Wadén Johan, Forsblom Carol, Thorn Lena M, Saraheimo Markku, Rosengård-Bärlund Milla, Heikkilä Outi, Hietala Kustaa, Ong Ken, Wareham Nicholas, Groop Per-Henrik
Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.
Diabetes. 2009 Aug;58(8):1914-20. doi: 10.2337/db08-1767. Epub 2009 Jun 2.
Short adult stature has previously been associated with cardiovascular disease, but its relationship with the microvascular complications of diabetes is uncertain. Therefore, we evaluated the association between adult stature and prevalence and incidence of diabetic microvascular complications.
This cross-sectional and longitudinal study comprises 3,968 adult patients with type 1 diabetes from the Finnish Diabetic Nephropathy (FinnDiane) Study and 1,246 adult patients from the Diabetes Control and Complications Trial (DCCT). In FinnDiane, diabetic nephropathy was defined as urinary albumin excretion > or = 300 mg/24 h, dialysis, or renal transplantation. Retinopathy was divided into background and proliferative (laser-treated) retinopathy. In the DCCT, original nephropathy (class 1-6) and retinopathy (Early Treatment of Diabetic Retinopathy Study) classifications were used.
In the FinnDiane study, patients in the lowest quartile of adult height had increased risks of prevalent diabetic nephropathy (odds ratio [OR] 1.71, 95% CI 1.44-2.02) and prevalent laser-treated retinopathy (1.66, 1.43-1.93) compared with other patients. Similarly, in the DCCT, patients in the lowest quartile of adult height had increased risks of incident diabetic nephropathy class 4-6 (hazard ratio 2.70, 95% CI 1.59-4.59) and incident proliferative retinopathy (2.06, 1.15-3.71). In the FinnDiane study, the associations were largely explained by childhood exposure to diabetes. However, in the DCCT, where a greater proportion of patients had diabetes onset >18 years, the association with nephropathy was independent of childhood diabetes exposure.
Short adult stature is associated with microvascular complications in patients with type 1 diabetes. These findings are compatible with either childhood diabetes exposure or "common soil" or both as potential explanations.
成人身材矮小此前已被证实与心血管疾病有关，但其与糖尿病微血管并发症之间的关系尚不确定。因此，我们评估了成人身高与糖尿病微血管并发症的患病率及发病率之间的关联。
这项横断面及纵向研究纳入了来自芬兰糖尿病肾病研究（FinnDiane）的3968例1型糖尿病成年患者以及来自糖尿病控制与并发症试验（DCCT）的1246例成年患者。在FinnDiane研究中，糖尿病肾病的定义为尿白蛋白排泄量≥300mg/24小时、透析或肾移植。视网膜病变分为背景性和增殖性（接受激光治疗）视网膜病变。在DCCT中，采用了原发性肾病（1 - 6级）和视网膜病变（糖尿病视网膜病变早期治疗研究）的分类方法。
在FinnDiane研究中，与其他患者相比，成年身高处于最低四分位数的患者患糖尿病肾病（优势比[OR]1.71，95%可信区间1.44 - 2.02）及接受激光治疗的视网膜病变（1.66，1.43 - 1.93）的风险增加。同样，在DCCT中，成年身高处于最低四分位数的患者发生4 - 6级糖尿病肾病（风险比2.70，95%可信区间1.59 - 4.59）及增殖性视网膜病变（2.06，1.15 - 3.71）的风险增加。在FinnDiane研究中，这种关联在很大程度上可由儿童期暴露于糖尿病来解释。然而，在DCCT中，糖尿病发病年龄＞18岁的患者比例更高，与肾病的关联独立于儿童期糖尿病暴露情况。
成人身材矮小与1型糖尿病患者的微血管并发症有关。这些发现符合儿童期糖尿病暴露或“共同土壤”学说或两者兼而有之作为潜在解释。
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