论文丨上海市社区老年人超重与2型糖尿病关联中脂质-葡萄糖代谢指标的中介作用

论文发表

近日，由我院王帆教授（共同通讯作者）、上海健康医学院访问学者卜佳老师（共同第一作者）、公共卫生学院博士研究生莫鸿飞（共同第一作者），以及上海市疾病预防控制中心程旻娜主任（共同通讯作者）、吴菲医生（共同第一作者）等合作完成的论文“Mediation by Lipid-Glucose Metabolic Indices in the Association between Overweight and T2DM among Shanghai Community-Dwelling Older Adults”发表于期刊《Journal of Diabetes Research》（JCR Q2）。该期刊是糖尿病领域专业期刊，聚焦糖尿病及其并发症的流行病学、临床管理及基础研究，涵盖脂代谢、肥胖与慢性病预后等方向。本研究成果体现了王帆教授团队在社区糖尿病风险识别及体重相关代谢异常机制方面的持续探索，这也是团队今年发表的第4篇相关领域论文。

本研究基于上海市慢性非传染性疾病管理队列中44,715名60岁及以上社区老年人，系统分析了甘油三酯-葡萄糖（TyG）指数、胆固醇-高密度脂蛋白-葡萄糖（CHG）指数及血浆致动脉粥样硬化指数（AIP）在超重（BMI ≥24 kg/m²）与2型糖尿病（T2DM）关联中的中介作用。结果显示，超重老年人T2DM患病比值较非超重者高26%（OR=1.26）；TyG、CHG和AIP指数均与T2DM独立正相关，且三者均部分中介了超重与T2DM的关联，中介比例分别为22.03%、32.24%和6.47%，其中CHG指数的中介效应最强。这一发现首次在社区老年人群中量化了三项脂质－葡萄糖代谢指标在超重影响T2DM通路中的间接效应，尤其揭示了CHG指数所反映的联合血脂与血糖代谢紊乱是一条潜在的更为突出的中间通路。该成果为超重老年人T2DM的早期代谢风险分层提供了简便、可计算的生物标志物，也为制定以改善脂质-葡萄糖代谢为核心的精准干预策略带来了新的循证依据，具有重要的社区慢性病防控意义。

作者/Authors

Jia Bo a†, Hongfei Mo bc†, Fei Wu d†, Jiayun Zhu a, Qinghua Yan d, Fan Wang cb*, Minna Cheng d*

aSchool of Nursing and Health Management, Shanghai University of Medicine & Health Sciences, Shanghai, China

bSchool of Public Health, Fudan University, Shanghai, China.

cFudan Development Institute, Fudan University, Shanghai, China.

dDivision of Chronic Non-Communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China.

†Jia Bo, Hongfei Mo, and Fei Wu contributed equally to this work.

*Corresponding author: Fan Wang, Minna Cheng

E-mail address: wangfan512@126.com (F Wang); chengminna@scdc.sh.cn (M Cheng).

摘要/Abstract

目的本研究旨在探讨甘油三酯-葡萄糖（TyG）指数、胆固醇-高密度脂蛋白-葡萄糖（CHG）指数和血浆致动脉粥样硬化指数（AIP）在中国上海老年人超重与2型糖尿病（T2DM）关联中的中介作用。

方法共纳入上海市慢性非传染性疾病管理队列中44,715名年龄≥60岁的参与者。超重定义为身体质量指数（BMI）≥24 kg/m²。T2DM由临床医生依据诊断标准确诊。采用中介分析分别估计直接效应、间接效应和总效应。

结果参与者平均年龄为77±6.8岁，16,835例（37.65%）确诊为T2DM，27,880例（62.35%）未患病。在协变量校正模型中，超重老年人患T2DM的比值较非超重老年人高26%。TyG、CHG和AIP指数均与T2DM相关。中介分析显示，TyG、CHG和AIP指数所中介的总效应比例分别为22.03%、32.24%和6.47%。

结论所检测的脂质-葡萄糖代谢指标，尤其是CHG和TyG指数，部分中介了超重与T2DM之间的关联。这些生物标志物可作为预防超重老年人发生T2DM的早期干预靶点。

Objective:This study aimed to explore the mediating roles of the triglyceride-glucose (TyG) index, cholesterol-HDL-glucose (CHG) index, and atherogenic index of plasma (AIP) in the association between overweight and type 2 diabetes mellitus (T2DM) among older adults in Shanghai, China.

Methods:A total of 44,715 participants aged ≥60 years from the Shanghai Non-communicable Diseases Management Cohort were included. Overweight was defined as a body mass index (BMI) ≥24 kg/m². T2DM was diagnosed clinically by physicians. Mediation analysis was performed to estimate direct, indirect, and total effects.

Results:The mean age of the participants was 77 ± 6.8 years, 16,835 (37.65%) were diagnosed with T2DM, and 27,880 (62.35%) did not. In covariate-adjusted models, overweight older adults had a 26% higher odds of T2DM than non-overweight older adults. The TyG, CHG, and AIP indices were all associated with T2DM. In the mediation analysis, the proportions of the total effect mediated by the TyG, CHG, and AIP indices were 22.03%, 32.24%, and 6.47%, respectively.

Conclusion:The lipid-glucose metabolic indices examined, particularly CHG and TyG indices, partially mediated the association between overweight and T2DM. These biomarkers may serve as early intervention targets to prevent T2DM among overweight older adults.

关键词/Key Words

脂质-葡萄糖代谢指标；中介分析；老年人；超重；2型糖尿病

Lipid-glucose metabolic indices, Mediation analysis, Older adults, Overweight, Type 2 diabetes mellitus (T2DM)

全文链接/Link

https://onlinelibrary.wiley.com/doi/10.1155/jdr/8449810

来源｜ Journal of Diabetes Research