基于英国 2 型糖尿病风险的种族特异性 BMI 切点与肥胖：一项基于人群的队列研究。
Ethnicity-specific BMI cutoffs for obesity based on type 2 diabetes risk in England: a population-based cohort study.
机构信息
Nuffield Department of Population Health, University of Oxford, Oxford, UK; Warwick Medical School, University of Warwick, Coventry, UK.
Warwick Medical School, University of Warwick, Coventry, UK; Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
出版信息
Lancet Diabetes Endocrinol. 2021 Jul;9(7):419-426. doi: 10.1016/S2213-8587(21)00088-7. Epub 2021 May 11.
BACKGROUND
National and global recommendations for BMI cutoffs to trigger action to prevent obesity-related complications like type 2 diabetes among non-White populations are questionable. We aimed to prospectively identify ethnicity-specific BMI cutoffs for obesity based on the risk of type 2 diabetes that are risk-equivalent to the BMI cutoff for obesity among White populations (≥30 kg/m).
METHODS
In this population-based cohort study, we used electronic health records across primary care (Clinical Practice Research Datalink) linked to secondary care records (Hospital Episodes Statistics) from a network of general practitioner practices in England. Eligible participants were aged 18 years or older, without any past or current diagnosis of type 2 diabetes, had a BMI of 15·0-50·0 kg/m and complete ethnicity data, were registered with a general practitioner practice in England at any point between Sept 1, 1990, and Dec 1, 2018, and had at least 1 year of follow-up data. Patients with type 2 diabetes were identified by use of a CALIBER phenotyping algorithm. Self-reported ethnicity was collapsed into five main categories. Age-adjusted and sex-adjusted negative binomial regression models, with fractional polynomials for BMI, were fitted with incident type 2 diabetes and ethnicity data.
FINDINGS
1 472 819 people were included in our study, of whom 1 333 816 (90·6%) were White, 75 956 (5·2%) were south Asian, 49 349 (3·4%) were Black, 10 934 (0·7%) were Chinese, and 2764 (0·2%) were Arab. After a median follow-up of 6·5 years (IQR 3·2-11·2), 97 823 (6·6%) of 1 472 819 individuals were diagnosed with type 2 diabetes. For the equivalent age-adjusted and sex-adjusted incidence of type 2 diabetes at a BMI of 30·0 kg/m in White populations, the BMI cutoffs were 23·9 kg/m (95% CI 23·6-24·0) in south Asian populations, 28·1 kg/m (28·0-28·4) in Black populations, 26·9 kg/m (26·7-27·2) in Chinese populations, and 26·6 kg/m (26·5-27·0) in Arab populations.
INTERPRETATION
Revisions of ethnicity-specific BMI cutoffs are needed to ensure that minority ethnic populations are provided with appropriate clinical surveillance to optimise the prevention, early diagnosis, and timely management of type 2 diabetes.
FUNDING
National Institute for Health Research.
背景
针对非白人群体，各国和全球建议使用 BMI 切点来采取行动预防与肥胖相关的并发症，如 2 型糖尿病，但这些切点值得怀疑。我们旨在前瞻性地确定基于 2 型糖尿病风险的、针对不同种族的肥胖 BMI 切点，这些切点与白人群体（≥30kg/m²）的肥胖 BMI 切点（≥30kg/m²）风险相当。
方法
在这项基于人群的队列研究中，我们使用了英格兰全科医生实践网络中的初级保健（临床实践研究数据链接）中的电子健康记录，并与二级保健记录（医院发病统计）相关联。符合条件的参与者年龄在 18 岁或以上，没有任何过去或当前的 2 型糖尿病诊断，BMI 为 15.0-50.0kg/m²，且具有完整的种族数据，在 1990 年 9 月 1 日至 2018 年 12 月 1 日期间的任何时候都在英格兰的全科医生实践中登记，并至少有 1 年的随访数据。使用 CALIBER 表型算法确定 2 型糖尿病患者。将自我报告的种族分为五个主要类别。使用年龄和性别调整的负二项式回归模型，结合 BMI 的分数多项式，对 2 型糖尿病和种族数据进行拟合。
结果
我们的研究共纳入了 1472819 人，其中 1333816 人（90.6%）为白人，75956 人（5.2%）为南亚人，49349 人（3.4%）为黑人，10934 人（0.7%）为中国人，2764 人（0.2%）为阿拉伯人。在中位数为 6.5 年（IQR 3.2-11.2）的随访后，1472819 人中的 97823 人（6.6%）被诊断患有 2 型糖尿病。对于白人人群中 BMI 为 30.0kg/m²时相当于年龄和性别调整的 2 型糖尿病发生率，南亚人群的 BMI 切点为 23.9kg/m²（95%CI 23.6-24.0），黑人人群为 28.1kg/m²（28.0-28.4），中国人为 26.9kg/m²（26.7-27.2），阿拉伯人为 26.6kg/m²（26.5-27.0）。
解释
需要修订针对特定种族的 BMI 切点，以确保向少数民族提供适当的临床监测，从而优化 2 型糖尿病的预防、早期诊断和及时管理。
资助
英国国家卫生研究院。
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