代谢健康型肥胖增加糖尿病风险

Metabolically healthy obesity is associated with increased risk of diabetes

    摘要
  • 摘要:
    目的 探讨代谢健康型肥胖（MHO）与糖尿病风险之间的关联。
    方法 本研究为前瞻性队列研究。选取参加开滦研究2006—2007年度体检的101 510例观察对象，收集基线资料，以完成体检的时间点作为基线时间，并进行随访。将满足收缩压＜130 mmHg且未服用降压药，女性腰臀比＜0.95，男性腰臀比＜1.03以及既往无糖尿病病史的观察对象定义为代谢健康。体重指数（BMI）＜24 kg/m2定义为体重正常，24～＜28 kg/m2定义为超重，≥28 kg/m2定义为肥胖。根据代谢状态和BMI，将研究对象分为代谢健康体重正常（MHNW）组，代谢健康超重（MHOW）组，MHO组，代谢不健康体重正常（MUHNW）组，代谢不健康超重（MUHOW）组，代谢不健康肥胖（MUO）组。采用Cox风险比例模型，探讨不同代谢状态-BMI分组与糖尿病风险的关联。
    结果 符合纳入标准的非糖尿病观察对象有80 404例，其中MHNW组18 312例，MHOW组14 662例，MHO组4 536例，MUHNW组13 541例，MUHOW组19 390例，MUO组9 963例。在中位随访11.24（8.03，12.71）年期间，共发生糖尿病11 215例。多因素Cox回归分析结果显示，与MHNW相比，MHOW、MHO、MUHNW、MUHOW和MUO组发生糖尿病的风险比（95%CI）分别为1.91（1.77～2.06）、3.16（2.89～3.46）、1.37（1.25～1.50）、2.14（1.98～2.33）和3.29（3.03～3.58）。基于不同诊断标准重新定义代谢状态后结果未发生显著改变。此外，相比于男性和空腹血糖≥6.1 mmol/L人群，在女性和空腹血糖＜6.1 mmol/L的人群中，不同代谢状态-BMI分组与糖尿病风险之间的关联更强。
    结论 尽管MHO人群的代谢指标正常，但是仍与糖尿病风险增加存在关联。

     

    Abstract:
    Objective To investigate the association between metabolically healthy obesity (MHO) and the risk of diabetes.
    Methods This study was a prospective cohort study. A total of 101 510 participants from the Kailuan Study who underwent health examinations in 2006–2007 were selected, and baseline data were collected, using the time point of the completion of the health examination as the baseline time for follow-up. Metabolic health was defined as systolic blood pressure ＜130 mmHg in the absence of antihypertensive medications, waist-to-hip ratio ＜0.95 for women and ＜1.03 for men, and no prior history of diabetes. Body mass index (BMI) categories were defined as follows: normal weight (BMI＜24 kg/m²), overweight (24–＜28 kg/m²), and obesity (BMI≥28 kg/m²). Participants were classified into six groups based on metabolic health and BMI: metabolically healthy normal weight (MHNW), metabolically healthy overweight (MHOW), MHO, metabolically unhealthy normal weight (MUHNW), metabolically unhealthy overweight (MUHOW), and metabolically unhealthy obesity (MUO). Cox proportional hazards models were used to assess the association between these groups and the risk of diabetes.
    Results A total of 80 404 participants met the inclusion criteria, with 18 312 in the MHNW group, 14 662 in the MHOW group, 4 536 in the MHO group, 13 541 in the MUHNW group, 19 390 in the MUHOW group, and 9 963 in the MUO group. During a median follow-up of 11.24 (8.03, 12.71) years, 11 215 cases of diabetes were identified. Multivariable Cox regression analysis showed that, compared with the MHNW group, the hazard ratios (HR) and 95% confidence intervals (CI) for diabetes risk were as follows: MHOW (HR: 1.91, 95%CI: 1.77–2.06), MHO (HR: 3.16, 95%CI: 2.89–3.46), MUHNW (HR: 1.37, 95%CI: 1.25–1.50), MUHOW (HR: 2.14, 95%CI: 1.98–2.33), and MUO (HR: 3.29, 95%CI: 3.03–3.58). After redefining metabolic health based on different criteria, the results remained unchanged. Moreover, the association between different metabolic status-BMI groups and diabetes risk was more pronounced among women and individuals with fasting blood glucose ＜6.1 mmol/L compared with men and individuals with fasting blood glucose ≥6.1 mmol/L, respectively.
    Conclusion Despite normal metabolic indicators, MHO is still associated with an increased risk of diabetes.

     

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