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新发2型糖尿病成年患者的体质指数与死亡率
Body-Mass Index and Mortality among Adults with Incident Type 2 Diabetes


Deirdre K. Tobias ... 糖尿病 • 2014.01.16
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• 从儿童期至成年早期超重的变化与2型糖尿病风险的关系

摘要


背景

2型糖尿病患者中体重与死亡率是否相关依然是尚未解决的问题。某些研究提示,超重或肥胖的2型糖尿病患者的死亡率比正常体重的患者低(“肥胖悖论”)。

 

方法

我们对护士健康研究(Nurses’ Health Study,NHS)(8,970名参与者)和健康专业人员随访研究(Health Professionals Follow-up Study,HPFS)(2,457名参与者)中的糖尿病患者进行了研究,参与者在诊断糖尿病时未患有心血管疾病或癌症。参与者在糖尿病确诊之前的体重和身高用于计算体质指数(BMI,以千克为单位的体重除以米为单位的身高平方数)。我们使用多变量Cox模型来估计不同BMI区间死亡率的风险比和95%可信区间(CI)。

 

结果

在平均15.8年的随访期间,共有3,083次死亡事件。我们观察到不同BMI区间(18.5~22.4,22.5~24.9 [参照],25.0~27.4,27.5~29.9,30.0~34.9,≥35.0)和全因死亡率(风险比各为,1.29 [95% CI,1.05~1.59];1.00;1.12 [95% CI,0.98~1.29];1.09 [95% CI,0.94~1.26];1.24 [95% CI,1.08~1.42];1.33 [95% CI,1.14~1.55])之间呈现J形相关。

这种相关性在从未吸烟的人群中(不同区间的BMI 的风险比:1.12、1.00、1.16、1.21、1.36、1.56)呈现为线性关系,而在有过吸烟史的人群中(不同区间的BMI的风险比:1.32、1.00、1.09、1.04、1.14、1.21)没有呈现出线性关系(交互作用的P值为0.04)。在65岁前确诊糖尿病的人群中观察到一个直线相关趋势,但在年龄≥65岁时确诊糖尿病的人群中则未见此种关系(交互作用的P<0.001)。

 

结论

我们观察到BMI和死亡率在所有试验参与者以及有吸烟史的人群中呈现J形相关,在从未吸烟的人群中则呈现为线性相关。我们没有发现能支持肥胖悖论的证据,即确诊糖尿病时超重或肥胖的患者比正常体重的患者死亡率更低。本研究由美国国家卫生研究院(National Institutes of Health)和美国糖尿病学会(American Diabetes Association)资助。





作者信息

Deirdre K. Tobias, Sc.D., An Pan, Ph.D., Chandra L. Jackson, Ph.D., Eilis J. O'Reilly, Sc.D., Eric L. Ding, Sc.D., Walter C. Willett, M.D., Dr.P.H., JoAnn E. Manson, M.D., Dr.P.H., and Frank B. Hu, M.D., Ph.D.
From the Departments of Nutrition (D.K.T., A.P., C.L.J., E.J.O., E.L.D., W.C.W., F.B.H.) and Epidemiology (W.C.W., J.E.M., F.B.H.), Harvard School of Public Health, and the Channing Division of Network Medicine (E.J.O., E.L.D., W.C.W., F.B.H.) and the Division of Preventive Medicine (J.E.M.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School — all in Boston; and Saw Swee Hock School of Public Health and Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore (A.P.). Address reprint requests to Dr. Tobias at the Department of Nutrition, Harvard School of Public Health, 665 Huntington Ave., Boston, MA 02115, or at dbanel@hsph.harvard.edu; or to Dr. Pan at the Saw Swee Hock School of Public Health, National University of Singapore, 16 Medical Dr., MD3, Singapore 117597, or at ephanp@nus.edu.sg.

 

参考文献

1. Adams KF, Schatzkin A, Harris TB, et al. Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med 2006;355:763-778

2. Chen Z, Yang G, Offer A, et al. Body mass index and mortality in China: a 15-year prospective study of 220 000 men. Int J Epidemiol 2012;41:472-481

3. Berrington de Gonzalez A, Hartge P, Cerhan JR, et al. Body-mass index and mortality among 1.46 million white adults. N Engl J Med 2010;363:2211-2219[Erratum, N Engl J Med 2011;365:869.]

4. Zheng W, McLerran DF, Rolland B, et al. Association between body-mass index and risk of death in more than 1 million Asians. N Engl J Med 2011;364:719-729

5. Schmidt D, Salahudeen A. The obesity-survival paradox in hemodialysis patients: why do overweight hemodialysis patients live longer? Nutr Clin Pract 2007;22:11-15

6. Uretsky S, Messerli FH, Bangalore S, et al. Obesity paradox in patients with hypertension and coronary artery disease. Am J Med 2007;120:863-870

7. Lavie CJ, Milani RV, Ventura HO, Romero-Corral A. Body composition and heart failure prevalence and prognosis: getting to the fat of the matter in the “obesity paradox.” Mayo Clin Proc 2010;85:605-608

8. Doehner W, Erdmann E, Cairns R, et al. Inverse relation of body weight and weight change with mortality and morbidity in patients with type 2 diabetes and cardiovascular co-morbidity: an analysis of the PROACTIVE study population. Int J Cardiol 2012;162:20-26

9. McEwen LN, Karter AJ, Waitzfelder BE, et al. Predictors of mortality over 8 years in type 2 diabetic patients: Translating Research Into Action for Diabetes (TRIAD). Diabetes Care 2012;35:1301-1309

10. Carnethon MR, De Chavez PJ, Biggs ML, et al. Association of weight status with mortality in adults with incident diabetes. JAMA 2012;308:581-590[Erratum, JAMA 2012;308:2085.]

11. Logue J, Walker JJ, Leese G, et al. Association between BMI measured within a year after diagnosis of type 2 diabetes and mortality. Diabetes Care 2013;36:887-893

12. Florez H, Castillo-Florez S. Beyond the obesity paradox in diabetes: fitness, fatness, and mortality. JAMA 2012;308:619-620

13. Manson JE, Stampfer MJ, Hennekens CH, Willett WC. Body weight and longevity: a reassessment. JAMA 1987;257:353-358

14. Manson JE, Willett WC, Stampfer MJ, et al. Body weight and mortality among women. N Engl J Med 1995;333:677-685

15. Pischon T, Boeing H, Hoffmann K, et al. General and abdominal adiposity and risk of death in Europe. N Engl J Med 2008;359:2105-2120[Erratum, N Engl J Med 2010;362:2433.]

16. Hu FB. Obesity epidemiology. New York: Oxford University Press, 2008.

17. Colditz GA, Manson JE, Hankinson SE. The Nurses' Health Study: 20-year contribution to the understanding of health among women. J Womens Health 1997;6:49-62

18. Rimm EB, Giovannucci EL, Willett WC, et al. Prospective study of alcohol consumption and risk of coronary disease in men. Lancet 1991;338:464-468

19. Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes 1979;28:1039-1057

20. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 1997;20:1183-1197

21. Manson JE, Rimm EB, Stampfer MJ, et al. Physical activity and incidence of non-insulin-dependent diabetes mellitus in women. Lancet 1991;338:774-778

22. Hu FB, Leitzmann MF, Stampfer MJ, Colditz GA, Willett WC, Rimm EB. Physical activity and television watching in relation to risk for type 2 diabetes mellitus in men. Arch Intern Med 2001;161:1542-1548

23. Rimm EB, Stampfer MJ, Colditz GA, Chute CG, Litin LB, Willett WC. Validity of self-reported waist and hip circumferences in men and women. Epidemiology 1990;1:466-473

24. Rich-Edwards JW, Corsano KA, Stampfer MJ. Test of the National Death Index and Equifax Nationwide Death Search. Am J Epidemiol 1994;140:1016-1019

25. Stampfer MJ, Willett WC, Speizer FE, et al. Test of the National Death Index. Am J Epidemiol 1984;119:837-839

26. Chiuve SE, Fung TT, Rimm EB, et al. Alternative dietary indices both strongly predict risk of chronic disease. J Nutr 2012;142:1009-1018

27. Durrleman S, Simon R. Flexible regression models with cubic splines. Stat Med 1989;8:551-561

28. American Diabetes Association. Standards of medical care in diabetes -- 2013. Diabetes Care 2013;36:Suppl 1:S11-S66

29. Ross C, Langer RD, Barrett-Connor E. Given diabetes, is fat better than thin? Diabetes Care 1997;20:650-652

30. Khalangot M, Tronko M, Kravchenko V, Kulchinska J, Hu G. Body mass index and the risk of total and cardiovascular mortality among patients with type 2 diabetes: a large prospective study in Ukraine. Heart 2009;95:454-460

31. Chaturvedi N, Fuller JH. Mortality risk by body weight and weight change in people with NIDDM. Diabetes Care 1995;18:766-774

32. Zoppini G, Verlato G, Leuzinger C, et al. Body mass index and the risk of mortality in type II diabetic patients from Verona. Int J Obes Relat Metab Disord 2003;27:281-285

33. Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath CW Jr. Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med 1999;341:1097-1105

34. Manson JE, Bassuk SS, Hu FB, Stampfer MJ, Colditz GA, Willett WC. Estimating the number of deaths due to obesity: can the divergent findings be reconciled? J Womens Health (Larchmt) 2007;16:168-176

35. Perry JR, Voight BF, Yengo L, et al. Stratifying type 2 diabetes cases by BMI identifies genetic risk variants in LAMA1 and enrichment for risk variants in lean compared to obese cases. PLoS Genet 2012;8:e1002741-e1002741

36. Conus F, Rabasa-Lhoret R, Peronnet F. Characteristics of metabolically obese normal-weight (MONW) subjects. Appl Physiol Nutr Metab 2007;32:4-12

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