Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece.
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
PLoS One. 2018 Mar 20;13(3):e0194127. doi: 10.1371/journal.pone.0194127. eCollection 2018.
Type 2 diabetes mellitus (T2DM) is a global epidemic associated with increased health expenditure, and low quality of life. Many non-genetic risk factors have been suggested, but their overall epidemiological credibility has not been assessed.
We searched PubMed to capture all meta-analyses and Mendelian randomization studies for risk factors of T2DM. For each association, we estimated the summary effect size, its 95% confidence and prediction interval, and the I2 metric. We examined the presence of small-study effects and excess significance bias. We assessed the epidemiological credibility through a set of predefined criteria.
We captured 86 eligible papers (142 associations) covering a wide range of biomarkers, medical conditions, and dietary, lifestyle, environmental and psychosocial factors. Adiposity, low hip circumference, serum biomarkers (increased level of alanine aminotransferase, gamma-glutamyl transferase, uric acid and C-reactive protein, and decreased level of adiponectin and vitamin D), an unhealthy dietary pattern (increased consumption of processed meat and sugar-sweetened beverages, decreased intake of whole grains, coffee and heme iron, and low adherence to a healthy dietary pattern), low level of education and conscientiousness, decreased physical activity, high sedentary time and duration of television watching, low alcohol drinking, smoking, air pollution, and some medical conditions (high systolic blood pressure, late menarche age, gestational diabetes, metabolic syndrome, preterm birth) presented robust evidence for increased risk of T2DM.
A healthy lifestyle pattern could lead to decreased risk for T2DM. Future randomized clinical trials should focus on identifying efficient strategies to modify harmful daily habits and predisposing dietary patterns.
2 型糖尿病（T2DM）是一种全球性疾病，与医疗支出增加和生活质量下降有关。许多非遗传风险因素已被提出，但它们的总体流行病学可信度尚未得到评估。
我们在 PubMed 上搜索了所有关于 T2DM 风险因素的荟萃分析和孟德尔随机化研究。对于每种关联，我们估计了汇总效应大小、95%置信区间和预测区间以及 I2 指标。我们检查了小样本研究效应和过度显著性偏倚的存在。我们通过一组预先确定的标准评估了流行病学的可信度。
我们捕获了 86 篇合格的论文（142 项关联），涵盖了广泛的生物标志物、医疗状况以及饮食、生活方式、环境和心理社会因素。肥胖、低臀围、血清生物标志物（丙氨酸氨基转移酶、γ-谷氨酰转移酶、尿酸和 C 反应蛋白水平升高，脂联素和维生素 D 水平降低）、不健康的饮食模式（加工肉类和含糖饮料摄入增加，全谷物、咖啡和血红素铁摄入减少，以及对健康饮食模式的依从性低）、低教育水平和尽责性、体力活动减少、久坐时间和看电视时间延长、低酒精摄入、吸烟、空气污染以及一些医疗状况（收缩压升高、初潮年龄晚、妊娠糖尿病、代谢综合征、早产）均为 T2DM 风险增加的有力证据。
健康的生活方式可能会降低 T2DM 的风险。未来的随机临床试验应重点确定有效的策略，以改变有害的日常习惯和易患的饮食模式。
