Lee Han Rim, Shin Jungeun, Han Kyungdo, Chang Jiwon, Jeong Su-Min, Chon Seung Joo, Choi Soo Jung, Shin Dong Wook
Department of Family Medicine & Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
International Healthcare Center, Samsung Medical Center, Seoul 06351, Korea.
J Clin Med. 2021 Nov 6;10(21):5189. doi: 10.3390/jcm10215189.
Although both obesity and menopause are associated with increased risk of diabetes mellitus (DM), the association between obesity and DM according to menopausal status remains uncertain. Therefore, we conducted a study to examine the relationship between obesity and incidence of diabetes mellitus (DM) in premenopausal and postmenopausal women. Total of 926,196 premenopausal and 1,193,881 postmenopausal women who underwent health examinations from 2009 to 2014 were identified using the database of the Korean National Health Insurance Service. We compared the incidence and risk of DM according to body mass index (BMI) and waist circumference (WC) in the two groups of women. Cox proportional hazards analyses were performed to evaluate the association between the presence of obesity and risk of DM according to menopausal state. During the 7.8-year follow-up period, 37,736 (4.1%) premenopausal women and 121,102 (10.1%) postmenopausal women were diagnosed with DM. Compared to the reference group (BMI 18.5-23), a stronger association between obesity and risk of DM was observed in both pre- and postmenopausal women: multivariable-adjusted hazard ratios and 95% confidence intervals for BMI subgroups <18.5, 23-25, 25-30, and >30 were 0.62 (0.54, 0.70), 1.91 (1.85, 1.97), 3.38 (3.28, 3.47), and 6.25 (6.02, 6.48), respectively ( trend < 0.001) in premenopausal women and 0.87 (0.82, 0.92), 1.44 (1.41, 1.46), 2.00 (1.97, 2.03), and 2.96 (2.89, 3.02) in postmenopausal women ( trend < 0.001, -interaction < 0.001). A similar trend was observed for WC. Subgroup analyses of women aged 45 to 55 also showed a stronger association with DM in premenopausal than in postmenopausal women. In conclusion, the association between obesity and DM was stronger in premenopausal women than in postmenopausal women. As estrogens are synthesized in adipose tissue by aromatization of androgens after menopause, increased estrogen levels in obese postmenopausal might have a protective effect against DM.
尽管肥胖和绝经都与糖尿病（DM）风险增加相关，但肥胖与DM之间的关联在绝经状态下仍不确定。因此，我们开展了一项研究，以探讨绝经前和绝经后女性中肥胖与糖尿病（DM）发病率之间的关系。利用韩国国民健康保险服务数据库，确定了2009年至2014年期间接受健康检查的926196名绝经前女性和1193881名绝经后女性。我们比较了两组女性中根据体重指数（BMI）和腰围（WC）的DM发病率和风险。进行Cox比例风险分析，以评估根据绝经状态肥胖的存在与DM风险之间的关联。在7.8年的随访期内，37736名（4.1%）绝经前女性和121102名（10.1%）绝经后女性被诊断为DM。与参考组（BMI 18.5 - 23）相比，绝经前和绝经后女性中肥胖与DM风险之间均观察到更强的关联：绝经前女性中BMI亚组<18.5、23 - 25、25 - 30和>30的多变量调整风险比及95%置信区间分别为0.62（0.54, 0.70）、1.91（1.85, 1.97）、3.38（3.28, 3.47）和6.25（6.02, 6.48）（趋势<0.001），绝经后女性分别为0.87（0.82, 0.92）、1.44（1.41, 1.46）、2.00（1.97, 2.03）和2.96（2.89, 3.02）（趋势<0.001，交互作用<0.001）。WC也观察到类似趋势。45至55岁女性的亚组分析也显示，绝经前女性中肥胖与DM的关联比绝经后女性更强。总之，绝经前女性中肥胖与DM之间的关联比绝经后女性更强。由于绝经后雌激素在脂肪组织中通过雄激素的芳香化合成，肥胖绝经后女性中升高的雌激素水平可能对DM有保护作用。
