論文發(fā)表

近日，由我院王帆教授（共同通訊作者）、公共衛(wèi)生學(xué)院博士研究生莫鴻飛（共同第一作者），以及上海市疾病預(yù)防控制中心程旻娜主任（共同通訊作者）、楊沁平醫(yī)師（共同第一作者）等專家合作完成的論文“Low BMI predicts mortality in T2DM older adults: cholesterol parameters demonstrate negative mediation”發(fā)表于期刊《Diabetology & Metabolic Syndrome》（JCR Q2）。該期刊是糖尿病與內(nèi)分泌代謝領(lǐng)域?qū)I(yè)期刊，聚焦糖尿病及其并發(fā)癥的流行病學(xué)、臨床管理及基礎(chǔ)研究，涵蓋脂代謝、肥胖與慢性病預(yù)后等方向。本研究成果體現(xiàn)了王帆教授團(tuán)隊在社區(qū)糖尿病管理及體重相關(guān)代謝異常方面的積極探索。

本研究基于上海市糖尿病管理隊列中372,559名老年2型糖尿�。═2DM）患者，系統(tǒng)探討了低身體質(zhì)量指數(shù)（BMI＜22 kg/m2）與全因死亡風(fēng)險的關(guān)聯(lián)，并量化了總膽固醇（TC）、高密度脂蛋白膽固醇（HDL-C）、低密度脂蛋白膽固醇（LDL-C）在該關(guān)聯(lián)中的中介作用。研究發(fā)現(xiàn)，低BMI顯著增加老年T2DM患者的全因死亡風(fēng)險（HR=1.10）；TC和LDL-C與死亡風(fēng)險呈U型非線性關(guān)系，HDL-C呈L型關(guān)系，最佳閾值分別為5.03 mmol/L、0.98 mmol/L和3.39 mmol/L。更重要的是，TC、HDL-C、LDL-C均呈現(xiàn)負(fù)向中介作用（即“遮掩效應(yīng)”），其中HDL-C的負(fù)向中介效應(yīng)最強(qiáng)（中介比例為?111.99%），提示低BMI相關(guān)的HDL-C下降可能部分解釋了低BMI與死亡風(fēng)險之間的關(guān)聯(lián)。該成果首次揭示了膽固醇參數(shù)在老年T2DM患者低BMI與死亡風(fēng)險關(guān)聯(lián)中的復(fù)雜間接作用，尤其是HDL-C的核心遮掩角色，為臨床實(shí)踐中關(guān)注低體重老年糖尿病患者的血脂代謝紊亂（特別是HDL-C偏低）提供了新的科學(xué)依據(jù)，對優(yōu)化個體化體重與血脂管理策略具有重要臨床與公共衛(wèi)生意義。

作者/Authors

Hongfei Mo1,2?, Qinping Yang3?, Yining Wang2, Qinghua Yan3, Shuyue Sun1,2, Huiting Yu4, Yan Shi3, Fan Wang1* and Minna Cheng3*

1Fudan Development Institute, Fudan University, Shanghai, People's Republic of China

2School of Public Health, Fudan University, Shanghai, People's Republic of China

3Institute for Chronic Non-Communicable Diseases Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China

4Department of Vital Statistics, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China

?Hongfei Mo and Qinping Yang contributed equally

*Correspondence to Fan Wang and Minna Cheng

摘要/Abstract

目的本研究旨在探討低身體質(zhì)量指數(shù)（BMI＜22 kg/m2）及核心血脂指標(biāo)與老年2型糖尿�。═2DM）患者全因死亡風(fēng)險的關(guān)聯(lián)，并評估總膽固醇（TC）、甘油三酯（TG）、高密度脂蛋白膽固醇（HDL-C）和低密度脂蛋白膽固醇（LDL-C）在其中的中介作用。

方法研究數(shù)據(jù)來源于上海市疾病預(yù)防控制中心（SCDC）糖尿病管理隊列，共納入372,559名年齡≥60歲的T2DM患者，按BMI＜22 kg/m2進(jìn)行分層分析。采用線性回歸分析低BMI與血脂指標(biāo)的關(guān)聯(lián)，采用Cox回歸評估低BMI及血脂指標(biāo)與死亡風(fēng)險的關(guān)系。使用限制性立方樣條（RCS）模型評估非線性趨勢，并采用貝葉斯中介模型量化中介效應(yīng)。

結(jié)果與低BMI組相比，非低BMI組的全因死亡風(fēng)險顯著更高（HR = 1.10，95% CI：1.06～1.13）。在血脂指標(biāo)中，TC、HDL-C和LDL?C與死亡風(fēng)險呈非線性關(guān)聯(lián)（TC和LDL-C呈U型，HDL-C呈L型），其最佳閾值分別為5.03 mmol/L、0.98 mmol/L和3.39 mmol/L。中介分析顯示，TC（中介比例PE = -16.68%）、HDL-C（PE = -111.99%）和LDL-C（PE = -4.12%）均表現(xiàn)出顯著的負(fù)向中介作用，其中HDL-C的遮掩效應(yīng)最強(qiáng)（βACME = 1.44，95% CI：1.33～1.56）。

結(jié)論低BMI與老年T2DM患者死亡風(fēng)險增加獨(dú)立相關(guān)。膽固醇指標(biāo)，尤其是HDL-C，可能通過負(fù)向中介作用部分解釋這一關(guān)聯(lián)。該發(fā)現(xiàn)提示臨床應(yīng)更多關(guān)注低體重老年T2DM患者的脂代謝紊亂問題。

ObjectiveThe present study aims to investigate the association of low body mass index (BMI?<?22 kg/m2) and core lipid parameters on all-cause mortality among older adults with type 2 diabetes mellitus (T2DM), and to assess the mediating roles of total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C).

MethodsData were analyzed from 372,559 T2DM participants aged?≥?60 years, obtained from the Shanghai Center for Disease Control and Prevention (SCDC) diabetes management cohort, stratified by BMI?<?22 kg/m2. Associations between low BMI and lipid parameters were examined using linear regression, associations of low BMI and lipid parameters with mortality risk were assessed via Cox regression. Restricted cubic spline (RCS) models were used to evaluate nonlinear trends, and Bayesian mediation models quantified the mediating effects.

ResultsThe low BMI group had a significantly higher risk of all-cause mortality compared to the non-low BMI group (HR?=?1.10, 95% CI: 1.06?~?1.13). Among the lipid parameters, TC, HDL-C, and LDL-C were nonlinearly associated with mortality risk (U-shaped for TC and LDL-C, L-shaped for HDL-C), with optimal thresholds identified at 5.03 mmol/L, 0.98 mmol/L, and 3.39 mmol/L, respectively. Mediation analysis demonstrated significant negative mediation for TC (proportion mediated, PE?=?–16.68%), HDL-C (PE?=?–111.99%), and LDL-C (PE?=?–4.12%), with HDL-C showing the strongest masking effect (βACME?=?1.44, 95% CI: 1.33?~?1.56).

ConclusionLow BMI is independently associated with an increased risk of mortality in T2DM older adults. Cholesterol parameters, particularly HDL-C, may explain part of this association through negative mediation. These findings suggest the need for clinical attention to lipid metabolic disturbances among underweight older adults.

關(guān)鍵詞/Key Words

全因死亡率；膽固醇；低身體質(zhì)量指數(shù)；脂質(zhì)參數(shù)；中介分析；老年人；2型糖尿病

All-cause mortality, Cholesterol, Low BMI, Lipid parameters, Mediation analysis, Older adults, Type 2 diabetes mellitus (T2DM)

全文鏈接/Link

https://link.springer.com/article/10.1186/s13098-026-02118-y

來源｜Diabetology & Metabolic Syndrome