体重状况与新发糖尿病成人死亡率的相关性。
Association of weight status with mortality in adults with incident diabetes.
机构信息
Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Dr, Ste 1400, Chicago, IL 60611, USA.
出版信息
JAMA. 2012 Aug 8;308(6):581-90. doi: 10.1001/jama.2012.9282.
CONTEXT
Type 2 diabetes in normal-weight adults (body mass index [BMI] <25) is a representation of the metabolically obese normal-weight phenotype with unknown mortality consequences.
OBJECTIVE
To test the association of weight status with mortality in adults with new-onset diabetes in order to minimize the influence of diabetes duration and voluntary weight loss on mortality.
DESIGN, SETTING, AND PARTICIPANTS: Pooled analysis of 5 longitudinal cohort studies: Atherosclerosis Risk in Communities study, 1990-2006; Cardiovascular Health Study, 1992-2008; Coronary Artery Risk Development in Young Adults, 1987-2011; Framingham Offspring Study, 1979-2007; and Multi-Ethnic Study of Atherosclerosis, 2002-2011. A total of 2625 participants with incident diabetes contributed 27,125 person-years of follow-up. Included were men and women (age >40 years) who developed incident diabetes based on fasting glucose 126 mg/dL or greater or newly initiated diabetes medication and who had concurrent measurements of BMI. Participants were classified as normal weight if their BMI was 18.5 to 24.99 or overweight/obese if BMI was 25 or greater.
MAIN OUTCOME MEASURES
Total, cardiovascular, and noncardiovascular mortality.
RESULTS
The proportion of adults who were normal weight at the time of incident diabetes ranged from 9% to 21% (overall 12%). During follow-up, 449 participants died: 178 from cardiovascular causes and 253 from noncardiovascular causes (18 were not classified). The rates of total, cardiovascular, and noncardiovascular mortality were higher in normal-weight participants (284.8, 99.8, and 198.1 per 10,000 person-years, respectively) than in overweight/obese participants (152.1, 67.8, and 87.9 per 10,000 person-years, respectively). After adjustment for demographic characteristics and blood pressure, lipid levels, waist circumference, and smoking status, hazard ratios comparing normal-weight participants with overweight/obese participants for total, cardiovascular, and noncardiovascular mortality were 2.08 (95% CI, 1.52-2.85), 1.52 (95% CI, 0.89-2.58), and 2.32 (95% CI, 1.55-3.48), respectively.
CONCLUSION
Adults who were normal weight at the time of incident diabetes had higher mortality than adults who are overweight or obese.
背景
正常体重成年人（体重指数 [BMI] <25）的 2 型糖尿病代表了具有未知死亡率后果的代谢肥胖正常体重表型。
目的
检测体重状态与新发糖尿病成年人死亡率之间的关联，以尽量减少糖尿病病程和自愿减肥对死亡率的影响。
设计、地点和参与者：对 5 项纵向队列研究进行汇总分析：社区动脉粥样硬化风险研究，1990-2006 年；心血管健康研究，1992-2008 年；年轻人动脉粥样硬化风险发展研究，1987-2011 年；弗雷明汉后代研究，1979-2007 年；和多民族动脉粥样硬化研究，2002-2011 年。共有 2625 名新发糖尿病患者参与了研究，共随访 27125 人年。纳入标准为空腹血糖≥126mg/dL 或新开始使用糖尿病药物且同时测量 BMI 的男性和女性（年龄>40 岁）。BMI 为 18.5 至 24.99 的参与者被归类为正常体重，BMI 为 25 或更高的参与者被归类为超重/肥胖。
主要结局指标
总死亡率、心血管死亡率和非心血管死亡率。
结果
新发糖尿病时正常体重的成年人比例为 9%-21%（总体 12%）。随访期间，有 449 名参与者死亡：178 例死于心血管原因，253 例死于非心血管原因（18 例未分类）。正常体重参与者的总死亡率、心血管死亡率和非心血管死亡率均高于超重/肥胖参与者（分别为 284.8、99.8 和 198.1/10000 人年，152.1、67.8 和 87.9/10000 人年）。在校正人口统计学特征和血压、血脂水平、腰围和吸烟状况后，正常体重参与者与超重/肥胖参与者的总死亡率、心血管死亡率和非心血管死亡率的风险比分别为 2.08（95%CI，1.52-2.85）、1.52（95%CI，0.89-2.58）和 2.32（95%CI，1.55-3.48）。
结论
新发糖尿病时正常体重的成年人死亡率高于超重或肥胖成年人。
Zotero 插件