School of Public Health, Fudan University, Shanghai, People's Republic of China.
Shanghai Minhang Center for Disease Control and Prevention, Shanghai, People's Republic of China.
Diabet Med. 2018 Nov;35(11):1562-1570. doi: 10.1111/dme.13763. Epub 2018 Jul 9.
To examine the associations between BMI and the risks of all-cause, cardiovascular disease (CVD)-specific and cancer-specific mortality among people with Type 2 diabetes, and thus provide recommendations for weight management in the population.
This retrospective cohort study was conducted among 52 763 people with newly diagnosed Type 2 diabetes between 1 January 2004 and 31 December 2014 in Shanghai, China. All cases of death were identified by linking to the Shanghai Vital Statistics. Some 52 488 people were included in the analysis. Survival curves for people with different BMI categories were plotted using the Kaplan-Meier method. Cox proportional hazard models within or without restricted cubic spline functions were applied to examine the potential non-linear or linear relationship between BMI and the risk of mortalities respectively.
A total of 4777 deaths were identified during an average of 6-year follow-up. An L-shaped association was observed between BMI and all-cause mortality in men (P for overall association < 0.001 and P for non-linearity < 0.001) while a U-shaped association was found in women (P for overall association < 0.001 and P for non-linearity< 0.001). In men, no significant association was observed for BMI with cancer-specific and CVD-specific mortality. In women, an increased risk of cancer-specific mortality was observed with increasing BMI, whereas decreasing BMI was associated with the increased CVD-specific mortality rate.
The increased all-cause mortality in men with low BMI and in women with either low or high BMI indicate the importance of keeping BMI in a normal range for Chinese adults with Type 2 diabetes.
探讨 2 型糖尿病患者体重指数（BMI）与全因、心血管疾病（CVD）特异性和癌症特异性死亡率风险之间的关联，从而为该人群的体重管理提供建议。
本回顾性队列研究纳入了 2004 年 1 月 1 日至 2014 年 12 月 31 日期间在中国上海新诊断为 2 型糖尿病的 52763 例患者。所有死亡病例均通过与上海生命统计数据进行关联进行确定。在分析中纳入了 52488 例患者。使用 Kaplan-Meier 方法绘制不同 BMI 类别人群的生存曲线。应用 Cox 比例风险模型分别在有无限制三次样条函数的情况下，评估 BMI 与死亡率风险之间的潜在非线性或线性关系。
在平均 6 年的随访期间，共确定了 4777 例死亡。在男性中，BMI 与全因死亡率之间观察到 L 形关联（整体关联 P<0.001，非线性 P<0.001），而在女性中则观察到 U 形关联（整体关联 P<0.001，非线性 P<0.001）。在男性中，BMI 与癌症特异性和 CVD 特异性死亡率之间无显著关联。在女性中，随着 BMI 的增加，癌症特异性死亡率的风险增加，而 BMI 降低则与 CVD 特异性死亡率的增加相关。
低 BMI 男性和低或高 BMI 女性全因死亡率的增加表明，对于中国 2 型糖尿病成年患者，保持 BMI 在正常范围内非常重要。
