Hu R Y, He Q F, Pan J, Wang M, Zhou X Y, Yu M
Department of Chronic and Non-communicable Disease Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2021 Jul 10;42(7):1194-1199. doi: 10.3760/cma.j.cn112338-20200615-00841.
To investigate the association between body mass index (BMI) changes and other risk factors for cardiovascular disease in patients with type 2 diabetes mellitus (T2DM). Based on the T2DM cohort in rural communities of Zhejiang province, baseline and follow up information of height, weight, blood pressure, glycated hemoglobin (HbA1c), TC, TG, LDL-C and HDL-C of the T2DM patients were collected. After excluding those who died during the follow-up period, lost follow-up or had incomplete information, a total of 8 953 T2DM patients were included in the final analysis. Multiple linear regression and Cox proportional hazards regression models were used for analysis. At baseline survey, 40.97% of the T2DM patients were overweight and obese. Compared with those with normal BMI, the SBP, DBP and TG level were significantly higher, while HDL-C level was significantly lower in the overweight and obese T2DM patients (<0.01). During the follow-up period, the blood glucose control rate in the patients increased by 15%, and the levels of HbA1c decreased in the patients with different BMI changes at different degrees. Compared with the patients who kept normal BMI, the HbA1c level decrease had a smaller range, while the SBP and DBP increase had a larger range in the patients with persistent overweight and obesity, and their substandard rates of HbA1c, SBP, DBP, TG, HDL-C levels were 1.142 (1.057-1.233) times, 1.123 (1.055-1.196) times, 1.220 (1.128-1.320) times, 1.400 (1.282-1.528) times and 1.164 (1.069-1.267) times higher. The changes of blood pressure, blood lipids and other related indicators in the patients whose BMI became abnormal were similar to those of the patients with persistent overweight and obesity; Compared with the patients whose BMI were kept normal, the differences in changes and substandard rate of blood glucose level, blood pressure level in the patients whose BMI became normal were not significant (>0.05). The change value of BMI was positively correlated with the change value of SBP, DBP, TG and LDL-C, while negatively correlated with the change value of HDL-C (<0.05). Abnormal changes in BMI are associated with the adverse changes of blood glucose level, blood pressure, and blood lipids level and other cardiovascular disease risk factors. Keeping normal BMI would benefit the positive outcome of cardiovascular adverse factors.
探讨2型糖尿病(T2DM)患者体重指数(BMI)变化与心血管疾病其他危险因素之间的关联。基于浙江省农村社区的T2DM队列,收集了T2DM患者的身高、体重、血压、糖化血红蛋白(HbA1c)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)和高密度脂蛋白胆固醇(HDL-C)的基线和随访信息。在排除随访期间死亡、失访或信息不完整的患者后,最终分析共纳入8953例T2DM患者。采用多元线性回归和Cox比例风险回归模型进行分析。在基线调查时,40.97%的T2DM患者超重和肥胖。与BMI正常者相比,超重和肥胖的T2DM患者收缩压(SBP)、舒张压(DBP)和TG水平显著升高,而HDL-C水平显著降低(<0.01)。随访期间,患者血糖控制率提高了15%,不同BMI变化程度的患者HbA1c水平均有不同程度下降。与BMI维持正常的患者相比,持续超重和肥胖患者的HbA1c水平下降幅度较小,而SBP和DBP升高幅度较大,其HbA1c、SBP、DBP、TG、HDL-C水平不达标的发生率分别高1.142(1.0571.233)倍、1.123(1.0551.196)倍、1.220(1.1281.320)倍、1.400(1.2821.528)倍和1.164(1.069~1.267)倍。BMI变为异常的患者血压、血脂等相关指标变化与持续超重和肥胖患者相似;与BMI维持正常的患者相比,BMI变为正常的患者血糖水平、血压水平变化及不达标的发生率差异无统计学意义(>0.05)。BMI变化值与SBP、DBP、TG和LDL-C变化值呈正相关,与HDL-C变化值呈负相关(<0.05)。BMI异常变化与血糖水平、血压和血脂水平等心血管疾病危险因素的不良变化有关。维持正常BMI有利于心血管不良因素的转归。