Hypertriglyceridemic-waist phenotype is a risk factor for type 2 diabetes mellitus (T2DM). The risk of T2DM may vary in different genders, regions, age groups, and overweight /obese people.

To explore the risk of T2DM by hypertriglyceridemic-waist phenotype in different genders, regions, ages, and overweight /obese people, and to provide a scientific basis for the prevention and control of T2DM.

This was a prospective cohort study involving 9 280 permanent residents over 18 years in 12 districts (counties) of Guizhou province in 2010 selected by multi-stage stratified cluster random sampling. From 2016 to 2020, 8 163 residents were followed up, and finally 6 743 eligible participants were enrolled after excluding those with baseline T2DM, lacking sufficient clinical data, lost to follow-up and deaths. Participants were assigned into 4 groups based on their baseline waist circumference (WC) and serum triacylglycerol (TG) levels: Normal WC and TG group (NWNT, WC<90 cm in men and WC<85 cm in women, TG<1.7 mmol/L), normal WC and high TG group (NWHT, WC<90 cm in men and WC<85 cm in women, TG≥1.7 mmol/L), large WC and normal TG group (EWNT, WC≥90 cm in men or WC≥85 cm in women, TG<1.7 mmol/L) and large WC and high TG group (EWHT, WC≥90 cm in men or WC≥85 cm in women, TG≥1.7 mmol/L). A Cox proportional hazards regression model was used to analyze the correlation between hypertriglyceridemic-waist phenotype grouping and new-onset T2DM.

The median follow-up period was 6.58 years. Among 6 743 participants, new-onset T2DM was observed in 706 (10.47%) individuals. After adjusting confounding factors, the Cox proportional hazards regression analysis showed that the risk of T2DM was 1.486 times in the EWHT group than the NWNT group (HR=1.486, 95%CI=1.185-1.865, P=0.001). Multivariate Cox proportional hazards regression analysis showed that in the subgroups of male gender, rural region, aged<45 years, and overweight /obese, the risk of T2DM in the EWHT group was 1.792 (HR=1.792, 95%CI=1.297-2.476, P<0.001), 1.483 (HR=1.483, 95%CI=1.115-1.971, P=0.007), 1.540 (HR=1.540, 95%CI=1.083-2.190, P=0.016), and 1.614 (HR=1.614, 95%CI=1.123-2.321, P=0.010) times higher than the NWNT group, respectively.

After a median follow-up time of 6.58 years in a large cohort, the hypertriglyceridemic-waist phenotype is the risk of T2DM in Guizhou Province, which is more significant in males, rural areas, aged<45 years, and overweight /obese people. Therefore, health education should be strengthened for high-risk populations. Weight control through reasonable diet and appropriate exercise, and reducing serum triacylglycerol levels are necessary and effective methods to prevent the incidence of T2DM.

高三酰甘油血症-腰围表型是2型糖尿病（T2DM）的风险因素，不同性别、不同地区、不同年龄段及超重/肥胖人群中T2DM发病风险可能不同。

探讨不同性别、不同地区、不同年龄段及超重/肥胖人群高三酰甘油血症-腰围表型与T2DM发病风险的关系，为糖尿病防控提供科学依据。

本研究为前瞻性队列研究，2010年采取分层整群随机抽样方法，以贵州省12个县（市、区）18岁及以上9 280名常住居民为队列人群进行基线调查。于2016—2020年进行随访，共随访到8 163人，剔除基线时糖尿病患者、相关指标信息缺失者、失访和死亡的对象，最终纳入6 743名调查对象。根据基线腰围（WC）和血清三酰甘油（TG）水平将调查对象分为4组，正常腰围和正常血清三酰甘油（NWNT）组：男性腰围<90 cm或女性腰围<85 cm、血清三酰甘油<1.7 mmol/L；正常腰围和高血清三酰甘油（NWHT）组：男性腰围<90 cm或女性腰围<85 cm、血清三酰甘油≥1.7 mmol/L；腰围增大和正常血清三酰甘油（EWNT）组：男性腰围≥90 cm或女性腰围≥85 cm、血清三酰甘油<1.7 mmol/L；腰围增大和高血清三酰甘油（EWHT）组：男性腰围≥90 cm或女性腰围≥85 cm、血清三酰甘油≥1.7 mmol/L。采用Cox比例风险回归模型分析高三酰甘油血症-腰围表型分组与新发T2DM之间的关系。

中位随访时间6.58年，6 743名调查对象中新发T2DM 706例，发病率为10.47%。在调整了相关的混杂因素后，Cox比例风险回归分析显示，EWHT组T2DM发病风险是NWNT组的1.486倍（HR=1.486，95%CI=1.185~1.865，P=0.001）。亚组多因素Cox比例风险回归分析显示，在男性、农村、年龄<45岁、超重/肥胖人群中，EWHT组T2DM发病风险分别是NWNT组的1.792倍（HR=1.792，95%CI=1.297~2.476，P<0.001）、1.483倍（HR=1.483，95%CI=1.115~1.971，P=0.007）、1.540倍（HR=1.540，95%CI=1.083~2.190，P=0.016）、1.614倍（HR=1.614，95%CI=1.123~2.321，P=0.010）。

对大样本人群进行中位随访6.58年后，高三酰甘油血症-腰围表型是贵州省T2DM的发病风险，在男性、农村、年龄<45岁、超重/肥胖人群中更为显著。因此，对这类人群应该加强健康教育，通过合理饮食、适当运动从而控制体质量，降低血清三酰甘油水平是预防T2DM发病的必要手段和有效的方法。