家族史和肥胖交互作用对糖尿病前期人群糖尿病发病的影响

目的  探讨糖尿病家族史、肥胖及其交互作用对糖尿病前期人群糖尿病发病的影响。 方法  基于金昌队列平台，采用前瞻性队列研究，计算糖尿病家族史、体重指数（body mass index，BMI）、腰围身高比（waist-to-height ratio，WHtR）及不同组合下糖尿病的累积发病率。采用Cox比例风险模型，分析家族史、BMI、WHtR对糖尿病发病的独立作用和联合作用。运用相乘模型分析家族史与BMI/WHtR的交互作用。 结果  本研究共纳入糖尿病前期人群5 495例，平均随访2.2年后，糖尿病累积发病率为15.69%，其中有家族史组发病率（18.31%）高于无家族史组（15.26%）（χ²=4.664，P=0.031），随着BMI/WHtR水平增加，发病率呈上升趋势（χ²=91.727，P < 0.001；χ²=73.334，P < 0.001）。调整混杂因素后，当糖尿病家族史和肥胖（BMI ≥ 28 kg/m²或中心型肥胖）同时存在时，糖尿病发病风险增加（HR=4.401，95% CI：3.026~6.401；HR=2.565，95% CI：1.989~3.307），且均存在正向相乘交互作用。当家族史/BMI ≥ 28 kg/m²/中心型肥胖三个因素叠加，糖尿病发病风险达到最高（HR=4.977，95% CI：3.351~7.392）。 结论  糖尿病家族史与肥胖相互叠加增加糖尿病前期人群糖尿病的发病风险，但两者的独立效应同样不容忽视。

Prospective cohort study of the interaction between family history and obesity on the incidence of diabetes in pre-diabetics

  Objective  To explore the effects of family history of diabetes, obesity and their interactions on the incidence of diabetes in pre-diabetic population.  Methods  Based on the Jinchang cohort platform, a prospective cohort study was conducted to calculate the cumulative incidence of diabetes in different groups of family history, body mass index (BMI) and waist-to-height ratio(WHtR). Cox proportional hazards regression models were used to analyze independent and joint effects of family history, BMI and WHtR on the incidence of diabetes. The interactions between family history of diabetes and BMI or WHtR were analyzed by multiplicative models.  Results  A total of 5 495 pre-diabetic participants were included in this study. After an average follow-up of 2.2 years, the cumulative incidence of diabetes was 15.69%. Among them, the incidence of diabetes of those with a family history (18.31%) was higher than those without a family history (15.26%)(χ2=4.664, P=0.031). With the increase of BMI/WHtR level, the incidence rate of diabetes was on the rise(χ2=91.727, P < 0.001; χ2=73.334, P < 0.001). After adjusting for confounding factors, those people with a family history of diabetes and obesity (BMI ≥ 28 kg/m2 or central obesity) coexist, the risk of diabetes increased significantly (HR=4.401, 95% CI:3.026-6.401; HR=2.565, 95% CI:1.989-3.307), and there was a positive multiplication interaction. In addition, when family history, BMI ≥ 28 kg/m2 and central obesity were superimposed, the risk of diabetes have reached the highest(HR=4.977, 95% CI:3.351-7.392).  Conclusions  The superimposition of family history of diabetes and obesity increases the risk of diabetes in the pre-diabetic population, but the independent effects of the two cannot be ignored.