浦东新区高桥社区居民身体测量指标与2型糖尿病和糖调节异常的关系

Relationship between anthropometric indices and type 2 diabetes mellitus or impaired glucose regulation among the residents of Gao Qiao community in Pudong New Area of Shanghai

目的研究上海市浦东新区高桥社区35~75岁人群身体测量指标与2型糖尿病（T2DM）和糖调节异常（IGR）的关系,探索T2DM及IGR的最优预测指标。方法 2009年4-7月,采用多阶段随机抽样的方法,从上海市浦东新区高桥社区抽取35~75岁的常住居民1 317人为研究对象,进行T2DM和IGR的患病情况调查,测量身高、体重、腰围（WC）,计算体质指数（BMI）、腰臀比（WHR）和腰围身高比（WHtR）。采用有序多分类logistic回归和受试者操作特征曲线（receiver operating characteristics,ROC）等方法评估每个身体测量指标作为T2DM和IGR预测因子的准确性。结果 25.2%的调查对象血糖异常,其中T2DM患者占12.5%,IGR患者占12.7%,超重和肥胖人群达50.2%。随着WHR、WHtR的增加,男性、女性的T2DM患病率均上升,差异均有统计学意义（P〈0.01）。随着WHtR的增加,女性的IGR患病率上升,差异有统计学意义（P〈0.01）。有序多分类logistic回归分析结果表明,WHtR（OR=1.944,95%CI：1.472~2.568）和WHR（OR=1.980,95%CI：1.520~2.580）的OR值高于BMI（OR=1.598,95%CI：1.340~1.907）和WC（OR=1.713,95%CI：1.438~2.039）。ROC测定结果显示,BMI、WC、WHR和WHtR单独用于预测血糖异常状况的效果均不太理想,男性中WHR较好,ROC曲线下面积（AUC）为0.642,BMI最差,AUC为0.607;女性中WHtR较好,AUC为0.659,BMI最差,AUC为0.627。按年龄分层发现,不论性别,低年龄组（35~岁）4个身体测量指标预测血糖异常状况的AUC最大为WHR,高年龄组（55~75岁）则为WHtR。结论腹型肥胖指标WHtR、WHR对T2DM和IGR的预测价值优于BMI和WC。进行社区糖尿病高危人群筛选时,可根据年龄层及性别选择合适的身体测量指标。

Objective To study the relationship between anthropometric indices and type 2 diabetes mellitus（T2DM） or impaired glucose regulation（IGR） among the residents of Gao Qiao community in Pudong New Area of Shanghai and to explore the predictive values of anthropometric indices for T2 DM and IGR. Methods From April to July in 2009,1 317 residents（35-74 years old） from Gao Qiao community in Pudong New Area of Shanghai were selected by multi-stage random sampling method as the subjects for T2 DM and IGR. The height,weight,waist circumference（WC） were measured for all subjects. Body mass index（BMI）,waist hip ratio（WHR） and waist to height ratio（WHtR） were calculated. The multivariate logistic regression analysis and the receiver operating characteristics（ROC） curve were used to evaluate the predicative value of each index for T2 DM and IGR.Results The rate of abnormal blood glucose level in all subjects was 25.2%,the proportions of patients with T2 DM and IRG were12.5% and 12.7%,respectively. The proportion of subjects with overweight and obesity was 50.2%. The T2 DM morbidity in males and females increased with WHR and WHtR（P〈0.01）. The IGR morbidity in females increased with WHtR（P〈0.01）.Multivariate logistic regression analysis showed that the OR values（OR=1.944,95%CI： 1.472-2.568 and OR=1.980,95%CI：1.520-2.580） of WHtR and WHR were higher than those（OR=1.598,95%CI： 1.340-1.907 and OR=1.713,95%CI： 1.438-2.039） of BMI and WC. ROC curve indicated that WHR in male had the largest areas under the ROC curve（AUC） relative to abnormal glucose,AUC of WHR was 0.642,but AUC of BMI only was 0.607; AUC of WHtR in females was 0.659,but AUC of BMI only was0.627. According to age,of four indexes the AUC of WHR was the largest in young group（35 years old） and the AUC of WHtR was the largest in elder group（55-75 years old）. Conclusion The predicative value of WHtR and WHR（abdominal obesity indexes） is better than that of BMI and WC. When the subjects with high risk of T2 DM are screened,the anthropometric indices should be selected according to age and gender.