新加坡国立大学Cuilin Zhang团队研究了有妊娠期糖尿病病史的个体发生2型糖尿病的可改变危险因素和长期风险。相关论文发表在2022年9月21日出版的《英国医学杂志》上。

为了在有妊娠期糖尿病史的女性中，评估五种可改变危险因素与2型糖尿病风险的个体和综合关联，并检查这些相关性是否因肥胖和2型糖尿病遗传易感性而不同，研究组在美国护士健康研究II进行了一项前瞻性队列研究。招募4275名有妊娠期糖尿病史的女性，重复测量体重和生活方式因素，并于1991年至2009年进行随访。

主要结局为自我报告或临床诊断的2型糖尿病。研究组评估了五个可改变的危险因素，包括不超重或肥胖（体重指数<25.0）、高质量饮食（改良的替代健康饮食指数的前五分之二分位）、定期锻炼（中等强度训练≥150分钟/周，或高强度训练≥75分钟/周）、适量饮酒（5.0-14.9克/天）、目前不吸烟。根据参与者子集中与2型糖尿病相关的59个单核苷酸多态性的遗传风险评分，确定2型糖尿病的遗传易感性特征（1372例）。

在平均27.9年的随访中，924名女性患上了2型糖尿病。与没有任何2型糖尿病风险因素、处于最佳水平的参与者相比，所有五个因素处于最佳状态的参与者患糖尿病的风险降低了90%以上。有一个、两个、三个、四个和五个最佳可调整因素水平的患者与无可调整因素的患者相比，2型糖尿病的危险比分别为0.94、0.61、0.32、0.15和0.08。即使在超重/肥胖或遗传易感性较高的受试者中，最佳可调整因素的数量也与2型糖尿病风险呈负相关。在体重指数≥25的女性（2227例）中，其他四个风险因素达到最佳水平的风险比为0.40。在遗传易感性较高的女性中，有四个最佳因素的2型糖尿病发病风险比为0.11；在所有五个因素均达到最佳水平的组中，未观察到2型糖尿病事件。

研究结果表明，在有妊娠期糖尿病病史的女性中，每增加一个最佳的可调整因素都与2型糖尿病的风险逐渐降低相关。甚至在超重/肥胖或具有更高遗传易感性的个体中也可以看到这些相关性。

附：原文原文

Title: Modifiable risk factors and long term risk of type 2 diabetes among individuals with a history of gestational diabetes mellitus: prospective cohort study

Author: Jiaxi Yang, Frank Qian, Jorge E Chavarro, Sylvia H Ley, Deirdre K Tobias, Edwina Yeung, Stefanie N Hinkle, Wei Bao, Mengying Li, Aiyi Liu, James L Mills, Qi Sun, Walter C Willett, Frank B Hu, Cuilin Zhang

Issue&Volume: 2022/09/21

Abstract:

Objectives To evaluate the individual and combined associations of five modifiable risk factors with risk of type 2 diabetes among women with a history of gestational diabetes mellitus and examine whether these associations differ by obesity and genetic predisposition to type 2 diabetes.

Design Prospective cohort study.

Setting Nurses’ Health Study II, US.

Participants 4275 women with a history of gestational diabetes mellitus, with repeated measurements of weight and lifestyle factors and followed up between 1991 and 2009.

Main outcome measure Self-reported, clinically diagnosed type 2 diabetes. Five modifiable risk factors were assessed, including not being overweight or obese (body mass index <25.0), high quality diet (top two fifthsof the modified Alternate Healthy Eating Index), regular exercise (≥150 min/week of moderate intensity or ≥75 min/week of vigorous intensity), moderate alcohol consumption (5.0-14.9 g/day), and no current smoking. Genetic susceptibility for type 2 diabetes was characterised by a genetic risk score based on 59 single nucleotide polymorphisms associated with type 2 diabetes in a subset of participants (n=1372).

Results Over a median 27.9 years of follow-up, 924 women developed type 2 diabetes. Compared with participants who did not have optimal levels of any of the risk factors for the development of type 2 diabetes, those who had optimal levels of all five factors had >90% lower risk of the disorder. Hazard ratios of type 2 diabetes for those with one, two, three, four, and five optimal levels of modifiable factors compared with none was 0.94 (95% confidence interval 0.59 to 1.49), 0.61 (0.38 to 0.96), 0.32 (0.20 to 0.51), 0.15 (0.09 to 0.26), and 0.08 (0.03 to 0.23), respectively (Ptrend<0.001). The inverse association of the number of optimal modifiable factors with risk of type 2 diabetes was seen even in participants who were overweight/obese or with higher genetic susceptibility (Ptrend<0.001). Among women with body mass index ≥25 (n=2227), the hazard ratio for achieving optimal levels of all the other four risk factors was 0.40 (95% confidence interval 0.18 to 0.91). Among women with higher genetic susceptibility, the hazard ratio of developing type 2 diabetes for having four optimal factors was 0.11 (0.04 to 0.29); in the group with optimal levels of all five factors, no type 2 diabetes events were observed.

Conclusions Among women with a history of gestational diabetes mellitus, each additional optimal modifiable factor was associated with an incrementally lower risk of type 2 diabetes. These associations were seen even among individuals who were overweight/obese or were at greater genetic susceptibility.

DOI: 10.1136/bmj-2022-070312

Source: https://www.bmj.com/content/378/bmj-2022-070312