Zhang S T, Zhang J G, Jia X F, Jiang H R, Wang L S, Zhang B, Wang H J, Wang Z H, Ding G G
National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention/Key Laboratory of Trace Element Nutrition, National Health Commission of the People´s Republic of China, Beijing 100050, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2022 Oct 10;43(10):1596-1602. doi: 10.3760/cma.j.cn112338-20211115-00884.
To analyze the association between different types of obesity, BMI, and waist circumference (WC) and the risk of type 2 diabetes mellitus (T2DM) in Chinese adults. Based on the China Health and Nutrition Survey data in 2018, different types of obesity were defined across different BMI and WC combinations based on Criteria of weight for adults (WS/T 428-2013), including non-obesity, simple general obesity, simple central obesity, and complex obesity. The associations of different types of obesity, BMI, and WC with T2DM risk were explored using two-level mixed-effects logistic regression and restricted cubic spline models. A total of 7 030 subjects aged 18-65 were included in this study. The prevalence of general obesity and central obesity were 16.29% (502/3 082), 42.28% (1 303/3 082) in males, and 14.41% (569/3 948), 37.87% (1 495/3 948) in females. The prevalence of complex obesity was 14.70% and 12.97% in males and females, respectively. The prevalence of T2DM was 11.28% in participants, and the prevalence in complex obesity (18.98%, 22.07%) was higher than in simple central obesity (16.24%, 15.26%) and non-obesity (9.65%, 5.18%) in males and females, respectively. Multilevel regressions showed that males with simple central obesity and complex obesity had 1.61 (95%: 1.24-2.08) and 2.11 (95%: 1.56-2.86) times the odds of T2DM, respectively, as compared with the non-obesity; and the odds of T2DM in females were 2.70 (95%: 1.16-6.28) times for simple general obesity, 2.62 (95%: 2.01-3.40) times for simple central obesity, and 4.47 (95%: 3.35-5.98) times for complex obesity. A nearly linear positive association was observed between BMI and T2DM risk. WC was also positively associated with T2DM risk and a non-linearly increased risk in females ( for non-linear=0.024). The risk of T2DM increased when BMI ≥22.5 kg/m and 23.0 kg/m, WC ≥85.0 cm and 80.0 cm in males and females, respectively. Complex obesity adults are more likely to suffer from T2DM. The risk of T2DM increases significantly when BMI is at the normal high values and waist circumference at the stage of pre-central obesity.
分析中国成年人中不同类型肥胖、体重指数（BMI）和腰围（WC）与2型糖尿病（T2DM）风险之间的关联。基于2018年中国健康与营养调查数据，根据《成人失能权重（WS/T 428 - 2013）》标准，通过不同的BMI和WC组合定义了不同类型的肥胖，包括非肥胖、单纯性全身肥胖、单纯性中心性肥胖和复杂性肥胖。使用二级混合效应逻辑回归和受限立方样条模型探讨不同类型肥胖、BMI和WC与T2DM风险的关联。本研究共纳入7030名18 - 65岁的受试者。男性中全身肥胖和中心性肥胖的患病率分别为16.29%（502/3082）、42.28%（1303/3082），女性中分别为14.41%（569/3948）、37.87%（1495/3948）。男性和女性中复杂性肥胖的患病率分别为14.70%和12.97%。参与者中T2DM的患病率为11.28%，男性和女性中复杂性肥胖者的患病率（分别为18.98%、22.07%）高于单纯性中心性肥胖者（分别为16.24%、15.26%）和非肥胖者（分别为9.65%、5.18%）。多水平回归显示，与非肥胖者相比，男性中单纯性中心性肥胖和复杂性肥胖者患T2DM的几率分别为1.61倍（95%：1.24 - 2.08）和2.11倍（95%：1.56 - 2.86）；女性中单纯性全身肥胖者患T2DM的几率为2.70倍（95%：1.16 - 6.28），单纯性中心性肥胖者为2.62倍（95%：2.01 - 3.40），复杂性肥胖者为4.47倍（95%：3.35 - 5.98）。观察到BMI与T2DM风险之间存在近似线性正相关。WC也与T2DM风险呈正相关，且女性风险呈非线性增加（非线性检验P = 0.024）。男性和女性中，当BMI分别≥22.5 kg/m²和23.0 kg/m²、WC分别≥85.0 cm和80.0 cm时，T2DM风险增加。复杂性肥胖成年人更易患T2DM。当BMI处于正常高值且腰围处于中心性肥胖前期阶段时，T2DM风险显著增加。
