Inserm, CHU Lille, U1286 -INFINITE-Institute for Translational Research in Inflammation, Université de Lille, Lille, France.
Services Maladies de l'Appareil Digestif, Hôpital Claude Huriez, CHRU Lille, Lille, France.
PLoS One. 2024 Mar 28;19(3):e0301463. doi: 10.1371/journal.pone.0301463. eCollection 2024.
Help public health decision-making requires a better understanding of the dynamics of obesity and type 2 diabetes and an assessement of different strategies to decrease their burdens.
Based on 97,848 individual data, collected in the French Health, Health Care and Insurance Survey over 1998-2014, a Markov model was developed to describe the progression of being overweight to obesity, and the onset of type 2 diabetes. This model traces and predicts 2022-2027 burdens of obesity and type 2 diabetes, and lifetime risk of diabetes, according to different scenarios aiming at minimum to stabilize obesity at 5 years.
Estimated risks of type 2 diabetes increase from 0.09% (normal weight) to 1.56% (obesity II-III). Compared to the before 1995 period, progression risks are estimated to have nearly doubled for obesity and tripled for type 2 diabetes. Consequently, over 2022-2027, the prevalence of obesity and type 2 diabetes will continue to increase from 17.3% to 18.2% and from 7.3% to 8.1%, respectively. Scenarios statibilizing obesity would require a 22%-decrease in the probability of move up (scenario 1) or a 33%-increase in the probability of move down (scenario 2) one BMI class. However, this stabilization will not affect the increase of diabetes prevalence whereas lifetime risk of diabetes would decrease (30.9% to 27.0%). Combining both scenarios would decrease obesity by 9.9%. Only the prevalence of obesity III shows early change able to predict the outcome of a strategy: for example, 6.7%-decrease at one year, 13.3%-decrease at two years with scenario 1 stabilizing obesity at 5 years.
Prevalences of obesity and type 2 diabetes will still increase over the next 5 years. Stabilizing obesity may decrease lifetime risks of type 2 diabetes without affecting its short-term prevalence. Our study highlights that, to early assess the effectiveness of their program, public health policy makers should rely on the change in prevalence of obesity III.
帮助公共卫生决策需要更好地了解肥胖和 2 型糖尿病的动态，并评估减少其负担的不同策略。
基于 1998 年至 2014 年期间在法国健康、医疗保健和保险调查中收集的 97848 个人数据，开发了一个马尔可夫模型来描述超重向肥胖的进展，以及 2 型糖尿病的发病情况。该模型根据旨在将肥胖症稳定在 5 年内的不同情景，追踪和预测 2022-2027 年肥胖症和 2 型糖尿病的负担以及糖尿病的终身风险。
估计 2 型糖尿病的风险从 0.09%（正常体重）增加到 1.56%（肥胖 II-III）。与 1995 年之前相比，肥胖症和 2 型糖尿病的进展风险估计几乎翻了一番，而 2 型糖尿病的进展风险则增加了两倍。因此，在 2022-2027 年期间，肥胖症和 2 型糖尿病的患病率将继续从 17.3%增加到 18.2%和从 7.3%增加到 8.1%。稳定肥胖症的情景需要将向上移动的概率降低 22%（情景 1）或增加 33%（情景 2）一个 BMI 类别。然而，这种稳定不会影响糖尿病患病率的增加，而糖尿病的终身风险将降低（30.9%降至 27.0%）。结合两种情况，肥胖症将减少 9.9%。只有肥胖症 III 的患病率变化能够预测策略的结果：例如，情景 1 在 5 年内稳定肥胖症，一年减少 6.7%，两年减少 13.3%。
在未来 5 年内，肥胖症和 2 型糖尿病的患病率仍将继续上升。稳定肥胖症可能会降低 2 型糖尿病的终身风险，而不会影响其短期患病率。我们的研究强调，为了尽早评估其计划的有效性，公共卫生政策制定者应该依赖肥胖症 III 的患病率变化。
