2型糖尿病患者肥胖状态与全因死亡风险的关联研究

Association between obesity and risk for all-cause mortality in patients with type 2 diabetes

目的分析不同肥胖状态与2型糖尿病(T2DM)患者全因死亡风险的关联。方法研究对象来自浙江农村社区T2DM队列,该队列2016年完成基线调查,本研究使用的随访数据截至2021年12月31日,剔除随访期间失访或资料不全者,共纳入10310例研究对象。根据BMI和腰围将研究对象分为低体重、正常体型、单纯中心性肥胖、单纯全身肥胖、复合超重和复合肥胖6种状态,采用Cox比例风险回归模型分析不同肥胖状态T2DM患者的全因死亡风险比(HR)值及其95%CI。结果研究对象累计随访57049.47人年,随访(5.53±0.89)人年,随访期间共死亡971例,死亡密度为1702.03/10万人年。以正常体型患者为对照,调整混杂因素后低体重患者全因死亡风险增加104%(HR=2.04,95%CI:1.42~2.92),单纯全身肥胖、复合超重、复合肥胖患者的全因死亡风险分别下降34%(HR=0.66,95%CI:0.53~0.82)、22%(HR=0.78,95%CI:0.66~0.92)、38%(HR=0.62,95%CI:0.49~0.78),单纯中心性肥胖患者全因死亡风险差异无统计学意义。亚组分析显示,不同性别和不同年龄组低体重T2DM患者全因死亡风险增加,女性复合肥胖患者全因死亡风险较正常体型患者下降50%,而男性该肥胖状态患者全因死亡风险差异无统计学意义;≥65岁老年患者中,单纯全身肥胖、复合超重、复合肥胖患者的全因死亡风险均明显低于正常体型组(HR=0.61,95%CI:0.48~0.78;HR=0.76,95%CI:0.63~0.91;HR=0.56,95%CI:0.42~0.73),而<65岁的各种肥胖状态患者全因死亡风险差异无统计学意义。敏感性分析结果未见明显变化。结论T2DM患者全因死亡风险存在“肥胖悖论”现象,低体重患者的全因死亡风险明显高于正常体型者,全身型或复合型超重/肥胖患者的死亡风险明显降低。

Objective To investigate the association between obesity and the risk for all-cause mortality in type 2 diabetes(T2DM)patients.Methods The participants were from a rural community-based T2DM patient cohort in Zhejiang Province.The study used the data collected from baseline survey in 2016 and follow-up until December 31,2021.A total of 10310 participants were included,excluding those who were lost in follow-up or had incomplete data in follow-up.According to BMI and waist circumference,the study subjects were divided into 6 groups:low body weight,normal body weight,simple abdominal obesity,simple body obesity,complex overweight and complex obesity.Cox proportional hazards regression model was used to analyze hazard ratios(HRs)of all-cause mortality and their 95%CIs in T2DM patients with different obesity status.Results The cumulative follow-up period was 57049.47 person-years with an average follow-up of(5.53±0.89)person-years.During this period,971 subjects died.The death density was 1702.03/100000 person-years.After adjusting for confounders,low-weight patients had a 104%increased risk for all-cause death compared with normal-weight patients(HR=2.04,95%CI:1.42-2.92).The risk for all-cause death decreased by 34%(HR=0.66,95%CI:0.53-0.82),22%(HR=0.78,95%CI:0.66-0.92),38%(HR=0.62,95%CI:0.49-0.78)in the patients with simple body obesity,complex overweight and complex obesity,respectively,there was no significant difference for all-cause death in the patients with simple abdominal obesity alone.In subgroup analysis,the risk of all-cause mortality increased in low-weight T2DM patients of different sexes and ages,the mortality risk in women with complex obesity was 50%lower than that in the women with normal body weight,but there was no significant difference in men in the comparison between complex obesity group and normal body weight group.The risk for all-cause mortality was significantly lower in≥65 years old patients with simple body obesity,complex overweight and complex obesity than in patients with normal body weight(HR=0.61,95%CI:0.48-0.78;HR=0.76,95%CI:0.63-0.91;HR=0.56,95%CI:0.42-0.73),there was no significant difference in the patients aged<65 years.There was no significant change in sensitivity analysis.Conclusions There was an"obesity paradox"in the risk for all-cause mortality in T2DM patients.The risk of all-cause mortality in the low-weight patients was significantly higher than that in normal-weight patients,and the risk for death in the patients with simple body obesity or complex overweight and obesity were significantly lower.