Background: Cross-sectional studies have supported the association among depression, obesity, and type 2 diabetes, but the causality remains controversial in Chinese adults. In this longitudinal study, we evaluated the synergistic effect of depression and obesity on the risk of type 2 diabetes.
Methods: This study included 2809 participants randomly selected from the Qingdao Diabetes Prevention Program, and their type 2 diabetes incidence was determined over a follow-up period of 3 years. The WHO 2006 criteria and the Zung Self-Rating Depression Scale score were employed to identify type 2 diabetes and depression at baseline, respectively. Multivariable-adjusted logistic regression was used to evaluate the synergistic effects of depression and obesity indicators on type 2 diabetes, with adjustment for age, sex, family history of diabetes, and other potential risk factors.
Results: During 3-year follow-up, 316 new incident cases were identified. The relative risk and 95% confidence interval of depression for diabetes incidence was 1.52 (1.05-2.21), after controlling for potential confounders. Sensitivity analysis showed that depression was significantly associated with diabetes incidence in women, younger people, and obese people (1.82 [1.14-2.92], 1.94 [1.25-3.02], and 4.29 [1.44-12.78], respectively]. The synergistic effects of positive depression and body mass index ≥30 kg/m2 on type 2 diabetes incidence were observed, with a synergy index of 5.49 (1.75-17.19).
Conclusions: Depression was associated with a 52% increased risk of type 2 diabetes incidence and exerts synergistic effects with obesity on diabetes incidence in Chinese adults. Early identification and intervention for depression and obesity can reduce the risk of diabetes.
背景: 横断面研究证实抑郁、肥胖和糖尿病的相关性, 而它们之间的因果关系在中国人群中还未确定。在这项纵向性研究, 我们评估了抑郁和肥胖的交互作用对糖尿病发生风险的影响。 方法: 本研究纳入了青岛糖尿病预防项目的2809名随机调查者, 随访时间为3年, 并统计糖尿病的发生率。根据2006年世界卫生组织糖尿病诊断标准和Zung氏抑郁自评量表, 分别判定调查者基线的糖尿病和抑郁情况。借助多因素校正logistic回归模型评估抑郁和肥胖交互作用对糖尿病发病的影响, 校正因素包括年龄、性别、糖尿病家族史和其它潜在危险因素。 结果: 3年随访期间发现316名新诊糖尿病患者。校正可能的混杂因素后, 抑郁阳性者发生糖尿病的相对风险为1.52(1.05-2.21)。敏感性分析显示, 抑郁与糖尿病发病的相关性在女性、年轻人以及肥胖人群中有显著统计学意义, 相对风险分别为1.82(1.14-2.92)、1.94(1.25-3.02)和4.29(1.44-12.78)。抑郁阳性和体重指数≥ 30 kg/m2 交互作用增加2型糖尿病的风险, 交互作用指数为5.49(1.75-17.19)。 结论: 抑郁能够增加52%糖尿病的风险, 而且抑郁和肥胖的交互作用增加中国成年人糖尿病的发生风险。抑郁和肥胖的早期发现和干预能够降低糖尿病风险。.
Keywords: 2型糖尿病; depression; incidence; longitudinal study; obesity; type 2 diabetes; 发病率; 抑郁; 纵向研究; 肥胖.
© 2019 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.