肥胖及血脂异常与2型糖尿病关系

目的 探讨肥胖及血脂异常与2型糖尿病的关系.方法 采用病例对照研究方法,选取重庆市3所医院的糖尿病门诊和住院初诊患者及其他疾病和门诊健康体检者396例作为调查对象;其中糖尿病病例组184例,对照组212人.对调查对象进行问卷调查、体格检查和生化指标等实验室检测.结果 病例组体质指数(BMI)、腰臀比(WHR)、血清总胆固醇(TC)、甘油三酯(TG)均高于对照组,差异均有统计学意义(P<0.05);病例组超重及肥胖检出率(64.67%)、腹型肥胖检出率(77.17%)、高TC检出率(27.17%)、高TG检出率(50.00%)均高于对照组(45.28%,64.15%,14.15%,35.38%),差异均有统计学意义;经多因素非条件Logistic回归分析显示,高胆固醇、超重及肥胖是糖尿病的主要危险因素.结论 肥胖和血脂异常与2型糖尿病相关,控制体重、合理膳食是预防2型糖尿病发生的重要措施.     

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。     

Epidemiological link between obesity,type 2 diabetes mellitus and cancer

There exists a complex interaction between obesity, type 2 diabetes mellitus (T2DM) and cancer, and an increase in the incidence of cancer is expected with the growing obesity-diabetes pandemic. The association of cancer with diabetes mellitus and obesity appears to be site-specific, the highest risk being for post-menopausal breast cancer, endometrial cancer, and colorectal cancer. Moreover, there is worsening of hyperglycaemia with the onset of cancer, evidencing a bi-directional link between cancer and diabetes mellitus and the need for monitoring for diabetes in cancer survivors. In this review, we look at the epidemiological evidence from observational studies and Mendelian randomization studies linking obesity, diabetes, and cancer, as well as the complex pathophysiological mechanisms involved, including insulin resistance with associated hyperinsulinaemia, the effect of chronic low-grade inflammation, and the effect of various adipokines that are associated with obesity and T2DM. Additionally, we describe the novel therapeutic strategies, based on their role on the discrete pathophysiological mechanisms involved in the tumourigenesis.     

Physical activity, obesity, and the incidence of type 2 diabetes in a high-risk population

This study, examining the longitudinal relation among physical activity, body mass index, and development of type 2 diabetes in a high-risk population, is unique because diabetes was determined by oral glucose tolerance testing rather than by self-report. A physical activity questionnaire assessing past year leisure and occupational activity was administered to 1,728 nondiabetic Pima individuals aged 15-59 years as part of a series of clinic examinations in the Gila River Indian Community from 1987 to 2000. During an average follow-up period of 6 years, 346 subjects developed diabetes. Using time-dependent Cox proportional hazards modeling adjusting for age, the authors found that total activity was related to diabetes incidence in women and men (p < 0.05 in women only). After additional adjustment for body mass index, the relation between activity and diabetes incidence was weakened in both men and women. When the age-adjusted diabetes incidence rates were examined by levels of activity stratified by tertile of body mass index, the diabetes incidence rate remained lower in more active than in less active men and women from all body mass index groups, with the exception of the middle body mass index tertile in men (p < 0.05 in women only). These results suggest that the adoption and maintenance of a physically active lifestyle can play a significant role in preventing type 2 diabetes.     

Serum retinol-binding protein: a link between obesity, insulin resistance, and type 2 diabetes

Insulin resistance occurs under conditions of obesity, metabolic syndrome, and type 2 diabetes. It was found to be accompanied by down-regulation of the insulin-responsive glucose transporter GLUT4. Decreased adipocyte GLUT4 caused secretion by adipocytes of the serum retinol-binding protein RBP4. Enhanced levels of serum RBP4 appeared to be the signal for the development of systemic insulin resistance both in experimental animals and in humans. In mice, increased levels of serum RBP4 led to impaired glucose uptake into skeletal muscle and increased glucose production by liver, whereas lowered serum RBP4 levels greatly enhanced insulin sensitivity. Thus, a link has been established between obesity and insulin resistance: RBP4, the vitamin A-transport protein secreted into the circulation by adipocytes.     

糖尿病家族史、饮食及肥胖与糖尿病交互作用

目的 探讨糖尿病家族史、饮食及肥胖与糖尿病的交互作用。方法选取对湖南省长沙市望城县3个村所有≥15岁常住居民1 602人,调查社会人口资料、糖尿病家族史、饮食习惯及身高、体重、腰臀比、血糖值以及体育锻炼等情况,并对因素间的交互作用进行分析。结果 望城县农村居民糖尿病年龄标化患病率为5.35%,糖尿病家族史与向心性肥胖、年龄≥45岁、文化程度低及高脂饮食间均存在相加交互作用,其交互作用超额相对危险度(RERI)分别为6.2997、7.1803、3.500、3.020,向心性肥胖与高脂饮食间存在相加交互作用,RERI为6.642。结论 糖尿病家族史、饮食及肥胖间存在相加交互作用。     

Review of sitagliptin phosphate: a novel treatment for type 2 diabetes

Sitagliptin (Januvia, Merck Pharmaceuticals) is a dipeptidyl-peptidase inhibitor (DPP-4 inhibitor) that has recently been approved for the therapy of type 2 diabetes. Like other DPP-4 inhibitors its action is mediated by increasing levels of the incretin hormones glucagon-like peptide-1 (GLP-1) and gastric inhibitory polypeptide (GIP). Sitagliptin is effective in lowering HbA1c, and fasting as well as postprandial glucose in monotherapy and in combination with other oral antidiabetic agents. It stimulates insulin secretion when hyperglycemia is present and inhibits glucagon secretion. In clinical studies it is weight neutral. This article gives an overview of the mechanism of action, the pharmacology, and the clinical efficacy and safety of sitagliptin in type 2 diabetes therapy.     

Fatty acid metabolism in obesity and type 2 diabetes mellitus

Disturbances in pathways of lipolysis and fatty acid handling are of importance in the aetiology of obesity and type 2 diabetes mellitus. There is evidence that a lowered catecholamine-mediated lipolytic response may play a role in the development and maintenance of increased adipose tissue stores. Increased adipose tissue stores, a disturbed insulin-mediated regulation of lipolysis and subnormal skeletal muscle non-esterified fatty acid (NEFA) uptake under conditions of high lipolytic rate may increase circulating NEFA concentrations, which may promote insulin resistance and cardiovascular complications. In addition, a disturbance of NEFA uptake by adipose tissue postprandially is also a critical determinant of plasma NEFA concentration. Furthermore, evidence is increasing that insulin-resistant muscle is characterised by a lowered ability to oxidise fatty acids. A dysbalance between fatty acid uptake and fatty acid oxidation may in turn be a factor promoting accumulation of lipid intermediates and triacylglycerols within skeletal muscle, which is strongly associated with skeletal muscle insulin resistance. The present review describes the reported disturbances in pathways of lipolysis and skeletal muscle fatty acid handling, and discusses underlying mechanisms and metabolic consequences of these disturbances.     

Gene expression profile in obesity and type 2 diabetes mellitus

Obesity is an important component of metabolic syndrome X and predisposes to the development of type 2 diabetes mellitus. The incidence of obesity, type 2 diabetes mellitus and metabolic syndrome X is increasing, and the cause(s) for this increasing incidence is not clear. Although genetics could play an important role in the higher prevalence of these diseases, it is not clear how genetic factors interact with environmental and dietary factors to increase their incidence. We performed gene expression profile in subjects with obesity and type 2 diabetes mellitus with and without family history of these diseases. It was noted that genes involved in carbohydrate, lipid and amino acid metabolism pathways, glycan of biosynthesis, metabolism of cofactors and vitamin pathways, ubiquitin mediated proteolysis, signal transduction pathways, neuroactive ligand-receptor interaction, nervous system pathways, neurodegenerative disorders pathways are upregulated in obesity compared to healthy subjects. In contrast genes involved in cell adhesion molecules, cytokine-cytokine receptor interaction, insulin signaling and immune system pathways are downregulated in obese. Genes involved in signal transduction, regulation of actin cytoskeleton, antigen processing and presentation, complement and coagulation cascades, axon guidance and neurodegenerative disorders pathways are upregulated in subjects with type 2 diabetes with family history of diabetes compared to those who are diabetic but with no family history. Genes involved in oxidative phosphorylation, immune, nervous system, and metabolic disorders pathways are upregulated in those with diabetes with family history of diabetes compared to those with diabetes but with no family history. In contrast, genes involved in lipid and amino acid pathways, ubiquitin mediated proteolysis, signal transduction, insulin signaling and PPAR signaling pathways are downregulated in subjects with diabetes with family history of diabetes. It was noted that genes involved in inflammatory pathway are differentially expressed both in obesity and type 2 diabetes. These results suggest that genes concerned with carbohydrate, lipid and amino acid metabolic pathways, neuronal function and inflammation play a significant role in the pathobiology of obesity and type 2 diabetes.     

社区成年人腹型肥胖与2型糖尿病的现况调查

目的研究社区成年人2型糖尿病的患病率与分布，以分析腹型肥胖与2型糖尿病关系。方法以社区为单位，开展20岁以上成年人2型糖尿病普查。结果2689人中糖尿病患病率为6．32％，空腹血糖受损者2．79％；人群中腹型肥胖的分布为66．05％。结论糖尿病的发生与性别无关，随年龄增长糖尿病患病率增高：腹型肥胖是糖尿病发生的危险因素。     

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.     

家族史与肥胖对2型糖尿病协同作用

目的探讨糖尿病家族史与肥胖在2型糖尿病发病中的协同作用。方法以450例2型糖尿病患者为病例组3,158名血糖正常者为对照组,运用相加模型分析糖尿病家族史与肥胖对2型糖尿病的交互作用。结果糖尿病家族史与肥胖对2型糖尿病的发病有协同作用,协同效应指数为1.655;交互效应超额相对危险度为0.834;纯因子归因交互效应百分比为39.58%;用多因素Logistic回归模型调整年龄、性别、高血压、体力活动、经济收入、学历等影响因素后,协同效应指数为1.710;交互效应超额相对危险度为1.047;纯因子归因交互效应百分比为41.51%。结论糖尿病家族史与肥胖同时存在可增加患2型糖尿病的危险性。     

家族史、肥胖及自我管理行为在2型糖尿病患者糖化血红蛋白达标中的作用

目的 探讨家族史、肥胖及自我管理行为对中国基层2型糖尿病(type 2 diabetes mellitus, T2D)患者糖化血红蛋白(hemoglobin A1c, HbA1c)控制达标的作用。 方法 对2016年1月—2019年12月五家糖尿病专科连锁医院连续就诊且资料存储于院内糖尿病共同照护信息系统的门诊或住院T2D患者基线数据进行横断面分析,比较HbA1c是否达标(HbA1c<7.0%)两组的一般状况,采用多因素logistic 回归分析对HbA1c未达标相关因素进行分析。 结果 共纳入8 506例患者, HbA1c达标率27.75 %,有家族史者2 860例(33.62 %),肥胖者1 541例(18.12 %)。HbA1c是否达标,两组在年龄、病程、体质量指数、吸烟、学历、饮食依从性、运动、遵嘱监测血糖、遵嘱用药及治疗方案方面的比较,差异有统计学意义(均P＜0.05)。多因素logistic回归分析显示,肥胖(OR=1.226,95%CI:1.042～1.441)和病程长(OR=1.019,95%CI:1.009～1.028)增加了HbA1c不达标的风险,单纯口服药治疗(OR=0.388,95%CI:0.345～0.436)、遵嘱用药(OR=0.805,95%CI:0.699～0.928)、规律运动(OR=0.886,95%CI:0.786～1.000)降低了HbA1c不达标的风险。 结论 本研究提示中国基层T2D患者HbA1c达标率低,治疗方案、遵嘱用药、规律运动及肥胖是HbA1c达标的相关因素。在临床糖尿病管理中需特别关注胰岛素治疗患者及肥胖患者,并关注患者在遵嘱用药及规律运动方面的依从性。     

糖尿病与肥胖、血脂、血压的关系

目的 探讨2型糖尿病(DM)的体重和血脂、血压的关系。方法 DM患者66例,糖耐量减低(IGT)59例,糖耐 量正常者70例共三组。各组按BMI≥25及≤24.9分为肥胖(H组)及非肥胖(L组)两组。测定每例的腰围(W)、腰臀比 (WHR)、血脂(TG,TC,HDL-C,LDL-C)和血压(SBP和DBP)。统计用方差分析和多重比较法。结果 ①WHR糖尿病肥胖 组明显大于对照肥胖组,P<0.05。②TG肥胖组高于非肥胖组,DM非肥胖组明显高于IGT非肥胖组和对照非肥胖组,P <0.05。③血压在DM和IGT肥胖组明显高于非肥胖组,P<0.05。DM的血压明显高于IGT组,P<0.05。结论 肥胖 患者血脂紊乱和血压增高的患病率增高,尤其是腹型肥胖者明显。WHR增大和TG、血压增高是2型糖尿病的危险因素。     

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。     

Functional foods in the management of obesity and type 2 diabetes

PURPOSE OF REVIEW: The aim of this article is to evaluate food properties able to influence specific physiological targets that may be helpful for the prevention and management of overweight and diabetes. RECENT FINDINGS: Observational and intervention studies have clearly shown that type 2 diabetes can be prevented by lifestyle measures, including reduced energy intake to induce a modest but sustained weight reduction, together with changes in diet composition. SUMMARY: Foods can be regarded as functional if proven to affect beneficially one or more target functions in the body, beyond adequate nutritional effects, in a way relevant to improved state of health and well-being, reduction of risk of diseases, or both. Functional foods might have a particularly high impact for prevention or treatment of overweight and diabetes for which, more than in many other fields, the link between nutrition, biological responses and diseases is clearly established. Functional foods for obesity should be able to influence the energy balance equation regulated by the control of energy intake or of energy dissipated as heat (thermogenesis). For prevention of type 2 diabetes, several unmodified foods with functional properties have already been identified (low saturated fat products, vegetables, fruit, wholegrain foods, low glycemic index starchy foods). Overall, the available evidence on functional foods so far identified in this field is incomplete: the major gap is the lack of diet-based intervention trials of sufficient duration to be relevant for the natural history of diseases like overweight and diabetes.