Zheng Silan, Zhou Jingqi, Wang Kai, Wang Xinyue, Li Zhibin, Chen Ning
Department of Endocrinology, Zhongshan Hospital, Fudan University Xiamen Branch, Xiamen, People's Republic of China.
Department of Clinical Nutrition, Zhongshan Hospital, Fudan University Xiamen Branch, Xiamen, People's Republic of China.
Diabetes Metab Syndr Obes. 2022 Nov 3;15:3459-3468. doi: 10.2147/DMSO.S384266. eCollection 2022.
To evaluate associations of obesity indices with bone mineral densities (BMD) and risk of osteoporosis in T2DM patients totally and stratified across presence of any diabetic cardiovascular complications.
Cross-sectional analyses of baseline information on a cohort of 250 T2DM patients were conducted in Xiamen, China. Obesity indices included body weight, height, body mass index (BMI), waist and waist hip ratio (WHR). BMD was measured using dual-energy X-ray absorptiometry at three different sites, and osteoporosis was defined based on the minimum T-scores of BMD. Presence of any diabetic vascular complications was confirmed by checking their medical records histories.
Among the 250 T2DM patients, 50 (20.0%) were defined as osteoporosis. Multivariable linear regression and multivariable logistic regression analyses showed that igher obesity indices, including body weight, BMI and waist, but neither body height nor waist hip ratio, were positively associated with the minimum T-scores of BMD and had significantly decreased risk of osteoporosis. Stratified analyses across presence of any of diabetic vascular complications showed similar results for those with any of diabetic vascular complications, while no significant association between obesity indices and minimum T-scores of BMD was found for those without. Postmenopausal women (vs men) and ever drinking were significantly associated with increased risk of osteoporosis, and the adjusted odds ratios (95% CIs) were 5.165 (1.762-15.138, p = 0.003) and 3.789 (1.087-13.214, p = 0.037), respectively. None of metabolic profiles, including systolic and diastolic blood pressure, triglyceride, total cholesterol, high-density lipoprotein cholesterol, HbA1c and blood uric acid, was significantly associated with either minimum T-scores of BMD or risk of osteoporosis.
Associations of obesity indices with either BMD or risk of osteoporosis in T2DM patients varied by presence of any diabetic vascular complication and should be not interpreted as causal without considering the often-unmeasured effect modification by health status.
全面评估肥胖指数与2型糖尿病（T2DM）患者骨矿物质密度（BMD）及骨质疏松风险之间的关联，并根据是否存在糖尿病心血管并发症进行分层分析。
对中国厦门的250例T2DM患者队列的基线信息进行横断面分析。肥胖指数包括体重、身高、体重指数（BMI）、腰围和腰臀比（WHR）。采用双能X线吸收法在三个不同部位测量BMD，并根据BMD的最低T值定义骨质疏松。通过查阅病历确认是否存在任何糖尿病血管并发症。
在250例T2DM患者中，50例（20.0%）被定义为骨质疏松。多变量线性回归和多变量逻辑回归分析表明，较高的肥胖指数，包括体重、BMI和腰围，但不包括身高和腰臀比，与BMD的最低T值呈正相关，且骨质疏松风险显著降低。根据是否存在任何糖尿病血管并发症进行分层分析，结果显示存在糖尿病血管并发症的患者情况相似，而未患并发症的患者中肥胖指数与BMD的最低T值之间未发现显著关联。绝经后女性（与男性相比）和曾经饮酒与骨质疏松风险增加显著相关，校正后的优势比（95%置信区间）分别为5.165（1.762 - 15.138，p = 0.003）和3.789（1.087 - 13.214，p = 0.037）。包括收缩压和舒张压、甘油三酯、总胆固醇、高密度脂蛋白胆固醇、糖化血红蛋白（HbA1c）和血尿酸在内的所有代谢指标，与BMD的最低T值或骨质疏松风险均无显著关联。
肥胖指数与T2DM患者的BMD或骨质疏松风险之间的关联因是否存在糖尿病血管并发症而异，在不考虑健康状况通常无法测量的效应修饰作用的情况下，不应将其解释为因果关系。
