Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.
Health Services Research Centre, SingHealth, Singapore, Singapore.
J Clin Hypertens (Greenwich). 2019 Jul;21(7):953-962. doi: 10.1111/jch.13587. Epub 2019 Jun 21.
Identification of hypertensive patients with pre-diabetes or diabetes is important for timely prevention of complications including vascular disease. We aimed to compare the association and discrimination of central obesity measures (waist circumference [WC] and waist-to-height ratio [WHtR]) with generalized obesity measure (body mass index [BMI]) in relation to pre-diabetes and diabetes among a group of Asian hypertensive patients for the first time. We used the baseline data of 925 subjects aged 40 years or older with uncontrolled hypertension recruited at eight primary care clinics in Singapore. Information on height, weight, WC, fasting blood glucose, and hemoglobin A1c (HbA1c) was collected. Pre-diabetes or diabetes was defined as having reported physician-diagnosed diabetes or taking anti-diabetes medication, fasting blood glucose ≥ 5.6 mmol/dL or HbA1c ≥ 5.7%. Among 925 subjects, 495 (53.5%) had pre-diabetes or diabetes. In logistic regression models, BMI was not associated with pre-diabetes or diabetes after adjusting for WC or WHtR, while a positive association remained with both WC and WHtR after adjustment of BMI. Both WC and WHtR had significantly better discrimination than BMI (respective area under ROC curve: 0.63 for WC, 0.63 for WHtR, and 0.60 for BMI; P = 0.019), and adding WC or WHtR on top of BMI further correctly reclassified 42.7% and 38.7% hypertensive patients to the right risk group of pre-diabetes or diabetes indicated by net reclassification improvement. However, WHtR was not superior to WC. In conclusion, our results suggested that central obesity has stronger association with and better discrimination for pre-diabetes or diabetes than generalized obesity.
识别出患有糖尿病前期或糖尿病的高血压患者对于及时预防包括血管疾病在内的并发症非常重要。我们旨在首次比较中心性肥胖指标（腰围 [WC] 和腰高比 [WHtR]）与广义肥胖指标（体重指数 [BMI]）与亚洲一组高血压患者的糖尿病前期和糖尿病之间的关联和判别能力。我们使用了在新加坡 8 个初级保健诊所招募的 925 名年龄在 40 岁或以上且血压未得到控制的高血压患者的基线数据。收集了身高、体重、WC、空腹血糖和糖化血红蛋白（HbA1c）的信息。糖尿病前期或糖尿病的定义为有报告医生诊断的糖尿病或服用抗糖尿病药物、空腹血糖≥5.6mmol/dL 或 HbA1c≥5.7%。在 925 名受试者中，495 名（53.5%）患有糖尿病前期或糖尿病。在逻辑回归模型中，在调整 WC 或 WHtR 后，BMI 与糖尿病前期或糖尿病无关，而在调整 BMI 后，WC 和 WHtR 与两者均呈正相关。与 BMI 相比，WC 和 WHtR 的判别能力均显著提高（各自的 ROC 曲线下面积：WC 为 0.63，WHtR 为 0.63，BMI 为 0.60；P=0.019），并且在 BMI 的基础上增加 WC 或 WHtR 可将 42.7%和 38.7%的高血压患者正确地重新分类到糖尿病前期或糖尿病的正确风险组，净重新分类改善。然而，WHtR 并不优于 WC。总之，我们的结果表明，中心性肥胖与糖尿病前期或糖尿病的关联更强，判别能力更强。
