Pitts Samantha I, Maruthur Nisa M, Langley Gayle E, Pondo Tracy, Shutt Kathleen A, Hollick Rosemary, Schrag Stephanie J, Thomas Ann, Nichols Megin, Farley Monica, Watt James P, Miller Lisa, Schaffner William, Holtzman Corinne, Harrison Lee H
Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland.
Open Forum Infect Dis. 2018 Jun 8;5(6):ofy030. doi: 10.1093/ofid/ofy030. eCollection 2018 Jun.
Rates of invasive group B (GBS) disease, obesity, and diabetes have increased in US adults. We hypothesized that obesity would be independently associated with an increased risk of invasive GBS disease.
We identified adults with invasive GBS disease within Active Bacterial Core surveillance during 2010-2012 and used population estimates from the Behavioral Risk Factor Surveillance System to calculate invasive GBS incidence rates. We estimated relative risks (RRs) of invasive GBS using Poisson analysis with offset denominators, with obesity categorized as class I/II (body mass index [BMI] = 30-39.9 kg/m) and class III (BMI ≥ 40.0 kg/m).
In multivariable analysis of 4281 cases, the adjusted RRs of invasive GBS disease were increased for obesity (class I/II: RR, 1.52; 95% confidence interval [CI], 1.14-2.02; and class III: RR, 4.87; 95% CI, 3.50-6.77; reference overweight) and diabetes (RR, 6.04; 95% CI, 4.77-7.65). The adjusted RR associated with class III obesity was 3-fold among persons with diabetes (95% CI, 1.38-6.61) and nearly 9-fold among persons without diabetes (95% CI, 6.41-12.46), compared with overweight. The adjusted RRs associated with diabetes varied by age and BMI, with the highest RR in young populations without obesity. Population attributable risks of invasive GBS disease were 27.2% for obesity and 40.1% for diabetes.
Obesity and diabetes were associated with substantially increased risk of infection from invasive GBS. Given the population attributable risks of obesity and diabetes, interventions that reduce the prevalence of these conditions would likely reduce the burden of invasive GBS infection.
美国成年人侵袭性B族链球菌（GBS）疾病、肥胖症和糖尿病的发病率有所上升。我们推测肥胖症会独立增加侵袭性GBS疾病的风险。
我们在2010 - 2012年的主动细菌核心监测中识别出患有侵袭性GBS疾病的成年人，并使用行为危险因素监测系统的人口估计数来计算侵袭性GBS发病率。我们使用带偏移分母的泊松分析估计侵袭性GBS的相对风险（RRs），将肥胖分为I/II类（体重指数[BMI]=30 - 39.9kg/m）和III类（BMI≥40.0kg/m）。
在对4281例病例的多变量分析中，肥胖（I/II类：RR，1.52；95%置信区间[CI]，1.14 - 2.02；III类：RR，4.87；95%CI，3.50 - 6.77；参考超重）和糖尿病（RR，6.04；95%CI，4.77 - 7.65）患者侵袭性GBS疾病的校正RRs增加。与超重相比，III类肥胖相关的校正RR在糖尿病患者中为3倍（95%CI，1.38 - 6.61），在无糖尿病患者中近9倍（95%CI，6.41 - 12.46）。与糖尿病相关的校正RRs因年龄和BMI而异，在无肥胖的年轻人群中RR最高。侵袭性GBS疾病的人群归因风险肥胖为27.2%，糖尿病为40.1%。
肥胖症和糖尿病与侵袭性GBS感染风险大幅增加相关。鉴于肥胖症和糖尿病的人群归因风险，降低这些疾病患病率的干预措施可能会减轻侵袭性GBS感染的负担。
