Chen Hao-Wen, Liu Kuan, Cao Bi-Fei, Zhong Qi, Zhou Rui, Li Liang-Hua, Wang Shi-Ao, Wei Yan-Fei, Liu Hua-Min, Wu Xian-Bo
Department of Epidemiology, School of Public Health, Guangdong Provincial Key Laboratory of Tropical Disease Research, Southern Medical University, No. 1063-No. 1023, Shatai South Road, Baiyun District, Guangzhou, 510515, China.
Public Health Division, Hospital of Zhongluotan Town, Baiyun District, Guangzhou, 510515, China.
Cardiovasc Diabetol. 2024 Jun 12;23(1):201. doi: 10.1186/s12933-024-02284-1.
It's unclear if excess visceral adipose tissue (VAT) mass in individuals with prediabetes can be countered by adherence to a Mediterranean lifestyle (MEDLIFE). We aimed to examine VAT mass, MEDLIFE adherence, and their impact on type 2 diabetes (T2D) and diabetic microvascular complications (DMC) in individuals with prediabetes.
11,267 individuals with prediabetes from the UK Biobank cohort were included. VAT mass was predicted using a non-linear model, and adherence to the MEDLIFE was evaluated using the 25-item MEDLIFE index, encompassing categories such as "Mediterranean food consumption," "Mediterranean dietary habits," and "Physical activity, rest, social habits, and conviviality." Both VAT and MEDLIFE were categorized into quartiles, resulting in 16 combinations. Incident cases of T2D and related DMC were identified through clinical records. Cox proportional-hazards regression models were employed to examine associations, adjusting for potential confounding factors.
Over a median follow-up of 13.77 years, we observed 1408 incident cases of T2D and 714 cases of any DMC. High adherence to the MEDLIFE, compared to the lowest quartile, reduced a 16% risk of incident T2D (HR: 0.84, 95% CI: 0.71-0.98) and 31% for incident DMC (0.69, 0.56-0.86). Conversely, compared to the lowest quartile of VAT, the highest quartile increased the risk of T2D (5.95, 4.72-7.49) and incident any DMC (1.79, 1.36-2.35). We observed an inverse dose-response relationship between MEDLIFE and T2D/DMC, and a dose-response relationship between VAT and all outcomes (P for trend < 0.05). Restricted cubic spline analysis confirmed a nearly linear dose-response pattern across all associations. Compared to individuals with the lowest MEDLIFE quartile and highest VAT quartile, those with the lowest T2D risk had the lowest VAT and highest MEDLIFE (0.12, 0.08-0.19). High MEDLIFE was linked to reduced T2D risk across all VAT categories, except in those with the highest VAT quartile. Similar trends were seen for DMC.
High adherence to MEDLIFE reduced T2D and MDC risk in individuals with prediabetes, while high VAT mass increases it, but MEDLIFE adherence may offset VAT's risk partly. The Mediterranean lifestyle's adaptability to diverse populations suggests promise for preventing T2D.
尚不清楚糖尿病前期个体的内脏脂肪组织（VAT）过多是否可以通过坚持地中海式生活方式（MEDLIFE）来抵消。我们旨在研究糖尿病前期个体的VAT量、对MEDLIFE的依从性及其对2型糖尿病（T2D）和糖尿病微血管并发症（DMC）的影响。
纳入了英国生物银行队列中的11267名糖尿病前期个体。使用非线性模型预测VAT量，并使用包含“地中海食物消费”、“地中海饮食习惯”和“身体活动、休息、社交习惯和欢乐氛围”等类别的25项MEDLIFE指数评估对MEDLIFE的依从性。VAT和MEDLIFE均分为四分位数，产生16种组合。通过临床记录确定T2D和相关DMC的发病病例。采用Cox比例风险回归模型来检验关联，并对潜在混杂因素进行调整。
在中位随访13.77年期间，我们观察到1408例T2D发病病例和714例任何DMC病例。与最低四分位数相比，高度坚持MEDLIFE可使T2D发病风险降低16%（HR：0.84，95%CI：0.71 - 0.98），使任何DMC发病风险降低31%（0.69, 0.56 - 0.86）。相反，与VAT最低四分位数相比，最高四分位数会增加T2D风险（5.95, 4.72 - 7.49）和任何DMC发病风险（1.79, 1.36 - 2.35）。我们观察到MEDLIFE与T2D/DMC之间存在反向剂量反应关系，VAT与所有结局之间存在剂量反应关系（趋势P < 0.05）。受限立方样条分析证实了所有关联中几乎呈线性的剂量反应模式。与MEDLIFE最低四分位数和VAT最高四分位数的个体相比，T2D风险最低的个体VAT最低且MEDLIFE最高（0.12, 0.08 - 0.19）。除了VAT最高四分位数的个体外，在所有VAT类别中，高度MEDLIFE与降低T2D风险相关。DMC也有类似趋势。
高度坚持MEDLIFE可降低糖尿病前期个体的T2D和MDC风险，而高VAT量会增加风险，但坚持MEDLIFE可能部分抵消VAT的风险。地中海式生活方式对不同人群的适应性表明其在预防T2D方面具有前景。
