基于影像学的体脂分布与美国糖尿病一般人群的糖尿病视网膜病变：NHANES 分析（2003-2006 年和 2011-2018 年）。
Imaging-based body fat distribution and diabetic retinopathy in general US population with diabetes: an NHANES analysis (2003-2006 and 2011-2018).
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, Shanghai, 200080, China.
Department of Ophthalmology, Shanghai General Hospital, Shanghai, 200080, China.
出版信息
Nutr Diabetes. 2024 Jul 14;14(1):53. doi: 10.1038/s41387-024-00308-z.
BACKGROUND
Limited studies have investigated the correlation between fat distribution and the risk of diabetic retinopathy (DR) in the general population with diabetes. The relationship between obesity and DR remains inconclusive, possibly due to using simple anthropometric measures to define obesity. This study investigates the relationships between the android-to-gynoid fat ratio (A/G ratio, measured using dual-energy X-ray absorptiometry) and DR within the US population with diabetes.
METHODS
The study used a population-based, cross-sectional approach based on the 2003-2006 and 2011-2018 data of the National Health and Nutrition Examination Survey (NHANES). Multivariable logistic regression analyses were performed on participants with diabetes to evaluate the contribution of body mass index (BMI), waist-to-height ratio (WHtR), and A/G ratio to the prevalence of DR.
RESULTS
The prevalence of DR was 22.2, 21.2, and 17.6% among participants with A/G ratios <1.0, 1.0-1.2, and ≥1.2, respectively. After adjusting sex, age, ethnicity, diabetes duration, hemoglobin A1c level, blood pressure level, and non-high-density lipoprotein cholesterol level, a higher A/G ratio (≥1.2) was independently associated with decreased odds of DR (odds ratio [OR], 0.565; 95% CI: 0.372-0.858) compared with the A/G ratio of 1.0-1.2. Associations between a higher A/G ratio and DR remained statistically significant after adjusting for BMI (OR, 0.567; 95% CI: 0.373-0.861) and WHtR (OR, 0.586; 95% CI: 0.379-0.907). Moreover, these associations remained statistically significant in analyses using the ethnic-specific tertiles for the A/G ratio. In sex-stratified models, these correlations remained in males. There was a significant inverse association between the A/G ratio and diabetes duration in males, which persisted after multivariable adjustments (p < 0.05).
CONCLUSIONS
A novel finding indicates that a higher A/G ratio is associated with a reduced likelihood of DR in males with diabetes. The results from NHANES underscore the importance of considering imaging-based fat distribution as a critical indicator in clinical practice.
背景
已有有限研究调查了在一般糖尿病人群中，体脂分布与糖尿病性视网膜病变（DR）风险之间的相关性。肥胖与 DR 之间的关系仍不确定，这可能是由于使用简单的人体测量学指标来定义肥胖。本研究调查了美国糖尿病人群中安卓到臀围脂肪比（A/G 比，通过双能 X 射线吸收法测量）与 DR 之间的关系。
方法
本研究采用基于人群的横断面研究方法，基于 2003-2006 年和 2011-2018 年国家健康和营养检查调查（NHANES）的数据。对患有糖尿病的参与者进行多变量逻辑回归分析，以评估体重指数（BMI）、腰高比（WHtR）和 A/G 比对 DR 患病率的贡献。
结果
在 A/G 比<1.0、1.0-1.2 和≥1.2 的参与者中，DR 的患病率分别为 22.2%、21.2%和 17.6%。在校正性别、年龄、种族、糖尿病病程、糖化血红蛋白水平、血压水平和非高密度脂蛋白胆固醇水平后，较高的 A/G 比（≥1.2）与 DR 发生的几率降低相关（比值比[OR]，0.565；95%置信区间：0.372-0.858），与 1.0-1.2 的 A/G 比相比。在调整 BMI（OR，0.567；95%置信区间：0.373-0.861）和 WHtR（OR，0.586；95%置信区间：0.379-0.907）后，与较高的 A/G 比和 DR 之间的关联仍然具有统计学意义。此外，在按 A/G 比的种族特异性三分位数进行的分析中，这些关联仍然具有统计学意义。在性别分层模型中，这些相关性在男性中仍然存在。在男性中，A/G 比与糖尿病病程之间存在显著的负相关，在进行多变量调整后仍然存在（p<0.05）。
结论
一项新发现表明，较高的 A/G 比与男性糖尿病患者 DR 的可能性降低有关。NHANES 的结果强调了考虑基于影像学的脂肪分布作为临床实践中关键指标的重要性。
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