Hypertension and type 2 diabetes comorbidity in adults in the United States: risk of overall and regional adiposity

OBJECTIVE: To evaluate the impact of generalized, abdominal, and truncal fat deposits on the risk of hypertension and/or diabetes and to determine whether ethnic differences in these fat patterns are independently associated with increased risk for the hypertension-diabetes comorbidity (HDC). RESEARCH METHODS AND PROCEDURES: Data (n = 7075) from the Third U.S. National Health and Nutrition Examination Survey were used for this investigation. To assess risks of hypertension and/or diabetes that were due to different fat patterns, odds ratios of men and women with various cut-points of adiposities were compared with normal subjects in logistic regression models, adjusting for age, smoking, and alcohol intake. To evaluate the contribution of ethnic differences in obesity to the risks of HDC, we compared blacks and Hispanics with whites. RESULTS: Generalized and abdominal obesities were independently associated with increased risk of hypertension, diabetes and HDC in white, black, and Hispanic men and women. The risk of HDC due to generalized, truncal, and abdominal obesities tended to be higher in whites than blacks and Hispanics. In men, the contribution of black and Hispanic ethnicities to the increased risk of HDC due to the various obesity phenotypes was approximately 73% and approximately 61%, respectively. The corresponding values for black and Hispanic women were approximately 115% and approximately 125%, respectively. CONCLUSIONS: In addition to advocating behavioral lifestyles to curb the epidemic of obesity among at-risk populations in the United States, there is also the need for primary health care practitioners to craft their advice to the degree and type of obesity in these at-risk groups.     

2型糖尿病患者肥胖类型与死亡风险的前瞻性研究

目的 探究不同肥胖类型对2型糖尿病(T2DM)患者全死因死亡风险的影响.方法 选取2013年江苏省淮安市纳入基本公共卫生服务管理的9 759例T2DM患者,2018年通过死因监测平台跟踪随访其结局,根据BMI和腰围是否超标,将随访人群分为非肥胖、单纯中心性肥胖、单纯全身性肥胖、复合性肥胖4种类型,采用Cox比例风险模型...     

老年2型糖尿病患者营养不良及腹型肥胖发生率

目的调查老年2型糖尿病患者营养不良（包括营养不足、超重和肥胖）及腹型肥胖发生率。方法随机选取符合纳入标准并获知情同意的老年2型糖尿病患者133例[研究组,平均年龄（66．9±5．4）岁]及老年健康者133名[对照组,平均年龄（66．3±5．8）岁],采用多频生物电阻抗法测定体重、总体脂肪、腹部脂肪、内脏脂肪、内脏脂肪面积和腰臀围比值（WHR）,以体重指数（BMI）判定营养不足、超重和肥胖的发生率,以WHR判定腹型肥胖发生率,并比较两组结果。结果与对照组比较,老年2型糖尿病患者的BMI[（25．7±3．8）％（24．2．4±2．2）kg／m^2,P=0．001]、总体脂肪[（20．1±6．9）／）5．（17．4±5．0）kg,P=0．001]、WHR（0．92±0．10w．0．87±0．06,P=0．001）、腹部脂肪[（10．2±3．4）讹（8．6±2．5）kg,P=0．001]、内脏脂肪[（2．7±0．9）w．（2．3±0．7）kg,P=0．001]和内脏脂肪面积[（89．1±28．8）强（75．74±21．6）cm^2,P=0．001]均显著增高。老年2型糖尿病患者的营养不足（BMI〈18．5）（3．8％w．0,P=0．024）和肥胖（BMI≥28．0）发生率（26．3％％6．0％,P=0．001）均显著高于对照组。老年男性2型糖尿病患者体脂过高（52．1％傩．34．1％,P=0．023）和腹型肥胖的发生率（83．6％％67.1％,P=0．017）均显著高于对照组。结论对老年2型糖尿病患者应强调总体脂肪、腰围、腹部和内脏脂肪的测定与控制。     

Age of onset of obesity and risk of type 2 diabetes

Objective : To compare a simple measure ‐ age of onset of obesity ‐ to an obese‐years construct (a product of duration and magnitude of obesity) as risk factors for type 2 diabetes. Method : Participants from the Framingham Heart Study who were not obese and did not have diabetes at baseline were included (n=4,320). The Akaike Information Criterion (AIC) was computed to compare four Cox proportional hazards models with incident diabetes as the outcome and: (i) obese‐years; (ii) age of onset of obesity; (iii) body mass index (BMI); and (iv) age of onset of obesity plus magnitude of BMI combined, as exposures. Results : AIC indicated that the model with obese‐years provided a more effective explanation of incidence of type 2 diabetes compared to the remaining three models. Models including age of onset of obesity plus BMI were not appreciably different from the model with BMI alone, except in those aged ≥60. Conclusions : While obese‐years was the optimal obesity construct to explain risk of type 2 diabetes, age of onset may be a useful, practical addition to current BMI in the elderly. Implications : Where computation of obese‐years is not possible or impractical, age of onset of obesity combined with BMI may provide a useful alternative.     

Cigarette smoking and risk of type 2 diabetes mellitus among middle-aged and elderly Japanese men and women

For examination of sex- and age-specific relations between smoking and risk of type 2 diabetes mellitus, 39,528 nondiabetic men and 88,613 nondiabetic women aged 40-79 years who underwent health checkups in Ibaraki-ken, Japan, in 1993 were followed through 2002. Risk ratios for diabetes according to smoking habits were calculated using a Cox proportional hazards model. Compared with never smokers, the risk ratio for diabetes among current smokers, after adjustment for age, systolic blood pressure, antihypertensive mediation use, alcohol intake, parental history of diabetes, body mass index, fasting status, blood glucose concentration, total and high density lipoprotein cholesterol levels, and log-transformed triglyceride level, was 1.27 (95% confidence interval (CI): 1.16, 1.38) in men and 1.39 (95% CI: 1.20, 1.61) in women. The excess risk was more pronounced among men with a parental history of diabetes than among men without one. The excess risk among current smokers was observed in both age subgroups (40-59 and 60-79 years). Respective multivariate risk ratios for the age subgroups were 1.37 (95% CI: 1.18, 1.60) and 1.20 (95% CI: 1.08, 1.34) in men and 1.45 (95% CI: 1.18, 1.79) and 1.34 (95% CI: 1.09, 1.66) in women. Smoking was independently associated with increased risk of type 2 diabetes among both middle-aged and elderly men and women.     

Association of overall and abdominal obesity with coronary heart disease risk factors: comparison between urban and rural Indian men

The relationship of body mass index (BMI), conicity index (CI) and waist circumference to four coronary heart disease (CHD) risk factors (systolic and diastolic blood pressures, total cholesterol and high-density lipoprotein (HDL) cholesterol levels) was examined in urban (n = 110) and rural (n = 102) men aged > or = 20 years, drawn from the 'Reddy' population of Southern Andhra Pradesh, India. Using ANCOVA we found significant difference (< 0.01) for systolic blood pressure, total cholesterol and HDL cholesterol between the urban and rural samples. The Pearson's correlation coefficients suggest that BMI and waist circumference had significant relationships with most of the risk factors in both the populations. The CI did not significantly influence any of the risk factors in the urban population; however, in the rural population, CI did show a significant positive relationship with both of the blood pressures and with TC. Even after controlling for age, smoking and physical activity (partial correlations), the relations remained constant. In multiple linear regression, BMI showed significant positive association with systolic and diastolic blood pressures (<0.01) and HDL cholesterol (<0.05) in the rural population only. However, the Cl showed a significant association with HDL cholesterol, and waist circumference with total cholesterol and HDL cholesterol in the rural population. The results of the present study revealed that BMI and waist circumference had a greater influence on the CHD risk factors, and that the influence was more conspicuous in the rural sample. Comparing the association of abdominal obesity measures (CI and waist circumference) with CHD risk factors, waist circumference better correlated with most of the risk factors. Hence the present study suggests that BMI and waist circumference are better indicators of CHD risk factors. However, the importance of Cl has to be further studied in South Asian populations.     

Ten-year changes in the obesity, abdominal adiposity, and serum lipoprotein cholesterol measures of Western Samoan men

Previously reported associations between abdominal adiposity and coronary heart disease (CHD) may be mediated through serum lipids. In the present longitudinal study, 43 Western Samoan men who participated in a 1982 study were recontacted for a second determination of anthropometric and serum lipoprotein cholesterol levels. The men showed dramatic increases in weight (mean change ± SD: 10.5 ± 8.8 kg), abdominal circumference (10.0 ± 7.6 cm), total cholesterol (49.5 ± 26.4 mg/dl), and non-HDL cholesterol (53.1 ± 26.6 mg/dl). A new indicator was used to estimate changes in abdominal adiposity: the residual from the regression of change in the abdominal circumference on change in body weight (the AR). The AR was significantly correlated with changes in total (r = 0.38) and non-HDL cholesterol (r = 0.39). Changes in HDL cholesterol were correlated with changes in weight only (r = −0.37). These bivariate relations remained significant in multiple linear regression analyses. These longitudinal results are the first to suggest changes in abdominal adiposity are related to changes in total and non-HDL cholesterol levels.     

Migration and its impact on adiposity and type 2 diabetes

In this review, we discuss the impact of migration on the incidence and prevalence of obesity and type 2 diabetes mellitus (T2DM) in different ethnic groups and populations. We also analyze the determinants of such phenomena in view of the global increase in the migration and escalating prevalence of obesity and T2DM. The risk escalation of the obesity and T2DM followed a gradient, as migrants (Blacks, Hispanics, Chinese, South Asians, etc.) became more affluent and urbanized, indicating an important role of environmental factors. A stepwise increase in the prevalence of obesity in Blacks along the path of migration (5% in Nigeria, 23% in Jamaica, and 39% in the United States) is a classic example. Furthermore, South Asian migrants, who are particularly predisposed to develop insulin resistance and T2DM, showed nearly four times prevalence rates of T2DM than rural sedentee populations. Similar observations were also reported in intracountry migrants and resettled indigenous populations. The determinants were found to include nutrition transition, physical inactivity, gene-environment interaction, stress, and other factors such as ethnic susceptibility. However, certain contradictory trends were also seen in some migrant communities and have been explained by various phenomena such as healthy migrant effect, "salmon bias", and adherence to traditional diets. A review of the evidence suggests a critical role of environmental factors in conferring an increased risk of obesity and T2DM. The important contributory factors to this phenomenon were urbanization, mechanization, and changes in nutrition and lifestyle behaviors, but the role of stress and as yet unknown factors remain to be determined.     

2型糖尿病患者肥胖状态与肱踝脉搏波传导速度的相关性

目的  探讨2型糖尿病（type 2 diabetes,T2DM）患者全身性肥胖（overall obesity,OO）、中心性肥胖（abdominal obesity,AO）状态与肱踝脉搏波传导速度（brachial-ankle pulse wave velocity,baPWV）的关联。 方法  以北京某社区T2DM患者为研究对象,收集人口学资料、体格检查数据、血液生化指标及baPWV。采用多元线性回归分析各肥胖指标与baPWV的关联,采用Logistic回归模型探讨肥胖状态与baPWV异常（baPWV≥1700 cm/s）的关联。 结果  共纳入2 048名研究对象,平均年龄（59.2±8.3）岁,baPWV异常率为49.7%。调整年龄、糖尿病病程、高血压等混杂因素后,多元线性回归发现体重指数（body mass index,BMI）与baPWV负相关、腰臀比（waist-to-hip ratio,WHR）与baPWV正相关。Logistic回归分析发现与BMI正常组相比,BMI肥胖组baPWV异常（OR=0.59,95% CI：0.44~0.78,P < 0.001）;与WHR正常组相比,WHR肥胖组baPWV异常（OR=1.46,95%CI：1.07~2.00,P < 0.001）;与既无OO也无AO组患者相比,无OO但有AO组患者baPWV异常（OR=1.67,95%CI：1.19~2.35,P=0.003）。 结论  T2DM患者中,AO与baPWV间存在显著的关联,尤其是BMI不肥胖但WHR肥胖的糖尿病患者需要密切随访动脉僵硬度。     

中国2型糖尿病防治指南(2010年版)

  目的  了解AGTR1基因甲基化及其与超重、腹型肥胖联合作用对糖尿病患病的影响,为糖尿病的防治提供科学依据。  方法  于2015年4 — 9月采用分层随机抽样方法在福建省福清市、长乐市和南安市抽取60个社区共8 371名常住居民进行问卷调查和体格检查;采用高分辨率熔解曲线（HRM）方法抽取其中在福清市3个社区按性别、年龄、文化程度、婚姻状况进行1 : 4病例对照匹配的205名居民进行AGTR1基因甲基化水平测定,并采用叉生分析表结合logistic回归模型与Delta法分析AGTR1基因甲基化与超重、腹型肥胖联合作用对糖尿病患病的影响。  结果  福建省福清市、长乐市和南安市8 371名居民中,患糖尿病者705例,糖尿病患病率为8.42 %;经性别、年龄、文化程度、婚姻状况、吸烟情况、饮酒情况、参加体育锻炼情况、规律饮食情况等混杂因素调整后,多因素非条件logistic回归分析结果显示,超重者患糖尿病的风险为正常体重者的1.999倍（OR = 1.999,95 % CI = 1.671～2.392）,腹型肥胖者患糖尿病的风险为非腹型肥胖者的1.272倍（OR = 1.272,95 % CI = 1.060～1.527）;经吸烟情况、饮酒情况、参加体育锻炼情况、规律饮食情况、体质指数（BMI）、腰臀比（WHR）等混杂因素调整后,多因素条件logistic回归分析结果显示,AGTR1基因低甲基化者患糖尿病的风险为高甲基化者的2.222倍（OR = 2.222,95 % CI = 1.093～4.518）;联合作用分析结果显示,超重且AGTR1基因低甲基化者患糖尿病的风险为非超重且AGTR1基因非低甲基化者的3.584倍（OR = 3.584,95 % CI = 1.175～10.928）,腹型肥胖且AGTR1基因低甲基化者患糖尿病的风险为非腹型肥胖且AGTR1基因非低甲基化者的4.141倍（OR = 4.141,95 % CI = 1.138～15.075）;交互作用分析结果显示,超重和腹型肥胖与AGTR1基因低甲基化均不存在相乘和相加交互作用（均P > 0.05）。  结论  AGTR1基因低甲基化水平与超重、腹型肥胖联合作用均可增加糖尿病的患病风险。     

2型糖尿病患者肥胖状态与全因死亡风险的关联研究

目的 分析不同肥胖状态与2型糖尿病（T2DM）患者全因死亡风险的关联。方法 研究对象来自浙江农村社区T2DM队列,该队列2016年完成基线调查,本研究使用的随访数据截至 2021年12月31日,剔除随访期间失访或资料不全者,共纳入10 310例研究对象。根据BMI和腰围将研究对象分为低体重、正常体型、单纯中心性肥胖、单纯全身肥胖、复合超重和复合肥胖6种状态,采用Cox比例风险回归模型分析不同肥胖状态T2DM患者的全因死亡风险比（HR）值及其95%CI。结果 研究对象累计随访57 049.47人年,随访（5.53±0.89）人年,随访期间共死亡971例,死亡密度为1 702.03/10万人年。以正常体型患者为对照,调整混杂因素后低体重患者全因死亡风险增加104%（HR=2.04,95%CI：1.42~2.92）,单纯全身肥胖、复合超重、复合肥胖患者的全因死亡风险分别下降34%（HR=0.66,95%CI：0.53~0.82）、22%（HR=0.78,95%CI：0.66~0.92）、38%（HR=0.62,95%CI：0.49~0.78）,单纯中心性肥胖患者全因死亡风险差异无统计学意义。亚组分析显示,不同性别和不同年龄组低体重T2DM患者全因死亡风险增加,女性复合肥胖患者全因死亡风险较正常体型患者下降50%,而男性该肥胖状态患者全因死亡风险差异无统计学意义;≥65岁老年患者中,单纯全身肥胖、复合超重、复合肥胖患者的全因死亡风险均明显低于正常体型组（HR=0.61,95%CI：0.48~0.78;HR=0.76,95%CI：0.63~0.91;HR=0.56,95%CI：0.42~0.73）,而<65岁的各种肥胖状态患者全因死亡风险差异无统计学意义。敏感性分析结果未见明显变化。结论 T2DM患者全因死亡风险存在“肥胖悖论”现象,低体重患者的全因死亡风险明显高于正常体型者,全身型或复合型超重/肥胖患者的死亡风险明显降低。