School of Community and Global Health, Claremont Graduate University, The Claremont Colleges, Claremont, CA.
Heart Disease Prevention Program, Division of Cardiology, Department of Medicine, UC Irvine School of Medicine, University of California, Irvine, Irvine, CA.
Menopause. 2020 Jun;27(6):640-647. doi: 10.1097/GME.0000000000001512.
To determine the relationship of metabolic weight categories with incident diabetes mellitus (DM) in postmenopausal women.
The Women's Health Initiative (WHI) enrolled 161,808 postmenopausal women aged 50 to 79 years. We included those with cardiovascular disease (CVD) biomarkers and free of CVD and prevalent DM (n = 17,043) at baseline. Normal weight was defined as a body mass index (BMI) ≥18.5 and <25 kg/m, and waist circumference (WC) <88 cm and overweight/obesity as a BMI ≥25 kg/m or WC ≥88 cm. Metabolically healthy was based on <2 and metabolically unhealthy ≥2 traits of the following: triglycerides ≥150 mg/dL, systolic blood pressure (BP) ≥130 mm Hg or diastolic BP ≥85 mm Hg, or antihypertensives or diuretics, fasting glucose ≥100 mg/dL or DM medication, and high-density lipoprotein cholesterol <50 mg/dL. Cox regression was performed to determine the risk of incident DM among metabolically healthy normal weight (MHNW), metabolically unhealthy normal weight (MUHNW), metabolically healthy overweight/obese (MHO), and metabolically unhealthy overweight/obese (MUHO).
Among our sample, 2,253 (13.3%) participants developed DM over a mean ± standard deviation follow-up time of 15.6 ± 3.4 years. Compared with MHNW (n = 162 incident DM cases), an increased risk of incident DM was observed in MUHNW (n = 102 cases) (hazard ratio [HR] 2.24, 95% confidence interval [CI] 1.74-2.88, P < 0.0001), MHO (n = 624 cases) (HR 1.68, 95% CI 1.40-2.00, P < 0.0001), and MUHO (n = 1,365 cases) (HR 4.51, 95% CI 3.82-5.35, P < 0.0001).
Among postmenopausal women, MUHNW and MHO confer an approximate doubling in the risk and MUHO more than a four-fold increased risk for developing DM.
确定代谢体重类别与绝经后妇女发生糖尿病（DM）的关系。
妇女健康倡议（WHI）纳入了 161808 名年龄在 50 至 79 岁之间的绝经后妇女。我们纳入了基线时患有心血管疾病（CVD）生物标志物且无 CVD 和常见 DM（n=17043）的患者。正常体重定义为 BMI≥18.5 和<25kg/m，腰围（WC）<88cm，超重/肥胖定义为 BMI≥25kg/m 或 WC≥88cm。代谢健康是基于以下<2 个和代谢不健康≥2 个特征：甘油三酯≥150mg/dL、收缩压（BP）≥130mmHg 或舒张压（BP）≥85mmHg、或使用降压药或利尿剂、空腹血糖≥100mg/dL 或服用 DM 药物、高密度脂蛋白胆固醇<50mg/dL。采用 Cox 回归分析代谢健康正常体重（MHNW）、代谢不健康正常体重（MUHNW）、代谢健康超重/肥胖（MHO）和代谢不健康超重/肥胖（MUHO ）发生 DM 的风险。
在我们的样本中，15.6±3.4 年的平均随访期间，有 2253 名（13.3%）参与者发生 DM。与 MHNW（n=162 例 DM 病例）相比，MUHNW（n=102 例）（危险比[HR]2.24，95%置信区间[CI]1.74-2.88，P<0.0001）、MHO（n=624 例）（HR 1.68，95%CI 1.40-2.00，P<0.0001）和 MUHO（n=1365 例）（HR 4.51，95%CI 3.82-5.35，P<0.0001）发生 DM 的风险增加。
在绝经后妇女中，MUHNW 和 MHO 使发生 DM 的风险增加约一倍，而 MUHO 使发生 DM 的风险增加四倍以上。
