Mishra Gita D, Carrigan Gretchen, Brown Wendy J, Barnett Adrian G, Dobson Annette J
School of Population Health, University of Queensland, Herston, Queensland, Australia.
Diabetes Care. 2007 Jun;30(6):1418-24. doi: 10.2337/dc06-2187. Epub 2007 Mar 10.
Although there is consensus that excess adiposity is strongly associated with type 2 diabetes, its relationship with weight change is less clear. This study investigates the relative impact of BMI at baseline and short-term (2- or 3-year) weight changes on the incidence of diabetes.
Prospective data were collected from a population-based cohort of middle-aged women participating in the Australian Longitudinal Study on Women's Health (n = 7,239 for this report). To date, participants have completed four mailed surveys (S1, 1996; S2, 1998; S3, 2001; and S4, 2004). Generalized estimating equations were used to model binary repeated-measures data to assess the impact of BMI at S1 and weight change (S1 to S2; S2 to S3) on 3-year incidence of diabetes at S3 and S4, respectively, adjusting for sociodemographic and lifestyle factors.
BMI at S1 was strongly associated with the development of diabetes by S3 or S4. Compared with women who had a BMI <25 kg/m2, those with BMI > or =25 kg/m2 had higher incidence of diabetes (P < 0.0001), with odd ratios reaching 12.1 (95% CI 7.6-19.3) for women in the very obese group (BMI > or =35 kg/m2). There was no association between shorter-term weight gain or weight loss on first-reported diagnosis of diabetes (P = 0.08).
Because women's risk of developing type 2 diabetes in midlife is more closely related to their initial BMI (when aged 45-50 years) than to subsequent short-term weight change, public health initiatives should target the prevention of weight gain before and during early adulthood.
尽管人们普遍认为肥胖与2型糖尿病密切相关，但其与体重变化的关系尚不清楚。本研究调查了基线时的体重指数（BMI）和短期（2年或3年）体重变化对糖尿病发病率的相对影响。
前瞻性数据来自参与澳大利亚妇女健康纵向研究的中年女性人群队列（本报告中n = 7239）。迄今为止，参与者已完成四次邮寄调查（S1，1996年；S2，1998年；S3，2001年；S4，2004年）。使用广义估计方程对二元重复测量数据进行建模，以分别评估S1时的BMI和体重变化（S1至S2；S2至S3）对S3和S4时糖尿病3年发病率的影响，并对社会人口统计学和生活方式因素进行调整。
S1时的BMI与S3或S4时糖尿病的发生密切相关。与BMI<25 kg/m²的女性相比，BMI≥25 kg/m²的女性糖尿病发病率更高（P<0.0001），极肥胖组（BMI≥35 kg/m²）女性的比值比达到12.1（95%CI 7.6 - 19.3）。短期体重增加或减少与首次报告的糖尿病诊断之间无关联（P = 0.08）。
由于中年女性患2型糖尿病的风险与其初始BMI（45 - 50岁时）的关系比与随后的短期体重变化更为密切，公共卫生倡议应针对成年早期及之前预防体重增加。
