Lee Seung-Hwan, Yang Hae Kyung, Ha Hee-Sung, Lee Jin-Hee, Kwon Hyuk-Sang, Park Yong-Moon, Yim Hyeon-Woo, Kang Moo-Il, Lee Won-Chul, Son Ho-Young, Yoon Kun-Ho
From the Department of Internal Medicine, College of Medicine, The Catholic University of Korea (S-HL, HKY, H-SK, M-IK, H-YS, K-HY); Division of Endocrinology and Metabolism, Seoul St Mary's Hospital (S-HL, HKY, M-IK, H-YS, K-HY); Department of Preventive Medicine, College of Medicine (H-SH, Y-MP, H-WY, W-CL); Catholic Institute of U-Healthcare, The Catholic University of Korea (J-HL); Division of Endocrinology and Metabolism, Yeouido St Mary's Hospital, Seoul, Korea (H-SK); and Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina (Y-MP).
Medicine (Baltimore). 2015 Oct;94(40):e1705. doi: 10.1097/MD.0000000000001705.
Metabolic health and obesity are not stable conditions, and changes in the status of these conditions might lead to different clinical outcomes. We aimed to determine whether changes in metabolic health status or obesity over time have any effect on the risk of future diabetes. Nondiabetic individuals (n = 2692) from a population-based prospective cohort study with baseline and 2 follow-up examinations at 4-year intervals were included. Being "metabolically obese" (MO) was defined as being in the highest quartile of the TyG index (ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]), whereas falling into the lower 3 quartiles was regarded as being "metabolically healthy" (MH). Individuals were classified as "obese" (O) or "nonobese" (NO) using a body mass index of 25 kg/m2 as a cut-off. The risk of diabetes at year 8 was assessed according to changes of metabolic health status between year 0 and 4. Multivariate-adjusted relative risks (RRs) (95% confidence interval [CI]) of diabetes were significantly higher in individuals who retained the MONO phenotype (RR 3.72, 95% CI 2.10, 6.60) or who had progressed to MONO from the MHNO phenotype (RR 1.96, 95% CI 1.06, 3.61), whereas it was not significant in individuals who had improved to MHNO from the MONO phenotype (RR 0.67, 95% CI 0.26, 1.74) compared with individuals who retained the MHNO phenotype. In contrast, obese individuals had significantly higher RRs for diabetes, independent of changes in metabolic health status, whereas weight reduction resulted in a decreased risk of diabetes. Sensitivity analysis using the presence or absence of the metabolic syndrome as a definition of metabolic health revealed similar results. Changes in metabolic health status were an independent risk factor for future diabetes in nonobese individuals, whereas general obesity had a greater contribution to the risk of obese individuals developing diabetes. These observations might imply a different intervention strategy for diabetes prevention according to obesity status.
代谢健康和肥胖并非稳定状态，这些状态的变化可能导致不同的临床结果。我们旨在确定随着时间推移代谢健康状况或肥胖的变化是否会对未来患糖尿病的风险产生任何影响。纳入了一项基于人群的前瞻性队列研究中的非糖尿病个体（n = 2692），该研究有基线检查以及每4年进行一次的2次随访检查。“代谢性肥胖”（MO）定义为处于TyG指数（ln[空腹甘油三酯（mg/dL）×空腹血糖（mg/dL）/2]）的最高四分位数，而处于较低的3个四分位数则被视为“代谢健康”（MH）。使用体重指数25 kg/m²作为切点将个体分类为“肥胖”（O）或“非肥胖”（NO）。根据第0年和第4年之间代谢健康状况的变化评估第8年患糖尿病的风险。在保留MONO表型的个体（相对风险3.72，95%置信区间2.10，6.60）或从MHNO表型进展为MONO的个体（相对风险1.96，95%置信区间1.06，3.61）中，糖尿病的多变量调整相对风险（RRs）（95%置信区间[CI]）显著更高，而与保留MHNO表型的个体相比，从MONO表型改善为MHNO的个体中该风险不显著（相对风险0.67，95%置信区间0.26，1.74）。相比之下，肥胖个体患糖尿病的RRs显著更高，与代谢健康状况的变化无关，而体重减轻会降低患糖尿病的风险。使用代谢综合征的存在与否作为代谢健康定义的敏感性分析得出了相似的结果。代谢健康状况的变化是非肥胖个体未来患糖尿病的独立危险因素，而一般肥胖对肥胖个体患糖尿病的风险贡献更大。这些观察结果可能意味着根据肥胖状况采取不同的糖尿病预防干预策略。
