111例孕妇体重指数与妊娠期糖尿病关系研究

目的为早期发现妊娠期糖尿病(GDM),及早采取干预措施,对在郑州大学第三附属医院111例孕妇的体重指数(BMI)变化与GDM的相关性进行研究。方法将111例妊娠24至28周的孕妇以OGTT空腹血糖≥5.1 mmol/L,1h血糖≥10.0 mmol/L,2 h血糖≥8.5 mmol/L符合两项或以上为诊断标准分为55例病例组与56例健康孕妇为对照进行分析,对两组孕妇的孕前体重、孕前BMI及OGTT检测时体重、BMI进行统计学分析。结果两组孕妇的孕前体重及BMI比较差异无统计学意义(P>0.05),进行血糖异常时的体重及BMI,差异有统计学意义(P<0.05)。结论体重及BMI的增加是提示GDM发病风险的重要指标,为产科及围产期保健医生早期发现GDM并采取干预措施提供重要线索。     

上海市成年人中心性肥胖者糖尿病的患病风险

目的 采用腰围(waist circumference,WC)、体质指数(body mass index,BMI)综合评价上海35岁及以上成年人中心性肥胖者糖尿病患病风险。方法 利用2013年上海慢性病及其危险因素监测样本人数,采用多级抽样方法抽取35岁及以上成年人20 991人,采用问卷调查、身体测量和实验室检测方法收集数据,比较各BMI组别中心性肥胖者糖尿病患病的OR值。结果 体质指数正常、超重和肥胖组中,男性中心性肥胖者糖尿病患病率分别为19.68%、21.89%和27.03%;女性中心性肥胖者糖尿病患病率分别为17.78%、19.32%和26.73%;不同体质指数分组中心性肥胖人群糖尿病患病风险情况,男女性正常体重组和女性超重组,调整混杂因素前后,中心性肥胖者糖尿病患病率明显高于同组内的正常腰围人数(P＜0.01),OR值分别为男性正常体重组未调整OR值1.62(95%CI:1.16～2.28),调整后OR值1.65(95%CI:1.16～2.33);女性正常体重组未调整OR值2.28(95%CI:1.71～3.04),调整后OR值1.93(95%CI:1.49～2.50);女性超重组未调整OR值2.31(95%CI:1.66～3.22),调整后OR值2.01(95%CI:1.44～2.80)。结论 中心性肥胖者与正常腰围者比较具有更高的糖尿病患病风险。     

国民体质指数与Ⅱ型糖尿病关系Meta分析

目的 估计成年人体质指数与Ⅱ型糖尿病患病之间的关系。方法 通过文献检索收集1990年以来国内关于体质指数与糖尿病患病关系的现况调查文献，经质量评估最终18篇入选并进行Meta分析。结果 通过固定效应模型估算20岁以上人群体质指数≥24与体质指数≥25人群患糖尿病的相对危险度分别为2．28和2．46。结论 较高的体质指数是糠尿病的重要危险因素。从而为估计人群归因危险度提供一定依据。     

孕妇体质指数与妊娠期糖尿病关系

目的 探讨孕期体质指数增长速度与妊娠期糖尿病(GDM)发病率的关系。方法 通过流行病学调查和产检测量获得一般资料;通过实验室检查确诊妊娠期糖尿病。采用非条件Logistic回归分析孕期体质指数增加与妊娠期糖尿病的关系。结果 多因素回归分析显示,孕期体质指数(BMI)增加大(OR=89.1274,95%CI=6.2574~95.1757)、孕前体质指数大(OR=8.1826,95%CI=7.1804~41.3126)、有糖尿病家族史(OR=4.1254,95%CI=4.0247~27.2024)、年龄大(OR=2.4322,95%CI=2.2815~15.2251)均增加孕妇发生妊娠期糖尿病的风险;未发现身高与妊娠期糖尿病发病有关。排除孕前体重干扰后,孕期体重增长速度越快,发生妊娠期糖尿病的风险越大。结论 孕期体质指数增长过快是妊娠期糖尿病的独立危险因素。     

Diet and exercise in the prevention of diabetes

Background: Individuals with impaired fasting glucose or impaired glucose tolerance are at high risk of progression to type 2 diabetes. Lifestyle modification through change to diet and exercise habit has considerable potential to prevent or delay the onset of this disease. Methods: A systematic literature search was undertaken of Medline, EMBASE, the Cochrane library and the Cumulative Index to Nursing and Allied Health Literature for journal articles relevant to the question of whether type 2 diabetes can be prevented by lifestyle change. Results: Four cohort studies in a total of 4864 high risk individuals followed for a period of 2.5–6 years were identified. These showed that lifestyle change may reduce the incidence of type 2 diabetes by 28–59%. Moreover, follow‐up studies also indicate that diabetes incidence rates continue to be depressed many years after the discontinuation of a lifestyle intervention. Evidence from a meta‐analysis confirms this evidence and suggests that it would be necessary to treat 6.4 (95% confidence interval 5.0–8.4) individuals to prevent or delay one case of diabetes through lifestyle intervention. An examination of weight loss diets (low fat, high protein or Mediterranean) suggests each may be effective but each has limitations requiring care in food selection. Evidence also suggests that the maintenance of weight loss also requires regular exercise with an additional expenditure of approximately 8.4 MJ week^?1 (2000 kcal week^?1). Conclusions: Diabetes can be prevented by lifestyle change. The challenge is to develop public health approaches to support individuals with respect to incorporating the lifestyle changes needed to reduce the risk of diabetes into their everyday life.     

不同孕前BMI孕妇孕早期增重对妊娠期糖尿病的影响

目的探讨不同孕前身体质量指数(BMI)孕妇孕早期增重与妊娠期糖尿病(GDM)的关系。方法采用前瞻性队列研究,选取2017年12月至2019年12月在湖北医药学院附属国药东风总医院建档产检孕妇491例,专人记录孕妇的身高、年龄、孕前体重、BMI、孕早中期体重、分娩结局等一般信息,采用Logistic回归分析不同孕前BMI的孕妇孕早期体重增长与GDM的关系。结果孕早期增重不足、适宜及过多的孕妇GDM发病率比较差异有统计学意义(χ²=8.417,P<0.05),而孕中期不同的体重增长情况,孕妇GDM发病率差异无统计学意义(χ²=0.951,P>0.05)。孕早期增重按不同孕前BMI进行分组,Logistic回归分析显示:孕前BMI为18.5~24.9kg/m²的孕妇,孕早期增重过多,GDM发病风险增至1.913倍(OR=1.913,95%CI:1.033~3.543);孕前BMI≥25.0kg/m²的孕妇,孕早期增重适宜、过多,GDM的发病风险分别增至4.900倍(OR=4.900,95%CI:1.179~20.373)和5.444倍(OR=5.444,95%CI:1.290~22.976)。孕前BMI<18.5kg/m²的孕妇,孕早期增重不足、适宜、过多,妊娠期高血压疾病(χ²=118.600)、羊水异常(χ²=6.750)及剖宫产(χ²=6.166)的发生差异有统计学意义(均P<0.05);孕前BMI≥25.0kg/m²的孕妇,孕早期增重不足、适宜、过多,巨大儿发生率差异有统计学意义(χ²=19.372,P<0.05);孕前BMI=18.5~24.9kg/m²的孕妇,孕早期不同增重情况,其不良妊娠结局差异无统计学意义(均P>0.05)。结论孕前体重正常和孕前超重肥胖者,孕早期体重增长过多增加了GDM发生风险;而孕前低体重者,孕早期体重增长增加了妊娠期高血压疾病、羊水异常及剖宫产的发生风险,并不增加GDM的发生风险。     

妊娠期糖尿病妇女与分娩巨大儿的多因素临床研究

目的:为了研究妊娠期糖尿病妇女与分娩巨大儿的多因素临床相关性。方法:回顾性分析2004～2007年在我院分娩的孕周≥37周的妊娠期糖尿病妇女123例,按孕前体重指数(BMI)分为BMI≤23.9组(正常组)、BMI≥24组(肥胖组),妊娠期糖尿病分为单纯饮食治疗组(GDM1组)、饮食+胰岛素治疗组(GDM2组);分析正常BMI组与肥胖组、GDM1组与GDM2组分娩巨大儿的临床风险性。结果:巨大儿总的发生率为27.5%;妊娠28周前发现并治疗的GDM,其巨大儿的发生率为19.0%,妊娠28周后发现并治疗的患者,其巨大儿的发生率为30.2%,增加11.2%,但无统计学意义。GDM1组巨大儿的发生率为28.8%,GDM2组巨大儿的发生率17.4%,下降11.4%,亦无统计学差异。GDM孕前体重指数与巨大儿发病呈正相关,差异有显著性。P<0.05。结论:GDM孕前体重指数过高是分娩巨大儿的重要因素。孕期重视对孕前BMI的评估,及早发现GDM并强化胰岛素治疗,使孕期体重适当增长,可有效减少巨大儿的发生及改善母婴预后。     

妊娠期糖尿病孕妇孕前体质量指数对分娩方式和新生儿体质量的影响

目的探讨妊娠期糖尿病(gestational diabetes mellitus,GDM)孕妇孕前体质量指数(body mass index,BMI)对分娩方式和新生儿体质量的影响,为孕妇体质量管理提供参考依据。方法选取2011年7月至2013年12月在南京市妇幼保健院进行产前检查、分娩的GDM孕妇215例,根据孕妇孕前BMI不同,分为过低组、正常组、超重和肥胖组,分析GDM孕妇孕前不同BMI对分娩方式和新生儿体质量的影响。结果超重和肥胖组剖宫产率为82.76%、巨大儿为17.24%,高于正常组和过低组(P0.05);超重和肥胖组低体重儿发生率与正常组和过低组比较,差异无统计学意义(P0.05)。结论孕前孕妇BMI对GDM孕妇围产结局有一定的影响,GDM孕妇孕前超重和肥胖者剖宫产率和巨大儿增多,应给予合理有效的干预措施,控制BMI在正常范围,以降低不良妊娠结局的发生。     

妊娠期糖尿病孕妇孕期体重指数增长对妊娠结局影响的临床分析

目的:探讨妊娠期糖尿病孕妇孕期体重指数增长对母婴的影响。方法:对120名在我院检查及分娩的妊娠期糖尿病孕妇进行调查,记录孕妇孕前及分娩前的身高、体重,计算体重指数(BMI),计算出孕期体重指数增加值,并随访妊娠结局。结果:孕期体重指数增加<3的孕妇出现胎儿宫内窘迫及低体重儿的发生率高于孕期体重指数增加3～6的孕妇,有统计学意义,孕期体重指数增加>6的孕妇出现先兆子痫、产后出血、胎儿宫内窘迫、巨大儿的发生率高于孕期体重指数增加3～6的孕妇。结论:妊娠期糖尿病孕妇在治疗后控制体重指数增加在一定范围内可使母婴并发症的发生率降低。     

黑龙江省部分地区成年人既往最大体重指数与2型糖尿病关系的研究

目的 研究社区成年人2型糖尿病(T2DM)的患病情况和分布,探讨既往最大体重指数(MAxBMI)与T2DM的关系.方法 2005年6-8月对牡丹江市4个区和1个县级市分层整群抽样20岁以上社区常住居民,研究T2DM患病状况及其与不同水平MAXBMI和当前BMI的关系.结果纳入研究的社区居民为1071名,T2DM患病率7.09%;以MAXBMI为肥胖的T2DM患病率为12.10%.随MAXBMI水平升高,患T2DM的危险增大(趋势X~2=17.387 23,P<0.0001).多因素分析显示,MAXBMI高者患T2DM的OR值为3.06(P=0.0013).分组后的分层分析显示,T2DM患者中血糖水平在MAXBMI≥27.4 kg/m~2组,比MAXBMI低水平组显著升高(P=0.0408);血糖正常组,MAXBMI处于高值(≥25.4 kg/m~2)的人群比低值人群当前BMI相对MAXBMI下降的更大,血糖水平更高.结论 在T2DM患者和血糖正常组人群中,MAXBMI值与T2DM具有相关性;可作为肥胖指标预测糖尿病患病的风险.     

成年早中期体重变化与中老年糖尿病的相关性研究

目的 探讨成年早、中期体重变化与中老年糖尿病的相关性。方法 基于"广州生物库队列研究"（GBCS）平台,选取其中28 736例≥ 50岁广州市中老年人为研究对象,采用多因素logistic回归模型,分析调整年龄、吸烟、饮酒、体力活动、教育程度、职业、居住地、BMI后成年早中期体重变化、达到最重体重时的年龄等与糖尿病的关系。结果 研究对象年龄男性（64.3±6.7）岁,女性（61.0±7.0）岁,糖尿病患病率男、女性（13.1%和13.7%）基本一致。与体重基本不变组相比,男女性糖尿病患病风险均随其成年早、中期体重增加而增加（趋势检验P<0.01）,以体重增加>20 kg组患糖尿病风险最高,男女性OR值分别为2.83（95% CI：1.99~4.02）和3.13（2.47~3.96）。与在20岁时已达到最高体重者相比,以40~49岁达到最重体重组糖尿病患病风险最高,男性OR=5.32（95% CI：1.92~14.8）,女性OR=3.41（95% CI：2.49~4.67）。男女性成年后体重减少仅与中老年自报糖尿病有关,与新诊断糖尿病无关。结论 成年早、中期体重增加可增加中老年糖尿病患病风险,体重明显增重到发生糖尿病相隔时间可能为10~20年。     

初诊2型糖尿病代谢状态及慢性并发症与肥胖程度的相关性研究

目的探讨初诊2型糖尿病患者代谢状态及慢性并发症与肥胖程度的相关性。方法对我院2009年1月²011年12月期间308例新诊断的T2DM住院患者进行研究,患者根据体重指数进行成组配比病例对照研究,对比三组患者血糖、血压、血脂、空腹C肽水平及并发症发病率行相关性分析。结果低体重患者主要临床特征为胰岛素分泌水平低下,HbA及空腹血糖增高,而微血管并发症以视网膜病变较为突出。超重及肥胖的糖尿病患者主要临床特征表现为高血压、胰岛素抵抗、高甘油三酯及低高密度脂蛋白胆固醇血症,且超重组患者易伴发高血压及冠心病等大血管并发症。结论初诊T2DM的低体重患者需及时补充胰岛素并对视网膜病变并发症重点筛查;而初诊T2DM超重患者应积极进行减肥、降压及调脂等综合治疗。     

城市妇女孕前体质指数对孕期血糖、血压和体重变化的影响

目的观察孕前体质指数对孕期妇女血糖、血压和体重变化的影响。方法采用队列研究方法对2009年2月5日至2009年3月15日在北京海淀妇幼保健院建围产保健卡的北京市孕妇600名进行随访,监测整个孕期身高、体重、血压、血糖等指标的变化。结果孕前体质指数与不同孕期体重有显著相关性(p0.001),超重和肥胖孕妇的糖耐量受损和糖尿病、高血压患病率在不同孕期阶段均显著高于低体重和正常孕妇的患病率(P0.05)。结论孕前体质指数是影响孕期妇女血压、血糖和体重变化的重要危险因素,开展孕前健康教育是预防妊娠期并发症的重要措施。     

Changes in weight and health behaviors from freshman through senior year of college

ObjectiveTo assess weight changes, exercise and diet behaviors among college students from the beginning of freshman year until the end of senior year.DesignLongitudinal observational study.SettingPrivate university in St. Louis, Missouri.ParticipantsCollege students (138 females, 66 males).Main Outcome MeasuresWeight and height were measured, body mass index (BMI) was calculated, and exercise and dietary behaviors were assessed by questionnaire.AnalysisChanges in weight, BMI, exercise, and dietary patterns from the beginning of freshman year to the end of senior year.ResultsFemales gained 1.7 ± 4.5 kg (3.75 ± 9.92 lb) [mean ± SD] from freshman to senior year, and males gained 4.2 ± 6.4 kg (9.26 ± 14.11 lb) (both P < .001). Weight changes were highly variable between students, however, ranging from −13.2 kg to +20.9 kg (−29.10 to +46.08 lb).Conclusions and ImplicationsWeight gain was common but variable among college students. Importantly, exercise and dietary patterns did not meet the recommended guidelines for many college students, which may have long-term health implications.     

Acculturation and healthy lifestyle among Latinos with diabetes

PURPOSE Latinos have a high prevalence of diabetes and disproportionately experience diabetic complications. We sought to examine the association of acculturation on healthy lifestyle habits among the Latino population in the United States with diabetes.METHODS We studied Latino adults (aged ≥20 years) with previously diagnosed diabetes in the 1999–2004 National Health and Nutrition Examination Survey (unweighted N = 467; weighted N = 1,957,778). Healthy lifestyle habits were those consistent with recommendations of the American Diabetes Association (ADA) regarding exercise, smoking, obesity, and diet. Acculturation was measured with the Short Acculturation Scale, a validated 5-item scale assessing use of the Spanish language. Logistic regression analyses of acculturation and healthy behaviors were computed controlling for access to care, demographics, and disease characteristics.RESULTS In bivariate analyses, compared with their less-acculturated counterparts, individuals who were more-acculturated to any extent were less likely to have a higher fiber intake (9.4% vs 35.4%, P = .001) and lower saturated fat intake (17.2% vs 46.5%, P = .03). More-acculturated individuals were more likely to report leisure time exercise (59.2% vs 19.3%, P <.001), whereas the proportion of individuals who smoked did not differ. In logistic regression analyses using the 1994 ADA dietary guidelines, more-acculturated individuals were less likely than their less-acculturated counterparts to meet dietary criteria for saturated fat consumption (odds ratio, 0.13; 95% confidence interval [CI], 0.04–0.41). When using the stricter 2006 ADA dietary guidelines, more-acculturated individuals were less likely to have recommended consumption of both saturated fat (odds ratio, 0.06; 95% CI, 0.02–0.20) and fiber (odds ratio, 0.19; 95% CI, 0.08–0.48). Acculturation did not significantly influence exercise and smoking status in logistic regression analyses.CONCLUSIONS These results suggest that acculturation among diabetic Latinos to the general US culture is associated with adoption of some less desirable dietary habits.     

Dietary management of type 2 diabetes mellitus among South Asian immigrants: A mixed-methods study

Aims

There is a high prevalence of South Asian immigrants in Australia living with type 2 diabetes mellitus, with the dietary management of the condition presenting as a key challenge. However, their current dietary patterns and barriers to diabetes self-management are unclear. Therefore, this study aims to (i) investigate current dietary patterns and (ii) explore barriers and facilitators to dietary management in this population.

Methods

A concurrent mixed-methods study comprising three 24-h dietary recalls and a semi-structured interview for each self-identified South Asian immigrant adult with diabetes recruited across Victorian primary care clinics and social media to address the aforementioned two aims. Dietary recall data were converted into food groups using Foodworks, and data analysed in SPSS. Qualitative data were thematically analysed using NVivo.

Results

Among 18 participants recruited, 14, 16 and 17 participants had grain, fruit and dairy intake lower than daily Australian recommendations, respectively. These findings echoed qualitative data that participants viewed diabetes management as reducing carbohydrate intake. Participants reported difficulties incorporating diabetes-related dietary and lifestyle recommendations into their routine and a lack of knowledge about available organisational support. They mentioned challenges in receiving social support from families and friends and relied on support from health professionals. Facilitators included proficiency in nutrition information label reading and self-blood glucose monitoring skills.

Conclusion

Enhancing the accessibility to organisational support, facilitating the adaption of dietary recommendations into individuals' routines, and strengthening support from health professionals are essential components in intervention development to improve diabetes management for South Asians.     

妊娠期糖尿病影响因素的病例对照研究

目的:探讨妊娠期糖尿病(GDM)发病的影响因素,为预防和治疗GDM的发生和发展提供理论依据。方法:采用回顾性分析的方法,将2007年9月～2008年9月在沈阳市盛京医院住院的129例GDM孕产妇与129例正常孕产妇(均为初产妇、单胎妊娠、汉族)按1∶1的比例进行病例对照研究。结果:单因素分析结果显示,孕产妇怀孕年龄、孕前体重指数(BMI)、孕后期体重、文化程度、早起时间、晚睡时间、孕前口味、孕前常饮饮料、怀孕胎次、糖尿病(DM)家族史、高血压家族史、孕前高脂血症、孕前运动、流产史在两组间的差异均有统计学意义。经过Logistic回归分析,有5项因素进入回归模型即怀孕年龄、孕前BMI、DM家族史和孕前口味为危险因素(P=0.000,OR=1.861,95%C.I为1.795～1.932,P=0.000,OR=2.750,95%C.I为1.660～2.852,P=0.000,OR=8.690,95%C.I为3.588～21.046,P=0.000,OR=1.615,95%C.I为1.503～3.750);文化程度为保护因素(P=0.002,OR=0.910,95%C.I为0.259～0.898)。结论:孕产妇怀孕年龄、孕前BMI、DM家族史、孕前高盐和高热量的饮食习惯可能是GDM的危险因素,文化程度是GDM的保护因素。     

High early pregnancy serum 25-hydroxy vitamin D level,within a sub-optimal range,is associated with gestational diabetes mellitus: a prospective cohort study

BACKGROUND/OBJECTIVESLow early pregnancy serum 25-hydroxy vitamin D (25[OH]D) levels can increase gestational diabetes mellitus (GDM) risk, although inconsistent findings related to that association have been reported. This study examined the association of serum vitamin D with GDM and the possible influencers on this association.SUBJECTS/METHODSThis study included 259 pregnant women within the Seremban Cohort Study (SECOST). Blood samples at < 14 weeks of gestation were drawn to determine serum 25(OH)D levels. GDM diagnosis was made at 24 to 32 weeks of gestation using a standard procedure. Association between serum vitamin D and GDM was tested using binary logistic regression.RESULTSNearly all women (90%) had mild (68.3%) or severe (32.2%) vitamin D deficiency (VDD). Non-GDM women with mild VDD had a significantly higher mean vitamin D intake than GDM women with mild VDD (t = 2.04, p < 0.05). Women with higher early pregnancy serum vitamin D levels had a greater risk of GDM. However, this significant association was only identified among those with a family history of type 2 diabetes mellitus (T2DM) and in women with a body mass index indicating overweight or obese status.CONCLUSIONSThe high prevalence of VDD in this sample of pregnant women underscores the need for effective preventive public health strategies. Further investigation of this unexpected association between serum vitamin D level and GDM risk in predominantly VDD pregnant women and the potential effects of adiposity and family history of T2DM on that association is warranted.     

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.