{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T16:22:55Z","timestamp":1791562975254,"version":"4.3.4"},"reference-count":25,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"<jats:sec id=\"ab-zoi221316-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Uncertainty persists regarding the independent association of general and central adiposity with major stroke types.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi221316-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine the independent associations of general and central adiposity with risk of ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi221316-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>Between 2006 and 2010, adults without prior stroke at recruitment in England, Scotland, and Wales were recruited into the UK Biobank prospective cohort study and were followed up through linkage with electronic medical records. Data were analyzed from September 2021 to September 2022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi221316-7\">\n                    <jats:title>Exposures<\/jats:title>\n                    <jats:p>General adiposity (body mass index [BMI] calculated as weight in kilograms divided by height in meters squared) and central adiposity (waist circumference).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi221316-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>Incident ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage as recorded through record linkage with electronic hospital records. Cox regression estimated adjusted hazard ratios (HRs) by stroke type.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi221316-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 490\u202f071 participants, the mean (SD) age was 56.5 (8.1) years, 267\u202f579 (54.6%) were female, and 461\u202f647 (94.2%) were White. During a median (IQR) of 12 (11.2-12.7) years follow-up, 7117 incident ischemic strokes, 1391 intracerebral hemorrhages, and 834 subarachnoid hemorrhages were identified. After mutual adjustment for waist circumference, BMI had no independent association with ischemic stroke (HR per 5-unit higher BMI, 1.04; 95% CI, 0.97-1.11), but was inversely associated with intracerebral hemorrhage (HR, 0.85; 95% CI, 0.74-0.96) and subarachnoid hemorrhage (HR, 0.82; 95% CI, 0.69-0.96). Waist circumference (adjusted for BMI) was positively associated with ischemic stroke (HR per 10-cm higher waist circumference, 1.19; 95% CI, 1.13-1.25) and intracerebral hemorrhage (HR, 1.17; 95% CI, 1.05-1.30), but was not associated with subarachnoid hemorrhage (HR, 1.07; 95% CI, 0.93-1.22).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi221316-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>In this large-scale prospective study, the independent and contrasting associations of BMI and waist circumference with stroke types suggests the importance of considering body fat distribution to stroke risk. Waist circumference was positively associated with the risk of ischemic stroke and intracerebral hemorrhage, while BMI was inversely associated with the risk of subarachnoid hemorrhage and intracerebral hemorrhage. This study also suggests that some adverse correlate of low BMI may be associated with an increased risk of intracerebral hemorrhage and subarachnoid hemorrhage, which warrants further investigation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2022.46613","type":"journal-article","created":{"date-parts":[[2022,12,14]],"date-time":"2022-12-14T11:01:03Z","timestamp":1671015663000},"page":"e2246613","source":"Crossref","is-referenced-by-count":53,"title":["Adiposity, Body Fat Distribution, and Risk of Major Stroke Types Among Adults in the United Kingdom"],"prefix":"10.1001","volume":"5","author":[{"given":"Preyanka","family":"Pillay","sequence":"first","affiliation":[{"name":"Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Lewington","sequence":"additional","affiliation":[{"name":"Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford, United Kingdom"},{"name":"Medical Research Council Population Health Research Unit, Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Taylor","sequence":"additional","affiliation":[{"name":"Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben","family":"Lacey","sequence":"additional","affiliation":[{"name":"Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Carter","sequence":"additional","affiliation":[{"name":"Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2022,12,14]]},"reference":[{"issue":"10","key":"zoi221316r1","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1016\/S1474-4422(21)00252-0","article-title":"Global, regional, and national burden of stroke and its risk factors, 1990-2013;2019: a systematic analysis for the Global Burden of Disease Study 2019.","volume":"20","author":"GBD 2019 Stroke Collaborators","year":"2021","journal-title":"Lancet Neurol"},{"issue":"2","key":"zoi221316r2","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1093\/ageing\/afz163","article-title":"The future incidence, prevalence and costs of stroke in the UK.","volume":"49","author":"King","year":"2020","journal-title":"Age Ageing"},{"issue":"4","key":"zoi221316r3","doi-asserted-by":"publisher","first-page":"e298","DOI":"10.1212\/WNL.0000000000004856","article-title":"Differences in risk factors for 3 types of stroke: UK prospective study and meta-analyses.","volume":"90","author":"Price","year":"2018","journal-title":"Neurology"},{"issue":"9771","key":"zoi221316r4","doi-asserted-by":"publisher","first-page":"1085","DOI":"10.1016\/S0140-6736(11)60105-0","article-title":"Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: collaborative analysis of 58 prospective studies.","volume":"377","author":"Wormser","year":"2011","journal-title":"Lancet"},{"issue":"10046","key":"zoi221316r5","doi-asserted-by":"publisher","first-page":"761","DOI":"10.1016\/S0140-6736(16)30506-2","article-title":"Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study.","volume":"388","author":"O\u2019Donnell","year":"2016","journal-title":"Lancet"},{"issue":"6","key":"zoi221316r6","doi-asserted-by":"publisher","first-page":"e630","DOI":"10.1016\/S2214-109X(18)30216-X","article-title":"Adiposity and risk of ischaemic and haemorrhagic stroke in 0\u00b75 million Chinese men and women: a prospective cohort study.","volume":"6","author":"Chen","year":"2018","journal-title":"Lancet Glob Health"},{"issue":"14","key":"zoi221316r7","doi-asserted-by":"publisher","first-page":"1473","DOI":"10.1212\/WNL.0000000000003171","article-title":"Adiposity and ischemic and hemorrhagic stroke: prospective study in women and meta-analysis.","volume":"87","author":"Kroll","year":"2016","journal-title":"Neurology"},{"issue":"7","key":"zoi221316r8","doi-asserted-by":"publisher","first-page":"2064","DOI":"10.1161\/STR.0b013e318296aeca","article-title":"An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association\/American Stroke Association.","volume":"44","author":"Sacco","year":"2013","journal-title":"Stroke"},{"issue":"10244","key":"zoi221316r9","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1016\/S0140-6736(20)31179-X","article-title":"Stroke.","volume":"396","author":"Campbell","year":"2020","journal-title":"Lancet"},{"issue":"6","key":"zoi221316r10","doi-asserted-by":"publisher","first-page":"2068","DOI":"10.1161\/STROKEAHA.108.540112","article-title":"Hemorrhagic and ischemic strokes compared: stroke severity, mortality, and risk factors.","volume":"40","author":"Andersen","year":"2009","journal-title":"Stroke"},{"issue":"3","key":"zoi221316r11","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001779","article-title":"UK biobank: an open access resource for identifying the causes of a wide range of complex diseases of middle and old age.","volume":"12","author":"Sudlow","year":"2015","journal-title":"PLoS Med"},{"issue":"16","key":"zoi221316r12","doi-asserted-by":"publisher","first-page":"1614","DOI":"10.1001\/jama.2021.18236","article-title":"Strengthening the reporting of observational studies in epidemiology using Mendelian Randomization: the STROBE-MR Statement.","volume":"326","author":"Skrivankova","year":"2021","journal-title":"JAMA"},{"issue":"1","key":"zoi221316r14","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1002\/(ISSN)1097-0258","article-title":"Improved estimates of floating absolute risk.","volume":"23","author":"Plummer","year":"2004","journal-title":"Stat Med"},{"issue":"12","key":"zoi221316r15","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0114112","article-title":"Surrogate markers of visceral adiposity in young adults: waist circumference and body mass index are more accurate than waist hip ratio, model of adipose distribution and visceral adiposity index.","volume":"9","author":"Borruel","year":"2014","journal-title":"PLoS One"},{"issue":"3","key":"zoi221316r16","doi-asserted-by":"publisher","first-page":"886","DOI":"10.1161\/STROKEAHA.114.007682","article-title":"Sex differences in incidence, pathophysiology, and outcome of primary intracerebral hemorrhage.","volume":"46","author":"Gokhale","year":"2015","journal-title":"Stroke"},{"key":"zoi221316r17","doi-asserted-by":"publisher","DOI":"10.3389\/fnagi.2021.716068","article-title":"Association between body mass index and intracranial aneurysm rupture: a multicenter retrospective study.","volume":"13","author":"Chen","year":"2021","journal-title":"Front Aging Neurosci"},{"issue":"6","key":"zoi221316r18","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1111\/ane.2012.125.issue-6","article-title":"Risk factors for aneurysmal subarachnoid hemorrhage\u2014BMI and serum lipids: 11-year follow-up of the HUNT and the Troms\u00f8 Study in Norway.","volume":"125","author":"Sandvei","year":"2012","journal-title":"Acta Neurol Scand"},{"issue":"4","key":"zoi221316r19","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1093\/oxfordjournals.aje.a010013","article-title":"Underestimation of risk associations due to regression dilution in long-term follow-up of prospective studies.","volume":"150","author":"Clarke","year":"1999","journal-title":"Am J Epidemiol"},{"issue":"6","key":"zoi221316r20","doi-asserted-by":"publisher","first-page":"1584","DOI":"10.1161\/STROKEAHA.111.000069","article-title":"Obesity and the risk of intracerebral hemorrhage: the multicenter study on cerebral hemorrhage in Italy.","volume":"44","author":"Pezzini","year":"2013","journal-title":"Stroke"},{"issue":"5","key":"zoi221316r21","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1136\/jnnp.2004.039982","article-title":"What causes lacunar stroke?","volume":"76","author":"Wardlaw","year":"2005","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"3","key":"zoi221316r22","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1161\/01.STR.21.3.375","article-title":"Are hypertension or cardiac embolism likely causes of lacunar infarction?","volume":"21","author":"Lodder","year":"1990","journal-title":"Stroke"},{"issue":"20","key":"zoi221316r23","doi-asserted-by":"publisher","first-page":"2488","DOI":"10.1016\/j.jacc.2017.03.558","article-title":"Lean body mass is the predominant anthropometric risk factor for atrial fibrillation.","volume":"69","author":"Fenger-Gr\u00f8n","year":"2017","journal-title":"J Am Coll Cardiol"},{"issue":"12","key":"zoi221316r24","doi-asserted-by":"publisher","first-page":"1164","DOI":"10.1038\/sj.ijo.0800741","article-title":"Body mass index and percent body fat: a meta analysis among different ethnic groups.","volume":"22","author":"Deurenberg","year":"1998","journal-title":"Int J Obes Relat Metab Disord"},{"issue":"1","key":"zoi221316r25","first-page":"143","article-title":"Racial and ethnic differences in cardiovascular disease risk factors: a systematic review.","volume":"17","author":"Kurian","year":"2007","journal-title":"Ethn Dis"},{"key":"zoi221316r13","unstructured":"UK Biobank Anthropometry. 2014. Accessed May 29, 2022. https:\/\/biobank.ndph.ox.ac.uk\/ukb\/ukb\/docs\/Anthropometry.pdf"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2799554\/pillay_2022_oi_221316_1670430056.17416.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,14]],"date-time":"2022-12-14T11:01:06Z","timestamp":1671015666000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2799554"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,14]]},"references-count":25,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2022,12,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2022.46613","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,14]]}}}