Conway Rebecca Baqiyyah, Song Jooyoun, Figaro M Kathleen, Lokanadham Jyothi Sri, Perng Wei, Crume Tessa Lee, Blot William J
Department of Epidemiology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
American Academy of Epidemiology, Inc., Tyler, TX, USA.
Diabetes Metab Syndr Obes. 2025 Apr 18;18:1195-1206. doi: 10.2147/DMSO.S491681. eCollection 2025.
BACKGROUND/OBJECTIVES: BMI is a major risk factor for diabetes incidence, but a controversial predictor of mortality among those with diabetes.
SUBJECTS/METHODS: We conducted a mortality follow-up (2002-2019) of participants aged 40-79 with young-onset (diagnosed < age 30, n = 1335), older-onset (diagnosed ≥ 30, n = 15,194), and without (n = 62,295) diabetes at cohort entry. Cox analysis with age as the time scale assessing mortality according to BMI after adjusting for multiple potential confounding factors was used.
Mean baseline age and diabetes duration at cohort entry were 50.1 and 29.4 years and 55.3 and 7.7 years among those with young- and older-onset diabetes, respectively. During an average of 12.3 years of follow-up, 47% of the young-onset, 40% of the older-onset diabetes, and 22.6% of those without diabetes at cohort entry died. In multivariable adjusted analyses, compared to a BMI of 18.5-<25 kg/m, HRs (95% CIs) were 4.10 (1.65-10.18), 0.69 (0.54-0.88), 0.81 (0.63-1.05), 0.64 (0.48-0.86) and 0.64 (0.54-0.77) for BMI categories <18.5, 25-<30 30-<35, 35-<40, 40+ kg/m in those with young-onset diabetes. Corresponding HRs (95% CIs) were 2.02 (1.54-2.67), 0.74 (0.68-0.80), 0.74 (0.68-0.80), 0.83 (0.75-0.91) and 1.09 (0.99-1.19) in those with older-onset diabetes, and 1.50 (1.36-1.67), 0.76 (0.73-0.79), 0.73 (0.70-0.77), 0.83 (0.78-0.89) and 1.03 (0.95-1.10) in those without diabetes. Results were generally similar in analyses stratified by smoking status, gender, race and among those on insulin therapy.
Among this low socioeconomic status population with diabetes, overweight and obesity tend to be inversely associated with mortality. Risk factors for complications of diabetes other than BMI may be more clinically relevant when treating patients with diabetes.
背景/目的：体重指数（BMI）是糖尿病发病的主要危险因素，但对于糖尿病患者而言，它在死亡率预测方面存在争议。
对象/方法：我们对年龄在40 - 79岁的参与者进行了死亡率随访（2002 - 2019年），这些参与者在队列进入时分别患有早发型糖尿病（诊断年龄<30岁，n = 1335）、晚发型糖尿病（诊断年龄≥30岁，n = 15194）以及无糖尿病（n = 62295）。使用以年龄为时间尺度的Cox分析，在调整多个潜在混杂因素后，根据BMI评估死亡率。
队列进入时，早发型和晚发型糖尿病患者的平均基线年龄分别为50.1岁和55.3岁，糖尿病病程分别为29.4年和7.7年。在平均12.3年的随访期间，队列进入时早发型糖尿病患者中有47%、晚发型糖尿病患者中有40%以及无糖尿病患者中有22.6%死亡。在多变量调整分析中，与BMI为18.5 - <25 kg/m²相比，早发型糖尿病患者中BMI类别<18.5、25 - <30、30 - <35、35 - <40、40+ kg/m²的风险比（HRs）（95%置信区间）分别为4.10（1.65 - 10.18）、0.69（0.54 - 0.88）、0.81（0.63 - 1.05）、0.64（0.48 - 0.86）和0.64（0.54 - 0.77）。晚发型糖尿病患者的相应HRs（95%置信区间）分别为2.02（1.54 - 2.67）、0.74（0.68 - 0.80）、0.74（0.68 - 0.80）、0.83（0.75 - 0.91）和1.09（0.99 - 1.19），无糖尿病患者的相应HRs（95%置信区间）分别为1.50（1.36 - 1.67）、0.76（0.73 - 0.79）、0.73（0.70 - 0.77）、0.83（0.78 - 0.89）和1.03（0.95 - 1.10）。按吸烟状况、性别、种族分层以及在接受胰岛素治疗的患者中的分析结果总体相似。
在这群社会经济地位较低的糖尿病患者中，超重和肥胖往往与死亡率呈负相关。在治疗糖尿病患者时，除BMI外的糖尿病并发症危险因素可能在临床上更具相关性。
