Nokihara Megumi, Fujihara Kazuya, Yaguchi Yuta, Takizawa Hiroki, Khin Laymon, Ferreira Efrem D' Avila, Sato Takaaki, Horikawa Chika, Kitazawa Masaru, Matsubayashi Yasuhiro, Kodama Satoru, Sone Hirohito
Department of Hematology, Endocrinology, and Metabolism, Niigata University Faculty of Medicine, Niigata, Japan.
Department of Health and Nutrition, University of Niigata Prefecture Faculty of Human Life Studies, Niigata, Japan.
Diabetes Obes Metab. 2025 Aug;27(8):4259-4267. doi: 10.1111/dom.16461. Epub 2025 May 16.
To determine the associations of body mass index (BMI) and waist circumference (WC) with severe diabetic complications in patients with type 2 diabetes.
In total, 114 254 participants with type 2 diabetes (82% male; mean age, 52.52 ± 8.27 years; median follow-up, 4.64 years) were enrolled from a nationwide Japanese medical claims database. Cox proportional models with multivariate adjustment were used to assess the associations of BMI and WC with treatment-requiring diabetic eye disease (TRDED), initiation of dialysis, coronary artery disease (CAD), cerebrovascular disease (CVD), heart failure (HF) and amputation.
BMI was inversely associated with TRDED, especially in women. Men with WC ≥ 95 cm had a significantly lower risk of TRDED (hazard ratio [HR] = 0.79, 95% CI = 0.69-0.91). Dialysis initiation displayed L-shaped associations with BMI and WC. The risk of CAD was significantly reduced among men with BMI < 20.0 kg/m (HR = 0.68, 95% CI = 0.49-0.94). HF had U-shaped associations with BMI and WC. Abdominal obesity increased CVD risk (HR = 1.36, 95% CI = 1.08-1.70). BMI ≥ 25 kg/m/WC ≥ 90 cm significantly reduced the risk of dialysis (HR = 0.42, 95% CI = 0.29-0.62) and increased the risk of HF (HR = 1.33, 95% CI = 1.03-1.72).
BMI/WC had both positive and negative associations with diabetic complications. Therefore, each patient's BMI/WC target should be carefully determined for each diabetic complication, considering the risk of developing other diseases.
确定体重指数（BMI）和腰围（WC）与2型糖尿病患者严重糖尿病并发症之间的关联。
从日本全国医疗索赔数据库中纳入了总共114254名2型糖尿病患者（82%为男性；平均年龄52.52±8.27岁；中位随访时间4.64年）。使用多变量调整的Cox比例模型来评估BMI和WC与需要治疗的糖尿病眼病（TRDED）、透析起始、冠状动脉疾病（CAD）、脑血管疾病（CVD）、心力衰竭（HF）和截肢之间的关联。
BMI与TRDED呈负相关，尤其是在女性中。WC≥95 cm的男性发生TRDED的风险显著降低（风险比[HR]=0.79，95%置信区间[CI]=0.69-0.91）。透析起始与BMI和WC呈L形关联。BMI<20.0 kg/m²的男性患CAD的风险显著降低（HR=0.68，95% CI=0.49-0.94）。HF与BMI和WC呈U形关联。腹型肥胖增加CVD风险（HR=1.36，95% CI=1.08-1.70）。BMI≥25 kg/m²/WC≥90 cm显著降低透析风险（HR=0.42，95% CI=0.29-0.62）并增加HF风险（HR=1.33，95% CI=1.03-1.72）。
BMI/WC与糖尿病并发症既有正相关又有负相关。因此，考虑到发生其他疾病的风险，应针对每种糖尿病并发症仔细确定每位患者的BMI/WC目标。
