Lim R B T, Chen C, Naidoo N, Gay G, Tang W E, Seah D, Chen R, Tan N C, Lee J, Tai E S, Chia K S, Lim W Y
Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore city 117549, Singapore.
Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore city 117549, Singapore.
Diabetes Metab. 2015 Sep;41(4):291-300. doi: 10.1016/j.diabet.2014.12.003. Epub 2015 Jan 6.
The study investigated the relationship of general (body mass index [BMI]) and central (waist circumference [WC]; waist-hip ratio [WHipR]; waist-height ratio [WHeightR]) adiposity with all-cause and cardiovascular disease (CVD)-related mortality in an Asian population with diabetes.
A total of 13,278 participants with type 2 diabetes mellitus (T2DM) recruited from public-sector primary-care and specialist outpatients clinics in Singapore were followed-up for a median duration of 2.9 years, during which time there were 524 deaths. Cox proportional-hazards regression and competing-risk models were used to obtain hazard ratios (HRs) for anthropometric variables of all-cause and CVD-related mortality.
After adjusting for BMI, the highest quintiles of WC, WHipR and WHeightR were all positively associated with mortality compared with the lowest quintiles, with WHeightR exhibiting the largest effect sizes [all-cause mortality HR: 2.13, 95% confidence interval (CI): 1.33-3.42; CVD-related mortality HR: 3.42, 95% CI: 1.62-7.19]. Being overweight but not obese (BMI:≥23.0 but<27.5kg/m(2)) was associated with a decreased risk of CVD-related mortality in those aged≥65 years (HR: 0.47, 95% CI: 0.29-0.75), but not in those aged<65 years (HR: 1.11, 95% CI: 0.49-2.50).
Overweight, but not obesity, was associated with a reduction in risk of mortality. This was seen in T2DM patients aged≥65 years, but not in those younger than this. At the same BMI, having higher central-obesity indices such as WC, WHipR and WHeightR also increased the risk of mortality.
本研究调查了亚洲糖尿病患者群体中总体肥胖（体重指数[BMI]）和中心性肥胖（腰围[WC]；腰臀比[WHipR]；腰高比[WHeightR]）与全因死亡率及心血管疾病（CVD）相关死亡率之间的关系。
从新加坡公共部门基层医疗和专科门诊招募了总共13278名2型糖尿病（T2DM）患者，中位随访时间为2.9年，在此期间有524人死亡。采用Cox比例风险回归模型和竞争风险模型来获取全因死亡率和CVD相关死亡率的人体测量变量的风险比（HRs）。
在调整BMI后，WC、WHipR和WHeightR的最高五分位数与最低五分位数相比，均与死亡率呈正相关，其中WHeightR的效应量最大[全因死亡率HR：2.13，95%置信区间（CI）：1.33 - 3.42；CVD相关死亡率HR：3.42，95%CI：1.62 - 7.19]。超重但不肥胖（BMI：≥23.0但<27.5kg/m²）与≥65岁人群的CVD相关死亡率降低风险相关（HR：0.47，95%CI：0.29 - 0.75），但与<65岁人群无关（HR：1.11，95%CI：0.49 - 2.50）。
超重而非肥胖与死亡风险降低相关。这在≥65岁的T2DM患者中可见，但在年龄小于此的患者中未观察到。在相同BMI水平下，具有较高的中心性肥胖指标如WC、WHipR和WHeightR也会增加死亡风险。
