社区40岁以上人群颈围与代谢综合征的相关性分析

Relationship between neck circumference and metabolic syndrome in over 40 years old community residents

目的探讨社区40岁以上人群颈围与代谢综合征的关系.方法纳入2014年7-12月参加"2型糖尿病危险因素与肿瘤发生风险的临床研究"的大连市社区≥40岁居民,共5017例,男1256例,女3761例.问卷形式采集研究者的一般信息.检测颈围、腰围、身高、体质量、收缩压、舒张压、空腹血糖、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)、血脂等,并计算体质量指数.结果男性年龄、颈围、腰围、空腹血糖、2 h PG、收缩压、舒张压、肥胖发生率、高血压发生率和2型糖尿病发生率明显高于女性[(63.5±8.4)岁比(60.8±8.0)岁、(38.6±3.0)cm比(34.4±2.6)cm、(92.3±9.1)cm比(87.3±9.6)cm、5.59(5.20,6.42)mmol/L比5.43(5.09,5.99)mmol/L、7.67(6.06,11.08)mmol/L比7.20(5.97,9.64)mmol/L、(135.3±18.8)mmHg(1 mmHg=0.133 kPa)比(129.8±19.5)mmHg、(79.8±10.7)mmHg比(74.8±10.0)mmHg、53.0%(666/1256)比48.9%(1841/3761)、49.9%(627/1256)比40.6%(1528/3761)和29.8%(374/1256)比22.5%(846/3761)],总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇和中心性肥胖发生率明显低于女性[(5.04±0.94)mmol/L比(5.58±1.03)mmol/L、1.35(0.97,1.95)mmol/L比1.45(1.06,2.04)mmol/L、(1.18±0.27)mmol/L比(1.32±0.29)mmol/L、(2.99±0.78)mmol/L比(3.27±0.85)mmol/L和63.7%(800/1256)比79.7%(2998/3761)],差异有统计学意义(P<0.01或<0.05);男性与女性体质量指数、HbA1c和代谢综合征发生率比较差异无统计学意义(P>0.05).Logistic回归分析结果显示,校正年龄、吸烟、饮酒、绝经状态(女性)、体质量指数和腰围后,男性颈围增大仍会增加2型糖尿病(OR=1.075,95%CI 1.012~1.142,P=0.019)的发生风险;女性颈围增大会增加2型糖尿病(OR=1.143,95%CI 1.096~1.192,P=0.000)、高血压(OR=1.112,95%CI 1.071~1.156,P=0.000)、高三酰甘油血症(OR=1.099,95%CI 1.060~1.139,P=0.000)、低HDL-C血症(OR=1.104,95%CI 1.064~1.144,P=0.000)和代谢综合征(OR=1.167,95%CI 1.120~1.217,P=0.000)的发生风险.以颈围作为检测变量,代谢综合征作为结局变量进行受试工作特征曲线分析,男性曲线下面积为0.733,颈围最佳临界值为37.9 cm,敏感度为77.9%,特异度为55.9%;女性曲线下面积为0.720,颈围最佳临界值为33.3 cm,敏感度为76.7%,特异度为56.0%.结论社区≥40岁人群中颈围与代谢综合征密切相关,男性颈围>37.9 cm,女性颈围>33.3 cm可预测代谢综合征的发生.

Objective To investigate the relationship between neck circumference and metabolic syndrome(MS)in≥40 years old community residents.Methods A total of 5017 Dalian community residents who participated in"the risk evaluation of cancers in Chinese diabetic individuals:a longitudinal study"from July to December 2014 were selected,with 1256 male cases and 3761 female cases,aged≥40 years old.The basic information was selected by questionnaire.The neck circumference,waist circumference(WC),body height,weight,systolic blood pressure(SBP),diastolic blood pressure(DBP),fasting plasma glucose(FPG),2 h-postprandial plasma glucose(2 h PG),glycosylated hemoglobin(HbA1c)and blood fat were measured;the body mass index(BMI)was calculated.Results The age,neck circumference,WC,FPG,2 h PG,SBP,DBP,incidence of obesity,incidence of hypertension and incidence of type 2 diabetes mellitus in male were significantly higher than those in female:(63.5±8.4)years vs.(60.8±8.0)years,(38.6±3.0)cm vs.(34.4±2.6)cm,(92.3±9.1)cm vs.(87.3±9.6)cm,5.59(5.20,6.42)mmol/L vs.5.43(5.09,5.99)mmol/L,7.67(6.06,11.08)mmol/L vs.7.20(5.97,9.64)mmol/L,(135.3±18.8)mmHg(1 mmHg=0.133 kPa)vs.(129.8±19.5)mmHg,(79.8±10.7)mmHg vs.(74.8±10.0)mmHg,53.0%(666/1256)vs.48.9%(1841/3761),49.9%(627/1256)vs.40.6%(1528/3761)and 29.8%(374/1256)vs.22.5%(846/3761);the total cholesterol,triacylglycerol,high density lipoprotein cholesterol,low density lipoprotein cholesterol and incidence of central obesity in male were significantly lower than those in female:(5.04±0.94)mmol/L vs.(5.58±1.03)mmol/L,1.35(0.97,1.95)mmol/L vs.1.45(1.06,2.04)mmol/L,(1.18±0.27)mmol/L vs.(1.32±0.29)mmol/L,(2.99±0.78)mmol/L vs.(3.27±0.85)mmol/L and 63.7%(800/1256)vs.79.7%(2998/3761),and there were statistical differences(P<0.01 or<0.05).There were no statistical differences in BMI,HbA1c and incidence of MS between male and female(P>0.05).After adjustment for age,smoking,drinking,menopausal status(female),BMI and WC,Logistic regression analysis result showed that increased neck circumference in male increased the risk of type 2 diabetes mellitus(OR=1.075,95%CI 1.012 to 1.142,P=0.019);increased neck circumference in female increased the risks of type 2 diabetes mellitus(OR=1.143,95%CI 1.096 to 1.192,P=0.000),hypertension(OR=1.112,95%CI 1.071 to 1.156,P=0.000),hypertriacylglyceremia(OR=1.099,95%CI 1.060 to 1.139,P=0.000),low HDL-C(OR=1.104,95%CI 1.064 to 1.144,P=0.000)and MS(OR=1.167,95%CI 1.120 to 1.217,P=0.000).Taking neck circumference as detection variable and MS as outcome variable,the receiver operating characteristic curve was analyzed.In male,the area under curve was 0.733,the optimal cut-off value of neck circumference was 37.9 cm,with a sensitivity of 77.9%,and a specificity of 55.9%.In female,the area under curve was 0.720,the optimal cut-off value of neck circumference 33.3 cm,with a sensitivity of 76.7%,and a specificity of 56.0%.Conclusions Neck circumference is associated with MS in≥40 years old community residents.Male neck circumference>37.9 cm and female neck circumference>33.3 cm are the optimal cut-off value for forecasting MS.