The interactive effect of diabetes and central obesity on stroke: a prospective cohort study of inner Mongolians.
BACKGROUND
The relationship between central obesity and stroke is inconsistent in diabetic and non-diabetic populations. This indicates an interaction between diabetes and central obesity on stroke risk. The present study aimed to examine the interaction in a cohort of Inner Mongolians.


METHODS
In this prospective cohort study, we assessed the interaction between diabetes and central obesity on stroke incidence between June 2003 and July 2012. At baseline, 2,589 adults were recruited and examined from Inner Mongolia, China. Participants were categorized into four subgroups according to presence of diabetes and/or central obesity. Both additive and multiplicative interactions were evaluated using Cox proportional-hazard models.


RESULTS
121 stroke events were recorded during the follow-up period. The cumulative incidence of stroke was highest for participants with both diabetes and central obesity (log-rank test, P = 0.042). The multivariable-adjusted risk for stroke was significantly higher in participants with both conditions (HR = 3.02, 95% CI 1.24-7.33, P = 0.015) compared to those with neither diabetes nor central obesity. Attributable proportion due to the interaction between diabetes and central obesity was 0.571 (95% CI 0.017-1.125). The multiplicative interactive effect between diabetes and central obesity on stroke was also statistically significant (HR = 2.67, 95% CI 1.14-6.26, P = 0.024).


CONCLUSIONS
The participants who were both diabetic and centrally obese had significantly higher risk for incident stroke than the combination of individuals who individually had either condition among Mongolian population. This study suggests that central obesity and diabetes act synergistically to increase the risk of stroke.
Department of Epidemiology, School of Public Health, Medical College of Soochow University, 199 Ren-ai Road Industrial Park District, Suzhou, China. jolofind11@gmail.com.|Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA. jolofind11@gmail.com.
Jennifer
J
Olofindayo
Department of Epidemiology, School of Public Health, Medical College of Soochow University, 199 Ren-ai Road Industrial Park District, Suzhou, China. ph2108325@sina.com.
Hao
H
Peng
Department of Epidemiology, School of Public Health, Medical College of Soochow University, 199 Ren-ai Road Industrial Park District, Suzhou, China. liuyanwsazj@sina.com.
Yan
Y
Liu
Department of Epidemiology, School of Public Health, Medical College of Soochow University, 199 Ren-ai Road Industrial Park District, Suzhou, China. lihongmei_sochoow@163.com.
Hongmei
H
Li
Department of Epidemiology, School of Public Health, Medical College of Soochow University, 199 Ren-ai Road Industrial Park District, Suzhou, China. zhangmingzhi@suda.edu.cn.
Mingzhi
M
Zhang
Department of Epidemiology, School of Public Health, Medical College of Soochow University, 199 Ren-ai Road Industrial Park District, Suzhou, China. wangaili@suda.edu.cn.
Aili
A
Wang
Department of Epidemiology, School of Public Health, Medical College of Soochow University, 199 Ren-ai Road Industrial Park District, Suzhou, China. yhzhang@suda.edu.cn.|Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Soochow University, Suzhou, China. yhzhang@suda.edu.cn.
Yonghong
Y
Zhang
D000328:Adult; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D056128:Obesity, Abdominal / Q000453:epidemiology*; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology