Wu Yi-Fan, Fan Hsien-Yu, Chen Yang-Ching, Kuo Kuan-Liang, Chien Kuo-Liong
Department of Family Medicine, Taipei City Hospital, Renai Branch, Taipei, Taiwan.
Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
J Clin Endocrinol Metab. 2021 Jul 13;106(8):e2919-e2927. doi: 10.1210/clinem/dgab235.
Studies have reported the influence of adolescent obesity on development of adult diabetes, but the effect of the growth pattern during this period has rarely been explored. Also, the tri-ponderal mass index (TMI) was thought to be a better estimation of adolescent body fat levels than the body mass index (BMI), so we sought to investigate whether growth trajectories derived by these two indices could predict incident diabetes.
We conducted a study by using the Taipei City Hospital Radiation Building Database, a longitudinal cohort established in 1996. Physical exam results including blood test results were collected annually and the BMI z-score/TMI growth trajectory groups during 13 to 18 years of age were identified using growth mixture modeling. A Cox proportional hazard model for incident diabetes was used to examine the risk of baseline obese status and different BMI/TMI growth trajectories.
Five growth trajectory groups were identified for the BMI z-score and the TMI. During approximately 20 400 person-years follow-up, 33 of 1387 participants developed diabetes. Baseline obesity defined by the BMI z-score and the TMI were both related to adult diabetes. The persistent increase TMI growth trajectory exhibited a significantly increased risk of diabetes after adjusting for baseline obese status and other correlated covariates (hazard ratio: 2.85, 95% confidence interval: 1.01-8.09). There was no association between BMI growth trajectory groups and incident diabetes.
A specific TMI growth trajectory pattern during adolescence might be critical for diabetes prevention efforts.
已有研究报道青少年肥胖对成人糖尿病发病的影响，但这一时期生长模式的影响却鲜有探讨。此外，三 ponderal 质量指数（TMI）被认为比体重指数（BMI）更能准确估计青少年的体脂水平，因此我们试图研究由这两个指数得出的生长轨迹是否能预测糖尿病的发病。
我们利用台北市立医院放射大楼数据库进行了一项研究，该数据库是1996年建立的纵向队列。每年收集包括血液检测结果在内的体检结果，并使用生长混合模型确定13至18岁期间的BMI z评分/TMI生长轨迹组。采用Cox比例风险模型对糖尿病发病情况进行分析，以检验基线肥胖状态和不同BMI/TMI生长轨迹的风险。
BMI z评分和TMI确定了五个生长轨迹组。在大约20400人年的随访中，1387名参与者中有33人患糖尿病。由BMI z评分和TMI定义的基线肥胖均与成人糖尿病有关。在调整基线肥胖状态和其他相关协变量后，持续上升的TMI生长轨迹显示糖尿病风险显著增加（风险比：2.85，95%置信区间：1.01-8.09）。BMI生长轨迹组与糖尿病发病之间无关联。
青春期特定的TMI生长轨迹模式可能对糖尿病预防工作至关重要。
