第2型糖尿病風險和腹部脂肪有關


  【24drs.com】根據一篇大型案例世代研究的結果,腰圍是一種簡單便宜的脂肪分佈測量方法,也可強力預測誰更有風險發生第2型糖尿病,特別是對女性。
  
  英國劍橋Addenbrooke醫院代謝科學研究中心Claudia Langenberg博士和InterAct Consortium的研究夥伴,在6月5日PLoS Medicine期刊線上發表他們的結果。
  
  校正身體質量指數(BMI)、體能活動、抽菸、教育等因素之後,研究者發現,男性腰圍每增加一個標準差時,第2型糖尿病發生率風險增加達37% (95%信心區間19% - 58%),至於女性,腰圍每增加一個標準差,則與第2型糖尿病發生率風險增加125%有關(95%信心區間90% - 166%)。
  
  全球超過3億5千萬人患有糖尿病,雖然肥胖者發生此病的風險較高,許多只是過重者也發生了第2型糖尿病。理想的話,有風險者應考慮健康飲食並且規律運動,但是,提供個別化的生活方式建議給那些過重或肥胖者,有其困難度且昂貴。
  
  研究團隊試圖找到一種可以辨識哪些人發生糖尿病風險最高、哪些人風險最低的方法,且在不同BMI值都可信賴的方法。作者們寫道,以前的研究往往樣本數太少而無法估計不同BMI值和腰圍者的第2型糖尿病發生率,也未精準到足以指引臨床決策或對大眾做出正式建議。
  
  研究者使用「InterAct Consortium」研究資料估計BMI及腰圍與第2型糖尿病之長期風險的關聯,他們檢測12,403名第2型糖尿病患在研究開始時的體重、身高、腰圍,以及歐洲8國、26個醫學中心、參加「European Prospective Investigation into Cancer and Nutrition」的16,154名研究對象。根據BMI和腰圍定義各組的風險增加,腰圍強烈地增加了女性的糖尿病風險。
  
  肥胖男性(BMI > 35 kg/m2)且腰圍大於102公分者,發生糖尿病的風險是正常體重(BMI,18.5 - 22.4 kg/m2)且腰圍小於94公分男性的22倍(95%信心區間,14.3 - 33.8)。腰圍88公分以上的肥胖女性,發生第2型糖尿病的風險是正常體重且腰圍小於80公分者的31.8倍。
  
  測量腰圍強調了某一組過重者在10年間發生第2型糖尿病的可能性(男性為70/1000人-年;女性44/1000人-年),也反映出肥胖者的糖尿病風險(範圍:男性為50 – 103/1000人-年;女性28 – 74/1000人-年)。
  
  Langenberg博士等人結論指出,腰圍和第2型糖尿病有獨立而強烈的關聯,特別是女性,應更推廣其測量。
  
  作者們也指出,這是迄今探討BMI及腰圍與糖尿病發生率之影響的最大型研究。因為研究對象是歐洲血統族群,作者們表示,可能不易據以推斷其他種族之腰圍對糖尿病風險和第2型糖尿病發生率的影響,因身體組成可能不同。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6846&x_classno=0&x_chkdelpoint=Y
  

Type 2 Diabetes Risk Linked to Abdominal Fat

By Diedtra Henderson
Medscape Medical News

June 5, 2012 — Waist circumference, a simple, cheap measure of fat distribution, also strongly predicts who is most at risk of developing type 2 diabetes, especially for women, according to the results of a large, case–cohort study.

Claudia Langenberg, MD, PhD, from the Institute of Metabolic Science at Addenbrooke's Hospital in Cambridge, United Kingdom, and colleagues from the InterAct Consortium describe their findings in an article published online June 5 in PLoS Medicine.

After adjusting for body mass index (BMI), physical activity, smoking, and education, the investigators found that for each 1 standard deviation increase in waist circumference in men, the risk for incident type 2 diabetes increased by 37% (95% confidence interval, 19% - 58%). Among women, each 1 standard deviation increase in waist circumference corresponded to a 125% increase in the risk for type 2 diabetes (95% confidence interval, 90% - 166%).

More than 350 million people around the world suffer from diabetes. Although people who are obese are at the greatest risk of developing diabetes, many people who are merely overweight also develop type 2 diabetes. Ideally, people at risk would be counseled to eat a healthy diet and to exercise regularly, but it has been difficult and prohibitively expensive to provide such individualized lifestyle advice to everyone who is overweight or obese.

The research team sought to identify a way to distinguish those who have the highest risk of developing diabetes from those who have the lowest risk that would prove reliable at differing levels of BMI. "[E]arlier studies were generally too small to estimate [type 2 diabetes] incidence rates at different levels of BMI and [waist circumference] with the precision required to guide clinical decision making or inform policy recommendations," the authors write.

The researchers used data from the InterAct Consortium study to estimate the association between BMI and waist circumference and long-term risk for type 2 diabetes. They examined baseline measurements of weight, height, and waist circumference of 12,403 people who developed type 2 diabetes, as well as of a stratified subcohort of 16,154 participants in the European Prospective Investigation into Cancer and Nutrition in 26 centers in 8 European countries. Risk increased across groups defined by BMI and waist circumference, with waist circumference strongly upping diabetes risk for women.

Obese men (BMI > 35 kg/m2) with a waist circumference of 102 cm or greater were 22 times more likely (95% confidence interval, 14.3 - 33.8) to develop diabetes than men with a normal weight (BMI, 18.5 - 22.4 kg/m2) and waists narrower than 94 cm. Obese women with a waist circumference of 88 cm or larger were 31.8 times more likely to develop type 2 diabetes than women with a normal weight and a waist circumference narrower than 80 cm.

Waist circumference measures highlighted a subgroup of overweight individuals whose likelihood of developing type 2 diabetes over the course of 10 years (men, 70/1000 person-years; women, 44/1000 person-years) mirrored the diabetes risk among obese people (range, 50 - 103 per 1000 person-years in men and 28 - 74 per 1000 person-years in women).

Waist circumference "is independently and strongly associated with [type 2 diabetes], particularly in women, and should be more widely measured," Dr. Langenberg and colleagues conclude.

The authors also point out that theirs is the largest study of incident diabetes to date to investigate the separate and joint contributions of BMI and waist circumference. Because study participants were of European descent, the authors caution against inferring waist circumference's contribution to diabetes risk in other ethnic groups with potentially different body composition and type 2 diabetes incidence.

The study was funded by the EU Integrated Project. One of the study authors received funding from Novo Nordisk.

PLoS Med. Published online June 5, 2012.

    
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