. The high prevalence of BMI greater than this level suggests the need for greater awareness and prevention of metabolic dis-orders related to overweight or obesity.

In conclusion, this study has demonstrated that excess BMI in adulthood increases the risk of de-veloping type 2 diabetes, hypertension, hyper-triglyceridemia and hyperuricemia. These results indicate the need for weight management programs in adults.

References

1. Mokdad AH, Ford ES, Bowman BA. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 2003;289:76–9.

2. Silventoinen K, Sans S, Tolonen H, et al. Trends in obesity and energ supply in the WHO MONICA Project. Int J Obes Relat Metab Disord 2004;28:710–8.

3. Flegal KM, Carroll MD, Ogden C, et al. Prevalence and trends in obesity among US adults, 1999–2000. JAMA 2002;288:1723–7.

4. Lin YC, Yen LL, Chen SY, et al. Prevalence of overweight and obesity and its associated factors: findings from National Nutrition and Health Survey in Taiwan, 1993–1996. Prev Med 2003;37:233–41.

5. Colditz GA, Willett WC, Rotnitzky A, et al. Weight gain as a risk factor for clinical diabetes mellitus in women. Ann Intern Med 1995;122:481–6.

6. Chan JM, Rimm EB, Colditz GA, et al. Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men. Diabetes Care 1994;17:961–9.

7. Willett WC, Dietz WH, Colditz GA: Guidelines for healthy weight. New Engl J Med 1999;341:427–34.

8. Carey VJ, Walters EE, Colditz GA, et al. Body fat distribution and risk of non-insulin-dependent diabetes mellitus in women. The Nurses’ Health Study. Am J Epidemiol 1997; 145:614–9.

9. Tai T, Chuang L, Wu H, et al. Association of body build with non-insulin-dependent diabetes mellitus and hypertension among Chinese adults: a 4-year follow-up study. Int J Epidemiol 1992;21:511–7.

10. World Health Organization. The health consequences of overweight and obesity in adults and children. In: Obesity, Preventing and Managing the Global Epidemic. Geneva: WHO, 1998:43–72.

11. Must A, Spadano J, Coakley EH, et al. The disease burden associated with overweight and obesity. JAMA 1999;282: 1523–9.

12. Brown CD, Higgins M, Donato KA, et al. Body mass index and the prevalence of hypertension and dyslipidemia. Obes Res 2000;8:605–19.

13. Ishikawa-Takata K, Ohta T, Moritaki K, et al. Obesity, weight change and risks for hypertension, diabetes and hypercholesterolemia in Japanese men. Eur J Clin Nutr 2002;56:601–7.

14. Jousilahti P, Tuomilehto J, Vartiainen E, et al. Body weight, cardiovascular risk factors, and coronary mortality. 15-year follow-up of middle-aged men and women in eastern Finland. Circulation 1996;93:1372–9.

15. Little P, Byrne CD. Abdominal obesity and the “hypertri-glyceridaemic waist” phenotype. BMJ 2001;322:687–9. 16. Chu NF, Wang DJ, Liou SH, et al. Relationship between

hy-peruricemia and other cardiovascular disease risk factors among adult males in Taiwan. Eur J Epidemiol 2000;16:

(8)

13–7.

17. Nagahama K, Iseki K, Inoue T, et al. Hyperuricemia and cardiovascular risk factor clustering in a screened cohort in Okinawa, Japan. Hypertens Res 2004;27:227–33. 18. Lai SW, Ng KC. Which anthropometric indices best predict

metabolic disorders in Taiwan? Southern Med J 2004;97: 578–82.

19. Kanazaawa M, Yoshiike N, Osaka T, et al. Criteria and clas-sification of obesity in Japan and Asia-Oceania. Asia Pac Clin Nutr 2002;11:S732–7.

20. Siervogel RM, Wisemandle W, Maynard LM. Lifetime overweight status in relation to serial changes in body composition and risk factors for cardiovascular disease: The Fels Longitudinal Study. Obes Res 2000;8:422–30. 21. Rabkin SW, Chen Y, Leiter L. Risk factor correlates of body

mass index. Can Med Assoc J 1997;157:S26–31. 22. Reaven GM. Role of insulin resistance in human disease.

Diabetes 1988;37:1595–607.

23. George AB. Medical consequences of obesity. J Clin Endocrinol Metab 2004;89:2583–9.

24. Tuomilehto J, Lindstrom J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001;344:1343–50.

25. Goldstein BJ, Scalia R. Adiponectin: a novel adipokine linking adipocytes and vascular function. J Clin Endocrinol Metab 2004;89:2563–8.

26. Kannel WB, D’Agostino RB, Cobb JL. Effect of weight on cardiovascular disease. Am J Clin Nutr 1996;63(3 Suppl): S419–22.

27. Field AE, Coakley EH, Must A, et al. Impact of overweight on the risk of developing common chronic diseases during a 10-year period. Arch Intern Med 2001;161:1581–6. 28. Tokunaga K, Matsuzawa Y, Kotani K, et al. Ideal body

weight estimated from the body mass index with the lowest morbidity. Int J Obes 1991;15:1–5.

數據

Table 1 summarizes the clinical characteristics at the start of this study in 1993 and at the end of the study in 2003 for the 1027 subjects with complete follow-up
Table 2. Cumulative incidence of obesity-related metabolic disorders at the 10.5-year follow-up by baseline body mass index (BMI) categories
Table 3.    Effect of baseline body mass index (BMI) categories on risk of subsequent metabolic disorders*

參考文獻

相關文件

(1) Crystal-storing histiocytosis (CSH), a rare condition in which crystalline material accumulates in the cytoplasm of histiocytes, is typically associated with disorders that

Aim: The aim of this study is to investigate the prevalence of medical con- ditions and medications used by patients accessing emergency dental care at Manchester Dental

SUMMARY The purpose of this systematic review was to describe the prevalence of whiplash trauma in patients with temporomandibular disorders (TMDs) and to describe clinical signs

Thus, our study revealed that the fre- quency of clinical symptoms of TN was closely related to the site of NVC of the trigeminal nerve, that is, the distance from the trigeminal

Direct and indirect effects of high dose of radiotherapy on periodontium resulted in increased attachment loss and tooth loss and greater risk for the development of ORN.

In conclusion, data from the present study demonstrat- ed that signs of carotid calcifications in panoramic radio- graphs are associated with future events of stroke and/or

The aim of this study was to investigate, through a prospective clinical study, the prevalence and characteristics of oral lichen planus (OLP) and lichenoid lesions (OLL) in

This is in agreement with the finding of Nakagawa et al., 11 which showed that interruption of white line on panoramic radi- ography was a predictor of increased risk of contact