College of Medicine The Ohio State University Columbus OH.
Division of Endocrinology, Diabetes and Metabolism Johns Hopkins University School of Medicine Baltimore MD.
J Am Heart Assoc. 2021 Sep 21;10(18):e020716. doi: 10.1161/JAHA.120.020716. Epub 2021 Sep 8.
Background The prognostic value of anthropometric, adipokine, and computed tomography measures of adiposity to predict diabetes in Black, specifically by normoglycemia versus prediabetes, remains incompletely understood. Methods and Results Among Black participants without diabetes in the JHS (Jackson Heart Study), waist circumference [WC], body mass index, adiponectin, leptin, and leptin:adiponectin ratio were standardized in sample 1 (2422 participants at baseline [2000-2004]) and WC, body mass index, visceral adipose tissue (VAT), subcutaneous adipose tissue, and liver attenuation in 1537 participants at examination 2 (2005-2008) (sample 2). Hazard ratios (HRs) for diabetes were estimated using interval-censored Cox modeling adjusting for traditional risk factors and validated with the C index. Over 5 years, 300 and 122 incident diabetes cases occurred in sample 1 and sample 2, respectively. In sample 1 and sample 2, a 1-SD higher log-leptin:adiponectin ratio and VAT had the strongest associations (HR, 1.95 [95% CI, 1.67-2.27] and 1.76 [95% CI, 1.52-2.04]) and discriminatory power (C index 0.68 [95% CI, 0.64-0.71] and C index 0.67 [95% CI, 0.61-0.74]) with diabetes. The normoglycemic compared with the prediabetes group had a 1.3 to 1.9 times greater magnitude of associations with diabetes for WC, liver attenuation, and VAT ( interaction <0.10). In sample 2, C indices for WC (HR, 0.84; 95% CI, 0.73-0.95), VAT (HR, 0.91; 95% CI, 0.85-0.98), and liver attenuation (HR, 0.90; 95% CI, 0.77-1.00) were greater than HbA (HR, 0.74; 95% CI, 0.57-0.90) in normoglycemia, whereas HbA was best in prediabetes (HR, 0.72; 95% CI, 0.66-0.78). Conclusions Overall, among Black adults, multiple measures of adiposity were associated with incident diabetes with modest predictive ability. In Black patients with normoglycemia, WC, liver attenuation, and VAT may appropriately identify those at high risk for diabetes, whereas HbA was the best predictor in individuals with prediabetes.
背景 对于黑种人（尤其是血糖正常和糖尿病前期患者），人体测量学、脂肪因子和计算机断层扫描（CT）测量的肥胖指标对糖尿病的预测价值仍不完全清楚。
方法和结果 在 JHS（杰克逊心脏研究）中无糖尿病的黑种人参与者中，腰围[WC]、体重指数、脂联素、瘦素和瘦素：脂联素比值在样本 1（基线[2000-2004]时的 2422 名参与者）中进行了标准化，WC、体重指数、内脏脂肪组织（VAT）、皮下脂肪组织和肝脏衰减值在样本 2（2005-2008 年检查时的 1537 名参与者）中进行了标准化。采用间隔 censored Cox 模型估计糖尿病的风险比（HR），并通过 C 指数进行验证。在 5 年内，样本 1 和样本 2 分别发生了 300 例和 122 例糖尿病事件。在样本 1 和样本 2 中，log 瘦素：脂联素比值和 VAT 每增加 1 个标准差与糖尿病的关联最强（HR，1.95 [95%CI，1.67-2.27] 和 1.76 [95%CI，1.52-2.04]），预测能力（C 指数 0.68 [95%CI，0.64-0.71] 和 C 指数 0.67 [95%CI，0.61-0.74]）最高。与糖尿病前期组相比，血糖正常组的 WC、肝脏衰减和 VAT 与糖尿病的相关性更强（交互作用 <0.10）。在样本 2 中，WC（HR，0.84；95%CI，0.73-0.95）、VAT（HR，0.91；95%CI，0.85-0.98）和肝脏衰减（HR，0.90；95%CI，0.77-1.00）的 C 指数大于 HbA（HR，0.74；95%CI，0.57-0.90）在血糖正常人群中，而 HbA 在糖尿病前期患者中是最佳预测因子（HR，0.72；95%CI，0.66-0.78）。
结论 总体而言，在黑种成年人中，多种肥胖指标与糖尿病的发生有关，预测能力适中。在血糖正常的黑种人群中，WC、肝脏衰减和 VAT 可能可以适当识别出糖尿病风险较高的人群，而 HbA 是糖尿病前期患者的最佳预测指标。
