评估基线体重指数、腰围和腰高比的时间差异在预测未来糖尿病中的作用。

Assessing temporal differences of baseline body mass index, waist circumference, and waist-height ratio in predicting future diabetes.

机构信息

Jiangxi Provincial Geriatric Hospital, Jiangxi Provincial People's Hospital, Medical College of Nanchang University, Nanchang, Jiangxi, China.

Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China.

出版信息

Front Endocrinol (Lausanne). 2023 Jan 6;13:1020253. doi: 10.3389/fendo.2022.1020253. eCollection 2022.

DOI:10.3389/fendo.2022.1020253

PMID:36686484

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9852880/

Abstract

OBJECTIVE

Obesity is the prominent modifiable risk factor known to influence the occurrence and progression of diabetes other than age, and the objective of this study was to evaluate and compare the predictive value of three simple baseline anthropometric indicators of obesity, body mass index (BMI), waist circumference (WC), and waist-height ratio (WHtR), for the occurrence of diabetes at different time points in the future.

METHODS

The study subjects were 12,823 individuals with normoglycemic at baseline who underwent health screening and had measurements of BMI, WC, and WHtR. The outcome of interest was new-onset diabetes during follow-up. Time-dependent receiver operator characteristics (ROC) curves of baseline BMI, WC, and WHtR for predicting the risk of diabetes in the next 2 to 12 years were constructed and their area under the ROC curves (AUCs) and corresponding optimal threshold values were calculated for each time point, which were used to compare the accuracy and stability of the above three indicators for predicting the occurrence of diabetes in different future periods.

RESULTS

During a median follow-up period of 7.02 years, with a maximum follow-up of 13 years, 320 new-onset diabetes were recorded. After adjusting for confounders and comparing standardized hazard ratios (HRs), WC was shown to be the best simple anthropometric indicator of obesity reflecting diabetes risk in all models, followed by WHtR. Time-dependent ROC analysis showed that WC had the highest AUC in predicting the occurrence of diabetes in the short term (2-5 years), and WHtR had the highest AUC in predicting the occurrence of diabetes in the medium to long term (6-12 years), while in any time point, both WC and WHtR had higher AUC than BMI in predicting future diabetes. In addition, we found relatively larger fluctuations in the thresholds of BMI and WC for predicting diabetes over time, while the thresholds of WHtR consistently remained between 0.47-0.50; comparatively speaking, WHtR may have greater application value in predicting future diabetes.

CONCLUSIONS

Our analysis sustained that central obesity is a more important predictor of diabetes, and in clinical practice, we proposed measuring WHtR as a useful tool for predicting future diabetes.

摘要

目的

肥胖是已知的除年龄以外影响糖尿病发生和发展的重要可改变危险因素，本研究旨在评估和比较三种简单的基线肥胖人体测量指标，即体重指数（BMI）、腰围（WC）和腰高比（WHtR），在未来不同时间点预测糖尿病发生的预测价值。

方法

研究对象为 12823 名基线时血糖正常的个体，他们接受了健康筛查，并测量了 BMI、WC 和 WHtR。主要结局是随访期间新发糖尿病。构建了基线 BMI、WC 和 WHtR 对未来 2 至 12 年内糖尿病风险的时间依赖性受试者工作特征（ROC）曲线，并计算了每个时间点的 ROC 曲线下面积（AUC）及其相应的最佳阈值，用于比较上述三种指标在预测不同未来时间段糖尿病发生的准确性和稳定性。

结果

在中位随访时间为 7.02 年（最长随访时间为 13 年）期间，共记录到 320 例新发糖尿病。在调整混杂因素并比较标准化风险比（HR）后，WC 被证明是反映所有模型中糖尿病风险的最佳肥胖简单人体测量指标，其次是 WHtR。时间依赖性 ROC 分析显示，WC 在预测短期（2-5 年）糖尿病发生方面具有最高的 AUC，WHtR 在预测中至长期（6-12 年）糖尿病发生方面具有最高的 AUC，而在任何时间点，WC 和 WHtR 预测未来糖尿病的 AUC 均高于 BMI。此外，我们发现 BMI 和 WC 预测糖尿病的阈值随时间变化波动较大，而 WHtR 的阈值在 0.47-0.50 之间始终保持一致；相对而言，WHtR 在预测未来糖尿病方面可能具有更大的应用价值。