Department of Medicine Northwestern University Feinberg School of Medicine Chicago IL.
Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL.
J Am Heart Assoc. 2021 Feb 16;10(4):e018799. doi: 10.1161/JAHA.120.018799. Epub 2021 Feb 10.
Background Given the increasing prevalence of diabetes mellitus (DM) in the United States, estimating the effects of population-level increases in obesity on incident DM has substantial implications for public health policy. Therefore, we determined the population attributable fraction, which accounts for the prevalence and excess risk of DM associated with obesity. Methods and Results We included non-Hispanic White, non-Hispanic Black, and Mexican American participants without DM at baseline from MESA (Multi-Ethnic Study of Atherosclerosis) with available data on body mass index and key covariates from 2000 to 2017 to calculate unadjusted and adjusted (age, study site, physical activity, diet, income, and education level) hazard ratios (HR) for obesity-attributable DM. We calculated national age-adjusted prevalence estimates for obesity using data from NHANES (National Health and Nutrition Examination Survey) in 4 pooled cycles (2001-2016) among adults with similar characteristics to MESA participants. Last, we calculated unadjusted and adjusted population attributable fractions from the race/ethnic and sex-specific HR and prevalence estimates. Of 4200 MESA participants, the median age was 61 years, 46.8% were men, 53.9% were non-Hispanic White, 32.9% were non-Hispanic Black, and 13.3% were Mexican. Among MESA participants, incident DM occurred in 11.6% over a median follow-up of 9.2 years. The adjusted HR for obesity-related DM was 2.7 (95% CI, 2.2-3.3). Adjusted population attributable fractions were 0.35 (95% CI, 0.29-0.40) in 2001 to 2004 and 0.41 (95% CI, 0.36-0.46) in 2013 to 2016, and greatest among non-Hispanic White women. Conclusions The contribution of obesity towards DM in the population remains substantial and varies significantly by race/ethnicity and sex, highlighting the need for tailored public health interventions to reduce obesity. Registration URL: https://www.clinicaltrials.gov; Unique identifiers: NC00005487, NCT00005154.
背景 鉴于美国糖尿病（DM）的患病率不断上升，评估人群中肥胖率的增加对 DM 发生率的影响对公共卫生政策具有重要意义。因此，我们确定了人群归因分数，该分数考虑了与肥胖相关的 DM 的患病率和超额风险。 方法和结果 我们纳入了 MESA（动脉粥样硬化多民族研究）中基线时无 DM 的非西班牙裔白人、非西班牙裔黑人以及墨西哥裔美国人参与者，这些参与者在 2000 年至 2017 年期间有体重指数和关键协变量的数据，以计算肥胖相关 DM 的未调整和调整（年龄、研究地点、体力活动、饮食、收入和教育水平）风险比（HR）。我们使用来自 NHANES（国家健康和营养检查调查）的 4 个合并周期（2001-2016 年）的数据，计算了具有与 MESA 参与者相似特征的成年人的全国年龄调整肥胖患病率估计值。最后，我们根据种族/民族和性别特异性 HR 和患病率估计值计算了未调整和调整后的人群归因分数。在 4200 名 MESA 参与者中，中位年龄为 61 岁，46.8%为男性，53.9%为非西班牙裔白人，32.9%为非西班牙裔黑人，13.3%为墨西哥裔。在 MESA 参与者中，中位随访 9.2 年期间，11.6%发生了 DM 事件。肥胖相关 DM 的调整 HR 为 2.7（95%CI，2.2-3.3）。调整后的人群归因分数在 2001 年至 2004 年为 0.35（95%CI，0.29-0.40），在 2013 年至 2016 年为 0.41（95%CI，0.36-0.46），在非西班牙裔白人女性中最高。 结论 肥胖对人群中 DM 的贡献仍然很大，且因种族/民族和性别而异，这突出表明需要采取有针对性的公共卫生干预措施来减少肥胖。 注册网址：https://www.clinicaltrials.gov；独特标识符：NC00005487、NCT00005154。
