Peter Raphael Simon, Keller Ferdinand, Klenk Jochen, Concin Hans, Nagel Gabriele
Institute of Epidemiology and Medical Biometry, Ulm University Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Ulm, Ulm Department of Geriatrics and Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany Agency for Preventive and Social Medicine, Bregenz, Austria.
Medicine (Baltimore). 2016 Dec;95(49):e5608. doi: 10.1097/MD.0000000000005608.
There are only few studies on latent trajectories of body mass index (BMI) and their association with diabetes incidence and mortality in adults.We used data of the Vorarlberg Health Monitoring & Prevention Program and included individuals (N=24,875) with BMI measurements over a 12-year period. Trajectory classes were identified using growth mixture modeling for predefined age groups (<50, 50-65, >65 years of age) and men, women separately. Poisson models were applied to estimate incidence and prevalence of diabetes for each trajectory class. Relative all-cause mortality and diabetes-related mortality was estimated using Cox proportional hazard regression.We identified 4 trajectory classes for the age groups <50 years and 50 to 65 years, and 3 for age groups >65 years. For all age groups, a stable BMI trajectory class was the largest, with about 90% of men and 70% to 80% of women. For the low stable BMI classes, the corresponding fasting glucose levels were the lowest. The highest diabetes prevalences were observed for decreasing trajectories. During subsequent follow-up of mean 8.1 (SD 2.0) years, 2741 individuals died. For men <50 years, highest mortality was observed for steady weight gainers. For all other age-sex groups, mortality was the highest for decreasing trajectories.We found considerably heterogeneity in BMI trajectories by sex and age. Stable weight, however, was the largest class over all age and sex groups, and was associated with the lowest diabetes incidence and mortality suggesting that maintaining weight at a moderate level is an important public health goal.
关于成人体重指数（BMI）的潜在轨迹及其与糖尿病发病率和死亡率的关联，相关研究较少。我们使用了福拉尔贝格州健康监测与预防项目的数据，纳入了在12年期间有BMI测量值的个体（N = 24,875）。使用生长混合模型针对预先定义的年龄组（<50岁、50 - 65岁、>65岁）以及男性和女性分别确定轨迹类别。应用泊松模型估计每个轨迹类别的糖尿病发病率和患病率。使用Cox比例风险回归估计相对全因死亡率和糖尿病相关死亡率。我们为<50岁和50至65岁的年龄组确定了4种轨迹类别，为>65岁的年龄组确定了3种轨迹类别。对于所有年龄组，稳定的BMI轨迹类别占比最大，男性约占90%，女性占70%至80%。对于低稳定BMI类别，相应的空腹血糖水平最低。下降轨迹的糖尿病患病率最高。在随后平均8.1（标准差2.0）年的随访期间，有2741人死亡。对于<50岁的男性，体重稳步增加者的死亡率最高。对于所有其他年龄 - 性别组，下降轨迹的死亡率最高。我们发现BMI轨迹在性别和年龄方面存在相当大的异质性。然而，稳定体重在所有年龄和性别组中是占比最大的类别，并且与最低的糖尿病发病率和死亡率相关，这表明将体重维持在适度水平是一个重要的公共卫生目标。
