Asgari Samaneh, Molavizadeh Danial, Soltani Kiarash, Khalili Davood, Azizi Fereidoun, Hadaegh Farzad
Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, 19395-4763, Tehran, Islamic Republic of Iran.
School of Medicine, Kashan University of Medical Sciences, Kashan, Iran.
Diabetol Metab Syndr. 2024 Jan 25;16(1):27. doi: 10.1186/s13098-023-01253-0.
The effect of obesity in different glucose tolerance statuses i.e. normoglycemia (NGT), pre-diabetes, and type 2 diabetes (T2DM) on cardiovascular disease (CVD) and mortality has been an area of ongoing debate and uncertainty. In the present study, we aimed to examine the impact of being obese, whether general or central separately, in comparison with non-obese in different glucose tolerance statuses on the above outcomes.
The study population included 18,184 participants aged 30-60 years (9927 women) from three longitudinal studies, including Atherosclerosis Risk in Communities, Multi-Ethnic Study of Atherosclerosis, and Tehran Lipid and Glucose Study. Glucose tolerance status was defined as NGT (fasting plasma glucose < 5.55 mmol/L), pre-diabetes (5.55-7.00 mmol/L), and T2DM (≥ 7 mmol/L or taking any medication for diabetes). Moreover, general and central obesity were defined based on body mass index and waist circumference (WC), respectively. Multivariable stratified Cox regression analysis was used to estimate hazard ratios (HRs (95% CI)) for CVD and mortality events.
During a 16-year follow-up, 2733 CVD events, 1101 CV mortality, and 3678 all-cause mortality events were recorded. We observed that being generally obese in comparison with non-obese increased the risk of CV and all-cause mortality in all glucose tolerance statuses; while considering CVD events, only among individuals with T2DM, the presence of general obesity was associated with marginally significant higher risk [1.19 (0.98-1.43); p-value = 0.07]. Regarding central adiposity, multivariate analysis revealed that elevated WC in NGT participants is associated with incident CVD [1.27(1.12-1.46)] and all-cause mortality [1.13(1.00-1.28)]. Moreover, central adiposity increased the risk of CV mortality in pre-diabetes individuals [1.47 (1.11-1.95)].
Findings from this pooled prospective cohort studies provide evidence that general obesity shows an unfavorable association with CV and all-cause mortality among the general population irrespective of their glucose tolerance statusThe findings imply that it's important to take into account the requirement and magnitude of weight reduction in people who are obese when offering guidance.
肥胖在不同糖耐量状态（即正常血糖（NGT）、糖尿病前期和2型糖尿病（T2DM））下对心血管疾病（CVD）和死亡率的影响一直是一个持续争论且存在不确定性的领域。在本研究中，我们旨在探讨在不同糖耐量状态下，与非肥胖者相比，一般肥胖或中心性肥胖单独对上述结局的影响。
研究人群包括来自三项纵向研究的18184名年龄在30 - 60岁的参与者（9927名女性），这些研究包括社区动脉粥样硬化风险研究、多族裔动脉粥样硬化研究和德黑兰血脂与血糖研究。糖耐量状态定义为NGT（空腹血糖＜5.55 mmol/L）、糖尿病前期（5.55 - 7.00 mmol/L）和T2DM（≥7 mmol/L或正在服用任何糖尿病药物）。此外，一般肥胖和中心性肥胖分别根据体重指数和腰围（WC）来定义。采用多变量分层Cox回归分析来估计CVD和死亡事件的风险比（HRs（95%CI））。
在16年的随访期间，记录了2733例CVD事件、1101例心血管死亡和3678例全因死亡事件。我们观察到，与非肥胖者相比，一般肥胖会增加所有糖耐量状态下心血管和全因死亡的风险；而考虑CVD事件时，仅在T2DM个体中，一般肥胖的存在与略高的风险相关[1.19（0.98 - 1.43）；p值 = 0.07]。关于中心性肥胖，多变量分析显示，NGT参与者中WC升高与新发CVD[1.27（1.12 - 1.46）]和全因死亡[1.13（1.00 - 1.28）]相关。此外，中心性肥胖增加了糖尿病前期个体心血管死亡的风险[1.47（1.11 - 1.95）]。
这项汇总的前瞻性队列研究结果提供了证据，表明一般肥胖与普通人群的心血管和全因死亡存在不利关联，无论其糖耐量状态如何。研究结果意味着在提供指导时，考虑肥胖者减轻体重的需求和幅度很重要。
