Body Mass Index, Waist Circumference, and the Risk of Type 2 Diabetes Mellitus Implications for Routine Clinical Practice
Body Mass Index, Waist Circumference, and the Risk of Type 2 Diabetes Mellitus Implications for Routine Clinical Practice
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DOI：
10.3238/arztebl.2010.0470
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发表时间：
2010-07-02
影响因子：
7.7
通讯作者：
Pischon, Tobias
中科院分区：
文献类型：
--
作者：
Feller, Silke;Boeing, Heiner;Pischon, Tobias
背景：目前评估2型糖尿病（DM）发生风险的指南推荐使用患者的身体质量指数（BMI）作为主要指标。建议仅对超重或肥胖患者（BMI >= 25）测量腰围。方法：我们研究了BMI和腰围与2型糖尿病发生风险之间的相互作用，研究对象为9753名男性和15491名女性，年龄在35岁至65岁之间，他们参加了欧洲癌症与营养前瞻性调查(EPIC)-波茨坦。采用多变量校正Cox比例风险回归进行统计分析。结果：在平均8年的随访期间，583名男性和425名女性新诊断为2型糖尿病。BMI和腰围与2型糖尿病风险之间存在显著的交互作用（p < 0.0001）。在BMI较低的人群中，腰围与糖尿病风险之间的正相关更强。低体重或正常体重（BMI < 25）、腰围大的人群与体重超重（BMI 25-29.9）、腰围小的人群发生2型糖尿病的相对危险度（RR）至少相同：前者男性为3.62[1.67-7.83]，女性为2.74 [1.52-4.94]；对于第二种情况，男性的RR为2.26[1.51-3.37]，女性的RR为1.40[0.61-3.19]（方括号内的数字为95%置信区间）。这些相对风险是通过与低体重或正常体重（BMI < 25）、腰围小的人的风险进行比较来计算的。结论：这些发现表明，腰围是评估2型糖尿病风险的重要附加信息，特别是在体重低或正常的人群中。
Background: Current guidelines for assessing the risk of developing type 2 diabetes mellitus (DM) recommend using the patient's body-mass index (BMI) as a primary measure. Waist circumference measurement is recommended for overweight or obese patients only (BMI >= 25).Methods: We studied the interaction between BMI and waist circumference with respect to the risk of developing type 2 DM in a cohort of 9753 men and 15491 women, aged 35 to 65, who participated in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam. The statistical analysis was performed with multivariable-adjusted Cox proportional hazard regression.Results: During a mean follow-up interval of 8 years, type 2 DM was newly diagnosed in 583 men and 425 women. A statistically significant interaction was found between BMI and waist circumference with respect to the risk of type 2 DM (p < 0.0001). The positive association between waist circumference and diabetes risk was stronger in persons with lower BMI. The relative risk (RR) of developing type 2 DM among persons of low or normal weight (BMI < 25) who had a large waist circumference was at least as high as that among overweight persons (BMI 25-29.9) with a small waist circumference: for the first case, the RR was 3.62 [1.67-7.83] in men and 2.74 [1.52-4.94] in women; for the second case, the RR was 2.26 [1.51-3.37] in men and 1.40 [0.61-3.19] in women (The figures in square brackets are 95% confidence intervals). These relative risks were calculated in comparison to the risk among persons of low or normal weight (BMI < 25) with a small waist circumference.Conclusion: These findings imply that the waist circumference is an important additional piece of information for assessing the risk of type 2 DM, particularly among persons of low or normal weight.