美国成年人中肥胖与糖尿病的关系：1999-2006 年全国健康和营养调查的结果。
Relationship between obesity and diabetes in a US adult population: findings from the National Health and Nutrition Examination Survey, 1999-2006.
机构信息
Department of Surgery, University of California, Irvine Medical Center, 333 City Bldg. West, Suite 850, Orange, CA 92868, USA.
出版信息
Obes Surg. 2011 Mar;21(3):351-5. doi: 10.1007/s11695-010-0335-4.
BACKGROUND
Obesity is one of the most important modifiable risk factors for the prevention of type 2 diabetes. The aim of this study was to examine the prevalence of diabetes with increasing severity of obesity and the distribution of HbA1c levels in diabetics participating in the latest National Health and Nutrition Examination Survey (NHANES).
METHODS
Data from a representative sample of adults with diabetes participating in the NHANES between 1999 and 2006 were reviewed. The prevalence of diabetes and levels of fasting glucose, insulin, c-peptide, and HbA1c were examined across different weight classes with normal weight, overweight, and obesity classes 1, 2, and 3 were defined as body mass index (BMI) of <25.0, 25.0-29.9, 30.0-34.9, 35.0-39.9, and equal to 40.0, respectively. The distribution of HbA1c levels among adults with diabetes was also examined.
RESULTS
There were 2,894 adults with diabetes (13.6%) among the 21,205 surveyed participants. Among the adults with diabetes, the mean age was 59 years, the mean fasting glucose was 155 ± 2 mg/dl, and the mean HbA1c was 7.2%; 80.3% of diabetics were considered overweight (BMI ≥ 25) and 49.1% of diabetics were considered obese (BMI ≥ 30). The prevalence of adults with diabetes increased with increasing weight classes, from 8% for normal weight individuals to 43% for individuals with obesity class 3; the distribution of HbA1c levels were considered as good (<7.0%) in 60%, fair (7.0-8.0%) in 17%, and poor (>8.0%) in 23%. The mean fasting glucose and HbA1c levels were highest for diabetics with BMI <25.0, suggesting a state of higher severity of disease. Mean insulin and c-peptide levels were highest for diabetics with BMI = 35.0, suggesting a state of insulin resistance.
CONCLUSIONS
In a nationally representative sample of US adults, the prevalence of diabetes increases with increasing weight classes. Nearly one fourth of adults with diabetes have poor glycemic control and nearly half of adult diabetics are considered obese suggesting that weight loss is an important intervention in an effort to reduce the impact of diabetes on the health care system.
背景
肥胖是预防 2 型糖尿病最重要的可改变危险因素之一。本研究的目的是检查随着肥胖严重程度的增加，糖尿病的患病率以及参加最新国家健康和营养检查调查（NHANES）的糖尿病患者的糖化血红蛋白（HbA1c）水平分布。
方法
对 1999 年至 2006 年间参加 NHANES 的具有代表性的糖尿病成人样本数据进行了回顾。使用正常体重、超重和肥胖 1 型、2 型和 3 型（体重指数（BMI）<25.0、25.0-29.9、30.0-34.9、35.0-39.9 和等于 40.0）来检查不同体重类别的糖尿病患病率以及空腹血糖、胰岛素、C 肽和 HbA1c 水平。还检查了糖尿病成人的 HbA1c 水平分布。
结果
在 21205 名接受调查的参与者中，有 2894 名成人患有糖尿病（13.6%）。在患有糖尿病的成年人中，平均年龄为 59 岁，平均空腹血糖为 155 ± 2mg/dl，平均 HbA1c 为 7.2%；80.3%的糖尿病患者被认为超重（BMI≥25），49.1%的糖尿病患者被认为肥胖（BMI≥30）。糖尿病患者的患病率随着体重类别而增加，从正常体重个体的 8%增加到肥胖 3 型个体的 43%；HbA1c 水平的分布情况为，60%的患者被认为血糖控制良好（<7.0%），17%的患者被认为血糖控制一般（7.0-8.0%），23%的患者被认为血糖控制较差（>8.0%）。对于 BMI<25.0 的糖尿病患者，空腹血糖和 HbA1c 水平最高，表明疾病严重程度较高。对于 BMI=35.0 的糖尿病患者，胰岛素和 C 肽水平最高，表明存在胰岛素抵抗。
结论
在具有美国代表性的成年人群体中，糖尿病的患病率随着体重类别而增加。近四分之一的糖尿病患者血糖控制不佳，近一半的成年糖尿病患者被认为肥胖，这表明减肥是减少糖尿病对医疗体系影响的重要干预措施。
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