Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Diabetes Metab J. 2023 Jul;47(4):514-522. doi: 10.4093/dmj.2022.0159. Epub 2023 Apr 25.
Although obesity is a well-known risk factor of type 2 diabetes mellitus (T2DM), there is scant data on discriminating the contribution of previous obesity and recent weight gain on developing T2DM.
We analyzed the Korean National Health Insurance Service-Health Screening Cohort data from 2002 to 2015 where Korean residents underwent biennial health checkups. Participants were classified into four groups according to their obesity status (body mass index [BMI] ≥25 kg/m2) before and after turning 50 years old: maintaining normal (MN), becoming obese (BO), becoming normal (BN), and maintaining obese (MO). Cox proportional hazards regression model was used to estimate the risk of T2DM factoring in the covariates age, sex, BMI, presence of impaired fasting glucose or hypertension, family history of diabetes, and smoking status.
A total of 118,438 participants (mean age, 52.5±1.1 years; men, 45.2%) were prospectively evaluated for incident T2DM. A total of 7,339 (6.2%) participants were diagnosed with T2DM during a follow-up period of 4.8±2.6 years. Incidence rates of T2DM per 1,000 person-year were 9.20 in MN, 14.81 in BO, 14.42 in BN, 21.38 in MO. After factoring in covariates, participants in the groups BN (adjusted hazard ratio [aHR], 1.15; 95% confidence interval [CI], 1.04 to 1.27) and MO (aHR, 1.14; 95% CI, 1.06 to 1.24) were at increased risk of developing T2DM compared to MN, whereas BO (hazard ratio, 1.06; 95% CI, 0.96 to 1.17) was not.
Having been obese before 50 years old increased the risk of developing T2DM in the future, but becoming obese after 50 did not. Therefore, it is important to maintain normal weight from early adulthood to prevent future metabolic perturbations.
肥胖是 2 型糖尿病（T2DM）的一个众所周知的危险因素，但关于区分先前肥胖和近期体重增加对 T2DM 发展的贡献的数据很少。
我们分析了 2002 年至 2015 年韩国国民健康保险服务-健康筛查队列的数据，该数据来自接受两年一次健康检查的韩国居民。根据他们在 50 岁前后的肥胖状况（BMI≥25kg/m2），参与者被分为四组：保持正常（MN）、变得肥胖（BO）、恢复正常（BN）和保持肥胖（MO）。使用 Cox 比例风险回归模型，考虑年龄、性别、BMI、空腹血糖受损或高血压、糖尿病家族史和吸烟状况等协变量，估计 T2DM 的风险。
共有 118438 名参与者（平均年龄 52.5±1.1 岁；男性 45.2%）前瞻性评估了 T2DM 的发生情况。在 4.8±2.6 年的随访期间，共有 7339（6.2%）名参与者被诊断为 T2DM。每 1000 人年的 T2DM 发生率为 MN 组 9.20、BO 组 14.81、BN 组 14.42、MO 组 21.38。在考虑了协变量后，与 MN 组相比，BN 组（调整后的风险比[aHR]，1.15；95%置信区间[CI]，1.04 至 1.27）和 MO 组（aHR，1.14；95% CI，1.06 至 1.24）患 T2DM 的风险增加，而 BO 组（风险比，1.06；95% CI，0.96 至 1.17）则不然。
50 岁之前肥胖会增加未来患 T2DM 的风险，但 50 岁后肥胖不会。因此，从成年早期开始保持正常体重对于预防未来的代谢紊乱很重要。
