Qiu Zixin, Lee Dong Hoon, Lu Qi, Li Rui, Zhu Kai, Li Lin, Li Ruyi, Pan An, Giovannucci Edward L, Liu Gang
Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
Department of Sport Industry Studies, Yonsei University, Seoul 03722, Republic of Korea.
J Clin Endocrinol Metab. 2025 Jan 21;110(2):e372-e381. doi: 10.1210/clinem/dgae192.
It is largely unknown whether regional fat accumulation is associated with risk of cardiovascular disease (CVD) and mortality among individuals with type 2 diabetes (T2D), who often exhibit changes in relative fat distribution and have increased CVD risk.
To prospectively examine the association between regional body fat and risk of CVD in individuals with T2D and to determine whether the associations are independentof traditional measures of obesity.
The main analysis included 21 472 participants with T2D from the UK Biobank. Regional body fat was measured by bioelectric impedance assessment. Cox proportional-hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs.
Over a median of 7.7 years of follow-up, 3976 CVD events occurred. After multivariable adjustment, upper and lower body fat were independently and oppositely associated with CVD risk among patients with T2D. Higher arm fat percentage was linearly associated with increased CVD risk (Pnonlinear > .05), while higher trunk fat percentage was nonlinearly associated with increased CVD risk (Pnonlinear < .05). In contrast, higher leg fat percentage was nonlinearly associated with lower CVD risk (Pnonlinear < .05). When comparing extreme quartiles, the multivariable-adjusted HR (95% CI) of CVD was 0.72 (0.58-0.90) for leg fat percentage, 1.63 (1.29-2.05) for arm fat percentage, and 1.27 (1.06-1.52) for trunk fat percentage. Similar patterns of associations were observed for all-cause and CVD mortality. In addition, leg fat percentage, but not other regional fat percentage, was associated with CVD risk independently of traditional measures of obesity.
Among people with T2D, arm fat and trunk fat were positively, whereas leg fat was inversely, associated with the risk of CVD and mortality. These findings highlight the importance of considering both the amount and the location of body fat when assessing CVD and mortality risk among individuals with T2D.
在2型糖尿病（T2D）患者中，区域脂肪堆积是否与心血管疾病（CVD）风险及死亡率相关很大程度上尚不清楚，这类患者常表现出相对脂肪分布的变化且CVD风险增加。
前瞻性研究T2D患者区域体脂与CVD风险之间的关联，并确定这些关联是否独立于传统肥胖指标。
主要分析纳入了英国生物银行的21472例T2D患者。通过生物电阻抗评估测量区域体脂。采用Cox比例风险回归模型估计风险比（HR）和95%置信区间（CI）。
在中位7.7年的随访期内，发生了3976例CVD事件。多变量调整后，上半身和下半身脂肪与T2D患者的CVD风险独立且呈相反关联。较高的手臂脂肪百分比与CVD风险增加呈线性相关（P非线性>.05），而较高的躯干脂肪百分比与CVD风险增加呈非线性相关（P非线性<.05）。相反，较高的腿部脂肪百分比与较低的CVD风险呈非线性相关（P非线性<.05）。比较极端四分位数时，腿部脂肪百分比的多变量调整后CVD风险比（95%CI）为0.72（0.58 - 0.90），手臂脂肪百分比为1.63（1.29 - 2.05），躯干脂肪百分比为1.27（1.06 - 1.52）。全因死亡率和CVD死亡率也观察到类似的关联模式。此外，腿部脂肪百分比而非其他区域脂肪百分比与CVD风险的关联独立于传统肥胖指标。
在T2D患者中，手臂脂肪和躯干脂肪与CVD及死亡风险呈正相关，而腿部脂肪与之呈负相关。这些发现凸显了在评估T2D患者的CVD和死亡风险时考虑体脂量和位置的重要性。
