青年期至中年期肥胖进展与新发糖尿病的关系：一项美国成年人的回顾性队列研究。
Obesity Progression Between Young Adulthood and Midlife and Incident Diabetes: A Retrospective Cohort Study of U.S. Adults.
机构信息
Department of Global Health, Boston University School of Public Health, Boston, MA
Department of Global Health, Boston University School of Public Health, Boston, MA.
出版信息
Diabetes Care. 2018 May;41(5):1025-1031. doi: 10.2337/dc17-2336. Epub 2018 Mar 5.
OBJECTIVE
Understanding how changes in weight over the life course shape risk for diabetes is critical for the prevention of diabetes. Using data from the National Health and Nutrition Examination Survey (NHANES), we investigated the association between self-reported weight change from young adulthood to midlife and incident diabetes.
RESEARCH DESIGN AND METHODS
We categorized individuals into four weight-change groups: those who remained nonobese (stable nonobese), those who moved from an obese BMI to a nonobese BMI (losing), those who moved from a nonobese BMI to an obese BMI (gaining), and those who remained obese (stable obese). Diabetes status was determined by self-report of a prior diagnosis, and age at diagnosis was used to establish time of diabetes onset. Hazard ratios (HRs) relating weight change to incident diabetes over 10 years of follow-up were calculated using Cox models adjusting for covariates.
RESULTS
Those who were obese and lost weight exhibited a significantly lower risk (HR 0.33; 95% CI 0.14, 0.76) of diabetes compared with those with stable obesity. We also observed lower risk among those who were stable nonobese (HR 0.22; 95% CI 0.18, 0.28) and those in the gaining category (HR 0.70; 95% CI 0.57, 0.87). Further, there was evidence of an increased incidence of diabetes among obese individuals who lost weight compared with individuals who were stable nonobese; however, weight loss was rare, and the association was not statistically significant. If those who were obese had become nonobese during the 10-year period, we estimate that 9.1% (95% CI 5.3, 12.8) of observed diabetes cases could have been averted, and if the population had maintained a normal BMI during the period, 64.2% (95% CI 59.4, 68.3) of cases could have been averted.
CONCLUSIONS
The findings from this study underscore the importance of population-level approaches to the prevention and treatment of obesity across the life course of individuals.
目的
了解一生中体重变化如何影响糖尿病风险对于糖尿病的预防至关重要。利用来自国家健康和营养检查调查（NHANES）的数据，我们研究了从青年到中年期间自我报告的体重变化与新发糖尿病之间的关联。
研究设计和方法
我们将个体分为四组体重变化组：保持非肥胖状态的个体（稳定非肥胖组）、从肥胖 BMI 转变为非肥胖 BMI 的个体（减轻组）、从非肥胖 BMI 转变为肥胖 BMI 的个体（增重组）和保持肥胖状态的个体（稳定肥胖组）。糖尿病的状态通过自我报告的既往诊断来确定，诊断年龄用于确定糖尿病发病时间。使用 Cox 模型调整协变量后，计算了体重变化与 10 年随访期间新发糖尿病之间的风险比（HR）。
结果
与稳定肥胖组相比，肥胖且体重减轻的个体患糖尿病的风险显著降低（HR 0.33；95%CI 0.14，0.76）。我们还观察到稳定非肥胖组（HR 0.22；95%CI 0.18，0.28）和增重组（HR 0.70；95%CI 0.57，0.87）的风险较低。此外，与稳定非肥胖个体相比，肥胖个体体重减轻后糖尿病的发病率增加，但体重减轻的比例很少，且该关联无统计学意义。如果肥胖个体在 10 年内体重减轻至非肥胖状态，我们估计可避免 9.1%（95%CI 5.3，12.8）的观察到的糖尿病病例，如果在此期间人群保持正常 BMI，可避免 64.2%（95%CI 59.4，68.3）的病例。
结论
本研究的结果强调了在个体的整个生命过程中采取人群层面的方法来预防和治疗肥胖的重要性。
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