维生素 D、甲状旁腺激素、葡萄糖代谢与动脉粥样硬化多民族研究中的新发糖尿病。
Vitamin D, parathyroid hormone, glucose metabolism and incident diabetes in the multiethnic study of atherosclerosis.
机构信息
Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, Ohio, USA.
出版信息
BMJ Open Diabetes Res Care. 2022 Sep;10(5). doi: 10.1136/bmjdrc-2022-002931.
INTRODUCTION
Higher concentrations of serum 25-hydroxyvitamin D (25(OH)D) and lower concentrations of parathyroid hormone (PTH) are associated with lower insulin resistance and incident diabetes in non-Hispanic White and Hispanic Americans. Results are mixed in other populations, with no observational studies in a large multiethnic cohort. The association of serum 25(OH)D with diabetes may vary by adiposity level.
RESEARCH DESIGN AND METHODS
Among 5611 participants in the Multi-Ethnic Study of Atherosclerosis without diabetes at baseline, cross-sectional associations of serum 25(OH)D with homeostasis model assessment of insulin resistance (HOMA-IR) and HOMA-β were examined using linear regressions. The association of 25(OH)D with incident diabetes over 9 years was examined using Cox proportional hazard regression.
RESULTS
Black Americans had the highest proportion of individuals with 25(OH)D<20 ng/mL (61%) and White Americans had the least (17%). Serum 25(OH)D was inversely associated with HOMA-IR in fully adjusted models (-0.34% difference in HOMA-IR per ng/mL higher 25(OH)D, p<0.0001). Longitudinally, a 1 ng/mL higher serum 25(OH)D was associated with 2% lower risk of incident diabetes (HR 0.982, CI 0.974 to 0.991), and a 1 pg/mL higher serum PTH was associated with 1% higher risk of incident diabetes (HR 1.007, CI 1.004 to 1.010), both prior to adjustment for waist circumference. After adjusting for waist circumference, a 1 ng/mL higher 25(OH)D was associated with 1% lower risk of incident diabetes (HR 0.991, CI 0.983 to 1.000). The magnitude of association of serum 25(OH)D with incident diabetes was largest at lower waist circumference (p for interaction=0.025). There was no heterogeneity by race/ethnicity (p=0.317).
CONCLUSIONS
Serum 25(OH)D is inversely associated with insulin resistance and incident diabetes in a diverse cohort, including non-Hispanic White, Black, Hispanic and Chinese Americans. Future research should explore mechanisms for the interaction between serum 25(OH)D and adiposity in this relationship.
简介
非西班牙裔白人和西班牙裔美国人中，血清 25-羟维生素 D（25（OH）D）浓度较高和甲状旁腺激素（PTH）浓度较低与胰岛素抵抗降低和糖尿病发病相关。在其他人群中结果不一，且在大型多民族队列中尚无观察性研究。血清 25（OH）D 与糖尿病的相关性可能因肥胖程度而异。
研究设计和方法
在基线时无糖尿病的多民族动脉粥样硬化研究（Multi-Ethnic Study of Atherosclerosis）5611 名参与者中，采用线性回归检验了血清 25（OH）D 与稳态模型评估的胰岛素抵抗（HOMA-IR）和 HOMA-β之间的横断面相关性。采用 Cox 比例风险回归检验了 9 年期间血清 25（OH）D 与新发糖尿病的相关性。
结果
黑种美国人的血清 25（OH）D<20ng/ml 比例最高（61%），而白种美国人的比例最低（17%）。在完全调整模型中，血清 25（OH）D 与 HOMA-IR 呈负相关（每增加 1ng/ml 血清 25（OH）D，HOMA-IR 降低 0.34%，p<0.0001）。纵向研究显示，血清 25（OH）D 增加 1ng/ml 与新发糖尿病风险降低 2%相关（HR 0.982，CI 0.974 至 0.991），血清 PTH 增加 1pg/ml 与新发糖尿病风险增加 1%相关（HR 1.007，CI 1.004 至 1.010），两者均在未调整腰围前得出。调整腰围后，血清 25（OH）D 每增加 1ng/ml，新发糖尿病风险降低 1%（HR 0.991，CI 0.983 至 1.000）。血清 25（OH）D 与新发糖尿病的相关性在较低的腰围时最大（p 交互=0.025）。种族/民族之间无差异（p=0.317）。
结论
在包括非西班牙裔白人、黑种人、西班牙裔和中国人在内的不同人群中，血清 25（OH）D 与胰岛素抵抗和新发糖尿病呈负相关。未来的研究应探索在这种关系中血清 25（OH）D 与肥胖之间相互作用的机制。
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