Am J Epidemiol. 2024 May 7;193(5):685-694. doi: 10.1093/aje/kwad080.
This study investigated the association between body mass index (BMI) trajectories in late middle age and incident diabetes in later years. A total of 11,441 participants aged 50-60 years from the Health and Retirement Study with at least 2 self-reported BMI records were included. Individual BMI trajectories representing average BMI changes per year were generated using multilevel modeling. Adjusted risk ratios (ARRs) and 95% confidence intervals (95% CIs) were calculated. Associations between BMI trajectories and diabetes risk in participants with different genetic risks were estimated for 5,720 participants of European ancestry. BMI trajectories were significantly associated with diabetes risk in older age (slowly increasing vs. stable: ARR = 1.31, 95% CI: 1.12, 1.54; rapidly increasing vs. stable: ARR = 1.5, 95% CI: 1.25, 1.79). This association was strongest for normal-initial-BMI participants (slowly increasing: ARR = 1.34, 95% CI: 0.96, 1.88; rapidly increasing: ARR = 2.06, 95% CI: 1.37, 3.11). Participants with a higher genetic liability to diabetes and a rapidly increasing BMI trajectory had the highest risk for diabetes (ARR = 2.15, 95% CI: 1.67, 2.76). These findings confirmed that BMI is the leading risk factor for diabetes and that although the normal BMI group has the lowest incidence rate for diabetes, people with normal BMI are most sensitive to changes in BMI.
这项研究调查了中老年时期体重指数（BMI）轨迹与晚年新发糖尿病之间的关系。共有 11441 名年龄在 50-60 岁的参与者来自健康与退休研究，他们至少有 2 次自我报告的 BMI 记录。使用多层次建模生成代表每年平均 BMI 变化的个体 BMI 轨迹。计算了调整后的风险比（ARR）和 95%置信区间（95%CI）。在具有不同遗传风险的参与者中，估计了 5720 名欧洲血统参与者的 BMI 轨迹与糖尿病风险之间的关联。BMI 轨迹与老年时的糖尿病风险显著相关（缓慢增加与稳定相比：ARR=1.31，95%CI：1.12，1.54；快速增加与稳定相比：ARR=1.5，95%CI：1.25，1.79）。对于初始 BMI 正常的参与者，这种关联最强（缓慢增加：ARR=1.34，95%CI：0.96，1.88；快速增加：ARR=2.06，95%CI：1.37，3.11）。具有更高糖尿病遗传易感性和 BMI 快速增加轨迹的参与者患糖尿病的风险最高（ARR=2.15，95%CI：1.67，2.76）。这些发现证实 BMI 是糖尿病的主要危险因素，尽管正常 BMI 组的糖尿病发病率最低，但 BMI 变化对正常 BMI 人群的影响最大。
