成年健康体检人群糖尿病前期流行现状及其与超重肥胖的关系

Prevalence of pre-diabetes and its association with overweight and obesity in an adult health check-up population

目的分析成年健康体检人群糖尿病前期(PDM)流行现状及其与超重肥胖的关系。方法本研究为横断面及回顾性队列研究,采用整群随机抽样方法,选取2017年1月至2023年7月在四川省人民医院健康管理中心进行健康体检的491379例成年人为研究对象,分析其PDM和超重肥胖的流行特征,以及随时间的变化趋势。对其中进行≥3次健康体检且基线未患糖尿病和PDM的19001例人群进行回顾性队列研究,采用Cox比例风险回归模型分析体重指数、腰围与PDM发生风险的关系,采用限制性立方样条回归(RCS)分析体重指数、腰围与PDM发生风险之间的剂量反应关系。结果纳入横断面研究的491379例人群中,男性275084例,女性216295例,<40岁者163158例,≥40岁者328221例;2017—2023年PDM总患病率为19.41%,整体呈上升趋势。纳入队列研究的19001例人群中,随访结束新发PDM者2487例(13.09%)。调整混杂因素后,超重(HR=1.150,95%CI:1.047~1.263)、肥胖(HR=1.335,95%CI:1.149~1.552)及腹型肥胖(HR=1.218,95%CI:1.105~1.342)均为PDM的危险因素。随着体重指数(>22.9 kg/m^(2),P_(非线性)=0.973)和腰围(>80 cm,P_(非线性)=0.830)的增加,PDM发生风险随之上升,二者呈线性剂量反应关系。在不同性别和不同年龄分组中,体重指数(男性>24.1 kg/m^(2),女性>21.5 kg/m^(2);年龄≥40者>23.3 kg/m^(2),年龄<40者>24.1 kg/m^(2))和腰围(男性>85 cm,女性>73 cm;年龄≥40者>82 cm,年龄<40者>85 cm)越大,PDM发生风险越高。结论成年健康体检人群PDM患病率呈上升趋势,预防PDM需要将体重指数和腰围控制在比超重和肥胖标准更低的水平。

Objective To analyze the current prevalence of pre-diabetes(PDM)and its relationship with overweight and obesity in an adult health check-up population.Methods This study was a cross-sectional and retrospective cohort study and was applied using whole-cluster random sampling method.A total of 491379 adults who underwent health check-ups at the Health Management Centre of Sichuan Provincial People's Hospital from January 2017 to July 2023 were selected to analyze the epidemiological characteristics of PDM and overweight-obesity,as well as the trend of change over time.A retrospective cohort study was conducted on 19001 of the subjects who underwent≥3 health check-ups and did not have diabetes and PDM at baseline,and the relationships between body mass index,waist circumference and the risk for developing PDM were analyzed using Cox proportional risk regression models.And the dose-response relationship between body mass index,waist circumference and the risk for developing PDM was analyzed using restricted cubic spline regression(RCS).Results Of the 491379 cases included in the cross-sectional study,275084 were male and 216295 were female,163158 cases were under 40 years old,and 328221 cases were 40 years old and above;the total prevalence of PDM was 19.41%in 2017-2023,with an overall increasing trend.Of the 19001 people included in the cohort study,a total of 2487(13.09%)new cases of PDM were identified at the end of follow-up.After adjusting for confounding factors,overweight(HR=1.150,95%CI:1.047-1.263),obesity(HR=1.335,95%CI:1.149-1.552)and abdominal obesity(HR=1.218,95%CI:1.105-1.342)were risk factors for PDM.The risk of PDM rised with the increase of body mass index(>22.9 kg/m^(2),P_(non-linear)=0.973)and waist circumference(>80 cm,P_(non-linear)=0.830),with a linear dose-response mode.In different gender and age groups,it was found the greater the body mass index(>24.1 kg/m^(2) for men,>21.5 kg/m^(2) for women;>23.3 kg/m^(2) for age≥40 years,>24.1 kg/m^(2) for age<40 years)and waist circumference(>85 cm for men,>73 cm for women;>82 cm for age≥40 years,>85 cm for age<40 years),the higher the risk of PDM.Conclusions The prevalence of PDM is on the rise in the adult health check-up population.To prevent PDM,it is necessary to control the body mass index and waist circumference to a lower level than the overweight and obesity standards.