Ning Feng, Wang Shaojie, Wang Yumei, Sun Jianping, Zhang Lei, Gao Weiguo, Nan Hairong, Ren Jie, Qiao Qing, Pang Zengchang
Qingdao Centers for Disease Control and Prevention, Qingdao 266033, China.
Dongying People's Hospital.
Zhonghua Liu Xing Bing Xue Za Zhi. 2014 Jul;35(7):764-8.
Since the incidence rates and risk factor for type 2 diabetes in Chinese populations had not been well known, the aim of this study was to evaluate the impact of weight change and other risk factors on incident type 2 diabetes in Qingdao, China.
A prospective population-based cohort study was carried out, based on subjects aged 35-74 years who participated in the 'Qingdao Diabetes Survey' in 2006. Subjects were free of diabetes at baseline. A total of 1 294 subjects attended the follow up survey between 2009 and 2011. The diagnostic criteria for Diabetes was classified according to both the World Health Organization and the International Diabetes Federation 2006. A logistic regression was built using the backward stepwise selection to assess the effects of risk factors on the incident type 2 diabetes.
During a 4-year follow up period, 120 cases with incident type 2 diabetes were identified, with cumulative incidence of diabetes as 11.8% . Participants who developed type 2 diabetes were significantly older, having significantly higher age-adjusted BMI/waist circumference/systolic blood pressure and total cholesterol, than those subjects who remained non-diabetic both in urban and rural areas. Among individuals with no diabetes at the baseline, factors as age, living in the rural areas, baseline BMI and weight change had all independently contributed to the development of diabetes. The multivariate adjusted relative risks (95%CIs) related to the incidence of diabetes were 1.45 (1.13-1.87), 1.93 (1.12-3.34), 1.46 (1.05-2.03) and 1.49 (1.18-1.88), respectively, for a one standard deviation increase in continuous variables. Compared with the reference group of non-obese and with stable weight, factor as weight loss >5% and BMI <28 kg/m² were independently associated with a 67% (RR = 0.33, 95% CI: 0.11-0.97)reduction in the risk of type 2 diabetes, while BMI >28 kg/m² could increase the risk across the levels of weight change. Similar trends were observed in higher waist and weight gain at baseline.
This study confirmed the critical importance of obesity in the development of type 2 diabetes. Baseline BMI and weight gain appeared independent predictors on type 2 diabetes.
由于中国人群中2型糖尿病的发病率和危险因素尚未完全明确，本研究旨在评估体重变化及其他危险因素对中国青岛地区2型糖尿病发病的影响。
基于2006年参加“青岛糖尿病调查”的35 - 74岁人群开展了一项前瞻性队列研究。研究对象在基线时均无糖尿病。2009年至2011年期间，共有1294名研究对象参加了随访调查。糖尿病的诊断标准依据世界卫生组织和国际糖尿病联盟2006年的标准。采用向后逐步选择法构建逻辑回归模型，以评估危险因素对2型糖尿病发病的影响。
在4年的随访期内，共确诊120例2型糖尿病新发病例，糖尿病累积发病率为11.8%。无论是城市还是农村地区，发生2型糖尿病的参与者年龄显著更大，年龄调整后的体重指数/腰围/收缩压和总胆固醇水平显著更高。在基线时无糖尿病的个体中，年龄、农村居住、基线体重指数和体重变化等因素均独立促成了糖尿病的发生。连续变量每增加一个标准差，与糖尿病发病相关的多因素调整相对风险（95%置信区间）分别为1.45（1.13 - 1.87）、1.93（1.12 - 3.34）、1.46（1.05 - 2.03）和1.49（1.18 - 1.88）。与非肥胖且体重稳定的参照组相比，体重减轻>5%且体重指数<28 kg/m²的因素与2型糖尿病风险降低67%（相对风险 = 0.33，95%置信区间：0.11 - 0.97）独立相关，而体重指数>28 kg/m²会在不同体重变化水平上增加风险。在较高腰围和基线体重增加方面也观察到类似趋势。
本研究证实了肥胖在2型糖尿病发生中的关键重要性。基线体重指数和体重增加似乎是2型糖尿病的独立预测因素。
