Body-mass index and mortality among adults with incident type 2 diabetes.
Body-mass index and mortality among adults with incident type 2 diabetes.
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DOI：
10.1056/nejmoa1304501
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发表时间：
2014-01-16
期刊：
影响因子：
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通讯作者：
Hu FB
中科院分区：
文献类型：
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作者：
Tobias DK;Pan A;Jackson CL;O'Reilly EJ;Ding EL;Willett WC;Manson JE;Hu FB
2型糖尿病患者的体重与死亡率之间的关系仍未得到解决，一些研究表明，与正常体重的人相比，超重或肥胖的人死亡率降低（“肥胖悖论”）。我们研究了来自护士健康研究（8970名参与者）和健康专业人员随访研究（2457名参与者）的糖尿病事件参与者，他们在诊断糖尿病时没有心血管疾病和癌症。使用诊断前不久的体重和身高计算体重指数（BMI，体重（kg）除以身高（m）的平方）。多变量考克斯模型用于估计BMI类别中死亡率的风险比和95%置信区间。在平均15.8年的随访期间，有3083例死亡。在BMI类别中观察到J形关联全因死亡率（18.5至22.4、22.5至24.9 [参考]、25.0至27.4、27.5至29.9、30.0至34.9和≥35.0）（风险比，1.29 [95%置信区间{CI}，1.05至1.59]; 1.00; 1.12 [95% CI，0.98至1.29]; 1.09 [95% CI，0.94至1.26]; 1.24 [95% CI，1.08至1.42];和1.33 [95% CI，1.14至1.55]）。这种关系在从不吸烟的参与者中是线性的（BMI类别的风险比分别为：1.12、1.00、1.16、1.21、1.36和1.56），但在曾吸烟的参与者中呈非线性（BMI类别的风险比：1.32、1.00、1.09、1.04、1.14和1.21）（相互作用P = 0.04）。在诊断糖尿病时年龄小于65岁的参与者中观察到直接线性趋势，但在诊断时年龄≥ 65岁的参与者中未观察到直接线性趋势（相互作用P<0.001）。我们观察到所有参与者和曾经吸烟者的BMI与死亡率之间存在J形关联，而从不吸烟者的BMI与死亡率之间存在直接线性关系。我们没有发现诊断时超重或肥胖的糖尿病患者与正常体重的患者相比死亡率较低的证据，也没有发现肥胖悖论的证据。（由美国国立卫生研究院和美国糖尿病协会资助。
The relation between body weight and mortality among persons with type 2 diabetes remains unresolved, with some studies suggesting decreased mortality among overweight or obese persons as compared with normal-weight persons (an “obesity paradox”). We studied participants with incident diabetes from the Nurses’ Health Study (8970 participants) and Health Professionals Follow-up Study (2457 participants) who were free of cardiovascular disease and cancer at the time of a diagnosis of diabetes. Body weight shortly before diagnosis and height were used to calculate the body-mass index (BMI, the weight in kilograms divided by the square of the height in meters). Multivariable Cox models were used to estimate the hazard ratios and 95% confidence intervals for mortality across BMI categories. There were 3083 deaths during a mean period of 15.8 years of follow-up. A J-shaped association was observed across BMI categories (18.5 to 22.4, 22.5 to 24.9 [reference], 25.0 to 27.4, 27.5 to 29.9, 30.0 to 34.9, and ≥35.0) for all-cause mortality (hazard ratio, 1.29 [95% confidence interval {CI}, 1.05 to 1.59]; 1.00; 1.12 [95% CI, 0.98 to 1.29]; 1.09 [95% CI, 0.94 to 1.26]; 1.24 [95% CI, 1.08 to 1.42]; and 1.33 [95% CI, 1.14 to 1.55], respectively). This relationship was linear among participants who had never smoked (hazard ratios across BMI categories: 1.12, 1.00, 1.16, 1.21, 1.36, and 1.56, respectively) but was nonlinear among participants who had ever smoked (hazard ratios across BMI categories: 1.32, 1.00, 1.09, 1.04, 1.14, and 1.21) (P = 0.04 for interaction). A direct linear trend was observed among participants younger than 65 years of age at the time of a diabetes diagnosis but not among those 65 years of age or older at the time of diagnosis (P<0.001 for interaction). We observed a J-shaped association between BMI and mortality among all participants and among those who had ever smoked and a direct linear relationship among those who had never smoked. We found no evidence of lower mortality among patients with diabetes who were overweight or obese at diagnosis, as compared with their normal-weight counterparts, or of an obesity paradox. (Funded by the National Institutes of Health and the American Diabetes Association.)