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《工程(英文)》 >> 2023年 第22卷 第3期 doi: 10.1016/j.eng.2022.04.010

糖尿病前期成年人综合健康生活方式与糖尿病、心血管疾病、癌症和死亡的关联——中美英四队列研究

a Key Laboratory of Environment and Health of the Ministry of Education, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
b School of Public Health, North China University of Science and Technology, Tangshan 063000, China
Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, Tangshan 063000, China

# These authors contributed equally to this work.

收稿日期: 2021-08-19 修回日期: 2022-02-08 录用日期: 2022-03-01 发布日期: 2022-05-17

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摘要

在糖尿病前期人群中,采取健康的生活方式可以有效预防糖尿病的发生。然而,健康生活方式与心血管疾病(cardiovascular disease, CVD)、癌症和死亡的长期风险之间的关联尚不清晰。本文旨在探究糖尿病前期人群中综合健康生活方式与上述多种健康结局之间的关联。本研究纳入的121 254 名糖尿病前期研究对象来自以下4 个前瞻性队列,包括中国的东风-同济(Dongfeng-Tongji, DFTJ)队列和开滦研究,英国生物银行(UK Biobank, UKB)和美国的国家健康与营养调查(National Health and Nutrition Examination Survey, NHANES;仅用于死亡分析)。随访期间,共诊断了18 333 例新发糖尿病病例、10 829 例新发心血管疾病病例、6926 例新发癌症病例和9877 例全因死亡。本文基于5 个因素(从不吸烟或戒烟超过10 年、适量饮酒、充足的体力活动、健康膳食和理想的腰围)构建综合健康生活方式评分。各因素均被分为健康水平(赋1 分)和不健康水平(赋0 分),评分的加和为综合健康生活方式评分(0~5 分)。首先,采用Cox比例风险回归模型计算每个队列中综合健康生活方式评分与健康结局之间的关联;然后,通过随机效应模型的荟萃分析合并各独立队列结果的多变量校正的风险比(hazard ratio, HR)和95% 置信区间(confidence interval, CI)。与生活方式最不健康(评分为0~1 分)的研究对象相比,生活方式最健康(评分为4~5 分)的研究对象具有更低的糖尿病、心血管疾病、癌症和死亡风险,合并的HR(95% CI)分别为0.57(0.48~0.69)、0.67(0.62~0.73)、0.80(0.73~0.88)和0.54(0.42~0.70)。根据研究对象的基线人口学特征和代谢健康状况进行亚组分析的结果也与主要分析的结果一致。总而言之,本研究对来自三个国家的4个队列的合并分析表明,在糖尿病前期人群中,坚持更健康的生活方式与糖尿病及主要并发症的发生风险降低有关。本研究的发现为临床指南和公共卫生政策提供了可靠证据。

补充材料

参考文献

[ 1 ] Echouffo-Tcheugui JB, Selvin E. Prediabetes and what it means: the epidemiological evidence. Annu Rev Publ Health 2021;42(1):59‒77. 链接1

[ 2 ] Yudkin JS, Montori VM. The epidemic of pre-diabetes: the medicine and the politics. BMJ 2014;349:g4483. 链接1

[ 3 ] Wang L, Peng W, Zhao Z, Zhang M, Shi Z, Song Z, et al. Prevalence and treatment of diabetes in China, 2013‒2018. JAMA 2021;326(24):2498. 链接1

[ 4 ] Mainous AG, Tanner RJ, Baker R, Zayas CE, Harle CA. Prevalence of prediabetes in England from 2003 to 2011: population-based, cross-sectional study. BMJ Open 2014;4(6):e005002. 链接1

[ 5 ] Cheng YJ, Kanaya AM, Araneta MRG, Saydah SH, Kahn HS, Gregg EW, et al. Prevalence of diabetes by race and ethnicity in the United States, 2011‒2016. JAMA 2019;322(24):2389. 链接1

[ 6 ] Ligthart S, van Herpt TTW, Leening MJG, Kavousi M, Hofman A, Stricker BHC, et al. Lifetime risk of developing impaired glucose metabolism and eventual progression from prediabetes to type 2 diabetes: a prospective cohort study. Lancet Diabetes Endocrinol 2016;4(1):44‒51. 链接1

[ 7 ] Richter B, Hemmingsen B, Metzendorf MI, Takwoingi Y. Development of type 2 diabetes mellitus in people with intermediate hyperglycaemia. Cochrane Database Syst Rev 2018;10(11):CD012661. 链接1

[ 8 ] Tabak AG, Herder C, Rathmann W, Brunner EJ, Kivimaki M. Prediabetes: a high-risk state for diabetes development. Lancet 2012;379(9833):2279‒90. 链接1

[ 9 ] Schlesinger S, Neuenschwander M, Barbaresko J, Lang A, Maalmi H, Rathmann W, et al. Prediabetes and risk of mortality, diabetes-related complications and comorbidities: umbrella review of meta-analyses of prospective studies. Diabetologia 2022;65(2):275‒85. 链接1

[10] Dall TM, Yang W, Gillespie K, Mocarski M, Byrne E, Cintina I, et al. The economic burden of elevated blood glucose levels in 2017: diagnosed and undiagnosed diabetes, gestational diabetes mellitus, and prediabetes. Diabetes Care 2019;42(9):1661‒8. 链接1

[11] Gong Q, Zhang P, Wang J, Ma J, An Y, Chen Y, et al. Morbidity and mortality after lifestyle intervention for people with impaired glucose tolerance: 30-year results of the Da Qing Diabetes Prevention Outcome Study. Lancet Diabetes Endocrinol 2019;7(6):452‒61.

[12] Li G, Zhang P, Wang J, An Y, Gong Q, Gregg EW, et al. Cardiovascular mortality, all-cause mortality, and diabetes incidence after lifestyle intervention for people with impaired glucose tolerance in the Da Qing Diabetes Prevention Study: a 23-year follow-up study. Lancet Diabetes Endocrinol 2014;2(6):474‒80. 链接1

[13] Li G, Zhang P, Wang J, Gregg EW, Yang W, Gong Q, et al. The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study. Lancet 2008;371(9626):1783‒9. 链接1

[14] Uusitupa M, Peltonen M, Lindström J, Aunola S, Ilanne-Parikka P, Keinänen-Kiukaanniemi S, et al. Ten-year mortality and cardiovascular morbidity in the Finnish Diabetes Prevention Study—secondary analysis of the randomized trial. PLoS ONE 2009;4(5):e5656. 链接1

[15] Ratner R, Goldberg R, Haffner S, Marcovina S, Orchard T, Fowler S, et al. Impact of intensive lifestyle and metformin therapy on cardiovascular disease risk factors in the diabetes prevention program. Diabetes Care 2005;28(4):888‒94. 链接1

[16] Lee CG, Heckman-Stoddard B, Dabelea D, Gadde KM, Ehrmann D, Ford L, et al. Effect of metformin and lifestyle interventions on mortality in the Diabetes Prevention Program and Diabetes Prevention Program Outcomes Study. Diabetes Care 2021;44(12):2775‒82.

[17] Hemmingsen B, Gimenez-Perez G, Mauricio D, Roque IFM, Metzendorf MI, DietRichter B., physical activity or both for prevention or delay of type 2 diabetes mellitus and its associated complications in people at increased risk of developing type 2 diabetes mellitus. Cochrane Database Syst Rev 2017;12(12):CD003054.. 链接1

[18] Haw JS, Galaviz KI, Straus AN, Kowalski AJ, Magee MJ, Weber MB, et al. Long-term sustainability of diabetes prevention approaches: a systematic review and meta-analysis of randomized clinical trials. JAMA Intern Med 2017;177(12):1808. 链接1

[19] Nathan DM, Bennett PH, Crandall JP, Edelstein SL, Goldberg RB, Kahn SE, et al. Does diabetes prevention translate into reduced long-term vascular complications of diabetes? Diabetologia 2019;62(8):1319‒28. 链接1

[20] Wang F, Zhu J, Yao P, Li X, He M, Liu Y, et al. Cohort profile: the Dongfeng-Tongji cohort study of retired workers. Int J Epidemiol 2013;42(3):731‒40. 链接1

[21] Zhang Q, Zhou Y, Gao X, Wang C, Zhang S, Wang A, et al. Ideal cardiovascular health metrics and the risks of ischemic and intracerebral hemorrhagic stroke. Stroke 2013;44(9):2451‒6. 链接1

[22] Sudlow C, Gallacher J, Allen N, Beral V, Burton P, Danesh J, et al. UK Biobank: an open access resource for identifying the causes of a wide range of complex diseases of middle and old age. PLoS Med 2015;12(3):e1001779. 链接1

[23] CDC/NCHS. About the national health and nutrition examination survey [Internet]. Atlanta: CDC/NCHS; [cited 2022 Mar 26]. Available from: https://www.cdc.gov/nchs/nhanes/about_nhanes.htm. 链接1

[24] ADA. 2. Classification and diagnosis of diabetes: Standards of Medical Care in Diabetes—2021. Diabetes Care 2021;44(Suppl 1):S15‒33. 链接1

[25] Zhang Y, Pan XF, Chen J, Xia L, Cao A, Zhang Y, et al. Combined lifestyle factors and risk of incident type 2 diabetes and prognosis among individuals with type 2 diabetes: a systematic review and meta-analysis of prospective cohort studies. Diabetologia 2020;63(1):21‒33. 链接1

[26] Beaglehole R, Bonita R, Horton R, Adams C, Alleyne G, Asaria P, et al. Priority actions for the non-communicable disease crisis. Lancet 2011;377(9775):1438‒47. 链接1

[27] WHO. Global status report on noncommunicable diseases 2014 [Internet]. Geneva: WHO; 2014 [cited 2022 Mar 26]. Available from: https://www.who.int/publications/i/item/9789241564854. 链接1

[28] Pan XF, Wang L, Pan A. Epidemiology and determinants of obesity in China. Lancet Diabetes Endocrinol 2021;9(6):373‒92. 链接1

[29] Lloyd-Jones DM, Hong Y, Labarthe D, Mozaffarian D, Appel LJ, Van Horn L, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s Strategic Impact Goal through 2020 and beyond. Circulation 2010;121(4):586‒613. 链接1

[30] Griswold MG, Fullman N, Hawley C, Arian N, Zimsen SRM, Tymeson HD, et al. Alcohol use and burden for 195 countries and territories, 1990‒2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet 2018;392(10152):1015‒35.

[31] Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc 1999;94(446):496‒509. 链接1

[32] Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002;21(11):1539‒58. 链接1

[33] Hopper I, Billah B, Skiba M, Krum H. Prevention of diabetes and reduction in major cardiovascular events in studies of subjects with prediabetes: meta-analysis of randomised controlled clinical trials. Eur J Cardiov Prev Rehabil 2011;18(6):813‒23. 链接1

[34] Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346(6):393‒403. 链接1

[35] ADA. 3. Prevention or delay of type 2 diabetes: Standards of Medical Care in Diabetes—2021. Diabetes Care 2021;44(Suppl 1):S34‒9. 链接1

[36] Pearson-Stuttard J, Bennett J, Cheng YJ, Vamos EP, Cross AJ, Ezzati M, et al. Trends in predominant causes of death in individuals with and without diabetes in England from 2001 to 2018: an epidemiological analysis of linked primary care records. Lancet Diabetes Endocrinol 2021;9(3):165‒73. 链接1

[37] Li H, Khor CC, Fan J, Lv J, Yu C, Guo Y, et al. Genetic risk, adherence to a healthy lifestyle, and type 2 diabetes risk among 550,000 Chinese adults: results from 2 independent Asian cohorts. Am J Clin Nutr 2020;111(3):698‒707. 链接1

[38] Lv J, Yu C, Guo Y, Bian Z, Yang L, Chen Y, et al. Adherence to a healthy lifestyle and the risk of type 2 diabetes in Chinese adults. Int J Epidemiol 2017;46(5):1410‒20. 链接1

[39] Lv J, Yu C, Guo Y, Bian Z, Yang L, Chen Y, et al. Adherence to healthy lifestyle and cardiovascular diseases in the Chinese population. J Am Coll Cardiol 2017;69(9):1116‒25.

[40] Song C, Lv J, Yu C, Zhu M, Yu C, Guo Y, et al. Adherence to healthy lifestyle and liver cancer in Chinese: a prospective cohort study of 0.5 million people. Brit. J Cancer 2022;126(5):815‒21. 链接1

[41] Zhu N, Yu C, Guo Yu, Bian Z, Han Y, Yang L, et al. Adherence to a healthy lifestyle and all-cause and cause-specific mortality in Chinese adults: a 10-year prospective study of 0.5 million people. Int J Behav Nutr Phy 2019;16(1):98. 链接1

[42] Keller A, O’Reilly EJ, Malik V, Buring JE, Andersen I, Steffen L, et al. Substitution of sugar-sweetened beverages for other beverages and the risk of developing coronary heart disease: results from the Harvard Pooling Project of Diet and Coronary Disease. Prev Med 2020;131:105970. 链接1

[43] Qi Q, Chu AY, Kang JH, Jensen MK, Curhan GC, Pasquale LR, et al. Sugar-sweetened beverages and genetic risk of obesity. N Engl J Med 2012;367(15):1387‒96. 链接1

[44] Xia B, Yang M, Nguyen LH, He Q, Zhen J, Yu Y, et al. Regular use of proton pump inhibitor and the risk of inflammatory bowel disease: pooled analysis of 3 prospective cohorts. Gastroenterology 2021;161(6). 1842‒52.e10. 链接1

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