Global Health Section, Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, Building 9, Mailbox 2099, 1014, Copenhagen K., Denmark.
Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Diabetologia. 2018 Jul;61(7):1572-1580. doi: 10.1007/s00125-018-4587-1. Epub 2018 Mar 8.
AIMS/HYPOTHESIS: In the UK, more than one million people have undiagnosed diabetes and an additional five million are at high risk of developing the disease. Given that early identification of these people is key for both primary and secondary prevention, new screening approaches are needed. Since spouses resemble each other in cardiometabolic risk factors related to type 2 diabetes, we aimed to investigate whether diabetes and cardiometabolic risk factors in one spouse can be used as an indicator of incident type 2 diabetes in the other spouse.
We analysed data from 3649 men and 3478 women from the English Longitudinal Study of Ageing with information on their own and their spouse's diabetes status and cardiometabolic risk factors. We modelled incidence rates and incidence rate ratios with Poisson regression, using spousal diabetes status or cardiometabolic risk factors (i.e. BMI, waist circumference, systolic and diastolic BP, HDL- and LDL-cholesterol and triacylglycerols) as exposures and type 2 diabetes incidence in the index individual as the outcome. Models were adjusted for two nested sets of covariates.
Spousal BMI and waist circumference were associated with incident type 2 diabetes, but with different patterns for men and women. A man's risk of type 2 diabetes increased more steeply with his wife's obesity level, and the association remained statistically significant even after adjustment for the man's own obesity level. Having a wife with a 5 kg/m higher BMI (30 kg/m vs 25 kg/m) was associated with a 21% (95% CI 11%, 33%) increased risk of type 2 diabetes. In contrast, the association between incident type 2 diabetes in a woman and her husband's BMI was attenuated after adjusting for the woman's own obesity level. Findings for waist circumference were similar to those for BMI. Regarding other risk factors, we found a statistically significant association only between the risk of type 2 diabetes in women and their husbands' triacylglycerol levels.
CONCLUSIONS/INTERPRETATION: The main finding of this study is the sex-specific effect of spousal obesity on the risk of type 2 diabetes. Having an obese spouse increases an individual's risk of type 2 diabetes over and above the effect of the individual's own obesity level among men, but not among women. Our results suggest that a couples-focused approach may be beneficial for the early detection of type 2 diabetes and individuals at high risk of developing type 2 diabetes, especially in men, who are less likely than women to attend health checks.
Data were accessed via the UK Data Service under the data-sharing agreement no. 91400 ( https://discover.ukdataservice.ac.uk/catalogue/?sn=5050&type=Data%20catalogue ).
目的/假设：在英国，超过 100 万人患有未确诊的糖尿病，另有 500 万人有患该病的高风险。鉴于这些人的早期识别对一级和二级预防都很关键，因此需要新的筛查方法。由于配偶在与 2 型糖尿病相关的心血管代谢风险因素方面彼此相似，我们旨在研究配偶一方的糖尿病和心血管代谢风险因素是否可以作为另一方发生 2 型糖尿病的指标。
我们分析了来自英国老龄化纵向研究的 3649 名男性和 3478 名女性的数据，这些数据包含了他们自己和配偶的糖尿病状况以及心血管代谢风险因素。我们使用泊松回归模型来计算发病率和发病率比值，将配偶的糖尿病状况或心血管代谢风险因素（即 BMI、腰围、收缩压和舒张压、HDL-和 LDL-胆固醇以及三酰甘油）作为暴露因素，将索引个体的 2 型糖尿病发病率作为结局。模型调整了两组嵌套的协变量。
配偶的 BMI 和腰围与 2 型糖尿病的发病有关，但男女之间的模式不同。男性患 2 型糖尿病的风险随着妻子肥胖程度的增加而急剧上升，即使在调整了男性自身肥胖程度后，这种关联仍然具有统计学意义。妻子的 BMI 每增加 5kg/m（30kg/m 与 25kg/m），男性患 2 型糖尿病的风险就会增加 21%（95%CI 11%，33%）。相比之下，女性 2 型糖尿病发病与丈夫 BMI 之间的关联在调整了女性自身肥胖程度后减弱了。腰围的结果与 BMI 的结果相似。关于其他风险因素，我们仅发现女性 2 型糖尿病发病风险与丈夫三酰甘油水平之间存在统计学显著关联。
结论/解释：本研究的主要发现是配偶肥胖对男性 2 型糖尿病发病风险的性别特异性影响。在男性中，肥胖配偶的存在会增加个体患 2 型糖尿病的风险，超过了个体自身肥胖程度的影响，但在女性中则没有。我们的研究结果表明，夫妻为重点的方法可能有助于早期发现 2 型糖尿病和患 2 型糖尿病风险高的个体，尤其是在男性中，他们比女性更不可能接受健康检查。
数据可通过英国数据服务中心（UK Data Service）根据数据共享协议（协议号为 91400）获取，网址为：https://discover.ukdataservice.ac.uk/catalogue/?sn=5050&type=Data%20catalogue。
