Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China.
Center for Disease Control and Prevention of Chaoyang District, Beijing, China.
JMIR Public Health Surveill. 2023 Jan 11;9:e39459. doi: 10.2196/39459.
General obesity and abdominal obesity, typically measured by BMI and waist circumference (WC), respectively, are associated with an increased risk of type 2 diabetes mellitus (T2DM). However, the magnitude of the association of these two obesity indicators and their joint association with the onset of T2DM remain controversial.
The aim of this study was to investigate the associations between these two obesity indicators and T2DM among the Chinese population to contribute scientific evidence for appropriate T2DM interventions.
A cohort of 3001 eligible participants was selected from the Ningbo Adult Chronic Disease Surveillance Project running since 2015. Based on BMI, individuals were categorized into groups of underweight or normal, overweight, and obesity. Based on WC, individuals were categorized in groups of normal, precentral obesity, and central obesity. Follow-up was performed by linking data of the baseline data set with the diabetes registry data set and the vital registry data set (both from the Ningbo Municipal Integrated Noncommunicable Disease Collaborative Management System), mainly using the participants' identity numbers. Follow-up was completed when a participant was diagnosed with T2DM. The associations were estimated with multivariate Cox proportional hazard regression.
In the cohort, 90 of 3001 participants developed T2DM (incidence density: 6.483/1000 person-years) with a median 4.72 years of follow-up. After controlling for age, sex, hypertension, dyslipidemia, smoking status, and family history of diabetes, the multivariate adjusted hazard ratios (HRs) across underweight/normal, overweight, and obesity BMI categories were 1.000, 1.653 (95% CI 1.030-2.654), and 2.375 (95% CI 1.261-4.473), respectively. The multivariate adjusted HRs across the normal, precentral obesity, and central obesity WC categories were 1.000, 1.215 (95% CI 0.689-2.142), and 1.663 (95% CI 1.016-2.723), respectively. Compared with the reference group (normal WC with an underweight/normal BMI), the multivariate adjusted HR for participants with both central obesity according to WC and obesity according to BMI was 2.489 (95% CI 1.284-4.825).
Both elevated BMI and WC at baseline increased the risk of T2DM. Compared with WC, BMI as an obesity indicator was more strongly associated with the onset of T2DM.
一般肥胖和腹部肥胖，通常分别通过体重指数（BMI）和腰围（WC）来衡量，与 2 型糖尿病（T2DM）的风险增加相关。然而，这两种肥胖指标的关联程度及其与 T2DM 发病的联合关联仍存在争议。
本研究旨在调查中国人群中这两种肥胖指标与 T2DM 之间的关联，为适当的 T2DM 干预提供科学依据。
从 2015 年开始运行的宁波成人慢性病监测项目中选择了 3001 名符合条件的参与者组成队列。根据 BMI，将个体分为体重不足或正常、超重和肥胖组。根据 WC，将个体分为正常、前中心性肥胖和中心性肥胖组。通过将基线数据集与糖尿病登记数据集和生命登记数据集（均来自宁波市级综合非传染性疾病协同管理系统）的数据相链接来进行随访，主要使用参与者的身份证号码。当参与者被诊断为 T2DM 时，随访完成。使用多变量 Cox 比例风险回归估计关联。
在队列中，3001 名参与者中有 90 名发生了 T2DM（发病率密度：6.483/1000 人年），中位随访时间为 4.72 年。在控制了年龄、性别、高血压、血脂异常、吸烟状况和糖尿病家族史后，体重不足/正常、超重和肥胖 BMI 类别中的多变量调整后的危险比（HR）分别为 1.000、1.653（95%置信区间 1.030-2.654）和 2.375（95%置信区间 1.261-4.473）。WC 正常、前中心性肥胖和中心性肥胖类别中的多变量调整 HR 分别为 1.000、1.215（95%置信区间 0.689-2.142）和 1.663（95%置信区间 1.016-2.723）。与参考组（WC 正常，BMI 体重不足/正常）相比，WC 根据 WC 为中心性肥胖且 BMI 根据 BMI 为肥胖的参与者的多变量调整 HR 为 2.489（95%置信区间 1.284-4.825）。
基线时升高的 BMI 和 WC 均增加了 T2DM 的风险。与 WC 相比，BMI 作为肥胖指标与 T2DM 的发病更密切相关。
