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1.
目的探讨饮酒及其他生活方式因子的交互作用对2型糖尿病(type 2diabetes mellitus,T2DM)发生风险的影响。方法 2015年6月—2016年2月,利用简单随机抽样方法,在淮南市东方医院与淮南市体检中心分别选取320例T2DM患者和640例同期健康体检者,比较两组间一般人口学信息、饮酒、吸烟、体力活动和饮食行为方面的差异,运用非条件Logistic回归与广义多因子降维法(GMDR)进行统计分析。结果 (1)Logistic回归分析结果显示:调整混杂因素后,各食物条目摄入得分相对于Q1,粮谷类(OR=0.301,95%CI 0.153~0.628)、蔬菜水果类(OR=0.444,95%CI 0.245~0.806)、奶及奶制品(OR=0.510,95%CI 0.329~0.790)、豆类(OR=0.434,95%CI 0.212~0.901)、红肉类(OR=0.461,95%CI 0.229~0.926)、西方食物类(OR=0.223,95%CI 0.076~0.652)、含糖饮料类(OR=0.150,95%CI0.035~0.643)摄入得分为Q5以及体质指数<24.0(OR=0.189,95%CI 0.109~0.329)为罹患T2DM的保护因素;而经常饮酒(OR=3.936,95%CI 1.145~8.734)、中等强度体力活动<5次/周(OR=1.558,95%CI 1.013~2.876)为罹患T2DM的危险因素。(2)相乘交互作用分析显示:经常饮酒分别与摄入粮谷类(Q5)(OR=0.852,95%CI 0.765~0.949)、蔬菜水果类(Q5)(OR=0.862,95%CI 0.757~0.982)及中等体力活动≥5次/周(OR=0.613,95%CI 0.468~0.803)间存在相乘交互作用。(3)相加交互作用分析显示:经常饮酒分别与高摄入红肉、含糖饮料及中等体力活动≥5次/周间存在相加交互作用。(4)GMDR法分析显示:含糖饮料、红肉和经常饮酒三因素间存在交互作用共同影响T2DM的发生(P=0.001)。结论经常饮酒与其他多种可控因素间存在交互作用共同影响T2DM的发生。  相似文献   

2.
目的 探讨吸烟、饮酒与糖尿病(DM)和糖耐量低减(IGT)的关系。方法 运用1∶1病例对照研究方法。结果 对吸烟和饮酒情况进行分析,发现吸烟与DM 有关,大量吸烟者(现在吸烟≥26 支/日)发生DM 的OR为4.85,曾经吸烟≥26 支/日者OR为5.60,随着每日吸烟支数的增加,发生DM 的OR有增高的趋势。吸烟与IGT无相关关系。配比分析提示一般饮酒与DM、IGT均无关,但大量饮酒者(曾经酒精消耗量≥35 kg/年)发生IGT的OR为2.40,具有显著性意义。结论 吸烟是DM 的危险因素,但与IGT无关;一般饮酒量与DM、IGT 均无关,但大量饮酒者发生IGT危险性增加  相似文献   

3.
目的探讨2型糖尿病(T2DM)合并骨质疏松的相关因素,为预防T2DM患者发生骨质疏松提供科学依据。方法回顾性查阅2011年8月30日至2012年5月30日在天津医科大学代谢病医院首次住院的T2DM患者的病历资料,摘录相关信息,采用病例对照研究方法,以T2DM合并骨质疏松者469例为病例组,骨量正常的T2DM患者383例为对照组,采用非条件logistic回归对T2DM合并骨质疏松的相关因素进行单因素和多因素分析,计算比值比(OR)及其95%CI。结果多因素非条件logistic回归分析结果显示,年龄≥55岁、女性、糖尿病病程≥7年与T2DM合并骨质疏松的高风险相关[OR值分别为3.690(95%CI:2.451~5.556)、3.327(95%CI:2.259~4.900)、1.729(95%CI:1.169~2.555)],而体质指数≥24 kg/m2与T2DM合并骨质疏松的低风险相关(OR=0.290,95%CI:0.184~0.457);未发现职业、吸烟、饮酒、糖尿病家族史、高血压、糖尿病视网膜病变、糖尿病肾病、糖尿病周围神经病变、糖化血红蛋白、空腹血糖、甘油三酯、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血钙和血磷与T2DM合并骨质疏松有关联。结论更应重视对年龄大、女性、糖尿病病程长的T2DM患者骨质疏松的预防,体质指数高与T2DM合并骨质疏松的低风险相关。  相似文献   

4.
采用配比病例对照研究方法,从医院选取158名缺血性脑卒中病例,并从社区和研究医院为病例选配两种对照,病例与两种对照分别作配比分析,以探讨吸烟、饮酒与缺血性脑卒中的关系。单因素分析结果表明:吸烟者患缺血性脑卒中的 OR 约为1.5~2(P<0.05),饮酒者患缺血性脑卒中的OR 约为3(P<0.01)。多因素分析结果显示大量吸烟(>20支/天)是缺血性脑卒中重要的危险因素;饮酒(尤其中、重度饮酒:>50ml/天)是一项独立的危险因素。  相似文献   

5.
[目的]调查和了解上海市南翔农村地区老年居民糖代谢异常状况及其相关危险因素. [方法]采用整体筛查方法对4 443名老年人测空腹静脉血糖,对于FBG≥6.0 mmol/L人群行OGTT,并进行问卷调查,调查和了解糖尿病(DM)、血糖调节受损(IGR)的患病率,并对其相关危险因素如高血压、饮食、肥胖、DM家族史、体力活动状况等进行分析. [结果]糖尿病患病率8.39%,空腹血糖受损(IFG)患病率5.49%,糖耐量受损(IGT)患病率5.85%,IGR(IFG IGT)患病率9.27%,高血压及肥胖是糖代谢异常的重要危险因素,其他危险园素有喜甜食、缺乏体力活动、性别、有DM家族史等,而与饮酒和吸烟无显著相关. [结论]上海市南翔农村地区老年人群DM和IGR患病率较高,多种危险因素参与糖代谢异常的发生、发展.  相似文献   

6.
目的 分析山东省中西部农村25岁~居民糖尿病及糖调节受损的流行特征.方法 采用多阶段分层随机抽样方法,共调查16 388人,开展同卷调查并测量身高、体重、腰围、血压和空腹血糖.空腹血糖在6.1~7.0mmol/L者再进行口服葡萄糖耐量(OGTT)试验.根据WHO 1999年糖尿病诊断标准将调查人群分为正常人、孤立性空腹血糖受损(I-IFG)、空腹血糖受损合并糖耐量受损(IFG/IGT)和糖尿病(DM).结果 该地区农村居民IFG标化患病率为6.85%,DM为3.38%,I-IFG为4.41%,IFG/IGT为0.83%,且患病率均随年龄、腰围、身高、体质指数(BMI)的增加而升高.年龄>35岁,I-IFG、IFG/IGT和年龄>45岁DM患病率升高明显.男性腰围≥85 cm、女性腰围≥80 cm.IFG/IGT和DM患病率升高明显.BMI≥24,I-IFG、IFG/IGT和DM患病率升高明显.调查对象的年龄、腰围、BMI、腰臀比、收缩压和舒张压按正常人→I-IFG→IFG/IGT、DM顺序逐渐升高,但IFG/IGT和DM两者问变化无差异.结论 山东省中西部农村居民I-IFG、IFG/IGT和DM的流行特征基本相同.糖尿病及糖调节受损发病较高,应重视和加强宣传和早期预防控制工作.  相似文献   

7.
目的探讨杭州市社区居民肥胖发生情况及体重指数(BMI)和腰臀比值(WHR)与糖尿病、糖耐量低减患病率的关系.方法采用分层整群抽样方法,随机抽取市区2个社区,郊县2个乡镇的15岁及以上居住5年以上的常住居民,共计4 682人.进行问卷调查,测量身高、体重、腰围、臀围,测定空腹血糖和空腹口服75 g葡萄糖后2 h血糖.结果杭州市社区人群超重和肥胖(BMI≥24)发生率达34.39%,其中腹型肥胖占53.95%;糖尿病(DM)与糖耐量低减(IGT)患病率分别为4.59%和7.07%;超重和肥胖组DM和IGT患病率明显高于正常组和低体重组,相对危险度(OR)分别为2.02和2.82,95%CI分别为1.50~2.72和1.87~4.28;腹型肥胖组DM和IGT患病率分别达8.02%和10.29%,明显高于正常体型组,OR值为2.83,95%CI为2.15~3.73.结论肥胖是糖尿病和糖耐量低减的重要危险因素,建议开展糖尿病宣传教育,对肥胖人群进行行为干预,控制膳食,适当运动,减轻体重.  相似文献   

8.
目的探讨吸烟及戒烟行为与2型糖尿病(T2DM)患者血糖控制的关系,为进一步开展社区糖尿病综合防治工作提供依据。方法于2013年12月至2014年1月采用随机整群抽样方法,抽取江苏省常熟市纳入国家基本公共卫生服务管理的10 246例T2DM患者进行问卷调查、体格测量和实验室检测。采用SPSS 22.0进行方差分析、χ~2检验、趋势χ~2检验和多因素非条件logistic回归分析。结果常熟市糖尿病患者吸烟率为27.09%,现吸烟率为20.51%,在吸烟者中,戒烟率为24.32%。多因素非条件logistic回归分析结果显示,调整相关混杂因素后,与从不吸烟者相比,现在吸烟(OR=1.53)、吸烟量(10,10~19和≥20支/d的OR值分别为1.55、1.45和1.90)、吸烟年限(30,30~39,40~49和≥50年的OR值分别为1.43、1.67、1.53和1.58)均与血糖控制不利高风险相关,均有统计学意义(P0.01);与现在吸烟者相比,戒烟年限(10,10~19年的OR值分别为0.52和0.50)与血糖控制不利低风险相关,均有统计学意义(P0.01)。结论吸烟不利于T2DM患者血糖的控制,戒烟可提高血糖控制率,应鼓励和帮助吸烟的T2DM患者及早戒烟。  相似文献   

9.
目的探讨膳食因素对吸烟和非吸烟人群舌癌发病的影响。方法采用病例-对照研究方法,收集2011年12月—2016年3月福州市某医院经病理学确诊的舌癌新发病例251例,同期收集来自福州市某社区的健康对照1382例。面访调查研究对象的吸烟、饮酒史以及一年前的膳食情况等内容,应用非条件Logistic回归模型计算膳食因素与舌癌发病风险的调整OR值及其95%CI,并进行吸烟与食畜肉类之间的相乘交互作用分析。结果进食鱼类≥3次/周、海鲜类≥1次/周、奶类及奶制品≥1次/周、绿叶蔬菜和非绿叶蔬菜≥1次/天以及新鲜水果≥3次/周均可降低舌癌的发病风险。按是否吸烟分层后,鱼类、海鲜类以及绿叶蔬菜和非绿叶蔬菜对舌癌的保护作用在吸烟人群中更加显著。而进食畜肉类≥3次/周仅与吸烟者舌癌的发病相关(调整OR=1.55,95%CI 1.02~2.34),且吸烟与食畜肉类存在正相乘交互作用(OR相乘=2.08,95%CI 1.43~3.03)。结论适量摄入新鲜的蔬菜水果、鱼及海鲜类、奶类及奶制品,以及在吸烟者中减少畜肉类的过量摄入可减少舌癌的发生。  相似文献   

10.
赵廷明  李鑫  向静  张劲 《华南预防医学》2022,48(9):1087-1091
目的了解四川省通江县35~75岁常住居民糖尿病(DM)、糖尿病前期(Pre-DM)患病情况及其影响因素,为制定并落实DM防控措施提供决策依据。方法于2018年9月至2019年3月采用多阶段分层随机整群抽样法抽取通江县35~75岁常住居民为调查对象,收集人口学资料、吸烟饮酒史和糖尿病、高血压、血脂异常患病史及服药情况,测量身高、体重、腰围和血压,检测空腹血脂和血糖。结果2018—2019年通江县35~75岁居民DM患病率、标化患病率分别为10.57%(633/5990)和8.38%;Pre-DM患病率、标化患病率分别为18.86%(1130/5990)和17.51%。多因素Logistic回归分析结果显示,年龄45~59、60~75岁(OR=1.718、2.556)、非农民(OR=1.369)、家庭年收入1~2.5、>2.5万元(OR=1.334、1.341)、中心性肥胖(OR=1.918)、高血压(OR=1.971)、血脂异常(OR=1.904)是DM患病的危险因素;年龄60~75岁(OR=1.400)、家庭年收入1~2.5、>2.5万元(OR=1.389、1.234)、中心性肥胖(OR=1.255)、高血压(OR=1.180)是Pre-DM患病的危险因素;饮酒(OR=0.745)是DM患病的保护因素,吸烟(OR=0.806)是Pre-DM患病的保护因素。结论通江县35~75岁居民DM、Pre-DM患病率相对较低,应当及时针对中老年、非农民、中高收入家庭、中心性肥胖、高血压、血脂异常等重点高危人群,开展健康教育和生活方式干预,加强Pre-DM患病人群早期筛查和健康管理,遏制DM患病率上升。  相似文献   

11.
The purpose of this case–control study was to evaluate the relationship between smoking and type 2 diabetes mellitus (T2DM) in adult females. A total of 168 women in Kaunas, Lithuania with newly diagnosed T2DM during the year 2001 and 336 controls who were women without diabetes were recruited. Participants were asked about their duration of smoking, the number of cigarettes smoked per day, pack-years, and smoking cessation. Odds ratios (OR), 95 percent confidence intervals (CI) for T2DM were calculated using conditional logistic regression. After adjustment for possible confounders, women with T2DM had a nearly threefold higher odds for smoking 10 or more cigarettes per day compared with controls and using never smokers as the referent category (OR = 2.8; 95 percent CI 1.0–7.7). Women with T2DM had over fourfold odds for having smoked for 40 years or more compared to controls (OR = 4.6; 95 percent CI 1.1–18.6). Compared to controls, women with T2DM had over a sixfold higher odds for stopping smoking for 19 or fewer years with never smokers as the referent category (OR = 6.4; 95 percent CI 1.5–27.3). The findings of our study suggest a possible relationship between smoking and T2DM in women. Also, despite smoking cessation, the association with T2DM remained for a long time.  相似文献   

12.
目的分析我国2型糖尿病发病的危险因素,为糖尿病的预防和治疗提供依据.方法利用自然人群,采取分层随机抽样,直接测OGTT服糖后2h血糖的方法诊断糖尿病和糖耐量损害,采用多元回归法进行分析.结果在年龄大于40岁、具有糖尿病家族史、体质指数25以上和腰臀比0.9以上以及吸烟人群中,糖尿病及糖耐量损害患病率剧增.高血压人群中糖尿病及糖耐量损害的发生率显著高于非高血压人群.结论年龄增大、阳性家族史、高腰臀比、体力活动量少、体质指数大及嗜好吸烟,是糖尿病及糖耐量损害的危险因子.2型糖尿病与高血压关系密切.  相似文献   

13.
PURPOSE: To investigate interactive effects of cigarette smoking and body mass index (BMI, measured in kilograms per square meter) on the risk for type 2 diabetes mellitus (DM). METHODS: We conducted a follow-up study in 16,829 apparently healthy men 30 to 59 years of age. At baseline, 23.1%, 24.6%, 24.0%, and 28.4% of the men were 'never' smokers, ex-smokers, light smokers (20 cigarettes/d), respectively. BMI was expediently categorized into quartiles (Q1: <21.3; Q2: 21.3-22.9; Q3: 23.0-24.7; and Q4: >24.7 kg/m2). Incident DM was identified by a fasting serum glucose level of 7.00 mmol/L or higher or the criterion 'under treatment for DM.' The risk ratio for incident DM, hazard ratio (HR) and the 95% confidence interval (CI), according to smoking and BMI, were estimated by using Cox proportional hazard models. Age, drinking, exercise, and education were computed as confounders. RESULTS: During mean follow-up of 7.4 years, 869 men developed DM. In Q4 of BMI, heavy smoking raised the risk against 'never smoking' (multivariate-adjusted HR (95%CI): 1.37 [1.05-1.80]), but neither light smoking nor ex-smoking did. In Q1 of BMI, light and heavy smoking reduced the risk (multivariate-adjusted HR (95% CI): 0.45 (0.23-0.88) and 0.74 (0.41-1.33), respectively). CONCLUSIONS: Smoking and BMI interactively influence risk for DM and the interaction is considerably complex. Heavy smoking moderately increases the risk for DM in obese men. But, light smoking reduces the risk in lean men.  相似文献   

14.
本研究对1981年北京市居民中发现的1586名高血压患者作前瞻性观察,观察截止于1991年,平均追访7年(11340人年),死亡329人.分析结果表明,高血压患者每日吸烟量与总死亡及心血管病死亡均呈显著的正相关,用M-H法分层及Cox模型调整年龄、性别、血压、糖尿病等危险因素,趋势无改变.戒烟≥5年者,总死亡、心血管病及脑卒中死亡危险明显降低,心血管病、脑卒中死亡危险趋势同于非吸烟者.年龄≤65岁的高血压患者,特别是15~54岁年龄组,吸烟≥10支时可增高心血管病死亡危险2倍及以上,死亡危险在大量吸烟(每日≥20支)时也明显上升.结果还提示,少量饮酒(每天约0.8两白酒)有降低高血压病人死亡、心血管病死亡危险的作用.  相似文献   

15.
Objective:To study factors influencing the various pro- gressive stages of type 2 diabetes mellitus in order to pro- vide more concrete scientific bases for the prevention and cure of it. Method:367 subjects with type 2 diabetes mellitus were investigated by retrospective means,and multistate Markov model was used to study factors influencing the transient pace of various progressive stages of type 2 diabetes mellitus. Results:Body mass index,monthly family income, drinking and sweetmeat primarily affected the transition from IGT to DM2.A higher BMI,more monthly family income,more frequent drinking and more intake of sweet- meat were associated with an increasing risk of the transi- tion from IGT to DM2.Monitoring of plasm glucose mostly influenced the transition from DM2 to CDM2.Less frequent monitoring of plasm glucose was associated with an increas- ing risk of the transition from DM2 to CDM2.Staple food, lard,life event,health education and physical-activity level were significantly associated with the transitions both from IGT to DM2 and from DM2 to CDM2.The subjects who took less staple food,more lard,and often experienced irri- table life events were at a higher risk of the two transitions, while those who accepted health education on diabetes mel- litus and had more physical-activity level were at lower risk. Conclusions:For subjects with IGT,controlling weight, rationally allocating family income,abstaining from drinking,and decreasing intake of sweetmeat should be re- garded as primary preventive measures;For ones with DM2,often accepting monitoring of plasm glucose should be considered as leading one.In order to delay the develop- ment and progression of type 2 diabetes mellitus,it is highly necessary to moderately increase intake of cereal or floury food,decrease intake of lard,keep optimistic and unclouded attitude,often listen to lectures on diabetes mellitus,and properly increase physical-activity level.  相似文献   

16.
Cigarette smoking is the leading avoidable cause of disease burden. Observational studies have suggested an association between smoking and risk of type 2 diabetes mellitus (T2DM). We conducted a meta-analysis of prospective observational studies to investigate the association of smoking status, smoking intensity, and smoking cessation with the risk of T2DM in Japan, where the prevalence of smoking has been decreasing but remains high. We systematically searched MEDLINE and the Ichushi database to December 2015 and identified 22 eligible articles, representing 343,573 subjects and 16,383 patients with T2DM. We estimated pooled relative risks (RRs) using a random-effects model and conducted subgroup analyses by participant and study characteristics. Compared with nonsmoking, the pooled RR of T2DM was 1.38 (95% confidence interval [CI], 1.28–1.49) for current smoking (19 studies) and 1.19 (95% CI, 1.09–1.31) for former smoking (15 studies). These associations persisted in all subgroup and sensitivity analyses. We found a linear dose-response relationship between cigarette consumption and T2DM risk; the risk of T2DM increased by 16% for each increment of 10 cigarettes smoked per day. The risk of T2DM remained high among those who quit during the preceding 5 years but decreased steadily with increasing duration of cessation, reaching a risk level comparable to that of never smokers after 10 years of smoking cessation. We estimated that 18.8% of T2DM cases in men and 5.4% of T2DM cases in women were attributable to smoking. The present findings suggest that cigarette smoking is associated with an increased risk of T2DM, so tobacco control programs to reduce smoking could have a substantial effect to decrease the burden of T2DM in Japan.  相似文献   

17.
目的探讨糖耐量低减(IGT)与C反应蛋白(CRP)及颈动脉内膜中层厚度(CAIMT)的关系。方法108例IGT患者与80例正常糖耐量(NGT)者,采用免疫比浊法测定血清CRP,彩色多普勒超声测定CAIMT。对所有IGT者随访3年,在随访1年半及3年分别重复75g口服葡萄糖耐量试验(OGTF)及复测各项指标。结果2例失访,其余106例中IGT组的CRP与CAIMT均明显高于NGT对照组;随访1年半及3年的结果均提示:按血糖转归对IGT者重新划分的IGT组与2型糖尿病(T2DM)组的CRP与CAIMT在初查与复查时分别均明显高于NGT组,CRP在初查与复查时均为T2DM组〉IGT组〉NGT组,各组间差异有统计学意义;对随访3年时的T2DM组各因素进行相关分析显示:复查FBG、2hPBG分别与初查CRP及CAIMT均呈正相关,CAIMT与血糖、CRP均呈正相关。多元回归分析提示CRP与血糖、CAIMT均显著相关。结论CRP水平高的IGT患者更容易转化为糖尿病,在IGT阶段已存在大血管病变的风险。对CRP或CAIMT增高较明显的IGT患者进行抗炎干预具有指导意义。  相似文献   

18.
糖耐量低减者的随访分析   总被引:6,自引:0,他引:6  
陈冠民 《中国公共卫生》1999,15(10):905-906
对178 例糖耐量低减者(IGT) 进行3 年的复查随访。结果发现3 年后有35.96 % 转化为DM,餐后2 小时血糖、体重指数、舒张压高是IGT转化DM 的危险因素,体力活动量增加可减缓IGT 向DM 的转化。而餐后2 小时血糖较低可促使IGT向糖耐量正常转化  相似文献   

19.
OBJECTIVE: To perform a cost-effectiveness analysis of treatment with acarbose in patients with impaired glucose tolerance (IGT) in comparison with conventional treatment (based on medical counseling on diet and health and without drug treatment) from the perspective of the public payer. MATERIAL AND METHOD: A cost-effectiveness analysis was performed using data on efficacy, the incidence of diabetes mellitus type 2 (DM2) and cardiovascular events from the STOP-NIDDM clinical trial of acarbose treatment vs. placebo. The study used a decision tree analysis to estimate the health and economic impact of the two alternative treatments in a population of 1,000 patients over a period of 40 months. Resource use and cost data refer to the Spanish health care system. RESULTS: In the base case, acarbose treatment was slightly dominant over conventional treatment since it achieved improved outcomes at an even lower cost. Sensitivity analysis revealed that acarbose treatment lost dominance due to a moderately positive cost-effectiveness ratio for avoided progression to DM2 in some scenarios. The cost-effectiveness ratio was particularly sensitive to the cost of cardiovascular treatments, the risk of progression to DM2, the daily doses of acarbose, and the publicly funded share of the cost of this drug. CONCLUSIONS: Acarbose treatment in patients diagnosed with IGT appeared to be the dominant alternative compared with conventional treatment. The cost per avoided progression to DM2 and per additional individual free of a cardiovascular event was moderately low in some of the scenarios included in the sensitivity analysis. For a more comprehensive evaluation of the possible treatment of patients with IGT, the alternatives under comparison and the time horizon of the study would need to be increased and more refined health outcome measures, comprising all the treatment's health effects, would need to be introduced.  相似文献   

20.
机关工作人员高血压、糖尿病及高脂血症患病情况分析   总被引:1,自引:0,他引:1  
目的了解机关工作人员高血压、糖尿病和高脂血症现患情况。方法对1462名体检人员的一般资料及血压、血糖和血脂等资料进行分析。结果①高血压现患率为21.8%,新诊断者占31.6%,过去确诊的高血压患者63.4%血压控制不达标;②糖尿病现患率为9.4%,空腹血糖受损和/或糖耐量减低现患率为12.5%,48.9%的糖尿病患者为首次确诊,过去确诊的糖尿病患者78.6%血糖控制不满意;③高脂血症现患率为41.5%,单纯高甘油三酯血症和单纯高胆固醇血症分别是16.6%和12.9%。高血压、糖尿病和高脂血症现患率基本上呈随龄递增趋势;体重指数(BMI)愈大,高血压、糖尿病和高脂血症患病率愈高。结论高血压、糖尿病和高脂血症是影响本组人群健康的常见病,年龄增大和体重增加是高血压、糖尿病和高脂血症的重要危险因素。  相似文献   

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