代谢健康型超重/肥胖与新发糖尿病的相关性研究

Title association between metabolically healthy overweight/obesity and risk of new-onset diabetes

目的探讨中国成年人代谢健康型超重/肥胖(metabolically healthy overweight/obesity,MHO)与新发糖尿病的相关性。方法本研究是对一项回顾性队列研究的二次分析,选取2010年至2016年于中国瑞慈集团相关医疗机构进行健康体检的117056名中国成年人作为研究对象,根据基线体重指数和代谢状态分为代谢健康型非肥胖(metabolically healthy non-obesity,MHNO)组、MHO组、代谢不健康型非肥胖(metabolically unhealthy non-obesity,MUNO)组和代谢不健康型超重/肥胖(metabolically unhealthy overweight/obesity,MUO)组。采用Kaplan-Meier法(log-rank检验)估计各组的糖尿病累积发病率,采用Cox比例风险模型估计不同肥胖代谢表型组别的糖尿病发病风险HR(95%CI),并进行亚组分析。结果纳入的117056名中国成年人中,MHO占总人群的24.3%。经过平均(3.1±1.0)年的随访,共有2685例糖尿病新发病例,累积发病率为2.3%。MHNO、MHO、MUNO和MUO组的累积发病率分别为0.5%、1.6%、4.8%和7.9%,组间比较差异有统计学意义(χ2=1224.164,P<0.001)。Cox比例风险模型分析显示,在校正性别、年龄、空腹血糖、吸烟、饮酒及糖尿病家族史之后,MHO组人群新发糖尿病风险是MHNO组的2.19倍(95%CI 1.89~2.55),而MUNO和MUO组人群发生糖尿病事件的HR值分别为2.25(95%CI 1.93~2.64)和3.00(95%CI 2.61~3.45)。结论中国成年人中,MHO与新发糖尿病风险升高有显著相关性。

ObjectiveTo investigate the association between metabolically healthy overweight/obesity(MHO)and risk of new-onset diabetes among Chinese adults.MethodsThis study was a secondary analysis of a retrospective cohort study recruiting 117056 Chinese adults who received a health check at the Rich Healthcare Group from 2010 to 2016.Participants were classified into metabolically healthy non-obesity(MHNO),MHO,metabolically unhealthy non-obesity(MUNO),and metabolically unhealthy overweight/obesity(MUO)group according to body mass index and metabolic status at baseline.Kaplan-Meier method(log-rank test)was used to estimate the cumulative incidence of diabetes in each group.The Cox proportional hazards model was employed to estimate the hazard ratios(HR and 95%CI)for diabetes incidence across different obesity metabolic phenotype groups,followed by subgroup analysis.ResultsA total of 117056 Chinese adults were enrolled and the prevalence of MHO was 24.3%.During the follow-up time of(3.1±1.0)years,2685 new-onset diabetes adults occurred,resulting in a cumulative incidence rate of 2.3%.The cumulative incidences of MHNO,MHO,MUNO and MUO groups were 0.5%,1.6%,4.8%,and 7.9%,respectively,and there was a statistical difference(χ2=1224.164,P<0.001).Cox proportional hazards model showed that after adjusting for sex,age,fasting plasma glucose,smoking,alcohol drinking,and diabetes family history,the risk of new-onset diabetes in MHO group was 2.19 folds of MHNO group(95%CI 1.89-2.55).Additionally,the HR for diabetes in MUNO and MUO groups were 2.25(95%CI 1.93-2.64)and 3.00(95%CI 2.61-3.45).ConclusionThe MHO phenotype was significantly associated with an increased risk of new-onset diabetes in Chinese adults.