体重指数（BMI）和腰围与糖尿病微血管并发症的关联：来自英国生物库的前瞻性队列研究和孟德尔随机化分析。

Association of BMI and waist circumference with diabetic microvascular complications: A prospective cohort study from the UK Biobank and Mendelian randomization analysis.

机构信息

Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Clinical Research Center for Eye Diseases, Shanghai Key Clinical Specialty, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, 100 Haining Road, Hongkou District, Shanghai 200080, China.

出版信息

Diabetes Res Clin Pract. 2023 Nov;205:110975. doi: 10.1016/j.diabres.2023.110975. Epub 2023 Oct 25.

DOI:10.1016/j.diabres.2023.110975

PMID:37884062

Abstract

AIMS

To investigate the precise association between BMI and waist circumference (WC) and diabetic complications, including retinopathy (DR), nephropathy (DN) and peripheral neuropathy (DPN).

METHODS

A multivariable-adjusted Cox proportional hazard model was used to evaluate the observed association from 30,541 UK Biobank participants with diabetes. A two-sample Mendelian randomization (MR) framework was applied to summary-level GWASs of BMI and WC comprising a total of 461,460 and 462,166 participants from UK Biobank to explore the potential causal association.

RESULTS

Higher BMI and WC were associated with increased risks of DR, DN, and DPN (HR (95% CI), per-SD increase: BMI: DR 1.09 (1.04-1.13), DN 1.37 (1.33-1.41), DPN 1.27 (1.20-1.34); WC: DR 1.11 (1.07-1.16), DN 1.41 (1.36-1.46), DPN 1.38 (1.30-1.45)) in the UK Biobank cohort. Univariate MR indicated that increased BMI and WC were causal risk factors for these complications (OR (95% CI), per-SD increase: BMI: DR 1.33 (1.22-1.45), DN 1.74 (1.47-2.07), DPN 2.20 (1.67-2.90); WC: DR 1.43 (1.27-1.61), DN 2.03 (1.62-2.55), DPN 2.80 (1.99-3.92)), and the effect sizes remained significant after adjustment for glycated hemoglobin.

CONCLUSIONS

Prospective observational and MR analyses provided evidence that high BMI and WC may represent potential causal risk factors for diabetic microvascular complications. Weight control might modify the risks of these complications independently of glycemic control and should be considered as a therapeutic recommendation.

摘要

目的

探讨 BMI 和腰围（WC）与糖尿病并发症（包括视网膜病变[DR]、肾病[DN]和周围神经病变[DPN]）的确切关联。

方法

使用多变量调整 Cox 比例风险模型评估了来自英国生物库 30541 名糖尿病患者的观察关联。应用两样本 Mendelian 随机化（MR）框架，对 BMI 和 WC 的汇总水平 GWAS 进行分析，共纳入英国生物库 461460 名和 462166 名参与者，以探讨潜在的因果关联。

结果

较高的 BMI 和 WC 与 DR、DN 和 DPN 的风险增加相关（HR（95%CI），每增加一个 SD：BMI：DR 1.09（1.04-1.13），DN 1.37（1.33-1.41），DPN 1.27（1.20-1.34）；WC：DR 1.11（1.07-1.16），DN 1.41（1.36-1.46），DPN 1.38（1.30-1.45））。在英国生物库队列中。单变量 MR 表明，BMI 和 WC 的增加是这些并发症的因果危险因素（OR（95%CI），每增加一个 SD：BMI：DR 1.33（1.22-1.45），DN 1.74（1.47-2.07），DPN 2.20（1.67-2.90）；WC：DR 1.43（1.27-1.61），DN 2.03（1.62-2.55），DPN 2.80（1.99-3.92）），并且在调整糖化血红蛋白后，这些效应大小仍然显著。