高三酰甘油血症-腰围表型与2型糖尿病发病风险:一项前瞻性队列研究

Hypertriglyceridemic-waist Phenotype and the Risk of Type 2 Diabetes Mellitus:a Prospective Cohort Study

背景高三酰甘油血症-腰围表型是2型糖尿病(T2DM)的风险因素,不同性别、不同地区、不同年龄段及超重/肥胖人群中T2DM发病风险可能不同。目的探讨不同性别、不同地区、不同年龄段及超重/肥胖人群高三酰甘油血症-腰围表型与T2DM发病风险的关系,为糖尿病防控提供科学依据。方法本研究为前瞻性队列研究,2010年采取分层整群随机抽样方法,以贵州省12个县(市、区)18岁及以上9280名常住居民为队列人群进行基线调查。于2016—2020年进行随访,共随访到8163人,剔除基线时糖尿病患者、相关指标信息缺失者、失访和死亡的对象,最终纳入6743名调查对象。根据基线腰围(WC)和血清三酰甘油(TG)水平将调查对象分为4组,正常腰围和正常血清三酰甘油(NWNT)组:男性腰围<90 cm或女性腰围<85 cm、血清三酰甘油<1.7 mmol/L;正常腰围和高血清三酰甘油(NWHT)组:男性腰围<90 cm或女性腰围<85 cm、血清三酰甘油≥1.7 mmol/L;腰围增大和正常血清三酰甘油(EWNT)组:男性腰围≥90 cm或女性腰围≥85 cm、血清三酰甘油<1.7 mmol/L;腰围增大和高血清三酰甘油(EWHT)组:男性腰围≥90 cm或女性腰围≥85 cm、血清三酰甘油≥1.7 mmol/L。采用Cox比例风险回归模型分析高三酰甘油血症-腰围表型分组与新发T2DM之间的关系。结果中位随访时间6.58年,6743名调查对象中新发T2DM 706例,发病率为10.47%。在调整了相关的混杂因素后,Cox比例风险回归分析显示,EWHT组T2DM发病风险是NWNT组的1.486倍(HR=1.486,95%CI=1.185~1.865,P=0.001)。亚组多因素Cox比例风险回归分析显示,在男性、农村、年龄<45岁、超重/肥胖人群中,EWHT组T2DM发病风险分别是NWNT组的1.792倍(HR=1.792,95%CI=1.297~2.476,P<0.001)、1.483倍(HR=1.483,95%CI=1.115~1.971,P=0.007)、1.540倍(HR=1.540,95%CI=1.083~2.190,P=0.016)、1.614倍(HR=1.614,95%CI=1.123~2.321,P=0.010)。结论对大样本人群进行中位随访6.58年后,高三酰甘油血症-腰围表型是贵州省T2DM的发病风险,在男性、农村、年龄<45岁、超重/肥胖人群中更为显著。因此,对这类人群应该加强健康教育,通过合理饮食、适当运动从而控制体质量,降低血清三酰甘油水平是预防T2DM发病的必要手段和有效的方法。

Background Hypertriglyceridemic-waist phenotype is a risk factor for type 2 diabetes mellitus(T2DM).The risk of T2DM may vary in different genders,regions,age groups,and overweight/obese people.Objective To explore the risk of T2DM by hypertriglyceridemic-waist phenotype in different genders,regions,ages,and overweight/obese people,and to provide a scientific basis for the prevention and control of T2DM.Methods This was a prospective cohort study involving 9280 permanent residents over 18 years in 12 districts(counties)of Guizhou province in 2010 selected by multi-stage stratified cluster random sampling.From 2016 to 2020,8163 residents were followed up,and finally 6743 eligible participants were enrolled after excluding those with baseline T2DM,lacking sufficient clinical data,lost to follow-up and deaths.Participants were assigned into 4 groups based on their baseline waist circumference(WC)and serum triacylglycerol(TG)levels:Normal WC and TG group(NWNT,WC<90 cm in men and WC<85 cm in women,TG<1.7 mmol/L),normal WC and high TG group(NWHT,WC<90 cm in men and WC<85 cm in women,TG≥1.7 mmol/L),large WC and normal TG group(EWNT,WC≥90 cm in men or WC≥85 cm in women,TG<1.7 mmol/L)and large WC and high TG group(EWHT,WC≥90 cm in men or WC≥85 cm in women,TG≥1.7 mmol/L).A Cox proportional hazards regression model was used to analyze the correlation between hypertriglyceridemic-waist phenotype grouping and new-onset T2DM.Results The median follow-up period was 6.58 years.Among 6743 participants,new-onset T2DM was observed in 706(10.47%)individuals.After adjusting confounding factors,the Cox proportional hazards regression analysis showed that the risk of T2DM was 1.486 times in the EWHT group than the NWNT group(HR=1.486,95%CI=1.185-1.865,P=0.001).Multivariate Cox proportional hazards regression analysis showed that in the subgroups of male gender,rural region,aged<45 years,and overweight/obese,the risk of T2DM in the EWHT group was 1.792(HR=1.792,95%CI=1.297-2.476,P<0.001),1.483(HR=1.483,95%CI=1.115-1.971,P=0.007),1.540(HR=1.540,95%CI=1.083-2.190,P=0.016),and 1.614(HR=1.614,95%CI=1.123-2.321,P=0.010)times higher than the NWNT group,respectively.Conclusion After a median follow-up time of 6.58 years in a large cohort,the hypertriglyceridemic-waist phenotype is the risk of T2DM in Guizhou Province,which is more significant in males,rural areas,aged<45 years,and overweight/obese people.Therefore,health education should be strengthened for high-risk populations.Weight control through reasonable diet and appropriate exercise,and reducing serum triacylglycerol levels are necessary and effective methods to prevent the incidence of T2DM.