贵阳城区40岁及以上居民体质量变化与代谢综合征发病率的随访研究

Relationship between Weight Change and Incidence of Metabolic Syndrome in Guiyang Urban Residents Aged 40 or Over:a 3-year Follow-up Study

背景体质量与代谢综合征(MS)有密切联系,而体质量变化与MS发病的关联也逐渐受到关注。目的通过对社区居民进行3年的随访调查,探讨体质量变化与MS发病风险的关系。方法选取2011年参加"中国2型糖尿病患者肿瘤发生风险的流行病学研究"的贵阳市城区40岁及以上居民5 850例为研究对象。测量身高、体质量、腰围、血压,检测空腹血糖(FPG)、高密度脂蛋白胆固醇(HDL-C)、三酰甘油(TG)水平。于2014年12月,重复测量上述指标,计算各指标变化的差值,并诊断出随访中的MS发病者。根据随访期间体质量变化,将受试者分为5组,即体质量减轻(WL)组(减轻≥1.0 kg)、体质量稳定(WS)组(变化<1.0 kg)、体质量增加(WG)-A组(增加1.0~<2.5 kg)、WG-B组(增加2.5~<5.0 kg)、WG-C组(增加WG≥5.0 kg)。结果本研究共完整随访4 392例,失访率24.92%。男性MS发病率为15.87%(223/1 405),低于女性MS发病率的27.18%(812/2 978)(χ2=55.293,P<0.05)。随着不同性别受试者体质量变化的增加,MS发病率呈增长趋势(P<0.05)。各组男性受试者随访期间体质指数(BMI)、腰围、腰围身高比变化比较,差异均有统计学意义(P<0.05)。各组女性受试者随访期间BMI、腰围、腰围身高比、收缩压(SBP)、舒张压(DBP)变化比较,差异均有统计学意义(P<0.05)。调整基线年龄、BMI、腰围、SBP、DBP、FPG、HDL-C、TG水平后,多因素Logistic回归分析显示,在男性受试者中,与WS组比较,WL组发生MS的风险降低[OR=0.411,95%CI(0.262,0.645)],WG-B组[OR=2.735,95%CI(1.664,4.497)]、WG-C组[OR=3.755,95%CI(1.907,7.395)]发生MS的风险升高(P<0.05);在女性受试者中,与WS组比较,WL组发生MS风险降低[OR=0.675,95%CI(0.534,0.854)],WG-A组[OR=1.446,95%CI(1.125,1.859)]、WG-B组[OR=1.778,95%CI(1.355,2.331)]、WG-C组[OR=2.801,95%CI(1.975,3.972)]发生MS的风险升高(P<0.05)。结论贵阳城区40岁及以上女性居民MS发病率高于男性;体质量的增长是MS发病的危险因素;男性在MS发病过程中对体质量的增长较女性敏感。

Background As weight is strongly related to metabolic syndrome（MS）,the association of weight change with the incidence of MS has become one of the focus.Objective To investigate the association between weight change and the incidence of MS based on a 3-year follow-up study of the community residents.Methods This study was conducted from 2011 to 2014.The participants enrolled in this study were 5 850 Guiyang urban residents who aged 40 or over and participated in the ＂Risk Evaluation of Tumor in Patients with Type 2 Diabetes in China：an Epidemiological Study＂ conducted in 2011.The participants′ height,weight,waist circumference and blood pressure were measured,and the values of fasting plasma glucose（FPG）,high-density lipoprotein cholesterol（HDL-C） and triglyceride（TG） of them were measured as well.We measured the above indicators of them again in December 2014 and those with MS were diagnosed.According to the weight changes during the follow-up,the participants were divided into 5 groups,the weight loss（WL） group（loss≥1.0 kg）,weight stable（WS） group（change 〈1.0 kg）,weight gain（WG）-A group（gain 1.0-〈2.5 kg）,WG-B group（gain 2.5-〈5.0 kg）,WG-C group（gain ≥5.0 kg）.Results A total of 4 392 participants completed the follow-up,with a lost follow-up rate of 24.92%.Of them,males had a lower incidence of MS than females did〔15.87%（223/1 405） vs.27.18%（812/2 987）,x2=55.293,P〈0.05〕.The incidence of MS increased with the increase of weight in each gender（P〈0.05）.There were significant differences in the changes of BMI,waist circumference and waist-to-height ratio among each group of the males during the follow-up（P〈0.05）.Significant differences in the changes of BMI,waist circumference,waist-to-height ratio,SBP and DBP were found among each group of the females during the follow-up（P〈0.05）.After adjusting for baseline age,BMI,waist circumference,SBP,DBP,FPG,HDL-C,and TG levels,multivariate Logistic regression analysis showed that,compared with WS group of males,the WL group had a lower risk of MS 〔OR=0.411,95%CI（0.262,0.645）〕,while those in the WG-B group〔OR=2.735,95%CI（1.664,4.497）〕 and WG-C group〔OR=3.755,95%CI（1.907,7.395）〕 showed a higher risk of MS;compared with the WS group of females,the WL group showed a lower risk of MS〔OR=0.675,95%CI（0.534,0.854）〕,while those in the WG-A group〔OR=1.446,95%CI（1.125,1.859）〕,WG-B group〔OR=1.778,95%CI（1.355,2.331）〕,and WG-C group〔OR=2.801,95%CI（1.975,3.972）〕 showed a higher risk of MS（P〈0.05）.Conclusion In Guiyang urban residents who aged 40 or over,females had a higher incidence of MS than males did,and weight gain was the significant risk factor of MS.Weight gain was more closely associated with the incidence of MS in males than in females.