PO.PS01.10 · 人群科学

以腰臀比（WHR）定义的肥胖表型与Sister Study中女性癌症生存者的糖尿病风险

Waist-hip ratio (WHR) defined obesity phenotype and risk of diabetes in cancer survivor women from Sister Study

编号 884 展板 30 时间 4/19 02:00–05:00 区域 Section 34 主讲 Mahfuja Luna, MBBS;MPH

分会场 Survivorship Research

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作者与单位 Authors & Affiliations

Mahfuja Luna¹, Hazel B. Nichols², Katie M. O'Brien³, Michael G. Fradley⁴, Mario Schootman⁵, Michael R. Thomsen⁶, Benjamin C. Amick III¹, Clarice R. Weinberg⁷, Dale P. Sandler⁸, Yong-Moon (Mark) Park¹

¹Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR,²Department of Epidemiology, University of North Carolina, Chapel Hill, NC,³Epidemiology Branch, National Institute of Environmental Health Sciences,, Research Triangle Park, NC, NC,⁴Cardio-Oncology Program, Division of Cardiology, Department of Internal Medicine, University of Pennsylvania, Philadelphia, PA,⁵Department of Internal Medicine, College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR,⁶Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR,⁷Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, NC,⁸Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, NC

摘要 Abstract

中文摘要

引言：癌症生存者罹患糖尿病的风险升高，且常经历与治疗相关的身体成分和胰岛素敏感性变化。然而，很少有研究评估全身性肥胖和中心性肥胖（各自独立及联合）是否与长期癌症生存者的糖尿病风险相关。我们考察了肥胖表型（全身性、中心性或联合性）是否与女性癌症生存者的新发糖尿病相关。方法：我们纳入了来自Sister Study（2003–2009年入组）的1,924名女性（年龄35至74岁），她们报告有除乳腺癌或非黑色素瘤皮肤癌以外的癌症病史，且基线时无糖尿病。我们排除了入组前<1年内确诊的参与者（自诊断以来的中位时间：11.6年）。参与者随访至2021年9月。全身性肥胖定义为检查者测量的体质指数（BMI）≥30 kg/m²，中心性肥胖定义为腰臀比（WHR）≥0.85。参与者被分类为：无肥胖（BMI<30，WHR<0.85）、仅中心性（WHR≥0.85，BMI<30）、仅全身性（BMI≥30，WHR<0.85）和联合性肥胖（BMI≥30且WHR≥0.85）。新发糖尿病通过随访期间自我报告的新的医生诊断来识别。采用多变量Cox比例风险模型估算各肥胖表型新发糖尿病的风险比（HR）及95%置信区间（CI）。结果：基线时16.5%的参与者为仅中心性肥胖，14.0%为仅全身性肥胖，13.3%为联合性肥胖。在中位随访12.9年期间，157名女性（8.2%）发生新发糖尿病。在校正潜在混杂因素后，与无肥胖相比，仅中心性肥胖与糖尿病发生率升高2倍以上相关（HR 2.14，95% CI 1.25–3.68），仅全身性肥胖也显示出类似的2倍以上关联（HR 2.33，95% CI 1.38–3.92）。联合性肥胖表型与最高的发生率相关，显示出6倍以上的风险（HR 6.48，95% CI 4.13–10.19），且全身性与中心性肥胖之间存在显著的乘法交互作用（交互作用p<0.0001）。其他中心性肥胖参数（腰围≥88 cm和腰高比≥0.50）显示出类似的关联。这些关联在自癌症诊断以来的各时间段类别（<5年、5–<15年和≥15年）中总体一致。这些关联在患有现有高血压、血脂异常或心血管疾病的女性中也可见到。结论：我们的研究结果提示，中心性肥胖和全身性肥胖，尤其是二者联合时，与癌症生存者的糖尿病发生率呈强烈正相关。将基于WHR的肥胖评估纳入生存者照护，可能有助于识别能从针对性糖尿病预防和监测中获益的女性癌症生存者。

查看英文原文 English abstract

Introduction : Cancer survivors are at elevated risk of developing diabetes and often experience treatment-related changes in body composition and insulin sensitivity. However, few studies have evaluated whether general and central obesity, independently and jointly, are associated with diabetes risk in long-term cancer survivors. We examined whether obesity phenotype (general, central, or combined) is associated with incident diabetes among women cancer survivors. Methods : We included 1,924 women (aged 35 to 74 years) from the Sister Study (enrolled 2003-2009) who reported a history of cancer other than breast or non-melanoma skin cancer and had no diabetes at baseline. We excluded participants diagnosed <1 year before enrollment (median time since diagnosis: 11.6 years). Participants were followed through September 2021. General obesity was defined as examiner-measured body mass index (BMI)≥30 kg/m 2 , and central obesity as waist-hip ratio (WHR)≥0.85. Participants were categorized as: no obesity (BMI<30, WHR<0.85), central-only (WHR≥ 0.85, BMI<30), general-only (BMI ≥30, WHR<0.85), and combined obesity (BMI≥30 and WHR ≥0.85). Incident diabetes was identified by self-reported new physician diagnosis during follow-up. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident diabetes across obesity phenotypes. Results : At baseline 16.5% of participants had central-only obesity, 14.0% had general-only obesity, and 13.3% had combined obesity. Over a median follow-up of 12.9 years, 157 women (8.2%) developed incident diabetes. After adjusting for potential confounders, central obesity alone was associated with more than 2-fold higher diabetes incidence (HR 2.14, 95% CI 1.25-3.68), and general obesity alone showed a similar >2-fold association (HR 2.33, 95% CI 1.38-3.92), each compared with no obesity. The combined obesity phenotype was associated with the highest incidence, showing a more than 6-fold risk (HR 6.48, 95% CI 4.13-10.19) with a significant multiplicative interaction between general and central obesity (p for interaction <0.0001). Alternative central obesity parameters (waist circumference ≥88 cm and waist-height ratio ≥0.50) showed similar associations. Associations were generally consistent across categories of time since cancer diagnosis (<5 years, 5-<15 years, and ≥15 years). These associations also were seen among women with prevalent hypertension, dyslipidemia, or cardiovascular disease. Conclusion : Our findings suggest that central and general obesity, especially in combination, are strongly positively associated with diabetes incidence in cancer survivors. Incorporating WHR-based obesity assessment into survivorship care may help identify women cancer survivors who would benefit from targeted diabetes prevention and monitoring.

利益披露 Disclosure

M. Luna, None.. H. B. Nichols, None.. K. M. O'Brien, None.. M. Fradley, None.. M. Schootman, None.. M. Thomsen, None.. B. Amick III, None.. C. R. Weinberg, None.. D. P. Sandler, None.. Y. Park, None.

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