Data_Sheet_1_Associations of obesity-related indices with prediabetes regression to normoglycemia among Chinese middle-aged and older adults: a prospective study.docx

BackgroundPrediabetes is associated with increased cardiovascular risk and all-cause mortality, while its regression will decrease the risks. This study investigated the associations of six obesity-related indices (waist-to-height ratio (WHtR), body roundness index (BRI), conicity index (CI), body shape index (ABSI), Chinese visceral adiposity index (CVAI), and triglyceride glucose (TyG) index) with prediabetes regression based on the China Health and Retirement Longitudinal Study (CHARLS), enrolling middle-aged and older adults.MethodsWe included 2,601 participants with prediabetes from CHARLS, who were followed up from 2011–2012 to 2015–2016, with blood samples collected for measuring fasting plasma glucose and hemoglobin A1c. All the obesity-related indices at baseline and their dynamic changes were calculated and categorized into tertiles. Logistic regression analysis was applied to obtain the odds ratio (OR) and 95% confidence intervals (CIs). Attributable fractions (AFs) and 95% CIs of these indices and the dynamic changes were calculated with the AF package in R software, and the cutoff values of initial obesity-related indices were obtained by the receiver operating characteristic (ROC) analysis.ResultsDuring the 4-year follow-up period, 562 (21.61%) participants regressed from prediabetes to normoglycemia. They had lower initial BRI, WHtR, CI, ABSI, CVAI, and TyG than those who did not (P < 0.05). After multivariable adjustment, participants in the first tertile of initial BRI (OR, 1.45, 95%CIs, 1.09–1.93), WHtR (OR, 1.46, 95%CIs, 1.10–1.95), and CVAI (OR, 1.47, 95%CIs, 1.11–1.93) had increased odds of prediabetes regression compared with those in the highest tertile. Participants with decreased TyG (OR, 2.08; 95%CIs, 1.61–2.70) also had increased odds of prediabetes regression compared with those with increased TyG. The cutoff values of initial obesity-related indices were 4.374 for BRI, 0.568 for WHtR, 8.621 for TyG, 1.320 for CI, 0.083 for ABSI, and 106.152 for CVAI, respectively. The AFs were 21.10% for BRI < 4.374, 20.85% for WHtR < 0.568, 17.48% for CVAI < 107.794, and 17.55% for ΔTyG < 0, respectively.ConclusionLow initial BRI, WHtR, and CVAI, as well as TyG reduction, were significantly related to prediabetes regression to normoglycemia, and the AFs were around 20%. Less abdominal fat and insulin resistance reduction would benefit future health outcomes among people with prediabetes.

背景：糖尿病前期与心血管风险及全因死亡率增加密切相关，而其逆转则能降低这些风险。本研究旨在探讨基于中国健康与养老追踪调查（CHARLS）的六项肥胖相关指数（腰高比（WHtR）、体形圆润指数（BRI）、锥形指数（CI）、体形指数（ABSI）、中国内脏脂肪指数（CVAI）和甘油三酯葡萄糖（TyG）指数）与糖尿病前期逆转的相关性，研究对象为中老年人群。方法：本研究纳入了来自CHARLS的2,601名糖尿病前期患者，从2011-2012年至2015-2016年进行随访，并采集血液样本以测量空腹血糖和糖化血红蛋白A1c。计算了基线时的肥胖相关指数及其动态变化，并将这些变化划分为三分位数。采用逻辑回归分析以获得比值比（OR）和95%置信区间（CIs）。利用R软件中的AF包计算了这些指数及其动态变化的归因分数（AFs）和95%置信区间，并通过受试者工作特征（ROC）分析获得了初始肥胖相关指数的截止值。结果：在4年的随访期间，562名（21.61%）参与者从糖尿病前期逆转至正常血糖。与未逆转者相比，这些逆转者的初始BRI、WHtR、CI、ABSI、CVAI和TyG均较低（P < 0.05）。在多变量调整后，初始BRI、WHtR和CVAI的前三分位数参与者相比最高三分位数的参与者，其糖尿病前期逆转的几率增加（OR分别为1.45、1.46和1.47，95%CIs分别为1.09-1.93、1.10-1.95和1.11-1.93）。TyG降低的参与者（OR为2.08；95%CIs为1.61-2.70）相比TyG增加的参与者，其糖尿病前期逆转的几率也增加。初始肥胖相关指数的截止值分别为：BRI 4.374，WHtR 0.568，TyG 8.621，CI 1.320，ABSI 0.083和CVAI 106.152。归因分数分别为：BRI < 4.374为21.10%，WHtR < 0.568为20.85%，CVAI < 107.794为17.48%，ΔTyG < 0为17.55%。结论：较低的初始BRI、WHtR和CVAI，以及TyG的降低，与糖尿病前期逆转至正常血糖显著相关，归因分数约为20%。减少腹部脂肪和降低胰岛素抵抗将有助于糖尿病前期人群未来的健康状况。