BMI、WC和腰臀比与2型糖尿病患者死亡风险的队列研究

  目的  了解淮安市2型糖尿病(diabetes mellitus type 2，T2DM)患者不同肥胖指标对其死亡风险的影响。  方法  将淮安市2013年1月1日―2020年12月31日队列随访的9 759例T2DM患者与死因监测平台进行匹配，确定死亡病例。根据BMI、WC、腰臀比(waist-to-hip ratio，WHR)对随访人群进行分组，采用Cox比例风险模型探究肥胖指标对于T2DM患者全死因死亡风险。随后采用敏感性分析，剔除吸烟人群、随访第1年死亡者、基线患心脑血管病者后分析全死因死亡风险情况。  结果  不同年龄、WC、WHR及其他指标的人群BMI差异均有统计学意义(均有P＜0.05)。且调整混杂因素后发现，在超重和肥胖人群与正常人群相比死亡风险分别下降17%和27%，差异均有统计学意义(均有P＜0.05)。患者WC与非中心性肥胖相比，中心性肥胖前期和中心性肥胖时期均可以降低死亡风险，不同WHR人群死亡风险差异无统计学意义。  结论  目前死亡风险存在“肥胖悖论”现象，研究发现超重和肥胖人群以及中心性肥胖前期死亡风险具有保护作用。

BMI,WC, and waist-hip ratio and the risk of death in type 2 diabetes mellitus: a cohort study

  Objective  To investigate the effects of different obesity indicators on the risk of death in diabetes mellitus type 2 (T2DM) patients in Huai 'an City.  Methods  A total of 9 759 T2DM patients were followed up in Huai 'an City from 2013 to 2020, and the cause of death was matched through the cause of death monitoring platform. The follow-up population was classified according to BMI, WC, waist-to-hip ratio (WHR), and Cox proportional risk model was adopted to explore the effect of obesity indicators on all-cause mortality risk of T2DM patients. Sensitivity analysis was then used to exclude smokers, those with less than three years of follow-up, and those who died in the first year of follow-up, and baseline patients with cardiovascular and cerebrovascular risk for all-cause mortality.  Results  The research results indicated the BMI groups in different age, WC, WHR and other indexes were different (P < 0.05). After adjusting for confounding factors, it was found that the risk of death decreased by 17% and 27% in overweight and obese people compared with normal people, respectively, with statistical significance (P < 0.05). Compared with non-central obesity, the waist circumference of patients with central obesity can reduce the risk of death in both pre-central obesity and central obesity, and there was no statistical significance in the risk of death among people with different WHR ratios.  Conclusions  The "obesity paradox" exists in the risk of death. It is found that BMI has a protective effect on the risk of death in overweight and obesity, as well as in the early stage of central obesity.