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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
Zhou-Zheng Tu, Qi Lu, Yan-Bo Zhang, Zhe Shu, Yu-Wei Lai, Meng-Nan Ma, Peng-Fei Xia, Ting-Ting Geng, Jun-Xiang Chen, Yue Li, Lin-Jing Wu, Jing Ouyang, Zhi Rong, Xiong Ding, Xu Han, Shuo-Hua Chen, Mei-An He, Xiao-Min Zhang, Lie-Gang Liu, Tang-Chun Wu, Shou-Ling Wu, Gang Liu, An Pan
工程（英文） ›› 2023, Vol. 22 ›› Issue (3) : 141-148.
PDF(357 KB)
PDF(357 KB)
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
Associations of Combined Healthy Lifestyle Factors with Risks of Diabetes, Cardiovascular Disease, Cancer, and Mortality Among Adults with Prediabetes: Four Prospective Cohort Studies in China, the United Kingdom, and the United States
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。
Lifestyle modification is an effective measure for diabetes prevention in people with prediabetes, but its associations with the long-term risks of cardiovascular disease (CVD), cancer, and mortality remain largely uncertain. We aimed to investigate the associations of combined healthy lifestyle factors with these health outcomes among participants with prediabetes. The study included 121 254 people with prediabetes from four prospective cohorts: the Dongfeng-Tongji (DFTJ) cohort and Kailuan study, both from China; the UK Biobank; and the US National Health and Nutrition Examination Survey (NHANES; for mortality analysis only). We documented a total of 18 333 incident diabetes, 10 829 incident CVD, 6926 incident cancer, and 9877 deaths during follow-up. Combined healthy lifestyle scores (scored from 0 to 5) were constructed based on never smoking or quitting smoking for ≥ 10 years, low-to-moderate alcohol drinking, optimal physical activity, healthy diet, and optimal waist circumference. First, Cox proportional-hazards regression models were used to quantify the associations of combined lifestyle score with health outcomes in each cohort; then, multivariable-adjusted hazard ratios (HRs) were pooled via a random-effects model of meta-analysis. Compared with participants with the least healthy lifestyle (a score of 0–1), participants with the healthiest lifestyle (a score of 4–5) had significantly reduced risks of all outcomes. The HRs (95% confidence interval (CI)) were 0.57 (0.48–0.69) for diabetes, 0.67 (0.62– 0.73) for CVD, 0.80 (0.73–0.88) for cancer, and 0.54 (0.42–0.70) for mortality. Significant associations were consistently found across subgroups of baseline demographic characteristics and metabolic health status. In conclusion, our pooled analyses of four cohorts from three countries reveal that greater adherence to a healthy lifestyle is associated with considerably lower risks of diabetes and its major complications among adults with prediabetes. These findings provide informative and compelling evidence for establishing clinical guidelines and public health policies.
糖尿病前期 / 生活方式 / 糖尿病 / 心血管疾病 / 癌症 / 死亡
Prediabetes / Lifestyle / Diabetes / Cardiovascular disease / Cancer / Mortality
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