Li Wei-Dong, Fu Kun-Fa, Li Gui-Mei, Lian Yan-Shu, Ren Ai-Min, Chen Yun-Jue, Xia Jin-Rong
Wei-Dong Li, Jin-Rong Xia, Department of Gastroenterology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China.
World J Gastroenterol. 2015 Aug 28;21(32):9607-13. doi: 10.3748/wjg.v21.i32.9607.
To compare and analyze the effects of obesity and non-alcoholic fatty liver disease (NAFLD) on the incidence of type 2 diabetes mellitus (T2DM) in Chinese subjects.
In 2008, a population of 4847 subjects was randomly sampled from 17 medical units for enrollment in this cohort study. Baseline information was obtained via a questionnaire on general information, physical examination (height, weight, and blood pressure), laboratory tests (triglycerides, total cholesterol, fasting blood glucose, alanine aminotransferase (ALT), uric acid, and creatinine), B-mode ultrasound, and ECG screening. The incidence of T2DM after four years of follow-up was calculated. Numeric variable data was tested for normality, with the data expressed as mean ± SD. Kaplan-Meier analysis was performed to calculate the cumulative incidence. The Cox proportional hazards model was used to analyze the relative risk (RR) of different body mass index (BMI) levels and NAFLD on T2DM, as well as analyzing the RR adjusted for age, sex, blood pressure, lipids, transaminases, uric acid, and creatinine.
A total of 4736 (97.71%) subjects completed 4-year follow-up, with a median follow-up time of 3.85 years, totaling 17223 person-years. 380 subjects were diagnosed with T2DM, with a cumulative incidence of 8.0%. The cumulative incidence of T2DM in the NAFLD and control groups was 17.4% vs 4.1% (P < 0.001), respectively, while the incidence in overweight and obese subjects was 11.0% vs 15.8% (P < 0.001), respectively. The incidence of T2DM increased with an increase in baseline BMI. Cox regression analysis showed that the risk of T2DM in the NAFLD group (RR = 4.492, 95%CI: 3.640-5.542) after adjustment for age, sex, blood pressure, lipids, ALT, uric acid, and creatinine was 3.367 (2.367-4.266), while the value (RR, 95%CI) in overweight and obese subjects after adjustment for age, sex, BMI, blood pressure, lipids and other factors was 1.274 (0.997-1.629) and 1.554 (1.140-2.091), respectively. Stratification of three BMI levels (BMI < 24 kg/m(2), 24 kg/m(2) ≤ BMI < 28 kg/m(2), BMI ≥ 28 kg/m(2)) showed that the risk of T2DM in the NAFLD group was significantly higher than that in the control group (RR = 3.860, 4.049 and 3.823, respectively).
Compared with BMI, NAFLD could be better at forecasting the risk of T2DM in Chinese subjects, and may be a high risk factor for T2DM, independent of overweight/obesity.
比较并分析肥胖和非酒精性脂肪性肝病（NAFLD）对中国人群2型糖尿病（T2DM）发病率的影响。
2008年，从17个医疗单位随机抽取4847名受试者纳入该队列研究。通过一般信息问卷、体格检查（身高、体重和血压）、实验室检查（甘油三酯、总胆固醇、空腹血糖、丙氨酸氨基转移酶（ALT）、尿酸和肌酐）、B超和心电图筛查获取基线信息。计算随访4年后T2DM的发病率。对数值变量数据进行正态性检验，数据以均值±标准差表示。采用Kaplan-Meier分析计算累积发病率。使用Cox比例风险模型分析不同体重指数（BMI）水平和NAFLD对T2DM的相对风险（RR），并分析调整年龄、性别、血压、血脂、转氨酶、尿酸和肌酐后的RR。
共有4736名（97.71%）受试者完成了4年随访，中位随访时间为3.85年，总计17223人年。380名受试者被诊断为T2DM，累积发病率为8.0%。NAFLD组和对照组T2DM的累积发病率分别为17.4%和4.1%（P<0.001），而超重和肥胖受试者的发病率分别为11.0%和15.8%（P<0.001）。T2DM的发病率随基线BMI的增加而升高。Cox回归分析显示，在调整年龄、性别、血压、血脂、ALT、尿酸和肌酐后，NAFLD组T2DM的风险（RR=4.492，95%CI：3.640-5.542）为3.367（2.367-4.266），而在调整年龄、性别、BMI、血压、血脂等因素后，超重和肥胖受试者的RR值（RR，95%CI）分别为1.274（0.997-1.629）和1.554（1.140-2.091）。将BMI分为三个水平（BMI<24kg/m²、24kg/m²≤BMI<28kg/m²、BMI≥28kg/m²）进行分层分析显示，NAFLD组T2DM的风险显著高于对照组（RR分别为3.860、4.049和3.823）。
与BMI相比，NAFLD能更好地预测中国人群T2DM的风险，可能是T2DM的一个高危因素，独立于超重/肥胖因素。
