Lim Soo, Kim Kyoung Min, Kim Min Joo, Woo Se Joon, Choi Sung Hee, Park Kyong Soo, Jang Hak Chul, Meigs James B, Wexler Deborah J
Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Korea ; Division of General Medicine, Harvard Medical School, Boston, Massachusetts, United States of America ; Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America.
PLoS One. 2013 Dec 4;8(12):e80525. doi: 10.1371/journal.pone.0080525. eCollection 2013.
Obesity precedes the development of type 2 diabetes (T2D). However, the relationship between the magnitude and rate of weight gain to T2D development and complications, especially in non-White populations, has received less attention.
We determined the association of rate and magnitude of weight gain to age at T2D diagnosis (Age(T2D)), HbA1c at T2D diagnosis (HbA1c(T2D)), microalbuminuria, and diabetic retinopathy after adjusting for sex, BMI at age 20 years, lifestyles, family history of T2D and/or blood pressure and lipids in 2164 Korean subjects aged ≥30 years and newly diagnosed with diabetes. Body weight at age 20 years (Wt(20y)) was obtained by recall or from participants' medical, school, or military records. Participants recalled their maximum weight (Wt(max)) prior to T2D diagnosis and age at maximum weight (Age(max_wt)). The rate of weight gain (Rate(max_wt)) was calculated from magnitude of weight gain (ΔWt = Wt(max)-Wt(20y)) divided by ΔTime (Age(max_wt) -20 years). The mean Age(max_wt) and Age(T2D) were 41.5±10.9 years and 50.1±10.5 years, respectively. The Wt(20y) and Wt(max) were 59.9±10.5 kg and 72.9±11.4 kg, respectively. The Rate(max_wt) was 0.56±0.50 kg/year. After adjusting for risk factors, greater ΔWt and higher Rate(max_wt) were significantly associated with earlier Age(T2D), higher HbA1c(T2D) after additional adjusting for Age(T2D), and microalbuminuria after further adjusting for HbA1c(T2D) and lipid profiles. Greater ΔWt and higher Rate(max_wt) were also significantly associated with diabetic retinopathy.
This finding supports public health recommendations to reduce the risk of T2D and its complications by preventing weight gain from early adulthood.
肥胖先于2型糖尿病（T2D）的发生。然而，体重增加的幅度和速率与T2D发生及并发症之间的关系，尤其是在非白人人群中，受到的关注较少。
我们在2164名年龄≥30岁且新诊断为糖尿病的韩国受试者中，调整了性别、20岁时的体重指数（BMI）、生活方式、T2D家族史和/或血压及血脂后，确定了体重增加速率和幅度与T2D诊断时的年龄（Age(T2D)）、T2D诊断时的糖化血红蛋白（HbA1c(T2D)）、微量白蛋白尿和糖尿病视网膜病变之间的关联。20岁时的体重（Wt(20y)）通过回忆或从参与者的医疗、学校或军事记录中获取。参与者回忆了他们在T2D诊断之前的最大体重（Wt(max)）以及达到最大体重时的年龄（Age(max_wt)）。体重增加速率（Rate(max_wt)）由体重增加幅度（ΔWt = Wt(max) - Wt(20y)）除以Δ时间（Age(max_wt) - 20岁）计算得出。平均Age(max_wt)和Age(T2D)分别为41.5±10.9岁和50.1±10.5岁。Wt(20y)和Wt(max)分别为59.9±10.5千克和72.9±11.4千克。Rate(max_wt)为0.56±0.50千克/年。在调整风险因素后，更大的ΔWt和更高的Rate(max_wt)与更早的Age(T2D)、在进一步调整Age(T2D)后更高的HbA1c(T2D)以及在进一步调整HbA1c(T2D)和血脂谱后微量白蛋白尿显著相关。更大的ΔWt和更高的Rate(max_wt)也与糖尿病视网膜病变显著相关。
这一发现支持了公共卫生建议，即通过防止成年早期体重增加来降低T2D及其并发症的风险。
