甲状腺结节与肥胖的关联：一项基于中国社区的横断面研究。
Association of thyroid nodules with adiposity: a community-based cross-sectional study in China.
作者信息
Song Bin, Zuo Zhihua, Tan Juan, Guo Jianjin, Teng Weiping, Lu Yibing, Liu Chao
机构信息
Department of Endocrinology, The Second Affiliated Hospital of Nanjing Medical University, 125 Jiangjiayuan Road, Nanjing, 211166, China.
Department of Endocrinology, Clinical Medical College, Yangzhou University, 98 Nantong West Road, Yangzhou, 225001, China.
出版信息
BMC Endocr Disord. 2018 Jan 27;18(1):3. doi: 10.1186/s12902-018-0232-8.
BACKGROUND
The association between thyroid nodules and adiposity remains controversial. We performed a cross-sectional, community-based study to examine whether thyroid nodules are associated with overweight and obesity, as defined with body mass index (BMI) and waist circumference.
METHODS
The study included 1482 subjects (≥20 years of age; residing in Nanjing, China) receiving questionnaire interview, anthropometric measurements, laboratory tests and thyroid ultrasonography in 2009-2010. Overweight and obesity were defined as BMI ≥24 and ≥28 kg/m, respectively. Central obesity was defined as waist circumference at ≥90 cm in men and ≥80 cm in women. A sensitivity analysis was conducted using the American Diabetes Association (ADA) criteria for overweight and obesity (BMI ≥ 23 and ≥25 kg/m).
RESULTS
Thyroid nodules were identified in 12.6% of the subjects. A greater proportion of the subjects with thyroid nodules had a BMI at ≥24 kg/m (51.9% vs. 40.5% in those without thyroid nodules, P = 0.003) and central obesity (43.3% vs. 24.2%, P < 0.001). After adjustment for other confounders, central obesity was still associated with significantly elevated risk of thyroid nodules (OR 1.62, 95%CI 1.14-2.28), whereas obesity/overweight based on BMI was not in both the main analysis and sensitivity analysis with the alternative criteria. In the subgroup analysis, BMI ≥24 kg/m (OR 1.61, 95%CI 1.01-2.54), as well as BMI ≥25 kg/m (OR 1.95, 95%CI 1.14-3.34), was significantly associated with higher risk of thyroid nodules among women. Using the ADA criteria, overweight and obesity were associated with thyroid nodules (OR 5.59, 95%CI 1.39-22.51 and 5.15, 95%CI 1.30-20.37) in thyroid-stimulating hormone (TSH) > 4.2 mIU/L subgroup. Central obesity correlated with higher risk of thyroid nodules regardless of age (< 50 years: OR 1.87, 95%CI 1.05-3.32: ≥50 years: OR 1.54, 95%CI 1.00-2.37) and in the following subgroups: men (OR 1.91, 95%CI 1.14-3.20), TSH > 4.2 mIU/L (OR 3.05, 95%CI 1.01-9.22), and urine iodine ≥200 µg/L (OR 1.79, 95%CI 1.14-2.81).
CONCLUSION
Waist circumference is superior to BMI for assessing risk of thyroid nodules in Chinese subjects.
背景
甲状腺结节与肥胖之间的关联仍存在争议。我们开展了一项基于社区的横断面研究，以探讨甲状腺结节是否与超重及肥胖相关，超重及肥胖分别采用体重指数（BMI）和腰围进行定义。
方法
该研究纳入了1482名受试者（年龄≥20岁；居住在中国南京），于2009年至2010年接受问卷调查、人体测量、实验室检查及甲状腺超声检查。超重和肥胖分别定义为BMI≥24和≥28kg/m²。中心性肥胖定义为男性腰围≥90cm，女性腰围≥80cm。采用美国糖尿病协会（ADA）超重和肥胖标准（BMI≥23和≥25kg/m²）进行敏感性分析。
结果
12.6%的受试者发现有甲状腺结节。甲状腺结节患者中，BMI≥24kg/m²的比例更高（51.9% vs. 无甲状腺结节者的40.5%，P = 0.003），中心性肥胖的比例也更高（43.3% vs. 24.2%，P < 0.001）。在调整其他混杂因素后，中心性肥胖仍与甲状腺结节风险显著升高相关（OR 1.62，95%CI 1.14 - 2.28），而基于BMI的肥胖/超重，在主要分析及采用替代标准的敏感性分析中均未显示相关。在亚组分析中，BMI≥24kg/m²（OR 1.61，95%CI 1.01 - 2.54）以及BMI≥25kg/m²（OR 1.95，95%CI 1.14 - 3.34）在女性中与甲状腺结节风险显著相关。采用ADA标准，在促甲状腺激素（TSH）> 4.2 mIU/L亚组中，超重和肥胖与甲状腺结节相关（OR 5.59，95%CI 1.39 - 22.51和5.15，95%CI 1.30 - 20.37）。无论年龄（< 50岁：OR 1.87，95%CI 1.05 - 3.32；≥50岁：OR 1.54，95%CI 1.00 - 2.37），以及在以下亚组中：男性（OR 1.91，95%CI 1.14 - 3.20）、TSH > 4.2 mIU/L（OR 3.05，95%CI 1.01 - 9.22）和尿碘≥200μg/L（OR 1.79，95%CI 1.14 - 2.81），中心性肥胖均与甲状腺结节风险更高相关。
结论
在中国受试者中，腰围在评估甲状腺结节风险方面优于BMI。
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