Lipid ratios and appropriate cut off values for prediction of diabetes: a cohort of Iranian men and women.
Lipid ratios and appropriate cut off values for prediction of diabetes: a cohort of Iranian men and women.
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DOI：
10.1186/1476-511x-9-85
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发表时间：
2010-08-17
影响因子：
4.5
通讯作者：
Azizi F
中科院分区：
文献类型：
--
作者：
Hadaegh F;Hatami M;Tohidi M;Sarbakhsh P;Saadat N;Azizi F
血脂异常是2型糖尿病发病的危险因素;然而，没有研究专门评估脂质比（即总胆固醇（TC）/高密度脂蛋白胆固醇（HDL-C）和甘油三酯（TG）/HDL-C）作为糖尿病的预测因子。我们的目的是比较伊朗男性和女性在中位随访6.4年期间不同血脂指标与糖尿病事件之间的独立关联。研究人群包括5201例年龄≥20岁的非糖尿病受试者（男性= 2173例，女性= 3028例）。采用多变量logistic回归分析，计算TC、对数转换TG、HDL-C、非HDL-C、TC/HDL-C和对数转换TG/HDL-C每1个标准差（SD）变化的糖尿病风险因素校正比值比（OR）。采用受试者工作特征曲线（ROC）分析来定义每种血脂指标的最大灵敏度和特异性之和（MAXss）作为糖尿病的预测因子。在随访期间，我们发现了366例（146例男性和220例女性）新发糖尿病病例。男性中TG、TC/HDL-C和TG/HDL-C增加1 SD的风险因素校正OR分别为1.23、1.27和1.25;女性中相应的风险分别为1.36、1.14和1.39（所有p < 0.05，女性中TC/HDL-C除外，其边缘显著，p = 0.07）。仅女性HDL-C升高1 SD，糖尿病风险降低25% [0.75（0.64-0.89）]。在两种性别中，在危险因素校正模型中，不同血脂指标预测糖尿病事件的区分能力没有差异（ROC = 82%）。TG临界值为1.98和1.66 mmol/l;男性和女性的TG/HDL-C临界值分别为4.7和3.7，两种性别的TC/HDL-C临界值均为5.3，女性的HDL-C临界值为1.18 mmol/l，得出了定义糖尿病发病率的MAXss。然而，TC/HDL-C和TG/HDL-C在男性人群中显示出相似的糖尿病预测性能;在女性中，TG/HDL-C比TC/HDL-C突出了更高的风险，尽管在区分能力方面没有差异。重要的是，HDL-C仅在女性中对糖尿病事件具有保护作用。
Dyslipidemia is a risk factor for incident type 2 diabetes; however, no study has specifically assessed the lipid ratios (i.e. total cholesterol (TC)/high density lipoprotein cholesterol (HDL-C) and triglyceride (TG)/HDL-C) as predictors of diabetes. We aimed to compare the independent association between the different lipid measures with incident diabetes over a median follow up of 6.4 years in Iranian men and women. The study population consisted of 5201 non diabetic (men = 2173, women = 3028) subjects, aged ≥20 years. The risk factor adjusted odds ratios (ORs) for diabetes were calculated for every 1 standard deviation (SD) change in TC, log-transformed TG, HDL-C, non-HDL-C, TC/HDL-C and log-transformed TG/HDL-C using multivariate logistic regression analysis. Receiver operator characteristic (ROC) curve analysis was used to define the points of the maximum sum of sensitivity and specificity (MAXss) of each lipid measure as a predictor of diabetes. We found 366 (146 men and 220 women) new diabetes cases during follow-up. The risk-factor-adjusted ORs for a 1 SD increase in TG, TC/HDL-C and TG/HDL-C were 1.23, 1.27 and 1.25 in men; the corresponding risks in females were 1.36, 1.14, 1.39 respectively (all p < 0.05, except TC/HDL-C in females which was marginally significant, p = 0.07). A 1 SD increase of HDL-C only in women decreased the risk of diabetes by 25% [0.75(0.64-0.89)]. In both genders, there was no difference in the discriminatory power of different lipid measures to predict incident diabetes in the risk factor adjusted models (ROC ≈ 82%). TG cutoff values of 1.98 and 1.66 mmol/l; TG/HDL-C cutoff values of 4.7 and 3.7, in men and women, respectively, TC/HDL-C cutoff value of 5.3 in both genders and HDL-C cutoff value of 1.18 mmol/l in women yielded the MAXss for defining the incidence of diabetes. TC/HDL-C and TG/HDL-C showed similar performance for diabetes prediction in men population however; among women TG/HDL-C highlighted higher risk than did TC/HDL-C, although there was no difference in discriminatory power. Importantly, HDL-C had a protective effect for incident diabetes only among women.