ÖZET
Amaç:
Toplum, obezite, ailede diyabet öyküsü (ADÖ) ve diyabet arasındaki bağlantıların farkındadır, ancak bunların kombinasyonundan kaynaklanan sinerjik etkilerin farkında değildir. Bu çalışmada, diyabet olgusunun horlama, ADÖ ve obezite arasındaki sinerjik etkilerini araştırdık.
Gereç ve Yöntem:
Çalışmadaki denekler, devam eden, ileriye dönük popülasyon tabanlı bir çalışma olan Kore Genom ve Epidemiyoloji Çalışması Ansan-Ansung kohortundaki katılımcılar arasından seçildi. Ansan-Ansung kohortu 2001 ve 2002’de başlatıldı ve iki yılda bir takip edildi. Başlangıçta, 10,030 denekten oluşan ilk kohortun yaşları 40 ile 69 arasında değişmekteydi. Bu çalışmaya toplam 5,759 katılımcı dahil edilmiştir. Diyabet ve horlama, ADÖ ve obezite arasındaki ilişkiler, karıştırıcı faktörler için uyarlandıktan sonra Cox tehlike regresyon modelleri kullanılarak tahmin edildi. Horlama, obezite ve ADÖ, ortak değişkenler için düzenlemelerden sonra hem erkeklerde hem de kadınlarda diyabet ile anlamlı derecede ilişkili bulundu. Bununla birlikte, erkeklerin ADÖ ve obezite olma olasılığı önemli ölçüde daha yüksekti.
Bulgular:
Bu iki risk faktörü arasındaki sinerjik bir etki, ortak değişkenler için düzeltme yapıldıktan sonra kadın olmanın tüm grupla ilişkili olduğunu gösterdi. Dahası, kadın hastalarda iki risk faktörüne sahip olma riski yüksekken, erkekler böyle bir eğilim göstermiyordu. Kadınlarda bu üç risk faktörü arasında önemli bir sinerjik etki görülmüştür. Bu üç faktöre sahip bir maruziyet grubu diğer gruplardan daha yüksek diyabet riskine sahipti (tehlike oranı (HR) 6,27 [%95 güven aralığı (GA): 2,93-13,41] p<0,01, ancak bu erkeklerde görülmedi. Özellikle premenopozal kadınlarda ADÖ, obezite, habitüel horlama anlamlı idi [HR=5,69 (%95 GA: 2,31-14,02) p<0,01]. Ancak menopoz sonrası hem obez hem de obez olmayan kadınlarda ADÖ ve habitüel horlama ile anlamlı ilişki görüldü [HR=7,22 (%95 GA: 1,68-30,99) p=0,01 ve HR=7,85 (%95 GA: 1,88-32,82) p<0,01, sırasıyla].
Sonuç:
Obezite, ADÖ ve habitüel horlama kombinasyonu kadın hastalarda diyabete yatkınlıkla ilişkiliyken, erkeklerde ise obezite ve habitüel horlama diyabete yatkınlıkla ilişkiliydi.
References
1
Kahn SE, Cooper ME, Del Prato S. Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future. Lancet 2014;383:1068-83.
2
NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants. Lancet 2016;387:1513-30.
3
Garcia MJ, McNamara PM, Gordon T, Kannel WB. Morbidity and mortality in diabetics in the Framingham population. Sixteen year follow-up study. Diabetes 1974;23:105-11.
4
Hansen T. Type 2 diabetes mellitus--a multifactorial disease. Ann Univ Mariae Curie Sklodowska Med 2002;57:544-9.
5
InterAct C, Scott RA, Langenberg C, Sharp SJ, Franks PW, Rolandsson O, Drogan D, van der Schouw YT, Ekelund U, Kerrison ND, Ardanaz E, Arriola L, Balkau B, Barricarte A, Barroso I, Bendinelli B, Beulens JW, Boeing H, de Lauzon-Guillain B, Deloukas P, Fagherazzi G, Gonzalez C, Griffin SJ, Groop LC, Halkjaer J, Huerta JM, Kaaks R, Khaw KT, Krogh V, Nilsson PM, Norat T, Overvad K, Panico S, Rodriguez-Suarez L, Romaguera D, Romieu I, Sacerdote C, Sanchez MJ, Spijkerman AM, Teucher B, Tjonneland A, Tumino R, van der AD, Wark PA, McCarthy MI, Riboli E, Wareham NJ. The link between family history and risk of type 2 diabetes is not explained by anthropometric, lifestyle or genetic risk factors: the EPIC-InterAct study. Diabetologia 2013;56:60-9.
6
Prentice AM. The emerging epidemic of obesity in developing countries. Int J Epidemiol 2006;35:93-9.
7
Hruby A, Hu FB. The epidemiology of obesity: a big picture. Pharmacoeconomics 2015;33:673-89.
8
Chen Y, Rennie DC, Dosman JA. Synergy of BMI and family history on diabetes: the Humboldt Study. Public Health Nutr 2010;13:461-5.
9
Mykkanen L, Laakso M, Uusitupa M, Pyorala K. Prevalence of diabetes and impaired glucose tolerance in elderly subjects and their association with obesity and family history of diabetes. Diabetes Care 1990;13:1099-105.
10
Anderson JW, Kendall CW, Jenkins DJ. Importance of weight management in type 2 diabetes: review with meta-analysis of clinical studies. J Am Coll Nutr 2003;22:331-9.
11
Shin C, Kim J, Kim J, Lee S, Shim J, In K, Kang K, Yoo S, Cho N, Kimm K, Joo S. Association of habitual snoring with glucose and insulin metabolism in nonobese Korean adult men. Am J Respir Crit Care Med 2005;171:287-91.
12
Joo S, Lee S, Choi HA, Kim J, Kim E, Kimm K, Kim J, Shin C. Habitual snoring is associated with elevated hemoglobin A1c levels in non-obese middle-aged adults. J Sleep Res 2006;15:437-44.
13
Al-Delaimy WK, Manson JE, Willett WC, Stampfer MJ, Hu FB. Snoring as a risk factor for type II diabetes mellitus: a prospective study. Am J Epidemiol 2002;155:387-93.
14
Elmasry A, Janson C, Lindberg E, Gislason T, Tageldin MA, Boman G. The role of habitual snoring and obesity in the development of diabetes: a 10-year follow-up study in a male population. J Intern Med 2000;248:13-20.
15
Wei Y, Zheng B, Fan J, Lv J, Guo Y, Bian Z, Du H, Yang L, Chen Y, Chen J, Zhong X, Chen J, Chen Z, Yu C, Li L, China Kadoorie Biobank Collaborative Group. Habitual snoring, adiposity measures and risk of type 2 diabetes in 0.5 million Chinese adults: a 10-year cohort. BMJ Open Diabetes Res Care 2020;8:e001015.
16
Xiong X, Zhong A, Xu H, Wang C. Association between self-reported habitual snoring and diabetes mellitus: a systemic review and meta-analysis. J Diabetes Res 2016;2016:1958981. doi: 10.1155/2016/1958981.
17
Enright PL, Newman AB, Wahl PW, Manolio TA, Haponik EF, Boyle PJ. Prevalence and correlates of snoring and observed apneas in 5,201 older adults. Sleep 1996;19:531-8.
18
Kim Y, Han BG, KoGES Group. Cohort profile: the Korean genome and epidemiology study (koges) consortium. Int J Epidemiol 2017;46:e20.
19
WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004;363:157-63.
20
Chalmers J, MacMahon S, Mancia G, Whitworth J, Beilin L, Hansson L, Neal B, Rodgers A, Ni Mhurchu C, Clark T. 1999 World Health Organization-International Society of Hypertension Guidelines for the management of hypertension. Guidelines sub-committee of the World Health Organization. Clin Exp Hypertens 1999;21:1009-60.
21
Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998;15:539-53.
22
Kahn SE, Hull RL, Utzschneider KM. Mechanisms linking obesity to insulin resistance and type 2 diabetes. Nature 2006;444:840-6.
23
Harrison TA, Hindorff LA, Kim H, Wines RC, Bowen DJ, McGrath BB, Edwards KL. Family history of diabetes as a potential public health tool. Am J Prev Med 2003;24:152-9.
24
Morris AP, Voight BF, Teslovich TM, Ferreira T, Segre AV, Steinthorsdottir V, Strawbridge RJ, Khan H, Grallert H, Mahajan A, Prokopenko I, Kang HM, Dina C, Esko T, Fraser RM, Kanoni S, Kumar A, Lagou V, Langenberg C, Luan J, Lindgren CM, Muller-Nurasyid M, Pechlivanis S, Rayner NW, Scott LJ, Wiltshire S, Yengo L, Kinnunen L, Rossin EJ, Raychaudhuri S, Johnson AD, Dimas AS, Loos RJ, Vedantam S, Chen H, Florez JC, Fox C, Liu CT, Rybin D, Couper DJ, Kao WH, Li M, Cornelis MC, Kraft P, Sun Q, van Dam RM, Stringham HM, Chines PS, Fischer K, Fontanillas P, Holmen OL, Hunt SE, Jackson AU, Kong A, Lawrence R, Meyer J, Perry JR, Platou CG, Potter S, Rehnberg E, Robertson N, Sivapalaratnam S, Stancakova A, Stirrups K, Thorleifsson G, Tikkanen E, Wood AR, Almgren P, Atalay M, Benediktsson R, Bonnycastle LL, Burtt N, Carey J, Charpentier G, Crenshaw AT, Doney AS, Dorkhan M, Edkins S, Emilsson V, Eury E, Forsen T, Gertow K, Gigante B, Grant GB, Groves CJ, Guiducci C, Herder C, Hreidarsson AB, Hui J, James A, Jonsson A, Rathmann W, Klopp N, Kravic J, Krjutskov K, Langford C, Leander K, Lindholm E, Lobbens S, Mannisto S, Mirza G, Muhleisen TW, Musk B, Parkin M, Rallidis L, Saramies J, Sennblad B, Shah S, Sigurethsson G, Silveira A, Steinbach G, Thorand B, Trakalo J, Veglia F, Wennauer R, Winckler W, Zabaneh D, Campbell H, van Duijn C, Uitterlinden AG, Hofman A, Sijbrands E, Abecasis GR, Owen KR, Zeggini E, Trip MD, Forouhi NG, Syvanen AC, Eriksson JG, Peltonen L, Nothen MM, Balkau B, Palmer CN, Lyssenko V, Tuomi T, Isomaa B, Hunter DJ, Qi L, Wellcome Trust Case Control Consortium, Meta-Analyses of Glucose and Insulin-related traits Consortium (MAGIC) Investigators, Genetic Investigation of ANthropometric Traits (GIANT) Consortium, Asian Genetic Epidemiology Network-Type 2 Diabetes (AGEN-T2D) Consortium; South Asian Type 2 Diabetes (SAT2D) Consortium, Shuldiner AR, Roden M, Barroso I, Wilsgaard T, Beilby J, Hovingh K, Price JF, Wilson JF, Rauramaa R, Lakka TA, Lind L, Dedoussis G, Njolstad I, Pedersen NL, Khaw KT, Wareham NJ, Keinanen-Kiukaanniemi SM, Saaristo TE, Korpi-Hyovalti E, Saltevo J, Laakso M, Kuusisto J, Metspalu A, Collins FS, Mohlke KL, Bergman RN, Tuomilehto J, Boehm BO, Gieger C, Hveem K, Cauchi S, Froguel P, Baldassarre D, Tremoli E, Humphries SE, Saleheen D, Danesh J, Ingelsson E, Ripatti S, Salomaa V, Erbel R, Jockel KH, Moebus S, Peters A, Illig T, de Faire U, Hamsten A, Morris AD, Donnelly PJ, Frayling TM, Hattersley AT, Boerwinkle E, Melander O, Kathiresan S, Nilsson PM, Deloukas P, Thorsteinsdottir U, Groop LC, Stefansson K, Hu F, Pankow JS, Dupuis J, Meigs JB, Altshuler D, Boehnke M, McCarthy MI, DIAbetes Genetics Replication And Meta-analysis (DIAGRAM) Consortium. Large-scale association analysis provides insights into the genetic architecture and pathophysiology of type 2 diabetes. Nat Genet 2012;44:981-90.
25
Roden M, Price TB, Perseghin G, Petersen KF, Rothman DL, Cline GW, Shulman GI. Mechanism of free fatty acid-induced insulin resistance in humans. J Clin Invest 1996;97:2859-65.
26
Pankow JS, Duncan BB, Schmidt MI, Ballantyne CM, Couper DJ, Hoogeveen RC, Golden SH, Atherosclerosis Risk in Communities Study. Fasting plasma free fatty acids and risk of type 2 diabetes: the atherosclerosis risk in communities study. Diabetes Care 2004;27:77-82.
27
Charles MA, Eschwege E, Thibult N, Claude JR, Warnet JM, Rosselin GE, Girard J, Balkau B. The role of non-esterified fatty acids in the deterioration of glucose tolerance in Caucasian subjects: results of the Paris prospective study. Diabetologia 1997;40:1101-6.
28
Weisberg SP, McCann D, Desai M, Rosenbaum M, Leibel RL, Ferrante AW, Jr. Obesity is associated with macrophage accumulation in adipose tissue. J Clin Invest 2003;112:1796-808.
29
Ning F, Pang Z, Laatikainen T, Gao W, Wang S, Zhang L, Tuomilehto J, Qiao Q, Qingdao 2006 Diabetes Survey and FINRISK 2002 Study. Joint effect of family history of diabetes with obesity on prevalence of type 2 diabetes mellitus among Chinese and Finnish men and women. Can J Diabetes 2013;37:65-71.
30
Hoffstein V, Chaban R, Cole P, Rubinstein I. Snoring and upper airway properties. Chest 1988;94:87-9.
31
Somers VK, Dyken ME, Clary MP, Abboud FM. Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest 1995;96:1897-904.
32
Somers VK, Mark AL, Abboud FM. Sympathetic activation by hypoxia and hypercapnia--implications for sleep apnea. Clin Exp Hypertens A 1988;10(Suppl 1):413-22.
33
Ciftci TU, Kokturk O, Bukan N, Bilgihan A. The relationship between serum cytokine levels with obesity and obstructive sleep apnea syndrome. Cytokine 2004;28:87-91.
34
Marshall S, Garvey WT, Traxinger RR. New insights into the metabolic regulation of insulin action and insulin resistance: role of glucose and amino acids. FASEB J 1991;5:3031-6.
35
Rizza RA, Cryer PE, Haymond MW, Gerich JE. Adrenergic mechanisms of catecholamine action on glucose homeostasis in man. Metabolism 1980;29:1155-63.
36
Flaa A, Aksnes TA, Kjeldsen SE, Eide I, Rostrup M. Increased sympathetic reactivity may predict insulin resistance: an 18-year follow-up study. Metabolism 2008;57:1422-7.
37
Szmuilowicz ED, Stuenkel CA, Seely EW. Influence of menopause on diabetes and diabetes risk. Nat Rev Endocrinol 2009;5:553-8.
