Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
The First Hospital of Jilin University, Changchun, China.
Lancet Healthy Longev. 2021 Oct;2(10):e618-e628. doi: 10.1016/S2666-7568(21)00177-X. Epub 2021 Sep 7.
National investigations of age-specific modifiable risk profiles for diabetes are crucial to promote personalised strategies for the prevention and control of diabetes, particularly in countries such as China, which is experiencing both a diabetes epidemic and a rapidly ageing population. We aimed to examine the associations of 12 potentially modifiable socioeconomic, lifestyle, and metabolic risk factors with diabetes in a nationwide prospective cohort of Chinese adults across four age groups.
We analysed data from the China Cardiometabolic Disease and Cancer Cohort Study, a nationwide, population-based, cohort study done between Jan 1, 2011, and Dec 31, 2016. Among 93 781 participants without diabetes at baseline and with complete information available about risk factors and diabetes incidence, we examined the hazard ratios (HRs) and population-attributable risk percentages (PAR%s) of incident diabetes associated with 12 potentially modifiable risk factors: two socioeconomic risk factors (less education and intermediate or low grade occupation), five lifestyle risk factors (unhealthy diet, physical inactivity, current alcohol consumption, current smoking, and unhealthy sleep), and five metabolic risk factors (general or central obesity, insulin resistance, prediabetes, hypertension, and dyslipidaemia) across four age groups (40 to <55 years, 55 to <65 years, 65 to <75 years, and ≥75 years).
With 337 932 person-years' follow-up, 6171 participants developed diabetes. Although diabetes risk attributable to metabolic risk factors decreased slightly with age, metabolic risk factors accounted for most incident diabetes cases across all age groups (from a PAR% of 73·8% in participants aged 40 to <55 years to 65·5% in those aged ≥75 years), with prediabetes (ranging from a PAR% of 56·6% to 47·4%, with increasing age) and hypertension (PAR% of 16·8% to 28·6% with increasing age) being the leading risk factors across all age groups. By contrast, diabetes risk attributable to lifestyle risk factors increased substantially with age (with a PAR% of 9·9% in adults aged 40 to <55 years increasing to 29·7% in adults aged ≥75 years), and was especially evident in participants aged 75 years or older, in whom unhealthy sleep was the largest lifestyle factor, accounting for a PAR% of 17·0%. The impact of socioeconomic risk factors on diabetes was mainly driven by less education, which contributed to a PAR% of 7·1% to 12·4% in participants younger than 75 years but conferred no excess risk in participants aged 75 years or older. The risk of diabetes associated with unhealthy sleep significantly increased with age group (HR 1·04 [95% CI 0·95-1·13] among participants aged 40 to <55 years vs 1·36 [1·01-1·85] among participants aged ≥75 years; p=0·0054), but there was an age-related decrease in the risk of diabetes associated with obesity (1·35 [1·23-1·48] vs 0·99 [0·72-1·36]; p=0·0003), prediabetes (3·00 [2·67-3·37] vs 2·18 [1·41-3·37]; p=0·0014), and dyslipidaemia (1·23 [1·13-1·34] vs 0·90 [0·66-1·21]; p=0·016).
These findings provide novel insights into age-related modifiable risk factor profiles for diabetes in Chinese adults, highlighting the importance of prioritising risk factors according to age groups for effective prevention and management of diabetes.
National Natural Science Foundation of China.
For the Chinese translation of the abstract see Supplementary Materials section.
对特定于年龄的可修改风险概况进行国家调查对于促进糖尿病的个性化预防和控制至关重要，特别是在中国这种同时经历糖尿病流行和人口迅速老龄化的国家。我们旨在通过全国性的前瞻性队列研究，调查 12 种潜在的可修改的社会经济、生活方式和代谢危险因素与中国成年人各年龄段糖尿病之间的关联。
我们分析了中国心脏代谢性疾病和癌症队列研究的数据，这是一项全国性的、基于人群的队列研究，于 2011 年 1 月 1 日至 2016 年 12 月 31 日进行。在基线时无糖尿病且具有完整的风险因素和糖尿病发病信息的 93781 名参与者中，我们检查了 12 种潜在的可修改的风险因素（两个社会经济风险因素[教育程度较低和职业等级为中级或低级]、五个生活方式风险因素[不健康饮食、身体活动不足、当前饮酒、当前吸烟和不健康睡眠]和五个代谢风险因素[一般或中心性肥胖、胰岛素抵抗、前驱糖尿病、高血压和血脂异常]）与 4 个年龄组（40 岁至<55 岁、55 岁至<65 岁、65 岁至<75 岁和≥75 岁）之间发生糖尿病的风险比（HR）和人群归因风险百分比（PAR%）。
在 337932 人年的随访中，有 6171 名参与者发生了糖尿病。尽管随着年龄的增长，糖尿病的风险归因于代谢危险因素略有下降，但代谢危险因素在所有年龄组中都占大多数的糖尿病病例（从 40 岁至<55 岁年龄组的 73.8%到≥75 岁年龄组的 65.5%），其中前驱糖尿病（PAR% 范围为 56.6%至 47.4%，随年龄增长）和高血压（PAR% 从 16.8%到 28.6%，随年龄增长）是所有年龄组的主要危险因素。相比之下，随着年龄的增长，糖尿病的风险归因于生活方式的风险因素显著增加（40 岁至<55 岁年龄组的 9.9%增加到≥75 岁年龄组的 29.7%），这在 75 岁或以上的参与者中尤为明显，其中不健康睡眠是最大的生活方式因素，占 PAR%的 17.0%。社会经济风险因素对糖尿病的影响主要由教育程度较低引起，在年龄小于 75 岁的参与者中占 7.1%至 12.4%，但在 75 岁或以上的参与者中没有额外的风险。与不健康睡眠相关的糖尿病风险随着年龄组的增加而显著增加（40 岁至<55 岁年龄组的 HR 为 1.04[95%CI 0.95-1.13]，而≥75 岁年龄组的 HR 为 1.36[1.01-1.85]；p=0.0054），但肥胖（1.35[1.23-1.48]与 0.99[0.72-1.36]；p=0.0003）、前驱糖尿病（3.00[2.67-3.37]与 2.18[1.41-3.37]；p=0.0014）和血脂异常（1.23[1.13-1.34]与 0.90[0.66-1.21]；p=0.016）相关的糖尿病风险随年龄呈下降趋势。
这些发现为中国成年人糖尿病的年龄相关可修改风险因素特征提供了新的见解，强调了根据年龄组优先考虑风险因素对于有效预防和管理糖尿病的重要性。
国家自然科学基金。
