摘要
目的探讨脂质蓄积指数(lipid accumulation product,LAP)与糖尿病患病风险的关系,并比较各种肥胖指标对糖尿病罹患风险的预测价值。方法采取多阶段分层随机抽样的方法,于2015年7—8月抽取蚌埠市龙子湖区≥18岁的常住居民共3 115人,进行问卷调查、体格及生化检查。采用Kruskal-Wallis H及非条件logistics回归分析来研究LAP与各种体检指标及糖尿病患病风险的关系,受试者工作特征曲线用来评估各种肥胖指标对糖尿病罹患风险的预测作用。LAP预测糖尿病最佳切点采用最大约登指数。结果不同LAP组间的体检指标存在显著差异(均P<0.001)。与低LAP组相比,男、女性高LAP组糖尿病的OR(95%CI)值分别是2.00(1.38,2.89)和3.82(2.46,5.93)。受试者工作特征曲线发现,在男性中,LAP预测糖尿病罹患风险的曲线下面积(area under curve,AUC)高于其他肥胖指标,但只有与腰臀比的比较差异有统计学意义(P<0.05);女性中,LAP预测糖尿病罹患风险的AUC显著高于其他指标(均P<0.05)。LAP预测糖尿病的最佳切点男、女性分别为51.63 cm·mmol/L及37.24 cm·mmol/L。结论糖尿病的患病风险随着LAP的增加而升高,与传统的肥胖指标相比,尤其在女性中,LAP是反映肥胖对糖尿病影响较好的肥胖指标。
Objective To explore the relationship between lipid accumulation product(LAP) and the risk of diabetes in adults, and to compare the predictive value of various obesity indicators in diabetes. Methods A multi-stage stratified random sampling method was used to select 3 115 permanent residents aged 18 or above in Longzihu district of Bengbu city from July to August 2015, and questionnaire survey, physical examination and biochemical examination were conducted.(Kruskal-Wallis H) and unconditional logistics regression were used to investigate the relationship between LAP and various physical examination indices and the risk of diabetes. Receiver operating characteristics curve was used to evaluate the predictive value of various obesity indicators in diabetes. The best cut-off point of LAP in prediction of diabetes was determined by the maximum Youden index. Results There were significant differences in physical examination indices between different LAP groups(all P<0.001). Compared with the lowest tertile group, the OR(95% CI) for diabetes in the group with highest tertile LAP was 2.00(1.38,2.89) in men, and 3.82(2.46,5.93) in women, respectively. Receiver operating characteristics curve found that in men the area under curve(AUC) of LAP predicting the risk of diabetes was higher than other obesity indicators, but only had statistical significance compared with WHR(P<0.05). In women, the AUC of LAP predicting the risk of diabetes was significantly higher than other indicators(all P<0.05). The best cut-off point for LAP in predicting diabetes was 51.63 cm·mmol/L for men and 37.24 cm·mmol/L for women. Conclusion The elevated level of LAP is associated with an increased risk of diabetes. Compared with the traditional indicators, especially for women, LAP is a better obesity indicator reflecting the impact of obesity on diabetes.
引文
[1] 许培培,张琳,杨帆,等.南京市某职业人群糖尿病患病现状及相关危险因素[J].职业与健康,2017,33(13):1810-1813.
[2] ZAFARI N,LOTFALIANY M,MANSOURNIA M A,et al.Optimal cut-points of different anthropometric indices and their joint effect in prediction of type 2 diabetes:results of a cohort study[J].BMC public health,2018,18(1):691.
[3] COHEN P,LEVY J D,ZHANG Y,et al.Ablation of PRDM16 and beige adipose causes metabolic dysfunction and a subcutaneous to visceral fat switch[J].Cell,2014,156(1-2):304-316.
[4] WOLFGRAM P M,CONNOR E L,REHM J L,et al.In nonobese girls,waist circumference as a predictor of insulin resistance is comparable to MRI fat measures and superior to BMI[J].Horm Res paediatr,2015,84(4):258-265.
[5] SEVEN E,THUESEN B H,LINNEBERG A,et al.Abdominal adiposity distribution quantified by ultrasound imaging and incident hypertension in a general population[J].Hypertension,2016,68(5):1115-1122.
[6] ZHONG C,XIA W,ZHONG X,et al.Lipid accumulation product and hypertension related to stroke:a 9.2-Year prospective study among mongolians in China[J].J Atheroscler Thromb,2016,23(7):830-838.
[7] LEE D H,KEUM N,HU F B,et al.Comparison of the association of predicted fat mass,body mass index,and other obesity indicators with type 2 diabetes risk:two large prospective studies in US men and women[J].Eur J Epidemiol,2018,33(11):1113-1123.
[8] 刘晨,张黎军.新型体脂指数脂质蓄积指数和内脏脂肪指数的相关研究进展[J].中国糖尿病杂志,2016,24(11):1032-1035.
[9] 苏健,吕淑荣,杨婕,等.江苏省成人脂质蓄积指数与高血压和糖尿病患病风险关系的研究[J].中华疾病控制杂志,2018,22(3):217-221,271.
[10] MOTAMED N,RAZMJOU S,HEMMASI G,et al.Lipid accumulation product and metabolic syndrome:a population-based study in northern Iran,Amol[J].J Endocrinol Invest,2016,39(4):375-382.
[11] RORIZ A K,PASSOS L C,DE OLIVEIRA C C,et al.Evaluation of the accuracy of anthropometric clinical indicators of visceral fat in adults and elderly[J].PLoS One,2014,9(7):e103499.
[12] MAZIDI M,KENGNE A P,KATSIKI N,et al.Lipid accumulation product and triglycerides/glucose index are useful predictors of insulin resistance[J].J Diabetes Complications,2018,32(3):266-270.
[13] NASCIMENTO-FERREIRA M V,RENDO-URTEAGA T,VILANOVA-CAMPELO R C,et al.The lipid accumulation product is a powerful tool to predict metabolic syndrome in undiagnosed Brazilian adults[J].Clin Nutr,2017,36(6):1693-1700.
[14] 中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017年版)[J].中华糖尿病杂志,2018,10(1):4-67.
[15] 车晓礼.酒精摄入量与糖尿病的关系研究[D].泸州:四川医科大学,2015.
[16] 申元媛.中国成人脂质蓄积指数与高血压、糖尿病及心血管疾病的关系[D].北京:北京协和医学院,2017.
[17] RAY L,RAVICHANDRAN K,NANDA S K.Comparison of lipid accumulation product index with body mass index and waist circumference as a predictor of metabolic syndrome in indian population[J].Metab Syndr Relat Disord,2018,16(5):240-245.
[18] NAMAZI SHABESTARI A,ASADI M,JOUYANDEH Z,et al.Association of lipid accumulation product with cardio-metabolic risk factors in postmenopausal women[J].Acta Med Iran,2016,54(6):370-375.
[19] 张一倩.腰围、腰高比、脂质蓄积指数对大连地区40岁以上女性新发糖尿病前期的预测价值[D].大连:大连医科大学,2018.
[20] WAKABAYASHI I.Influence of age and gender on lipid accumulation product and its relation to diabetes mellitus in Japanese[J].Clin Chim Acta,2014,431:221-226.
[21] WAKABAYASHI I,DAIMON T.A strong association between lipid accumulation product and diabetes mellitus in Japanese women and men[J].J Atheroscler Thromb,2014,21(3):282-288.
