柬埔寨2型糖尿病患者的社会经济地位、腰臀比与短期心率变异性

Socioeconomic Status, Waist-to-Hip Ratio, and Short-Term Heart Rate Variability in Cambodians with Type 2 Diabetes.

作者信息

Wagner Julie, Keuky Lim, Lampert Rachel, Fraser-King Lorraine, Feinn Richard, Kuoch Theanvy, Scully Mary

机构信息

University of Connecticut Health Center, Farmington, CT, USA.

Cambodian Diabetes Association, Siem Reap, Cambodia.

出版信息

Int J Behav Med. 2015 Dec;22(6):786-91. doi: 10.1007/s12529-015-9468-0.

DOI:10.1007/s12529-015-9468-0

PMID:25697144

Abstract

BACKGROUND

Diabetes, adiposity, and socioeconomic status (SES) are all associated with decreased heart rate variability (HRV), a marker of autonomic function predictive of mortality. Cambodians have high rates of diabetes and low SES. How these factors interact to explain HRV has not been examined.

PURPOSE

The aims of this study were to investigate associations among waist-to-hip ratio, socioeconomic status, and HRV among Cambodians with diabetes.

METHOD

Sixty patients with type 2 diabetes for ≥1 year, not taking insulin, aged 35-80 years were recruited from the Cambodian Diabetes Association. The 2010 Ministry of Health survey regarding household conditions was used to measure SES. Waist-to-hip ratio was measured two times and averaged. For HRV, beat-to-beat intervals were recorded on ambulatory ECG recorders, and short-term HRV was calculated in the time domain and in the frequency domain using spectral analysis. Cross-sectional data were analyzed using a series of multiple linear regressions using SPSS v21.

RESULTS

Participants were of mean age of 56 years old, 60 % female, with National Glycohemoglobin Standardization Program (NGSP) HbA1c mean = 8.4. Participants were poor (e.g., 18 % did not have flush toilets), had high waist-to-hip ratios (mean = 0.91), and had HRV values below published norms. In linear regression, there was a significant interaction between waist-to-hip ratio and SES explaining HRV in the time domain (standard deviation of the R-R interval (SDNN), beta = .33, t = 2.61, p < .05) and the frequency domain (log transformed very low frequency (Ln VLF), LF, and total power; all p < .05). Among those with lower SES only, higher waist-to-hip ratio was associated with lower HRV. Findings remained significant after controlling for age, sex, and HbA1c.

CONCLUSION

Central adiposity shows a stronger deleterious association with autonomic tone among individuals with more adverse social conditions.

摘要

背景

糖尿病、肥胖症和社会经济地位（SES）均与心率变异性（HRV）降低有关，HRV是自主神经功能的一个指标，可预测死亡率。柬埔寨人糖尿病发病率高且社会经济地位低。尚未研究这些因素如何相互作用来解释HRV。

目的

本研究旨在调查柬埔寨糖尿病患者的腰臀比、社会经济地位和HRV之间的关联。

方法

从柬埔寨糖尿病协会招募了60例2型糖尿病患者，病程≥1年，未使用胰岛素，年龄在35 - 80岁之间。采用2010年卫生部关于家庭状况的调查来衡量社会经济地位。腰臀比测量两次并取平均值。对于HRV，使用动态心电图记录仪记录逐搏间期，并使用频谱分析在时域和频域计算短期HRV。使用SPSS v21通过一系列多元线性回归分析横断面数据。

结果

参与者的平均年龄为56岁，60%为女性，糖化血红蛋白标准化计划（NGSP）糖化血红蛋白平均水平 = 8.4。参与者贫困（例如，18%没有冲水马桶），腰臀比高（平均 = 0.91），HRV值低于已发表的标准。在线性回归中，腰臀比和社会经济地位之间存在显著的交互作用，可在时域（RR间期标准差（SDNN），β = 0.33，t = 2.61，p < 0.05）和频域（对数转换的极低频（Ln VLF）、低频（LF）和总功率；所有p < 0.05）解释HRV。仅在社会经济地位较低的人群中，较高的腰臀比与较低的HRV相关。在控制年龄、性别和糖化血红蛋白后，结果仍然显著。