Navarro-González David, Sánchez-Íñigo Laura, Fernández-Montero Alejandro, Pastrana-Delgado Juan, Martinez Jose Alfredo
From the Garcia-Orcoyen Hospital (DN-G); Burlada Clinic (LS-Í), Navarra Health Service-Osasunbidea; Department of Occupational Medicine (AF-M), Preventive Medicine and Public Health; Department of Internal Medicine (JP-D), University of Navarra Clinic, Pamplona; IdiSNA-Health Research Institute of Navarra (JP-D, JAM); Food Science and Physiology (JAM), University of Navarra, Pamplona; and Centre of Biomedical Research in Pathophysiology of Obesity and Nutrition (CIBERObn) (JAM), Carlos III, Madrid, Spain.
Medicine (Baltimore). 2016 May;95(19):e3646. doi: 10.1097/MD.0000000000003646.
The risk of type 2 diabetes associated with obesity appears to be influenced by other metabolic abnormalities, and there is controversy about the harmless condition of the metabolically healthy obese (MHO) state. The aim of this study is to assess the risk of diabetes and the impact of changes in weight and in triglyceride-glucose index (TyG index), according to the metabolic health and obesity states.We analyzed prospective data of the Vascular Metabolic CUN cohort, a population-based study among a White European population (mean follow-up, 8.9 years). Incident diabetes was assessed in 1923 women and 3016 men with a mean age at baseline of 55.33 ± 13.68 and 53.78 ± 12.98 years old.A Cox proportional-hazard analysis was conducted to estimate the hazard ratio (HR) of diabetes on metabolically healthy nonobese (MHNO), metabolically healthy obese, metabolically unhealthy nonobese (MUNO), and metabolically unhealthy obese (MUO). A continuous standardized variable (z-score) was derived to compute the HR for diabetes per 1-SD increment in the body mass index (BMI) and the TyG index.MHO, MUNO, and MUO status were associated with the development of diabetes, HR of 2.26 (95% CI: 1.25-4.07), 3.04 (95% CI: 1.69-5.47), and 4.04 (95% CI: 2.14-7.63), respectively. MUNO individuals had 1.82 greater risk of diabetes compared to MHO subjects (95% CI: 1.04-3.22). The HRs for incident diabetes per 1-SD increment in BMI and TyG indexes were 1.23 (95% CI: 1.04-1.44) and 1.54 (95% CI: 1.40-1.68). The increase in BMI did not raise the risk of developing diabetes among metabolically unhealthy subjects, whereas increasing the TyG index significantly affect the risk in all metabolic health categories.Metabolic health is more important determinant for diabetes onset than weight gain. The increase in weight does not raise the risk of developing diabetes among metabolically unhealthy subjects.
与肥胖相关的2型糖尿病风险似乎受到其他代谢异常的影响，而且代谢健康的肥胖（MHO）状态是否无害存在争议。本研究的目的是根据代谢健康和肥胖状态评估糖尿病风险以及体重和甘油三酯-葡萄糖指数（TyG指数）变化的影响。我们分析了血管代谢CUN队列的前瞻性数据，这是一项针对欧洲白人人群的基于人群的研究（平均随访8.9年）。对1923名女性和3016名男性进行了新发糖尿病评估，其基线平均年龄分别为55.33±13.68岁和53.78±12.98岁。进行Cox比例风险分析以估计代谢健康的非肥胖（MHNO）、代谢健康的肥胖、代谢不健康的非肥胖（MUNO）和代谢不健康的肥胖（MUO）人群患糖尿病的风险比（HR）。得出一个连续标准化变量（z分数），以计算体重指数（BMI）和TyG指数每增加1个标准差时患糖尿病的HR。MHO、MUNO和MUO状态与糖尿病的发生相关，HR分别为2.26（95%CI：1.25 - 4.07）、3.04（95%CI：1.69 - 5.47）和4.04（95%CI：2.14 - 7.63）。与MHO受试者相比，MUNO个体患糖尿病的风险高1.82倍（95%CI：1.04 - 3.22）。BMI和TyG指数每增加1个标准差时新发糖尿病的HR分别为1.23（95%CI：1.04 - 1.44）和1.54（95%CI：1.40 - 1.68）。BMI的增加并未增加代谢不健康受试者患糖尿病的风险，而TyG指数的增加在所有代谢健康类别中均显著影响风险。代谢健康比体重增加更重要的是糖尿病发病的决定因素。体重增加并未增加代谢不健康受试者患糖尿病的风险。
