2型糖尿病患者体重指数与死亡风险的前瞻性研究

A prospective study on the association between body mass index and all-cause mortality in type 2 diabetic patients

目的探讨体重指数(body mass index,BMI)与2型糖尿病患者全死因死亡风险的关联。方法研究对象为江苏省苏南、苏北地区纳入国家基本公共卫生服务管理的17638名2型糖尿病患者,应用Cox比例风险回归模型计算基线时不同BMI组人群在随访期间的全死因死亡风险(hazard ratio,HR)值及95%置信区间(confidence interval,CI)。结果研究对象累计随访77451人年,平均随访4.39年,随访期间共死亡1274人,低体重组BMI<18.5kg/m^2、正常体重组(18.5kg/m^2≤BMI<24.0kg/m^2)、超重组(24.0kg/m^2≤BMI<28.0kg/m^2)、肥胖组(BMI≥28.0kg/m^2)死亡人数分别为39人、575人、484人和176人,相应的死亡率分别为15.6%、9.5%、6.2%、5.1%。调整混杂因素后,以正常体重组为参照,低体重组、超重组、肥胖组死亡风险的HR值(95%CI)分别为1.66(95%CI:1.20~2.30),0.68(95%CI:0.61~0.77),0.58(95%CI:0.48~0.68)。结论在2型糖尿病患者中,与正常体重人群相比,低体重人群的全死因死亡风险最高,超重和肥胖人群的死亡风险较低,超重和肥胖可以降低2型糖尿病患者死亡风险。

Objective The aim is to investigate the association between body mass index ( BMI) and risk of all-cause mortality among patients with type 2 diabetes.Methods A total of 17 638 patients with type 2 diabetes registered in the management of National Basic Public Health Services in two areas of southern and northern Jiangsu were recruited.Cox proportional risk regression model was used to calculate the hazard ratio( HR) value and 95% confidence interval ( 95% CI) of different BMI groups in the follow- up period.Results The subjects were followed up for a total of 77 451 person-years with an average duration of 4.39 years,and 1 274 patients died during the follow-up period.The number of death in low weight group ( BMI < 18.5 kg /m^2 ),normal weight group ( 18.5 kg /m^2≤BMI < 24 kg /m^2 ),overweight ( 24 kg /m^2≤BMI < 28 kg /m^2 ) and obese group ( BMI≥28 kg /m^2 ) were 39,575,484 and 176 respectively. The corresponding mortalities were 15.6%,9.5%,6.2% and 5.1%,respectively.Compared to normal weight group,the adjusted HR of all-cause mortality in low weight,overweight and obese group were 1.66 ( 95% CI: 1.20-2.30),0.68 ( 95% CI: 0.61-0.77),0.58 ( 95% CI: 0.48-0.68),respectively. Conclusions Low-weight patients have the highest risk of all-cause mortality compared with normal counterparts,while both overweight and obese people have a lower risk of death.Overweight and obesity may reduce the risk of all-cause mortality in type 2 diabetic patients.