Associations between general and abdominal obesity and incident diabetic neuropathy in participants with type 2 diabetes mellitus

J Diabetes. 2021 Jan;13(1):33-42. doi: 10.1111/1753-0407.13075. Epub 2020 Aug 6.

Abstract
in English, Chinese

Background: Previous epidemiological evidence on the sex-specific association of obesity, particularly abdominal obesity, as reflected by larger waist circumference (WC), with incident diabetic neuropathy (DN) remains limited.

Methods: We used data from a patient cohort with a median 10-year history of type 2 diabetes mellitus at the time of recruitment. A composite outcome of four types of predefined DN (Neuro 1-4) was used as the outcome of interest. Because of sex differences in abdominal obesity, analyses were conducted separately for men and women.

Results: Among the 7442 participants (4551 men and 2891 women) recruited in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study, 3999 cases of incident DN were documented (2529 in men and 1470 in women). Larger WCs were associated with a higher risk of DN among both men and women. Compared with the lowest quintile, the hazard ratio (HR) for the highest quintile was 1.30 (95% CI 1.13-1.49) among men (Ptrend <.001). For women, the HR for the highest vs lowest quintile was 1.25 (95% CI 1.04-1.51) (Ptrend <.001). A linear relationship between WC and DN was observed in men, and in women, the risk of DN increased as the WC quintile increased before it appeared to plateau. The relationship between body mass index and incident DN was similar to the results observed for WC.

Conclusion: General and abdominal obesity were both associated with an increased risk of incident DN among individuals with type 2 diabetes mellitus, regardless of sex.

背景: 肥胖症, 尤其是腹部肥胖症(反映为较大的腰围[WC])与糖尿病性神经病(DN)的性别特异性相关性的流行病学证据仍然很有限。 方法: 本研究来自一个招募时2型糖尿病病史中位数为10年的队列。研究结局为发生一种或一种以上预先定义的DN事件。由于腹部肥胖的性别差异, 我们分别对男性和女性进行了分析。 结果: 在糖尿病控制心血管风险行动(ACCORD)研究中招募的7442名参与者(4551名男性和2891名女性)中, 共有3999名患有DN(男性2529例, 女性1470例)。在男性和女性中, 较大的WC均与更高的DN风险相关。男性中, 与最低的WC五分位数相比, 最高的五分位数的风险比(HR)为1.30(95%CI 1.13-1.49)(趋势P<.001)。而对于女性, 最高WC五分位数与最低五分位数相比的HR为1.25(95%CI 1.04-1.51)(趋势P <.001)。男性的腰围与DN呈线性关系; 而对于女性, 随着腰围五分位数的增加, 发生DN的风险也随之增加, 但逐渐趋于稳定。体重指数与DN发病率的关系与WC的结果相似。 结论: 无论性别, 2型糖尿病患者的全身性肥胖和腹部肥胖都与DN的发生风险增加有关。.

Keywords: BMI; diabetic neuropathy; obesity; waist circumference; 糖尿病神经病变; 肥胖; 腰围.

MeSH terms

  • Aged
  • Body Mass Index*
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetes Mellitus, Type 2 / physiopathology
  • Diabetic Neuropathies / complications*
  • Diabetic Neuropathies / physiopathology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Obesity / complications*
  • Obesity / physiopathology
  • Obesity, Abdominal / complications*
  • Obesity, Abdominal / physiopathology
  • Proportional Hazards Models
  • Risk Factors
  • Sex Factors
  • Waist Circumference / physiology
  • Waist-Hip Ratio / statistics & numerical data