Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
Cardiovasc Diabetol. 2022 May 16;21(1):78. doi: 10.1186/s12933-022-01503-x.
Weight management is strongly promoted for overweight or obese patients with type 2 diabetes (T2DM) by current guidelines. However, the prognostic impact of weight loss achieved without behavioural intervention on the mortality and cardiovascular (CV) outcomes in diabetic patients is still contested.
We searched the PubMed, Embase, and Cochrane Library databases for studies that investigated the association of weight loss or weight variability with mortality and CV outcomes. Results of studies that measured weight loss by percentage weight loss from baseline and stratified it as > 10% and 5-10% or studies that computed weight variability were pooled using random effects model. Study quality was evaluated using the Newcastle-Ottawa Scale.
Thirty eligible studies were included in the systematic review and 13 of these were included in the meta-analysis. Large weight loss (> 10%) was associated with increased risk of all-cause mortality (pooled hazard ratio (HR) 2.27, 95% CI 1.51-3.42), composite of major CV events (pooled HR 1.71, 95% CI 1.38-2.12) and CV mortality (pooled HR 1.50, 95% CI 1.27-1.76) among T2DM patients. Moderate weight loss showed no significant association with all-cause mortality (pooled HR 1.17, 95% CI 0.97-1.41) or CV outcomes (pooled HR 1.12, 95% CI 0.94-1.33). Weight variability was associated with high hazard of all-cause mortality (pooled HR 1.54, 95% CI 1.52-1.56).
Large weight loss and large fluctuations in weight are potential markers of increased risk of mortality and CV events in T2DM patients. Maintaining a stable weight may have positive impact in these patients.
目前的指南强烈建议超重或肥胖的 2 型糖尿病（T2DM）患者进行体重管理。然而，对于未经行为干预就能减轻体重的糖尿病患者，其对死亡率和心血管（CV）结局的预后影响仍存在争议。
我们检索了 PubMed、Embase 和 Cochrane Library 数据库，以调查体重减轻或体重变化与死亡率和 CV 结局之间的关联。使用随机效应模型汇总了通过基线体重百分比变化衡量体重减轻且分为>10%和 5-10%的研究结果，或计算体重变化的研究结果。使用纽卡斯尔-渥太华量表评估研究质量。
系统评价共纳入 30 项符合条件的研究，其中 13 项纳入荟萃分析。大量体重减轻（>10%）与全因死亡率（合并危险比（HR）2.27，95%置信区间[CI] 1.51-3.42）、主要 CV 事件（合并 HR 1.71，95% CI 1.38-2.12）和 CV 死亡率（合并 HR 1.50，95% CI 1.27-1.76）的风险增加相关。中等程度的体重减轻与全因死亡率（合并 HR 1.17，95% CI 0.97-1.41）或 CV 结局（合并 HR 1.12，95% CI 0.94-1.33）无显著相关性。体重变化与全因死亡率的高风险相关（合并 HR 1.54，95% CI 1.52-1.56）。
大量体重减轻和体重波动大可能是 T2DM 患者死亡率和 CV 事件风险增加的潜在标志物。维持稳定的体重可能对这些患者有积极影响。
