2型糖尿病是生活方式和遗传因素共同作用的结果。以前的临床试验支持生活方式在预防障碍方面的有效性。该研究旨在评估有妊娠糖尿病病史的女性罹患2型糖尿病的5种可改变的风险因素的个体和综合相关性，并检查这些相关性是否因肥胖和2型糖尿病的遗传易感性而不同。

该项研究共纳入924例患者，数据结果显示，2型糖尿病风险因素中任何一项都没有达到最佳水平的参与者相比，所有5种因素都达到最佳水平的参与者患2型糖尿病的风险降低了90%。具有1、2、3、4和5个最佳可改变因素的患者与无最佳可改变因素的患者的2型糖尿病风险比分别为0.94(95%可信区间0.59 ~ 1.49)、0.61(0.38 ~ 0.96)、0.32(0.20 ~ 0.51)、0.15(0.09 ~ 0.26)和0.08 (0.03 ~ 0.23(P＜0.001)。

在有妊娠期糖尿病病史的妇女中，每一个额外的最佳可改变因素都与2型糖尿病的风险逐渐降低相关。甚至在超重/肥胖或遗传易感性较高的个体中也可见到这些关联。

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.

文章连接：

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

百度浏览   来源 : 医微客   

版权声明：本网站所有注明来源“医微客”的文字、图片和音视频资料，版权均属于医微客所有，非经授权，任何媒体、网站或个人不得转载，授权转载时须注明来源：”医微客”。本网所有转载文章系出于传递更多信息之目的，且明确注明来源和作者，转载仅作观点分享，版权归原作者所有。不希望被转载的媒体或个人可与我们联系，我们将立即进行删除处理。 本站拥有对此声明的最终解释权。