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Cited by 617Acute Ischemic Stroke ManagementCancer Risks and FactorsObesity, Physical Activity, Diet

A Prospective Study of Body Mass Index, Weight Change, and Risk of Stroke in Women

Rexrode, Kathryn M.·1997·JAMA: The Journal of the American Medical Association
DOI 10.1001/jama.1997.03540430051032
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Abstract

OBJECTIVE: To examine the associations of body mass index (BMI) and weight change with risk of stroke in women. SETTING AND DESIGN: Prospective cohort study among US female registered nurses participating in the Nurses' Health Study. PARTICIPANTS: A total of 116759 women aged 30 to 55 years in 1976 who were free from diagnosed coronary heart disease, stroke, and cancer. MAIN OUTCOME MEASURE: Incidence of ischemic stroke, hemorrhagic stroke (subarachnoid or intraparenchymal hemorrhage), and total stroke. RESULTS: During 16 years of follow-up, 866 total strokes (including 403 ischemic strokes and 269 hemorrhagic strokes) were documented. In multivariate analyses adjusted for age, smoking, postmenopausal hormone use, and menopausal status, women with increased BMI (> or =27 kg/m2) had significantly increased risk of ischemic stroke, with relative risks (RRs) of 1.75 (95% confidence interval [CI], 1.17-2.59) for BMI of 27 to 28.9 kg/m2; 1.90 (95% CI, 1.28-2.82) for BMI of 29 to 31.9 kg/m2; and 2.37 (95% CI, 1.60-3.50) for BMI of 32 kg/m2 or more (P for trend<.001), as compared with those with a BMI of less than 21 kg/m2. For hemorrhagic stroke there was a nonsignificant inverse relation between obesity and hemorrhagic stroke, with the highest risk among women in the leanest BMI category (P for trend=.20). For total stroke the RRs were somewhat attenuated compared with those for ischemic stroke but remained elevated for women with higher BMI (P for trend<.001). In multivariate analyses that also adjusted for BMI at age 18 years, weight gain from age 18 years until 1976 was associated with an RR for ischemic stroke of 1.69 (95% CI, 1.26-2.29) for a gain of 11 to 19.9 kg and 2.52 (95% CI, 1.80-3.52) for a gain of 20 kg or more (P for trend<.001), as compared with women who maintained stable weight (loss or gain <5 kg). Although weight change was not related to risk of hemorrhagic stroke (P for trend=.20), a direct relationship was observed between weight gain and total stroke risk (P for trend<.001). CONCLUSIONS: These prospective data indicate that both obesity and weight gain in women are important risk factors for ischemic and total stroke but not hemorrhagic stroke. The relationship between obesity and total stroke depends on the distribution of stroke subtypes in the population.

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Crossref · 10.1001/jama.1997.03540430051032

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  • Small weight increases still matter for later metabolic problems linked to adiposity, diabetes, heart disease, and cancer.

    “even modest increases in weight have implications for long-term adiposity-related metabolic dysfunction, diabetes, cardiovascular disease, and cancer.21–24”

    From Changes in diet and lifestyle and long-term weight gain in women and men (2011) · cites this paper as [23]

  • In these cohorts, body measurements and weight change are strong predictors of disease outcomes.

    “Anthropometric measurements and weight changes strongly predict disease outcomes in these cohorts.20–26”

    From Changes in diet and lifestyle and long-term weight gain in women and men (2011) · cites this paper as [23]

  • Even modest weight increases have significant long-term implications for adiposity-related metabolic dysfunction, diabetes, cardiovascular disease, and cancer.

    “However, even modest increases in weight have been shown to have significant implications for long-term adiposity-related metabolic dysfunction, diabetes, cardiovascular disease, and cancer [28, 46, 135, 208].”

    From Sleep and metabolic function (2012) · cites this paper as [135]

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Authors
Rexrode, K. M.
Affiliations
Brigham and Women's Hospital (US)
Corresponding author
Rexrode, Kathryn M.
ORCID
Rexrode, Kathryn M.
Venue
JAMA: The Journal of the American Medical Association
Publisher
American Medical Association (AMA)
Published
1997-05-21
Volume
277
Issue
19
Pages
1539
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.1997.03540430051032
OpenAlex
W1994185702
Cited by
617
References
43
Citations by year
2026: 8 · 2025: 4 · 2024: 5 · 2023: 9 · 2022: 8 · 2021: 14 · 2020: 20 · 2019: 17 · 2018: 7 · 2017: 24 · 2016: 25 · 2015: 18 · 2014: 27 · 2013: 32 · 2012: 28
FWCI
11.24
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institute on Aging (T32AG000158, AG 00158)
  • National Heart, Lung, and Blood Institute (HL-34595, R01HL034595)
  • National Cancer Institute (CA-40356)
Topics
  • Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
  • Health Sciences › Medicine › Oncology › Cancer Risks and Factors
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
Keywords
body mass index, obesity, weight gain, stroke risk, ischemic stroke, hemorrhagic stroke, subarachnoid hemorrhage, intraparenchymal hemorrhage, women, Nurses' Health Study, postmenopausal hormone use, menopausal status, smoking, childhood BMI
MeSH terms
Adult, Body Weight, Cerebral Hemorrhage, Brain Ischemia, Cerebrovascular Disorders, Diabetes Mellitus, Female, Follow-Up Studies, Humans, Hypercholesterolemia, Hypertension, Middle Aged, Obesity, Prospective Studies, Risk Factors, Cohort Studies, Weight Gain, Body Mass Index, Incidence, Multivariate Analysis

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