腰身比、BMI、代谢异常组分及其组合与2型糖尿病关系的前瞻性巢式病例对照研究

A prospective nested case-control study on association of waist-to-height ratio,body mass index,metabolic disorders,and their combinations and type 2 diabetes mellitus

目的:探讨腰身比、BMI、代谢异常组分及其组合与2型糖尿病(T2DM)发病的关系。方法:以2007至2008年和2013至2014年建立的大样本人群队列为基础,采用巢式病例对照研究,选择河南某农村人群随访时新发T2DM患者作为病例组(722例),按照性别、年龄进行频数匹配(1∶1),随机选择基线和随访时均未患T2DM的正常人群为对照组(722人)。应用Cox比例风险回归模型分析基线时腰身比、BMI、代谢异常组分及其组合与2型糖尿病发病风险的关系。结果:在调整了可能的混杂因素后,基线时腰身比肥胖、BMI异常、空腹血糖异常、高血压、甘油三酯异常均可增加T2DM的发病风险(P<0.05),高密度脂蛋白胆固醇异常不增加T2DM的发病风险(P>0.05)。在调整了多种潜在的混杂因素后,无论采用腰身比或BMI定义肥胖,与代谢正常体重正常或代谢正常腰身比正常组相比,代谢正常肥胖不增加T2DM的发病风险,代谢异常增加T2DM的发病风险(P<0.05)。结论:代谢正常肥胖不增加T2DM的发病风险,无论是否肥胖,代谢异常均可增加T2DM的发病风险。

Aim：To investigate the association between baseline waist-to-height ratio（WHtR）,body mass index （BMI）,metabolic disorders,and their combinations and the risk of incidence of type 2 diabetes mellitus（T2DM）.Methods： The prospective nested case-control study design was conducted based on the previous established large cohort populations.A total of 722 cases of T2DM were identified and 722 cohort members without T2DM event at both baseline and follow-up were randomly matched by sex and age to the cases at a ratio of 1：1.Cox proportional hazards regression models were used to evaluate the risk of T2DM associated with baseline WHtR,BMI,metabolic disorders,and their combinations.Results： After adjustment for potential confounders,abnormal WHtR,abnormal BMI,abnormal fasting plasma glucose,hypertension,and abnormal triglycerides at baseline all significantly increased the risk of T2DM（P〈0.05）,abnormal HDL-C did not increase the risk of T2DM（P〉0.05）.No matter which criteria was used to define obesity,compared with metabolically healthy and normal weight or metabolically healthy and normal WHtR population,metabolically healthy obesity（MHO） did not increase the risk of T2DM（P〉0.05）,however,metabolically unhealthy with normal weight or obesity both increased the risk of T2DM（P〈0.05）.Conclusion： MHO does not increaes the risk of T2DM;whether obese or not,metabolically unhealthy might increase the risk of T2DM.