Jerant A, Bertakis K D, Franks P
UC Davis School of Medicine, Department of Family and Community Medicine and Center for Healthcare Policy and Research, Sacramento, CA, USA.
Nutr Diabetes. 2015 Apr 27;5(4):e152. doi: 10.1038/nutd.2015.2.
BACKGROUND/OBJECTIVES: There is controversy regarding the existence of a body mass index (BMI) mortality paradox in diabetes, whereby the optimal BMI category is higher than it is in non-diabetic persons. To explore possible pathways to a mortality paradox, we examined the relationship of BMI with physical and mental health status in diabetic and non-diabetic persons.
SUBJECTS/METHODS: We examined adjusted SF-12 Physical and Mental Component Summary (PCS-12 and MCS-12) scores by BMI (kg m(-2)) category (underweight, <20; normal weight, 20 to <25; overweight, 25 to <30; obese, 30 to <35; severely obese ⩾35) in adult diabetic and non-diabetic respondents to the 2000-2011 United States national Medical Expenditure Panel Surveys (N=119 161). Adjustors were age, sex, race/ethnicity, income, health insurance, education, smoking, comorbidity, urbanicity, geographic region and survey year.
In non-diabetic persons the adjusted mean PCS-12 score was highest (that is, most optimal) in the normal-weight category, whereas for diabetic persons the optimal adjusted mean PCS-12 score was in the overweight category (adjusted difference between non-diabetic and diabetic persons in the difference in PCS-12 means for overweight versus normal-weight category=0.8 points, 95% confidence interval; CI 0.1, 1.6; P=0.03). This paradoxical pattern was not evident for the MCS-12, and the adjusted difference between non-diabetic and diabetic persons in the difference in MCS-12 means for overweight versus obese persons was not significant (-0.3 points, 95% CI -0.9, 0.4; P=0.43). The findings were not significantly moderated by smoking status, cancer diagnosis or time period.
The optimal BMI category for physical health status (but not mental health status) was higher among diabetic than non-diabetic persons. The findings are consistent with a BMI physical health status paradox in diabetes and, in turn, a mortality paradox.
背景/目的：关于糖尿病患者中是否存在体重指数（BMI）死亡率悖论存在争议，即糖尿病患者的最佳BMI类别高于非糖尿病患者。为了探究可能导致死亡率悖论的途径，我们研究了糖尿病患者和非糖尿病患者中BMI与身心健康状况之间的关系。
受试者/方法：我们在2000 - 2011年美国国家医疗支出小组调查的成年糖尿病患者和非糖尿病患者（N = 119161）中，按BMI（kg/m²）类别（体重过轻，<20；正常体重，20至<25；超重，25至<30；肥胖，30至<35；重度肥胖，⩾35）检查了调整后的SF - 12身体和心理成分总结（PCS - 12和MCS - 12）得分。校正因素包括年龄、性别、种族/民族、收入、健康保险、教育程度、吸烟状况、合并症、城市化程度、地理区域和调查年份。
在非糖尿病患者中，正常体重类别调整后的平均PCS - 12得分最高（即最理想），而对于糖尿病患者，最佳调整后的平均PCS - 12得分处于超重类别（超重与正常体重类别之间PCS - 12均值差异的非糖尿病患者与糖尿病患者之间的调整差异 = 0.8分，95%置信区间；CI 0.1，1.6；P = 0.03）。这种矛盾模式在MCS - 12中不明显，超重与肥胖患者之间MCS - 12均值差异的非糖尿病患者与糖尿病患者之间的调整差异不显著（-0.3分，95% CI -0.9，0.4；P = 0.43）。研究结果不受吸烟状况、癌症诊断或时间段的显著影响。
糖尿病患者中身体健康状况（而非心理健康状况）的最佳BMI类别高于非糖尿病患者。这些发现与糖尿病中的BMI身体健康状况悖论以及死亡率悖论相一致。
