OBJECTIVE:The epidemic of obesity and type 2 diabetes is evident in sub-Saharan Africa (SSA). However, their associations have hardly been examined in this region. METHODS:A hospital-based case-control study in urban Ghana consisting of 1221 adults (542 cases and 679 controls) investigated the role of anthropometric parameters for diabetes. Logistic regression was used for analysis. The discriminative power and population-specific cut-off points for diabetes were identified by receiver operating characteristic curves. RESULTS:The strongest association with diabetes was observed for waist-to-hip ratio: age-adjusted odds ratios per 1 standard deviation difference were 1.95 (95% confidence interval [CI]: 1.64-2.31) in women and 1.40 [1.01-1.94] in men. Also, among women, the odds of diabetes increased with higher waist circumference (1.35 [1.17-1.57]) and waist-to-height ratio (1.29 [1.12-1.50]). Among men, this was not discernible. Rather, hip circumference was inversely related (0.69 [0.50-0.95]). Body mass index was neither associated with diabetes in women (1.01 [0.88-1.15]) nor in men (0.74 [0.52-1.04]). Among both genders, waist-to-hip ratio showed the best discriminative ability for diabetes in this population and the optimal cut-off points were ≥ 0.88 in women and ≥ 0.90 in men. Recommended cut-off points for body mass index and waist circumference had a poor predictive ability. CONCLUSION:Our findings suggest that measures of central rather than general obesity relate to type 2 diabetes in SSA. It remains to be verified from larger population-based epidemiological studies whether anthropometric targets of obesity prevention in SSA differ from those in developed countries.

译文

目的:肥胖症和2型糖尿病的流行在撒哈拉以南非洲(SSA)很明显。但是,在该地区几乎没有检查过它们的关联。
方法:在加纳市区以医院为基础的病例对照研究,由1221名成人(542例和679例对照组)组成,调查了人体测量学参数在糖尿病中的作用。使用逻辑回归进行分析。糖尿病的鉴别力和特定人群的临界点通过接受者的操作特征曲线来确定。
结果:腰臀比与糖尿病的关系最大:女性每1个标准差的年龄校正比值比为1.95(95%置信区间[CI]:1.64-2.31),而女性为1.40 [1.01-1.94] ]的男人。另外,在女性中,糖尿病的几率随着腰围(1.35 [1.17-1.57])和腰高比(1.29 [1.12-1.50])的增加而增加。在男人中,这是不明显的。相反,髋围呈负相关(0.69 [0.50-0.95])。体重指数与女性(1.01 [0.88-1.15])和男性(0.74 [0.52-1.04])都不与糖尿病相关。在这两个性别中,腰臀比在该人群中表现出对糖尿病的最佳判别能力,并且最佳的分界点是女性≥0.88,男性≥0.90。推荐的体重指数和腰围临界点的预测能力较差。
结论:我们的研究结果表明,中枢性肥胖而非一般性肥胖与SSA中的2型糖尿病有关。撒哈拉以南非洲地区预防肥胖症的人体测量指标是否与发达国家不同,尚需从更大的基于人群的流行病学研究中得到验证。

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