ArticleObesity science & practice2020
Estimating the effects of body mass index and central obesity on stroke in diabetics and non-diabetics using targeted maximum likelihood estimation: Atherosclerosis Risk in Communities study.
Article in Obesity science & practice, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it, 13 citations in OpenAlex.
- Risk association and diagnostic value of body roundness index for cardiovascular-kidney-metabolic-related outcomes: a systematic review and meta-analysis.Frontiers in endocrinology · 2026Pooled it
- Time-varying confounders in association between general and central obesity and coronary heart disease: Longitudinal targeted maximum likelihood estimation on atherosclerosis risk in communities study.Global epidemiology · 2025Article
- Comparing the impact of cumulative insulin resistance surrogates exposure on stroke: optimizing prevention strategies.Lipids in health and disease · 2025Article
- Association Between Obesity and Risk of Total and Obesity-Related Cancer in People With Incident Cardiovascular Disease.Journal of the American Heart Association · 2024Article
- Comparison of outcomes between off-pump and on-pump coronary artery bypass graft surgery using collaborative targeted maximum likelihood estimation.Scientific reports · 2024Article
- Review
- Association of Body Shape Index with Cerebral Small Vessel Disease.Obesity facts · 2023Article
- Article
- Association of central obesity and high body mass index with function and cognition in older adults.Endocrine connections · 2021Article
- Estimating the effects of body mass index and central obesity on stroke in diabetics and non-diabetics using targeted maximum likelihood estimation: Atherosclerosis Risk in Communities study.Obesity science & practice · 2020Article
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesThe association of body mass index (BMI) with the risk of cardiovascular disease among diabetic patients is controversial. This study compared the effects of BMI and central obesity on stroke in diabetics and non-diabetics using targeted maximum likelihood estimation. MATERIALS AND
methodsThis analysis included 12 725 adults aged 45-75 years, after excluding prevalence cases and participants with missing data, from the Atherosclerosis Risk in Communities study. Obesity was defined with BMI, waist circumference, waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), body shape index (BSI) and body roundness index (BRI), which categorized all participants as obese and non-obese. Generalized linear models and TMLE (with the tmle package) were used to estimate risk ratio (RR).
resultsDuring 27 years of follow-up, 1078 (8.47%) cases of stroke occurred. After adjustment for demographic, behavioural, biologic and central obesity variables, the effect of BMI decreased in both diabetics and non-diabetics. The effect of BMI in diabetics was more attenuated, in full model, (RR: 1.04 [0.90, 1.20]) rather than non-diabetics (RR: 1.11 [1.00, 1.24]). This attenuation was more related to biologic variables in non-diabetics and central obesity in diabetics. With respect to central obesity, BSI (RR [95% CI]: 1.15 [0.96, 1.38]) and WHR (RR [95% CI]: 1.15 [0.87, 1.52]) had strongest and marginally significant effects for diabetics and BSI (RR [95% CI]: 1.10 [1.02, 1.20]) for non-diabetics.
conclusionsAmong diabetics, BSI and WHR indices were associated with a higher incidence of stroke. Future studies should consider how central obesity affects higher incidence of stroke among diabetics stratified by sex and age groups.
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