Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Sedigheh Tahereh Medical Research Complex, Khorram Street, Isfahan, 8187698191, Iran.
Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Acta Diabetol. 2018 Jun;55(6):569-577. doi: 10.1007/s00592-018-1126-y. Epub 2018 Mar 15.
The relationship between obesity and mortality rate among diabetic patients is a controversial topic. The aim of this study was to investigate the association between obesity and all-cause mortality risk in patients with type 2 diabetes.
In this retrospective database study, 2383 patients with type 2 diabetes, who had been registered in the Isfahan Endocrine and Metabolism Research Center, Iran, were enrolled between 1992 and 2010. The mean (SD) of diabetes duration and follow-up period was 15.5 (8.0) and 7.8 (3.9) years. The main outcome was all-cause mortality. All-cause mortality rates were calculated for the body mass index (BMI) categories of underweight, normal, overweight and class I, II and III obese. Cox proportional hazard models were used to estimate the adjusted hazard ratio for BMI as categorical variable using BMI of 18.5-24.9 kg/m as the reference group.
The mortality rate in patients with normal weight was higher than overweight patients (59.11 vs. 33.17 per 1000 person-years). The adjusted hazard ratios of all-cause mortality were 0.82 [95%CI 0.68-0.99; P = 0.037], 0.79 [95%CI 0.61-1.02; P = 0.069], 0.71 [95%CI 0.42-1.19; P = 0.191] and 1.36 [95%CI 0.55-3.33; P = 0.507] for overweight, class I, II and III obesity, respectively. When BMI was included in the Cox model as a time-dependent variable, the U-shaped relationship between BMI and all-cause mortality did not change.
The results show a U-shaped association of BMI with all-cause mortality in patients with type 2 diabetes with the lowest risk observed among the overweight patients.
肥胖与糖尿病患者死亡率之间的关系是一个有争议的话题。本研究旨在探讨 2 型糖尿病患者肥胖与全因死亡风险之间的关系。
在这项回顾性数据库研究中，共纳入了 1992 年至 2010 年期间在伊朗伊斯法罕内分泌与代谢研究中心登记的 2383 例 2 型糖尿病患者。糖尿病病程和随访期的平均值（标准差）分别为 15.5（8.0）年和 7.8（3.9）年。主要结局为全因死亡率。根据体重指数（BMI）类别计算了所有原因的死亡率，包括体重不足、正常、超重和 I、II 和 III 级肥胖。使用 Cox 比例风险模型，将 BMI 为 18.5-24.9 kg/m2的人群作为参考组，将 BMI 作为分类变量来估计 BMI 的调整后风险比。
正常体重患者的死亡率高于超重患者（59.11 比 33.17 人/1000 人年）。全因死亡率的调整后风险比分别为 0.82[95%CI 0.68-0.99；P = 0.037]、0.79[95%CI 0.61-1.02；P = 0.069]、0.71[95%CI 0.42-1.19；P = 0.191]和 1.36[95%CI 0.55-3.33；P = 0.507]，超重、I 级、II 级和 III 级肥胖的风险比分别为 0.82[95%CI 0.68-0.99；P = 0.037]、0.79[95%CI 0.61-1.02；P = 0.069]、0.71[95%CI 0.42-1.19；P = 0.191]和 1.36[95%CI 0.55-3.33；P = 0.507]。当 BMI 作为时间依赖性变量纳入 Cox 模型时，BMI 与全因死亡率之间的 U 型关系并未改变。
结果表明，2 型糖尿病患者 BMI 与全因死亡率之间呈 U 型关系，超重患者的风险最低。
