Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Division of Biostatistics, Department of R&D Management, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Atherosclerosis. 2018 Aug;275:50-57. doi: 10.1016/j.atherosclerosis.2018.05.042. Epub 2018 May 24.
Obesity is frequently associated with non-alcoholic fatty liver disease (NAFLD), insulin resistance (IR), inflammation and metabolic syndrome (MetS), all of which increase the risk of type 2 diabetes (T2DM). However, the role of these risk factors in mediating the effect of obesity remains unclear. We investigated the association between obesity and T2DM in the absence and presence of NAFLD, IR, inflammation and MetS components.
29,836 obese subjects without diabetes were studied in a Korean health screening program. Obesity was defined by the appropriate ethnic-specific body mass index (BMI) threshold ≥25 kg/m. Hazard ratios (HRs and 95% confidence intervals, CIs) for incident T2DM were estimated for the group with no hypertension, dyslipidemia, impaired fasting glucose, fatty liver, IR, or inflammation (n = 1717), compared to the reference group, with one or more of these factors (n = 19,757).
Mean (SD) age at baseline was 37 (7) years and 1200 incident cases of diabetes occurred. Crude T2D incidence was 12.6/10,000 person-years in the group without metabolic abnormality and 143/10,000 person-years in the reference group. HR (95% CIs) for incident diabetes was 0.13 (0.06, 0.33) in the group without metabolic abnormality.
Obese subjects without components of the metabolic syndrome, IR, fatty liver and inflammation have an approximately 11-fold lower risk of incident type 2 diabetes than obese subjects who have these risk factors. These simple factors could be used to target limited resources in high risk obese subjects in the prevention of diabetes.
肥胖常与非酒精性脂肪性肝病（NAFLD）、胰岛素抵抗（IR）、炎症和代谢综合征（MetS）相关，所有这些都会增加 2 型糖尿病（T2DM）的风险。然而，这些危险因素在介导肥胖的影响中的作用尚不清楚。我们研究了在不存在和存在 NAFLD、IR、炎症和 MetS 成分的情况下，肥胖与 T2DM 之间的关联。
在一项韩国健康筛查计划中，研究了 29836 名无糖尿病的肥胖患者。肥胖的定义是根据适当的种族特异性体重指数（BMI）阈值≥25kg/m2。与参考组（n=19757）相比，无高血压、血脂异常、空腹血糖受损、脂肪肝、IR 或炎症（n=1717）的患者发生 T2DM 的风险比（HRs 和 95%置信区间，CI）为 12.6/10000 人年。
基线时的平均（SD）年龄为 37（7）岁，共发生 1200 例糖尿病病例。在无代谢异常的组中，T2D 的粗发病率为 12.6/10000 人年，在参考组中为 143/10000 人年。在无代谢异常的组中，发生糖尿病的 HR（95%CI）为 0.13（0.06，0.33）。
无代谢综合征、IR、脂肪肝和炎症成分的肥胖患者发生 2 型糖尿病的风险比有这些危险因素的肥胖患者低约 11 倍。这些简单的因素可用于针对高危肥胖患者中的有限资源，以预防糖尿病。
