Prospective cohort study of the interaction between family history and obesity on the incidence of diabetes in pre-diabetics
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摘要:
目的 探讨糖尿病家族史、肥胖及其交互作用对糖尿病前期人群糖尿病发病的影响。 方法 基于金昌队列平台，采用前瞻性队列研究，计算糖尿病家族史、体重指数（body mass index，BMI）、腰围身高比（waist-to-height ratio，WHtR）及不同组合下糖尿病的累积发病率。采用Cox比例风险模型，分析家族史、BMI、WHtR对糖尿病发病的独立作用和联合作用。运用相乘模型分析家族史与BMI/WHtR的交互作用。 结果 本研究共纳入糖尿病前期人群5 495例，平均随访2.2年后，糖尿病累积发病率为15.69%，其中有家族史组发病率（18.31%）高于无家族史组（15.26%）（χ2=4.664，P=0.031），随着BMI/WHtR水平增加，发病率呈上升趋势（χ2=91.727，P < 0.001；χ2=73.334，P < 0.001）。调整混杂因素后，当糖尿病家族史和肥胖（BMI ≥ 28 kg/m2或中心型肥胖）同时存在时，糖尿病发病风险增加（HR=4.401，95% CI：3.026~6.401；HR=2.565，95% CI：1.989~3.307），且均存在正向相乘交互作用。当家族史/BMI ≥ 28 kg/m2/中心型肥胖三个因素叠加，糖尿病发病风险达到最高（HR=4.977，95% CI：3.351~7.392）。 结论 糖尿病家族史与肥胖相互叠加增加糖尿病前期人群糖尿病的发病风险，但两者的独立效应同样不容忽视。 Abstract:Objective To explore the effects of family history of diabetes, obesity and their interactions on the incidence of diabetes in pre-diabetic population. Methods Based on the Jinchang cohort platform, a prospective cohort study was conducted to calculate the cumulative incidence of diabetes in different groups of family history, body mass index (BMI) and waist-to-height ratio(WHtR). Cox proportional hazards regression models were used to analyze independent and joint effects of family history, BMI and WHtR on the incidence of diabetes. The interactions between family history of diabetes and BMI or WHtR were analyzed by multiplicative models. Results A total of 5 495 pre-diabetic participants were included in this study. After an average follow-up of 2.2 years, the cumulative incidence of diabetes was 15.69%. Among them, the incidence of diabetes of those with a family history (18.31%) was higher than those without a family history (15.26%)(χ2=4.664, P=0.031). With the increase of BMI/WHtR level, the incidence rate of diabetes was on the rise(χ2=91.727, P < 0.001; χ2=73.334, P < 0.001). After adjusting for confounding factors, those people with a family history of diabetes and obesity (BMI ≥ 28 kg/m2 or central obesity) coexist, the risk of diabetes increased significantly (HR=4.401, 95% CI:3.026-6.401; HR=2.565, 95% CI:1.989-3.307), and there was a positive multiplication interaction. In addition, when family history, BMI ≥ 28 kg/m2 and central obesity were superimposed, the risk of diabetes have reached the highest(HR=4.977, 95% CI:3.351-7.392). Conclusions The superimposition of family history of diabetes and obesity increases the risk of diabetes in the pre-diabetic population, but the independent effects of the two cannot be ignored. -
Key words:
- Diabetes /
- Obesity /
- Family history /
- Interaction /
- Prospective cohort study
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表 1 研究对象基线一般情况[n(%)]
Table 1. Baseline characteristics of study participants [n(%)]
变量 男性 女性 总人群 P值a 年龄[岁，(x±s)] 51.82±12.88 51.23±11.20 51.63±12.38 0.084 文化程度 ＜0.001 小学及以下 717(19.01) 350(20.30) 1 067(19.42) 初中 1 091(28.93) 588(34.11) 1 679(30.56) 高中/中专/技校 970(25.72) 476(27.61) 1 446(26.31) 大专及以上 993(26.34) 310(17.98) 1 303(23.71) 职业 ＜0.001 干部 497(13.18) 178(10.32) 675(12.28) 工人 2 973(78.84) 1 282(74.36) 4 255(77.43) 技术人员 181(4.80) 37(2.15) 218(3.97) 内勤服务人员 120(3.18) 227(13.17) 347(6.32) 家庭人均月收入(元) ＜0.001 ＜1 000 235(6.23) 31(1.80) 266(4.84) 1 000~ 1 943(51.52) 823(47.74) 2 766(50.34) ≥2 000 1 593(42.25) 870(50.46) 2 463(44.82) 体育锻炼 0.153 从不 474(12.57) 188(10.91) 662(12.05) 偶尔 1 352(35.85) 611(35.44) 1 963(35.72) 经常 1 945(51.58) 925(53.65) 2 870(52.23) 吸烟史 2 686(71.23) 26(1.51) 2 712(49.35) ＜0.001 饮酒史 1 512(40.10) 39(2.26) 1 551(28.23) ＜0.001 高盐饮食 1 049(27.82) 332(19.26) 1 381(25.13) ＜0.001 高脂饮食 936(24.82) 286(16.59) 1 222(22.24) ＜0.001 高糖饮食 693(18.38) 296(17.17) 989(18.00) 0.280 BMI(kg/m2) ＜0.001 ＜24 1 435(38.06) 915(53.07) 2 350(42.77) 24~ 1 797(47.65) 597(34.62) 2 394(43.57) ≥28 539(14.29) 212(12.31) 751(13.66) WHtR ＜0.001 正常 1 201(31.85) 870(50.46) 2 071(37.69) 中心型肥胖 2 570(68.15) 854(49.54) 3 424(62.31) 糖尿病家族史 454(12.04) 316(18.33) 770(14.01) ＜0.001 收缩压[mm Hg，(M, IQR)] 131.00(25.00) 126.00(28.00) 130.00(26.00) ＜0.001 舒张压[mm Hg，(M, IQR)] 83.00(17.00) 80.00(16.00) 82.00(16.00) ＜0.001 总胆固醇[mm Hg，(M, IQR)] 4.80(1.20) 5.00(1.20) 4.80(1.20) ＜0.001 甘油三酯[mm Hg，(M, IQR)] 1.90(1.50) 1.60(1.20) 1.80(1.40) ＜0.001 高密度脂蛋白胆固醇[mm Hg，(M, IQR)] 1.23(0.40) 1.42(0.47) 1.28(0.45) ＜0.001 低密度脂蛋白胆固醇[mm Hg，(M, IQR)] 3.17(0.95) 3.33(1.02) 3.21(0.97) ＜0.001 注：a表示t检验、秩和检验或x2检验。 
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表 2 家族史、BMI、WHtR对糖尿病发病的影响
Table 2. The influence of family history, BMI and WHtR on the incidence of diabetes
变量 总人数 发病人数 发病率(%) HR(95% CI)值a 糖尿病家族史 无 4 725 721 15.26 1.000 有 770 141 18.31 1.689(1.398~2.042) 父系 302 51 16.89 1.659(1.236~2.227) 母系 328 62 18.90 1.793(1.372~2.342) 兄弟姐妹 76 18 23.68 1.768(1.107~2.825) 其他类型 64 10 15.63 1.226(0.655~2.293) BMI(kg/m 2) ＜24 2 350 254 10.81 1.000 24~ 2 394 426 17.79 1.330(1.109~1.595) ≥28 751 182 24.23 1.809(1.444~2.266) WHtR 正常 2 071 213 10.28 1.000 中心型肥胖 3 424 649 18.95 1.215(1.005~1.468) 注：a多因素调整为年龄、性别、文化程度、职业、家庭月收入、吸烟、饮酒、体育锻炼、高盐、高脂、高糖饮食、收缩压、舒张压、总胆固醇、甘油三酯、高密度脂蛋白胆固醇和低密度脂蛋白胆固醇。
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表 3 家族史、BMI、WHtR对糖尿病发病的影响
Table 3. The influence of family history, BMI and WHtR on the incidence of diabetes
变量 总人数 发病人数 发病率(%) HR(95% CI)值a 糖尿病家族史 BMI(kg/m2) 无 ＜24 2 001 207 10.34 1.000 24~ 2 072 366 17.66 1.486(1.243~1.778) ≥28 652 148 22.70 1.928(1.545~2.407) 有 ＜24 349 47 13.47 1.720(1.248~2.372) 24~ 322 60 18.63 2.113(1.571~2.840) ≥28 99 34 34.34 4.401(3.026~6.401) 交互作用 1.020(1.013~1.027) 糖尿病家族史 WHtR 无 正常 1 724 171 9.92 1.000 中心型肥胖 3 001 550 18.33 1.415(1.180~1.698) 有 正常 347 42 12.10 1.432(1.016~2.019) 中心型肥胖 423 99 23.40 2.565(1.989~3.307) 交互作用 2.867(1.998~4.114) 注：a多因素调整为年龄、性别、文化程度、职业、家庭月收入、吸烟、饮酒、体育锻炼、高盐、高脂、高糖饮食、收缩压、舒张压、总胆固醇、甘油三酯、高密度脂蛋白胆固醇和低密度脂蛋白胆固醇。
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表 4 家族史、BMI、WHtR的联合作用对糖尿病发病的影响
Table 4. Joint effects of family history, BMI and WHtR on the incidence of diabetes
家族史 BMI (kg/m2) WHtR 总人数 发病人数 发病率(%) HR(95% CI)值a 无 ＜24 正常 1 349 115 8.52 1.000 中心型肥胖 652 92 14.11 1.295(0.979~1.714) 24~ 正常 360 53 14.72 1.663(1.324~2.089) 中心型肥胖 1 712 313 18.28 1.724(1.240~2.399) ≥28 正常 15 3 20.00 1.697(0.538~5.357) 中心型肥胖 637 145 22.76 2.188(1.686~2.838) 有 ＜24 正常 263 31 11.79 1.695(1.137~2.526) 中心型肥胖 86 16 18.60 2.468(1.460~4.172) 24~ 正常 82 11 13.41 1.597(0.834~3.057) 中心型肥胖 240 49 20.42 2.609(1.854~3.673) ≥28 正常 2 0 - - 中心型肥胖 97 34 35.05 4.977(3.351~7.392) 注：a多因素调整为年龄、性别、文化程度、职业、家庭月收入、吸烟、饮酒、体育锻炼、高盐、高脂、高糖饮食、收缩压、舒张压、总胆固醇、甘油三酯、高密度脂蛋白胆固醇和低密度脂蛋白胆固醇。
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