Nam Ga Eun, Kim Wonsock, Han Kyungdo, Lee Chung-Woo, Kwon Yeongkeun, Han Byoungduck, Park Seokwon, Park Joo-Hyun, Kim Yang-Hyun, Kim Do-Hoon, Kim Seon Mee, Choi Youn Seon, Cho Kyung Hwan, Park Yong Gyu
Department of Family Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
Department of Biostatistics, The Catholic University of Korea, Seoul, Republic of Korea.
Diabetes Care. 2020 Sep;43(9):2234-2241. doi: 10.2337/dc19-2552. Epub 2020 Jul 8.
Obesity and type 2 diabetes are risk factors for cardiovascular diseases and mortality, and they commonly result in weight variabilities. We aimed to investigate the association between body weight variability and risk of major cardiovascular outcomes and mortality in individuals with type 2 diabetes using large-scale, nationwide cohort data on the Korean population.
We enrolled 624,237 individuals with type 2 diabetes who underwent health examinations provided by the Korean National Health Insurance System between 2009 and 2010, with three or more body weight measurements within 5 years since enrollment and followed up until the end of 2017. We assessed body weight variability using four indices, including variability independent of the mean (VIM). A multivariate-adjusted Cox proportional hazards regression analysis was performed.
During the follow-up, 15,832, 25,038, and 44,716 cases of myocardial infarction (MI), stroke, and all-cause mortality, respectively, were recorded. Body weight variability was associated with increased risks of major cardiovascular outcomes after adjusting for confounding variables. Compared with the hazard ratios (HRs) of the lowest quartile group, the HRs (95% CIs) of the highest quartile group of VIM for body weight were 1.15 (1.10-1.20), 1.22 (1.18-1.26), and 1.58 (1.53-1.62) for MI, stroke, and all-cause mortality, respectively.
Body weight variability was associated with increased risks of MI, stroke, and all-cause mortality in patients with type 2 diabetes and may be a predictor of cardiovascular outcomes in such patients. Appropriate interventions to maintain stable weight could positively influence health outcomes in patients with type 2 diabetes.
肥胖和2型糖尿病是心血管疾病和死亡的危险因素，并且它们通常会导致体重波动。我们旨在利用韩国人群大规模的全国队列数据，研究2型糖尿病患者体重波动与主要心血管结局风险及死亡率之间的关联。
我们纳入了624237例2型糖尿病患者，这些患者在2009年至2010年间接受了韩国国民健康保险系统提供的健康检查，自入组后5年内有三次或更多次体重测量，并随访至2017年底。我们使用四个指标评估体重波动，包括独立于均值的波动（VIM）。进行了多变量调整的Cox比例风险回归分析。
在随访期间，分别记录了15832例心肌梗死（MI）、25038例中风和44716例全因死亡病例。在调整混杂变量后，体重波动与主要心血管结局风险增加相关。与最低四分位组的风险比（HRs）相比，VIM最高四分位组的体重对于MI、中风和全因死亡的HRs（95%可信区间）分别为1.15（1.10 - 1.20）、1.22（1.18 - 1.26）和1.58（1.53 - 1.62）。
体重波动与2型糖尿病患者的MI、中风和全因死亡风险增加相关，可能是此类患者心血管结局的一个预测指标。采取适当干预措施维持体重稳定可能会对2型糖尿病患者的健康结局产生积极影响。
