Department of Occupational and Environmental Health and State Key Laboratory of Environmental Health for Incubating, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Dongfeng Central Hospital, Dongfeng Motor Corporation and Hubei University of Medicine, Shiyan, China.
Diabetes Metab Res Rev. 2020 Jan;36(1):e3202. doi: 10.1002/dmrr.3202. Epub 2019 Jul 18.
We examined the association between metabolically healthy obese (MHO) and diabetes incidence in a middle-aged and elderly population and whether the association differed by the presence of nonalcoholic fatty liver disease (NAFLD).
We examined 17 801 participants without diabetes at study entry (7980 males and 9821 females with a mean age of 63.2 years) derived from the Dongfeng-Tongji cohort study (median follow-up: 4.6 years). Participants were divided into six groups based on BMI (normal weight, overweight, or obese) and metabolic health (healthy/unhealthy) defined by the Adult Treatment Panel III criteria. The MHO was defined as BMI greater than 28.0 kg/m with 0 or 1 of four metabolic abnormalities (elevated blood pressure, triglyceridaemia, hyperglycaemia, low HDL cholesterol). The hazard ratio (HR) and 95% confidence interval (CI) for incident diabetes were derived from the Cox proportional hazard regression model.
During 79 843 person-years of follow-up, 1453 individuals developed diabetes. Compared with metabolically healthy normal weight (MH-NW) individuals, the multivariable-adjusted HRs (95% CI) were 1.74 (1.16-2.59) for MHO and 2.15 (1.65-2.81) for metabolically unhealthy obese subjects after adjusting for age, sex, smoking, alcohol drinking, physical activity, fruit and vegetable consumption, family history of diabetes, fasting glucose, waist circumference, and NAFLD. Among those without NAFLD, MHO individuals showed higher incidence of diabetes (multivariate-adjusted HR = 2.71, 95% CI: 1.47-5.00) than MH-NW individuals.
The MHO phenotype was associated with increased incidence of diabetes in a middle-aged and elderly population, and the association did not differ by the presence or absence of NAFLD.
我们研究了代谢健康型肥胖（MHO）与中年和老年人群中糖尿病发病率之间的关系，以及这种关联是否因非酒精性脂肪性肝病（NAFLD）的存在而不同。
我们研究了 17801 名无糖尿病的参与者，这些参与者来自东风-同济队列研究（中位随访时间为 4.6 年）（男性 7980 名，女性 9821 名，平均年龄 63.2 岁）。参与者根据 BMI（正常体重、超重或肥胖）和代谢健康状况（根据成人治疗小组 III 标准定义为健康/不健康）分为六组。MHO 定义为 BMI 大于 28.0kg/m2，同时存在 0 或 1 种 4 种代谢异常（血压升高、甘油三酯升高、血糖升高、低 HDL 胆固醇）。使用 Cox 比例风险回归模型得出了新发糖尿病的风险比（HR）和 95%置信区间（CI）。
在 79843 人年的随访期间，1453 人发生了糖尿病。与代谢健康正常体重（MH-NW）个体相比，多变量调整后的 HR（95%CI）分别为 MHO 个体 1.74（1.16-2.59）和代谢不健康肥胖个体 2.15（1.65-2.81），调整因素包括年龄、性别、吸烟、饮酒、体力活动、水果和蔬菜摄入、糖尿病家族史、空腹血糖、腰围和 NAFLD。在没有 NAFLD 的人群中，MHO 个体的糖尿病发病率更高（多变量调整后的 HR=2.71，95%CI：1.47-5.00），高于 MH-NW 个体。
在中年和老年人群中，MHO 表型与糖尿病发病率增加相关，且这种关联与 NAFLD 的存在与否无关。
