| BackgroundThe prevalence and incidence of diabetes are rising rapidly worldwide,and China has become the country with the largest number of diabetes patients.Diabetes can lead to a variety of acute and chronic complications,causing great physical and mental suffering to patients and placing a heavy burden on the healthcare system.If simple and effective screening tools can be used to identify those at high risk of developing diabetes in the early stage,and a variety of interventions including lifestyle interventions can be carried out as early as possible,the possibility of diabetes in this high-risk population can be greatly reduced.This study was divided into two parts.In the first part,we investigated gender differences in body height and the risk of new-onset diabetes in Chinese adults.In the second part,we investigated the association between triglyceride glucose-body mass index(Ty G-BMI)and the risk of new-onset diabetes in Chinese adults.These data provide an useful reference for the primary prevention of diabetes in China.Part I Gender differences in body height and the risk of new-onset diabetes among Chinese adultsObjective:This study aimed to investigate the sex-specific association between body height and the risk of new-onset diabetes in Chinese adults.Methods:This study was a retrospective cohort study based on Chinese population,including 685277 participants from 11 cities in China(Shanghai,Beijing,Nanjing,Suzhou,Shenzhen,Changzhou,Chengdu,Guangzhou,Hefei,Wuhan,Nantong)who participated in health check-up.According to the purpose of the study,116661 adult subjects were finally included.Male and female subjects were divided into four groups according to their height quartiles(Quartile).Follow-up was conducted through retrospective review of annual physical examination results.The endpoint was newly diagnosed diabetes.Multivariable Cox regression models were used to examine the association between height and the risk of new-onset diabetes,as well as sex-specific differences.Restricted cubic splines(RCS)were constructed to fit the shape of female height and risk of new-onset diabetes.Cutoff values for female height for the risk of new-onset diabetes were also calculated with the use of piecewise regression models and a recursive algorithm.Finally,we examined the association of height with the risk of new-onset diabetes in subgroups of women according to age and body-mass index(BMI).Results:1.A total of 116661 subjects without diabetes at baseline were included in the study,including 62759 men and 53902 women(male to female ratio 1.16:1).The mean age of men and women was 44 and 43 years,respectively,and the mean height was 171.65cm and 160.06cm,respectively.2.During mean follow-up of 3.1 years,new diabetes was diagnosed in 1888 men(1.61%)and 793 women(0.68%),for a male to female ratio of 2.4:1.3.Multivariable Cox regression models were used to examine the association between height and new-onset diabetes.Our results showed a significant inverse association between body height and the risk of new-onset diabetes in Chinese women after the adjustment for age,body mass index,blood pressure,fasting blood glucose,urea nitrogen,creatinine,triglyceride,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,smoking and drinking history,and family history of diabetes.(HR[Hazard Ratio]:0.85,95%CI:0.74-0.98),while this association was not significant in men(P>0.05).4.The restricted cubic spline(RCS)and piecewise regression analysis of this study further identified that the height between 157-158cm may be the critical point for short stature used to assess the risk of future new-onset diabetes in Chinese women.For each 1cm increase in height,the risk for new-onset diabetes decreased by3%in those with height less than 157.9cm(HR:0.97,95%CI:0.95-0.99),whereas women with height greater than 157.9cm had an HR of 1 for risk.5.We also examined the association of height with new-onset diabetes according to age and BMI in women.The inverse association between height and incident diabetes was observed only in people older than 60 years of age and in those who were obese.However,further interaction tests suggested that these findings were not significantly different(P>0.05).Conclusion:The short stature phenotype is associated with the risk of new-onset diabetes in Chinese women,and 157-158cm may be the saturation effect point for short height in predicting the risk of new-onset diabetes.Part II Association between triglyceride glucose-body mass index and the risk of new-onset diabetes in Chinese adultsObjective:The aim of this study was to investigate the causal association of triglyceride glucose-body mass index(Ty G-BMI)with new-onset diabetes and its predictive performance in Chinese adult population.Methods:The study population was derived from 116661 adults from 11 cities in China who underwent health check-up in the first part of the study.Subjects included in this study were divided into five groups based on Ty G-BMI quintiles(Quintile).Multivariate Cox regression models were used to examine the association between Ty G-BMI and the risk of new-onset diabetes.Receiver operating characteristic curve(ROC)analysis was used to calculate the area under the curve(AUC)to compare the predictive ability of Ty G,BMI and Ty G-BMI for the risk of new-onset diabetes.We further explored the association and optimal predictive value of Ty G-BMI with new-onset diabetes in different gender,age and body mass index(BMI)populations.Results:1.During an average of 3.1 years of follow-up,2681 participants received a diagnosis of new-onset diabetes(518 self-reported).The cumulative incidence of diabetes was 0.33%in Q1 group,0.53%in Q2 group,1.41%in Q3 group,2.76%in Q4 group and 6.47%in Q5 group.The incidence of diabetes in Q5 group was significantly higher than that in other groups.2.There is a nonlinear association between Ty G-BMI and diabetes,and there may be an inflection point of the nonlinear association between Ty G-BMI between200 and 250.3.Three regression models were developed in this study.Model 1 was adjusted for sex,age,and height.Model 2 was adjusted for systolic blood pressure,fasting plasma glucose,high-density lipoprotein,and alanine aminotransferase.Model 3 was adjusted for age,sex,systolic blood pressure,diastolic blood pressure,fasting plasma glucose,triglyceride,high-density lipoprotein,low-density lipoprotein,alanine aminotransferase,aspartate aminotransferase,urea nitrogen,creatinine,smoking history,drinking history,and family history of diabetes.4.Multivariate Cox regression analysis showed that Ty G-BMI was strongly positively correlated with the risk of new-onset diabetes,with HR of 2.12(2.05,2.19)in model 1,1.46(1.40,1.52)in model 2,and 1.50(1.40,1.60)in model 3.5.The best cut-off value of Ty G-BMI for predicting new-onset diabetes was213.2966,with a sensitivity of 72.51%and a specificity of 69.54%.6.Subgroup analyses were performed according to sex,age,and BMI phenotype:After stratified by age,Ty G-BMI was most suitable for predicting the risk of new-onset diabetes in young and middle-aged people(HR:20-30 years:1.83,31-40 years:2.16,41-50 years:1.87,51-60 years:1.45,61-70 years:1.14,>70 years:1.26).The optimal cut-off values for predicting new-onset diabetes were 203.8758 for 20-30years old,211.4502 for 31-40 years old,219.4241 for 41-50 years old,and 217.3737for 51-60 years old.The optimal cut-off value for predicting new-onset diabetes was219.2023 for people aged 61-70 years.The optimal cut-off value for predicting new-onset diabetes was 219.2899 for over 70 years old.The optimal cut-off value of Ty G-BMI for predicting the risk of new-onset diabetes was 197.4111 in female population and 220.2488 in male population.Within BMI stratification,the results showed that Ty G-BMI-associated diabetes risk was significantly higher in non-obese subjects than in overweight and obese subjects(HR:BMI<24kg/m~2:2.32,BMI≥24,<28kg/m~2:1.68,BMI≥28kg/m~2:1.25).Conclusion:In the Chinese population,Ty G-BMI is an independent risk factor for new-onset diabetes,and this independent association is more obvious in young and middle-aged people,non-obese people and women. |
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