Chu Wen-Kai, Er Leay Kiaw, Chang Chin-Chen, Lu Jin-Ying, Wu Wan-Chen, Tsai Yao-Chou, Lin Yen-Hung, Wu Vin-Cent
Renal Division, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Tzu-Chi Hospital, Buddhist Tzu-Chi Medical Foundation, New Taipei City, Taiwan.
Ther Adv Chronic Dis. 2024 Nov 30;15:20406223241301892. doi: 10.1177/20406223241301892. eCollection 2024.
Patients with primary aldosteronism (PA) exhibit a high prevalence of diabetes mellitus (DM). However, the relationship between visceral adipose tissue (VAT) and new-onset diabetes mellitus (NODM) in PA patients remains unclear.
To explore the association between VAT and the risk of NODM in PA patients.
This is a prospective cohort study spanning 10 years (2010-2020).
A total of 342 PA patients were enrolled prospectively. Abdominal adiposity indexes, including VAT area, VAT ratio, subcutaneous adipose tissue (SAT) area, and SAT ratio, were measured using a computed tomography-based software at diagnosis.
Of 342 PA patients (46.2% male, mean age 50.8 ± 11.2 years), 35 (10.2%) developed NODM over a mean follow-up of 7.4 years. A positive nonlinear association between NODM risk and Log (VAT ratio) ⩾ -0.72 was observed (high-VAT group). High VAT (odds ratio (OR), 6.09; = 0.005), older age (OR, 1.09; < 0.001), higher body mass index (OR, 1.24; < 0.001), higher waist-to-hip ratio (OR, 1.11, < 0.001), lower baseline aldosterone (OR, 0.99, = 0.011), higher diastolic blood pressure (OR, 1.05, = 0.012), and lower systolic blood pressure (OR, 0.98, = 0.045) as risk factors for high VAT. Adrenalectomy did not significantly associate with reduced NODM risk (OR, 0.49; = 0.292).
Our findings highlight that 10.2% of PA patients develop NODM over a mean follow-up of 7.4 years, with high VAT increasing the risk. Baseline VAT is a key determinant of NODM development in PA patients, regardless of targeted treatments.
原发性醛固酮增多症（PA）患者中糖尿病（DM）的患病率较高。然而，PA患者内脏脂肪组织（VAT）与新发糖尿病（NODM）之间的关系仍不清楚。
探讨PA患者VAT与NODM风险之间的关联。
这是一项为期10年（2010 - 2020年）的前瞻性队列研究。
前瞻性纳入342例PA患者。在诊断时使用基于计算机断层扫描的软件测量腹部肥胖指数，包括VAT面积、VAT比率、皮下脂肪组织（SAT）面积和SAT比率。
在342例PA患者（男性占46.2%，平均年龄50.8±11.2岁）中，在平均7.4年的随访期间，35例（10.2%）发生了NODM。观察到NODM风险与Log（VAT比率）⩾ -0.72之间存在正非线性关联（高VAT组）。高VAT（比值比（OR），6.09；P = 0.005）、年龄较大（OR，1.09；P < 0.001）、体重指数较高（OR，1.24；P < 0.001）、腰臀比更高（OR，1.11，P < 0.001）、基线醛固酮水平较低（OR，0.99，P = 0.011）、舒张压较高（OR，1.05，P = 0.012）以及收缩压较低（OR，0.98，P = 0.045）是高VAT的危险因素。肾上腺切除术与降低NODM风险无显著关联（OR，0.49；P = 0.292）。
我们的研究结果表明，在平均7.4年的随访期间，10.2%的PA患者发生了NODM，高VAT会增加风险。无论采取何种针对性治疗，基线VAT都是PA患者发生NODM的关键决定因素。
