2型糖尿病患者体重指数与死亡风险的前瞻性研究

李莹; 苏健; 俞浩; 覃玉; 罗鹏飞; 潘恩春; 张宁; 沈冲; 周金意; 武鸣

doi:10.16462/j.cnki.zhjbkz.2019.08.012

2型糖尿病患者体重指数与死亡风险的前瞻性研究

doi: 10.16462/j.cnki.zhjbkz.2019.08.012

李莹¹,
苏健²,
俞浩²,
覃玉²,
罗鹏飞²,
潘恩春^{2, 3},
张宁⁴,
沈冲⁵,
周金意²,
武鸣^{1, 2, ,}

1.
210009 南京, 东南大学公共卫生学院
2.
210009 南京, 江苏省疾病预防控制中心慢性非传染性疾病防制所
3.
223001 淮安, 淮安市疾病预防控制中心
4.
215500 常熟, 常熟市疾病预防控制中心
5.
210009 南京, 南京医科大学公共卫生学院流行病与卫生统计学系

基金项目:

江苏省医学领军人才和创新团队项目 K201105

江苏省第四期"333工程"科研项目 BRA2013107

江苏省疾控中心科教强业工程青年人才 JKRC2016007

江苏省研究生实践创新计划 SJCX18-0080

详细信息

通讯作者:
武鸣. E-mail: jswuming@vip.sina.com

中图分类号: R330.21
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- 被引次数: 0
出版历程
- 收稿日期: 2018-12-18
- 修回日期: 2019-04-02
- 刊出日期: 2019-08-10

A prospective study on the association between body mass index and all-cause mortality in type 2 diabetic patients

LI Ying¹,
SU Jian²,
YU Hao²,
QIN Yu²,
LUO Peng-fei²,
PAN En-chun^{2, 3},
ZHANG Ning⁴,
SHEN Chong⁵,
ZHOU Jin-yi²,
WU Ming^{1, 2
, ,}

1.
School of Public Health, Southeast University, Nanjing 210009, China
2.
Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
3.
Huai'an Center for Disease Control and Prevention, Huai'an 223001, China
4.
Changshu Center for Disease Control and Prevention, Changshu 215500, China
5.
Department of Epidemiology and Health Statistics, School of Public Health, Nanjing Medical University, Nanjing 210009, China

Funds:

Medical Leading Talent and Innovation Team of Jiangsu Province K201105

Jiangsu Provincial Fourth "333 Project" BRA2013107

Science and Education Strong Industry Engineering Young Talents of Jiangsu Provincial Center for Disease Control and Prevention JKRC2016007

Jiangsu Provincial Graduate Student Practice Innovation Plan SJCX18-0080

More Information

Corresponding author: WU Ming, E-mail: jswuming@vip.sina.com

摘要

摘要: 目的探讨体重指数（body mass index，BMI）与2型糖尿病患者全死因死亡风险的关联。方法研究对象为江苏省苏南、苏北地区纳入国家基本公共卫生服务管理的17 638名2型糖尿病患者，应用Cox比例风险回归模型计算基线时不同BMI组人群在随访期间的全死因死亡风险（hazard ratio，HR）值及95%置信区间（confidence interval，CI）。结果研究对象累计随访77 451人年，平均随访4.39年，随访期间共死亡1 274人，低体重组BMI < 18.5 kg/m²、正常体重组（18.5 kg/m² ≤ BMI < 24.0 kg/m²）、超重组（24.0 kg/m² ≤ BMI < 28.0 kg/m²）、肥胖组（BMI ≥ 28.0 kg/m²）死亡人数分别为39人、575人、484人和176人，相应的死亡率分别为15.6%、9.5%、6.2%、5.1%。调整混杂因素后，以正常体重组为参照，低体重组、超重组、肥胖组死亡风险的HR值（95%CI）分别为1.66（95%CI：1.20~2.30），0.68（95%CI：0.61~0.77），0.58（95%CI：0.48~0.68）。结论在2型糖尿病患者中，与正常体重人群相比，低体重人群的全死因死亡风险最高，超重和肥胖人群的死亡风险较低，超重和肥胖可以降低2型糖尿病患者死亡风险。
- 体重指数 /
- 死亡风险 /
- 糖尿病 /
- 前瞻性研究
Abstract: Objective The aim is to investigate the association between body mass index (BMI) and risk of all-cause mortality among patients with type 2 diabetes. Methods A total of 17 638 patients with type 2 diabetes registered in the management of National Basic Public Health Services in two areas of southern and northern Jiangsu were recruited. Cox proportional risk regression model was used to calculate the hazard ratio(HR) value and 95% confidence interval (95% CI) of different BMI groups in the follow-up period. Results The subjects were followed up for a total of 77 451 person-years with an average duration of 4.39 years, and 1 274 patients died during the follow-up period. The number of death in low weight group (BMI < 18.5 kg/m²), normal weight group (18.5 kg/m² ≤ BMI < 24 kg/m²), overweight (24 kg/m² ≤ BMI < 28 kg/m²) and obese group (BMI ≥ 28 kg/m²) were 39, 575, 484 and 176 respectively.The corresponding mortalities were 15.6%, 9.5%, 6.2% and 5.1%, respectively. Compared to normal weight group, the adjusted HR of all-cause mortality in low weight, overweight and obese group were 1.66 (95% CI: 1.20-2.30), 0.68 (95% CI: 0.61-0.77), 0.58 (95% CI: 0.48-0.68), respectively. Conclusions Low-weight patients have the highest risk of all-cause mortality compared with normal counterparts, while both overweight and obese people have a lower risk of death. Overweight and obesity may reduce the risk of all-cause mortality in type 2 diabetic patients.
- Body mass index /
- Death risk /
- Diabetes mellitus /
- Cohort study

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表 1 研究对象的基线特征分布

Table 1. Baseline characteristics of the patients with T2DM by BMI in cohort study

变量	BMI分组				H/χ²值	P值
变量	低体重	正常	超重	肥胖	H/χ²值	P值
年龄(岁)	65.1±9.9	63.4±9.9	62.5±9.6	62.0±9.8	53.4	0.003
男性[n(%)]	72(28.8)	2 385(39.2)	3 259(41.6)	1 308(37.7)	30.4	< 0.001
文化程度[n(%)]					28.2	< 0.001
小学及以下	205(82.0)	4 346(71.5)	5 449(69.5)	2 463(71.0)
中学及中专	42(16.8)	1 590(26.2)	2 162(27.6)	937(27.0)
大专及以上	3(1.2)	144(2.4)	226(2.9)	71(2.0)
婚姻状况[n(%)]					37.5	< 0.001
已婚	208(83.2)	5 191(85.4)	6 591(88.7)	3 034(87.4)
其他	42(16.8)	889(14.6)	886(11.3)	437(12.6)
吸烟[n(%)]	65(26.0)	1 755(28.9)	2 271(29.0)	906(26.1)	11.6	0.009
饮酒[n(%)]	31(12.4)	940(15.5)	1 481(18.9)	623(17.9)	34.9	< 0.001
体力活动(MET-h/week)	56(20, 108)	47(16, 93)	56(21, 112)	53(20, 100)	4.7	0.196
静态行为时(h/d)	3.0(2.0, 4.0)	3.0(2.0, 4.0)	3.0(2.0, 4.0)	3.0(2.0, 4.5)	15.8	< 0.001
糖尿病病程(年)					19.3	< 0.001
＜1	31(12.4)	491(8.1)	649(8.3)	355(10.2)
≥1	219(87.6)	5 589(91.9)	7 188(91.7)	316(89.8)
疾病史[n(%)]
高血压	153(61.2)	4 256(70.0)	6 175(78.8)	3 005(86.6)	397.9	< 0.001
血脂异常	63(25.2)	2 252(37.0)	4 113(52.5)	2 064(59.5)	590.2	< 0.001
冠心病	13(5.2)	376(6.2)	625(8.0)	384(11.1)	77.9	< 0.001
肾脏疾病	9(3.6)	223(3.7)	327(4.2)	151(4.4)	17.4	0.008
脑卒中	5(2.0)	472(7.8)	743(9.5)	407(11.7)	59.7	< 0.001
用药史[n(%)]					1.9	0.575
是	166(75.5)	4 428(78.7)	5 685(78.0)	2 542(78.3)
否	54(24.5)	1 198(21.3)	1 602(22.0)	703(21.7)

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表 2 不同BMI分组的T2DM患者死亡情况分析

Table 2. Analysis of the mortality of T2DM patients with different BMI groups

BMI	随访人年	死亡人数(人)	死亡密度(‰)
低体重	1 037	39	37.6
正常体重	26 432	575	21.8
超重	34 581	484	14.0
肥胖	15 401	176	11.4

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表 3 2型糖尿病患者BMI与全死因死亡风险的Cox回归分析

Table 3. Cox regression analysis of BMI and all-cause mortality risk in type 2 diabetic patients

BMI	HR(95% CI)值
BMI	模型1^a	模型2^b	模型3^c	模型4^d
低体重	1.74(1.26~2.40)	1.55(1.12~2.14)	1.56(1.12~2.15)	1.66(1.20~2.30)
正常体重	1.00	1.00	1.00	1.00
超重	0.64(0.57~0.73)	0.71(0.63~0.80)	0.70(0.62~0.80)	0.68(0.61~0.77)
肥胖	0.52(0.44~0.62)	0.61(0.52~0.72)	0.60(0.51~0.72)	0.58(0.48~0.68)
P_趋势值	< 0.001	< 0.001	< 0.001	< 0.001
注：^a未调整混杂因素；^b调整性别、年龄、文化程度、婚姻状况；^c在模型2基础上调整吸烟、饮酒、体力活动、静态行为时间；^d在模型3基础上调整高血压、血脂异常、冠心病、脑卒中、肾脏疾病史、糖尿病用药史及病程。

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表 4 2型糖尿病患者BMI与全死因死亡风险的Cox回归分层分析

Table 4. Cox regression stratified analysis of BMI and all-cause mortality risk in type 2 diabetic patients

亚组	HR(95% CI)值			P_交互值
亚组	低体重	超重	肥胖	P_交互值
性别				0.431
男	1.81(1.09~3.01)	0.65(0.55~0.77)	0.54(0.42~0.69)
女	1.52(0.99~2.34)	0.71(0.60~0.85)	0.59(0.47~0.76)
年龄(岁)				0.021
< 60	1.98(0.85~4.59)	0.45(0.32~0.65)	0.34(0.21~0.58)
≥60	1.80(1.26~2.56)	0.69(0.60~0.78)	0.55(0.46~0.66)
吸烟				0.612
是	1.98(1.15~3.43)	0.62(0.50~0.77)	0.54(0.39~0.73
否	1.53(1.02~2.30)	0.71(0.61~0.83)	0.59(0.48~0.73)
饮酒				0.209
现在饮酒	2.65(1.20~5.85)	0.58(0.42~0.81)	0.44(0.27~0.70)
过去饮酒	1.38(0.41~4.70)	0.77(0.49~1.19)	0.57(0.29~1.11)
无饮酒	1.48(1.02~2.16)	0.70(0.60~0.80)	0.60(0.50~0.74)
体力活动(MET-h/week)				0.774
≤56	1.87(1.30~2.68)	0.68(0.59~0.79)	0.58(0.47~0.71)
>56	1.06(0.49~2.27)	0.71(0.56~0.89)	0.58(0.41~0.81)
静态行为时间(h/d)				0.015
≤3	1.63(1.02~2.60)	0.77(0.66~0.91)	0.73(0.59~0.91)
>3	1.65(1.04~2.61)	0.60(0.50~0.72)	0.42(0.32~0.56)
用药史				0.832
是	1.48(0.68~3.24)	0.68(0.50~0.94)	0.75(0.50~1.12)
否	1.71(1.19~2.45)	0.69(0.60~0.78)	0.55(0.45~0.66)
注：调整性别、年龄、文化程度、婚姻状况、吸烟、饮酒、体力活动、静态行为时间、高血压、血脂异常、冠心病、脑卒中、肾脏疾病史、糖尿病用药史及病程(分层因素除外)。

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表 5 BMI与全死因死亡风险的敏感性分析

Table 5. Sensitivity analysis of BMI and risk of all-cause mortality

排除项目	人数(人)	HR(95% CI)值
排除项目	人数(人)	正常	低体重	超重	肥胖
排除吸烟人群	12 641	1.00	1.53(1.02~2.30)	0.71(0.61~0.83)	0.59(0.48~0.73)
排除心脑血管疾病人群	14 950	1.00	1.58(1.11~2.25)	0.69(0.59~0.79)	0.57(0.46~0.70)
排除随访第一年死亡人群	17 437	1.00	1.39(0.94~2.05)	0.72(0.63~0.82)	0.58(0.48~0.70)
注：调整性别、年龄、文化程度、婚姻状况、饮酒、体力活动、静态行为时间、高血压、血脂异常、冠心病、脑卒中、肾脏疾病史、糖尿病用药史及病程。

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变量	BMI分组				H/χ²值	P值
变量	低体重	正常	超重	肥胖	H/χ²值	P值
年龄(岁)	65.1±9.9	63.4±9.9	62.5±9.6	62.0±9.8	53.4	0.003
男性[n(%)]	72(28.8)	2 385(39.2)	3 259(41.6)	1 308(37.7)	30.4	< 0.001
文化程度[n(%)]					28.2	< 0.001
小学及以下	205(82.0)	4 346(71.5)	5 449(69.5)	2 463(71.0)
中学及中专	42(16.8)	1 590(26.2)	2 162(27.6)	937(27.0)
大专及以上	3(1.2)	144(2.4)	226(2.9)	71(2.0)
婚姻状况[n(%)]					37.5	< 0.001
已婚	208(83.2)	5 191(85.4)	6 591(88.7)	3 034(87.4)
其他	42(16.8)	889(14.6)	886(11.3)	437(12.6)
吸烟[n(%)]	65(26.0)	1 755(28.9)	2 271(29.0)	906(26.1)	11.6	0.009
饮酒[n(%)]	31(12.4)	940(15.5)	1 481(18.9)	623(17.9)	34.9	< 0.001
体力活动(MET-h/week)	56(20, 108)	47(16, 93)	56(21, 112)	53(20, 100)	4.7	0.196
静态行为时(h/d)	3.0(2.0, 4.0)	3.0(2.0, 4.0)	3.0(2.0, 4.0)	3.0(2.0, 4.5)	15.8	< 0.001
糖尿病病程(年)					19.3	< 0.001
＜1	31(12.4)	491(8.1)	649(8.3)	355(10.2)
≥1	219(87.6)	5 589(91.9)	7 188(91.7)	316(89.8)
疾病史[n(%)]
高血压	153(61.2)	4 256(70.0)	6 175(78.8)	3 005(86.6)	397.9	< 0.001
血脂异常	63(25.2)	2 252(37.0)	4 113(52.5)	2 064(59.5)	590.2	< 0.001
冠心病	13(5.2)	376(6.2)	625(8.0)	384(11.1)	77.9	< 0.001
肾脏疾病	9(3.6)	223(3.7)	327(4.2)	151(4.4)	17.4	0.008
脑卒中	5(2.0)	472(7.8)	743(9.5)	407(11.7)	59.7	< 0.001
用药史[n(%)]					1.9	0.575
是	166(75.5)	4 428(78.7)	5 685(78.0)	2 542(78.3)
否	54(24.5)	1 198(21.3)	1 602(22.0)	703(21.7)

表(5)

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2型糖尿病患者体重指数与死亡风险的前瞻性研究

doi: 10.16462/j.cnki.zhjbkz.2019.08.012

通讯作者:
武鸣. E-mail: jswuming@vip.sina.com

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A prospective study on the association between body mass index and all-cause mortality in type 2 diabetic patients

Corresponding author: WU Ming, E-mail: jswuming@vip.sina.com

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留言板

2型糖尿病患者体重指数与死亡风险的前瞻性研究

doi: 10.16462/j.cnki.zhjbkz.2019.08.012

通讯作者: 武鸣. E-mail: jswuming@vip.sina.com

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出版历程

A prospective study on the association between body mass index and all-cause mortality in type 2 diabetic patients

Corresponding author: WU Ming, E-mail: jswuming@vip.sina.com

计量

出版历程

目录

通讯作者:
武鸣. E-mail: jswuming@vip.sina.com