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腰围和BMI动态变化对2型糖尿病发病的影响
作者:陈冯梅 郭志荣 武鸣 周正元 骆文书

摘要:

目的  探讨腰围和BMI的动态变化对队列人群2型糖尿病(T2DM)发病的影响。方法  以1999年4月开展的江苏省多代谢异常和代谢综合征(MS)综合防治队列研究为基础,获取基线调查对象资料,并于2002年1月至2003年8月及2006年3月至2007年11月进行两次随访。排除基线期患有T2DM、心血管疾病(CVD)、BMI≤18.5 kg/m2者,以及因搬迁、死亡等原因造成的失访者后,共有3 461名调查对象被纳入本研究,对其进行问卷调查、人体测量及实验室检测。不同人群性别、吸烟、饮酒及T2DM家族史的差异性分析采用χ2检验;TG在不同人群中的差异性分析采用秩和检验;将腰围和BMI差值进行四等分,纳入多元COX回归模型,分析腰围和BMI差值不同分位与T2DM之间的关联;运用COX比例风险回归模型,分析不同基线特征人群控制组和非控制组与T2DM发病的关系,以及腰围和BMI控制与否与T2DM发病风险之间的关联。结果  3 461名研究对象年龄为(50.21± 9.96)岁,男性1 406名,女性2 055名。在两次随访间隔期内,新发T2DM病例160例,男性60例,女性100例,累积发病率为4.6%(160/3 461)。多元COX回归模型分析结果显示,腰围差值的第四分位发生T2DM的风险较高(HR=2.06, 95%CI:1.27~3.16),BMI差值的第四分位发生T2DM的风险较高(HR= 1.30,95%CI:0.86~1.95)。基线腰围正常人群和腹型肥胖人群中,非控制组T2DM累计发病率分别为7.1%(40/565)、6.3%(45/645),均高于控制组[3.4%(71/2 096)、4.5%(4/155)](χ2值分别为3.98和15.18,P值分别为0.043和<0.001),差异均有统计学意义。基线腰围正常人群中非控制组人群的T2DM发病风险高于控制组(HR=2.12, 95%CI:1.40~3.22);基线腹型肥胖人群中非控制组人群的T2DM发病风险高于控制组(HR=1.14,95%CI:1.04~1.92)。当腰围未得到控制时,BMI控制与非控制组人群T2DM发病风险均会增加[HR(95%CI)值分别为1.73(1.17~2.54),2.45(1.63~3.69)]。结论  控制腰围可降低T2DM的发病风险,如果腰围未得到控制,BMI控制与否T2DM发病风险均会增加。

关键词:腰围;糖尿病,2型;前瞻性研究;BMI

Abstract:

Objective  To investigate the impact of dynamic change of waist circumference or body mass index (BMI) on type 2 diabetes mellitus (T2DM) populations in a cohort study.Methods  We not only obtained the baseline survey data from program 'Prevention of Multiple Metabolic Disorders and metabolic syndrome (MS) in Jiangsu Province'(PMMJS) which started in 1994, and we conducted twice follow-ups from January 2002 to August 2003, and March 2006 to November 2007. After excluding subjects who were found to have T2DM at baseline, cardiovascular disease(CVD), and BMI<18.5 kg/m2 , and loss to follow up because of relocation, death or other reasons, a total of 3 461 subjects were included in this analysis. They received investigation including questionnaires investigation, measurement and laboratory examination. The differences of gender, smoking, alcohol drinking and T2DM family history in different groups were examined using χ2-test, median and inter-quartile range were calculated for TG, and they were examined by rank test. Four equal parts of the differences of waist circumference and BMI were carried out in the COX regression model, to investigate the association between 2 years change of waist circumference or BMI and incidence of T2DM. We also examined the association between BMI and waist circumference modification and incident risk of T2DM in subjects with normal baseline BMI, baseline obese subjects, subjects with normal baseline waist circumference and baseline abdominal obese subjects.Results  A total of 3 461 participants (1 406 males, 2 055 females) were investigated, including 160 new T2DM cases (60 males, 100 females) who were from between baseline and the second following up. The accumulative incidence was 4.6% (60/3 461). Multivariate COX regression model analysis results showed that the T2DM risk was relatively high in the highest quartile of waist circumference D-value group(HR=2.06, 95% CI: 1.27-3.16), the T2DM risk was also high in the highest quartile of BMI D-value group (HR=1.30, 95% CI: 0.86-1.95). In subjects with abdominal obesity and normal waist circumference at baseline, the incidence rate of T2DM in non-control group was 7.1% (40/565) , 6.3% (45/645), higher than that in control group (3.4%(71/2 096), 4.5%(4/155)) (χ2 values were 3.98 and 15.18, P values were 0.043 and <0.001). In subjects with normal waist circumference, T2DM risk was higher in non-control group than that in control group (HR=2.12, 95% CI: 1.40-3.22). In abdominal obese subjects, T2DM risk was also higher in non-control group than that in control group (HR=1.14, 95% CI: 1.04-1.92). If waist circumference was not controlled, T2DM risk was high, no matter BMI controlled or not (HR(95% CI) were 1.73(1.17-2.54),2.45(1.63-3.69) respectively).Conclusion  Controlling the waistline could reduce the risk of diabetes, and once waist circumference was not controlled, T2DM risk would be increased no matter BMI was controlled or not.

Key words: Waist circumference;Diabetes mellitus, type 2;Prospective study;Body mass index

发表日期:2015/12

引用本文:

图/表:

  • 10.3760/cma.j.issn.0253-9624.2015.12.014.T001:表1 腰围正常与腹型肥胖者、BMI正常与肥胖者基线特征比较(n=3 461)

    10.3760/cma.j.issn.0253-9624.2015.12.014.T001:表1 腰围正常与腹型肥胖者、BMI正常与肥胖者基线特征比较(n=3 461)

  • 10.3760/cma.j.issn.0253-9624.2015.12.014.T002:表2 腰围和BMI差值四分位数与T2DM关联的多元COX回归模型分析结果

    10.3760/cma.j.issn.0253-9624.2015.12.014.T002:表2 腰围和BMI差值四分位数与T2DM关联的多元COX回归模型分析结果

  • 10.3760/cma.j.issn.0253-9624.2015.12.014.T003:表3 不同基线特征人群控制组和非控制组与T2DM发病关联的多元COX回归模型分析结果

    10.3760/cma.j.issn.0253-9624.2015.12.014.T003:表3 不同基线特征人群控制组和非控制组与T2DM发病关联的多元COX回归模型分析结果

  • 10.3760/cma.j.issn.0253-9624.2015.12.014.T004:表4 腰围和BMI控制与否与T2DM发病关联的多元COX回归模型分析结果

    10.3760/cma.j.issn.0253-9624.2015.12.014.T004:表4 腰围和BMI控制与否与T2DM发病关联的多元COX回归模型分析结果

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