| Objective As a global public health problem,obesity is one of the main risk factors of type 2 diabetes.Previous studies have found that metabolically healthy and obese individuals may not increase the risk of diabetes,but the findings are not consistent across ethnicities and age groups.The purpose of this study is to explore the risk of type 2 diabetes in the elderly with metabolic health obesity and other phenotypes through the follow-up of 49702 elderly people participating in physical examination in Binhai New Area of Tianjin.On this basis,to explore the relationship between the dynamic changes of different phenotypes and the occurrence of type 2 diabetes,as well as the impact of the length of unhealthy metabolism on the occurrence of type 2 diabetes.In addition,we also explored the risk factors of metabolic health of the elderly into metabolic unhealthy statue,and provided suggestions for positioning the high-risk population of diabetes and taking targeted interventions.Methods In this study,60 year old and above residents who participated in free comprehensive physical examination in Binhai New Area from 2014 to 2015 were taken as the research objects.Subjects with type 2 diabetes at baseline and missing data were excluded.A total of 49702 subjects(21709 males and 27993 females)met the study criteria after all factors were excluded.A total of 1043 patients were diagnosed with type 2 diabetes during the follow-up period from 2015 to 2018.Binhai health study was registered in the Chinese clinical trial registry with the registration number of Chi CTR1900023701.During the follow-up period,the elderly who participated in the physical examination were interviewed with the standard questionnaire to collect the demographic characteristics,health-related habits and other information of the elderly,and the physical measurement and blood test were carried out for the elderly.Cox proportional risk model was used to explore the effect of baseline different metabolic health / obesity phenotypes and dynamic changes among different phenotypes on the occurrence of type 2 diabetes in the elderly.Non conditional logistic regression was used to explore the risk factors of metabolic health in the elderly.Results 1.The prevalence of baseline mho phenotypes was 7.5% in the elderly and 54.3% in the obese in 2014.The prevalence of MHO in male elderly is higher than that in female.The prevalence of MHO was lower in the elderly.The prevalence of MHNW,MHOW,MUNW,MUOV and MUO phenotypes was 35.8%,27.3%,9.6%,13.4% and 6.3% respectively in the elderly population.2.Compared with baseline normal-weight elderly,the relative risks of type 2 diabetes in overweight and obese elderly were 1.385(95% CI 1.207-1.591)and 2.014(95% CI 1.703-2.381),respectively.Compared to the baseline-healthy elderly,the relative risk of type 2 diabetes in the baseline-unhealthy elderly were 1.847(95% CI 1.632-2.090).Compared with the MHNW elderly at baseline,the relative risks of type 2 diabetes in the elderly with MHOW,MHO,MUNW,MUOV,and MUO were 1.335(95% CI 1.120-1.591),1.786(95% CI 1.407-2.270),1.792(95% CI 1.439-2.231),2.193(95% CI 1.189-2.643),and 3.030(95% CI 2.448-3.752),respectively.3.During the follow-up period from 2014 to 2018,the metabolic health / obesity status of the elderly has always been in a dynamic change.During the follow-up period,about 23% of the elderly with MHNW phenotype changed to metabolic unhealthy state,most of them changed to MUNW(16%).About 30% of the elderly with MHOW phenotype changed to metabolic unhealthy state,and most of them changed to MUOV(22%).About 39% of the elderly with MHO phenotype changed to metabolic unhealthy state,most of them changed to MUO(31%).4.Compared with older people who have a baseline MHNW and maintain metabolic health,the relative risk of type 2 diabetes and its 95% CI with MHOW and MHO phenotypes at baseline and maintaining metabolic health were 1.272(0.996,1.623)and 1.670(1.166,2.391),respectively.Compared with the elderly with baseline MHNW and maintaining metabolic health,the relative risk of type 2 diabetes and its 95%CI in elderly with baseline MHNW,MHOW,and MHO phenotypes to metabolically unhealthy status were 2.672(2.082,3.431),3.035(2.443,3.772)and 3.727(2.721,5.105),respectively.Compared with the elderly with baseline MHNW and maintaining metabolic health,the relative risk and 95% CI of type 2 diabetes mellitus were 2.480(1.840,3.171),3.137(2.471,3.983)and 4.202(3.303,5.345)for the elderly with MUNW,MUOV,and MUO at baseline,respectively.5.Compared with those who continued to maintain metabolic health,the relative risk of diabetes and its 95% CI for those who experienced metabolic unhealthy status were 1.90(1.60,2.27).Compared with those who continued to maintain metabolic health,the relative risk of diabetes and its 95% CI in the elderly with intermittent and persistent metabolic unhealthy status were 1.62(1.35,1.95)and 5.62(4.32,7.33),respectively.Compared with those who continued to maintain metabolic health,the relative risk of diabetes and its 95% CI of the elderly who experienced one,two,three or more metabolic unhealthy states were 1.83(1.49,2.26),1.84(1.45,2.34)and 2.11(1.66,2.70),respectively.6.Among the elderly with a metabolically healthy baseline,the independent factors for the occurrence of metabolic unhealthy are baseline systolic blood pressure [OR(95% CI): 1.23(1.19,1.26)],diastolic blood pressure [OR(95% CI): 1.05(1.02,1.08)],fasting blood glucose [OR(95% CI): 1.33(1.29,1.37)],triglycerides [OR(95% CI): 1.45(1.40,1.51)],waist circumference [OR(95% CI): 1.24(1.20,1.27)],ALT [OR(95% CI): 1.04(1.01,1.07)] and gender [OR(95% CI): 1.23(1.17,1.31)].Conclusions In a word,the study of Binhai health found that metabolic health obesity is not a "healthy" concept for the elderly in the China,and found that obesity is still a risk factor for diabetes,even if metabolic health is maintained for more than 4 years.In addition,the majority of elderly people with healthy metabolism may change to an unhealthy metabolic phenotype over time,which would increase the risk of diabetes.In view of the unstable characteristics of metabolic health phenotype,our study suggests that early targeted interventions should be focused on elderly women to achieve a healthier waist circumference as well as blood pressure,fasting blood glucose,triglyceride and ALT levels. |
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