目的: 分析上海社区40岁及以上居民的代谢健康型肥胖与随访4年中的糖尿病发病风险间的相关性,并进一步探究胰岛素抵抗在两者关系中的作用。方法: 采用整群抽样的方法,选取上海宝山区淞南社区常住居民中非糖尿病者1 967名,根据体质量指数和代谢水平分为代谢健康型非肥胖（metabolically healthy non-obese,MHNO）组、代谢不健康型非肥胖（metabolically unhealthy non-obese,MUNO）组、代谢健康型肥胖（metabolically healthy obese,MHO）组及代谢不健康型肥胖（metabolically unhealthy obese,MUO）组。对其进行4年随访,针对相关病史进行问卷调查,并完成人体指标测量及相关实验室检查,观察各组间临床指标及随访时糖尿病发生率的差异。结果: 研究人群中,MHNO、MUNO、MHO和MUO组随访4年中的糖尿病发生率分别为3.4%、16.4%、7.7%和17.5%。多元Logistic回归分析显示,在校正年龄、性别、体质量指数、当前吸烟、当前饮酒、积极运动及糖尿病家族史后,与MHNO组相比,MHO组随访4年中的糖尿病发病风险增加了1.25倍（OR=2.25, 95%CI为1.31~3.85）。将4组人群再按胰岛素抵抗情况（胰岛素抵抗指数≥2.5）分组,与MHNO不合并胰岛素抵抗组相比,MHO不合并胰岛素抵抗组随访4年中的糖尿病发生风险没有显著增加,而MHO合并胰岛素抵抗组随访4年中的糖尿病发生风险增加了4.20倍（OR=5.20, 95%CI为2.56~10.56）。结论: MHO组较MHNO组随访4年中的糖尿病发生风险高,且胰岛素抵抗可能在上述相关性中起了一定作用。
Objective: To investigate the association between metabolically healthy obesity (MHO) and risk of diabetes in population in Shanghai and to assess the role of insulin resistance in their relationship. Methods: A prospective study was performed among 1 967 participants aged 40 years or older in Baoshan community, Shanghai. The participants were categorized into four groups according to obesity and metabolic status: metabolically healthy non-obese (MHNO), metabolically unhealthy non-obese(MUNO), metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO). Questionnaire interview, anthropometric measurements, and biochemical measurements were obtained in the participants. Metabolic profiles and rate of incident diabetes were compared between the groups. Results: After a median follow-up period of 4 years, the rate of incident diabetes in group MHNO, group MUNO, group MHO, and group MUO were 3.4%, 16.4%, 7.7%, and 17.5%, respectively. Multivariate logistic analysis revealed that patients in group MHO had an increased risk of incident diabetes [odds ratio (OR)=2.25, 95% confidence interval (CI) 1.31-3.85] when compared with subjects in MHNO. Compared with patients in group MHNO, patients resistant to insulin [homeostasis model assessment of insulin resistance(HOMA-IR≥2.5)] in group MHO had an increased OR for incident diabetes (OR=5.20, 95% CI 2.56-10.56). Conclusions: The 4-year follow-up revealed that patients of MHO have a high incidence of diabetes in which insulin resistance might play a role.
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