AbstractDiabetes mellitus (DM) is among the most widespread non-communicable diseases and poses a substantial global health challenge. The aim of this study was to examine the incidence of DM and its nutritional, anthropometric, laboratory, demographic, and behavioral determinants, as well as comorbidities, within a Kurdish population residing in western Iran.

摘要糖尿病（DM）是最广泛的非传染性疾病之一，对全球健康构成重大挑战。这项研究的目的是检查居住在伊朗西部的库尔德人中DM的发病率及其营养，人体测量，实验室，人口统计学和行为决定因素以及合并症。

This research was conducted in the Ravansar Non-Communicable Disease (RaNCD) cohort study, followed 9170 participants aged 35–65 years, for an average ± SD of 7.11 ± 1.26 years, from 2015 until 2023. A hierarchical Cox regression model was used to estimates the adjusted hazard ratios (HRs). The incidence of DM was 4.45 (95% CI 3.96, 4.99) per 1000 person-years.

这项研究是在Ravansar非传染性疾病（RaNCD）队列研究中进行的，从2015年到2023年，共有9170名年龄在35-65岁之间的参与者进行了随访，平均SD为7.11±1.26年。使用分层Cox回归模型来估计调整后的风险比（HR）。DM的发病率为每1000人年4.45（95%CI 3.96,4.99）。

We found several significant predictors for DM incidence, including prediabetes, comorbidity, urban residence, total antioxidant capacity (TAC), and the interaction between gender and body mass index (BMI). Prediabetes emerged as the strongest predictor of DM incidence, with a hazard ratio of 10.13 (CI 7.84, 13.09).

我们发现了糖尿病发病率的几个重要预测因素，包括糖尿病前期，合并症，城市居住，总抗氧化能力（TAC）以及性别与体重指数（BMI）之间的相互作用。糖尿病前期是糖尿病发病率最强的预测因子，风险比为10.13（CI 7.84，13.09）。

Additionally, having two diseases (HR = 2.18; 95% CI 1.44, 3.29) or three and more diseases (HR = 3.17; 95% CI 2.06, 4.90) increased the risk of developing DM. Also, the hazard ratios for the effects of gender on DM incidence in the normal, overweight, and obese BMI groups were 0.24, 0.81, and 1.01, respectively.

此外，有两种疾病（HR＝2.18）；95%可信区间1.44,3.29）或三种及以上疾病（HR＝3.17）；95%可信区间2.06、4.90）增加了患糖尿病的风险。此外，正常、超重和肥胖BMI组的性别对糖尿病发病率影响的危险比分别为0.24、0.81和1.01。

The presence of prediabetes and obesity serve as the crucial indicators for the onset of DM, emphasizing the pressing need for interventions to prevent DM in these circumstances. Furthermore, there are notable disparities between urban and rural populations in this study, warranting further investigations to ascertain the underlying causes of such variations..

糖尿病前期和肥胖的存在是糖尿病发病的关键指标，强调在这些情况下迫切需要干预措施来预防糖尿病。此外，在这项研究中，城市和农村人口之间存在显着差异，需要进一步调查以确定这种差异的根本原因。。

IntroductionNon communicable diseases (NCDs) are the main cause of death worldwide1,2. Diabetes mellitus (DM) is one of the most common NCDs3 and is a significant global health challenge. It has emerged as one of the fastest-growing health emergencies4, with its incidence doubling between 1980 and 20145.

引言非传染性疾病（NCDs）是全球死亡的主要原因1,2。糖尿病（DM）是最常见的NCDs3之一，是一项重大的全球健康挑战。它已成为增长最快的健康紧急事件之一4，其发病率在1980年至20145年间翻了一番。

In 2021, the global prevalence of diabetes was 6.1%, affecting approximately 529 million individuals. This number is projected to more than double to 1.3 billion people within the next 30 years6. It is also estimated that in 2021, diabetes-related causes accounted for approximately 6.7 million deaths, 90% of which were attributed to DM7,8.

2021年，全球糖尿病患病率为6.1%，影响约5.29亿人。预计在未来30年内，这一数字将增加一倍以上，达到13亿人6。据估计，2021年，糖尿病相关原因导致约670万人死亡，其中90%归因于DM7,8。

Between 1990 and 2021, the prevalence of diabetes in the North Africa and the Middle East regions increased by 161.5%, surpassing the global rate by 71%6. In Iran, based on the Persian cohort study, the sex- and age-standardized prevalence of diabetes and prediabetes among 35–75 year-olds were found to be 15.0% and 25.4%, respectively9.

1990年至2021年间，北非和中东地区的糖尿病患病率增加了161.5%，超过了全球71%的患病率6。在伊朗，根据波斯队列研究，35-75岁人群中糖尿病和前驱糖尿病的性别和年龄标准化患病率分别为15.0%和25.4%9。

Additionally, according to statistics from the International Diabetes Federation, the estimated prevalence of diabetes among the adult population in Iran in 2021 was 9.5%10. These statistics show that despite all the valuable efforts at the global and national levels in combating this disease, there appears to be no evidence of a reduction in the increasing trend11,12.Diabetes leads to numerous complications and limitations for patients13,14.

此外，根据国际糖尿病联合会的统计数据，2021年伊朗成年人群中糖尿病的估计患病率为9.5%。这些统计数字表明，尽管在全球和国家层面上为抗击这种疾病做出了所有有价值的努力，但似乎没有证据表明增加的趋势有所减少11,12。糖尿病导致患者出现许多并发症和限制13,14。

Moreover, poorly controlled diabetes can significantly increase the risk of various health issues, including atrial fibrillation15, heart failure and peripheral arterial disease16, aortic valve stenosis17 and periodontal diseases18. Additionally, diabetes diminishes quality of life, affects functional capacity, and contributes to morbidity and premature mortality1.

此外，控制不佳的糖尿病会显着增加各种健康问题的风险，包括心房纤颤15，心力衰竭和外周动脉疾病16，主动脉瓣狭窄17和牙周疾病18。此外，糖尿病会降低生活质量，影响功能能力，并导致发病率和过早死亡1。

Fasting plasma glucose level of [≥ 126 mg/dL (7.0 mmol/L)]

空腹血糖水平[≥126 mg/dL（7.0 mmol/L）]

Hemoglobin A1c (HbA1c) level of [≥ 6.5% (48 mmol/mol)]

血红蛋白A1c（HbA1c）水平[≥6.5%（48 mmol/mol）]

2-h plasma glucose level of [≥ 200 mg/dL (11.1 mmol/L)] during a 75-g oral glucose tolerance test (OGTT).

在75克口服葡萄糖耐量试验（OGTT）期间，2小时血糖水平为[≥200 mg/dL（11.1 mmol/L）]。

Or are currently prescribed one or more antidiabetic medications by a healthcare provider.

或者目前由医疗保健提供者开具一种或多种抗糖尿病药物。

In cases where the two reviewing physicians disagree on the diagnosis, a third reviewing physician (also an internist) provides the final diagnosis25.Statistical analysisDescriptive statistics (mean, standard deviation, or frequency, percent) were used to analyze the baseline data of the study participants.

如果两位复查医生对诊断意见不一致，第三位复查医生（也是内科医生）提供最终诊断25。统计分析描述性统计（平均值，标准差或频率，百分比）用于分析研究参与者的基线数据。

Additionally, the overall prevalence of the main covariates at the baseline level was reported. Differences in baseline characteristics between diabetes incidence/non-incident groups were examined by Student’s t-test for comparisons of means and chi-square test and Fisher exact test for comparisons of proportions.

此外，报告了基线水平主要协变量的总体患病率。糖尿病发病率/非发病组之间基线特征的差异通过学生t检验进行均值比较，卡方检验和Fisher精确检验进行比例比较。

Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident diabetes associated with various risk factors. To achieve this, three Cox models were executed. Model 1 included demographic, behavioral, anthropometric and nutritional covariates, namely, age, gender, residency, marital status, alcohol and smoking status, BMI, percent-protein-kcal, TAC, HEI, and metabolic equivalent of task (MET).

Cox比例风险模型用于计算与各种危险因素相关的糖尿病事件的风险比（HR）和95%置信区间（CI）。为了实现这一目标，执行了三个Cox模型。模型1包括人口统计学，行为学，人体测量学和营养协变量，即年龄，性别，居住地，婚姻状况，酒精和吸烟状况，BMI，蛋白质千卡百分比，TAC，HEI和任务代谢当量（MET）。

Model 2 was expanded on Model 1 by including disease profile variables, namely, comorbidity, dyslipidemia and pre-diabetes, in addition to the variables from Model 1. Finally, Model 3 included interaction term, “Gender* BMI”, alongside the variables from Model 2. Covariates with a p-value less than 0.2 were included in the multivariate Cox model.

模型2在模型1上扩展，除了模型1的变量外，还包括疾病概况变量，即合并症，血脂异常和糖尿病前期。最后，模型3包括交互作用术语“性别*BMI”，以及模型2的变量。p值小于0.2的协变量包括在多变量Cox模型中。

Furthermore, certain variables were excluded from the models due to collinearity. The Schoenfeld residuals test (both global and scaled) was used to check the proportionality assumption of hazard estimation. Firth's Cox regression was also conducted to examine potential bias resulting from data imbalance.

此外，由于共线性，某些变量被排除在模型之外。Schoenfeld残差检验（全局和缩放）用于检查危险估计的比例假设。还进行了Firth的Cox回归分析，以检查数据不平衡导致的潜在偏差。

However, since the results obtained from Firth's Cox regression.

然而，由于从Firth的Cox回归获得的结果。

Data availability

数据可用性

The data sets used and analyzed in this study are available from the corresponding author on reasonable request.

本研究中使用和分析的数据集可根据合理的要求从通讯作者处获得。

AbbreviationsRaNCD:

缩写RaNCD：

Ravansar non-communicable disease

Ravansar非传染性疾病

HR:

人力资源部：

Hazard ratio

危险比

CI:

CI公司：

Confidence intervals

置信区间

DM:

DM公司：

Diabetes mellitus

糖尿病

BMI:

体重指数：

Body mass index

体重指数

TAC:

战术司令部：

Total antioxidant capacity

总抗氧化能力

NCDs:

非传染性疾病：

Non communicable diseases

非传染性疾病

FBS:

FBS：

Fasting blood sugar

空腹血糖

HEI:

你好：

Healthy eating index

健康饮食指数

SES:

社会经济地位：

Socioeconomic status

社会经济地位

MET:

大都会：

Metabolic equivalent of task

任务的代谢当量

DII:

DII：

Dietary Inflammatory Index

饮食炎症指数

PDI:

交车前检查：

Plant diet index score

植物饮食指数得分

BUN:

尿素氮：

Blood urea nitrogen

血尿素氮

SGOT:

SGOT：

The aspartate aminotransferase

天冬氨酸转氨酶

SGPT:

SGPT：

The alanine aminotransferase

丙氨酸转氨酶

ALP:

ALP（碱性磷酸酶）：

Alkaline phosphatase

碱性磷酸酶

GGT:

GGT：

Gamma-glutamyl trans-peptidase

γ-谷氨酰反式肽酶

FPG:

FPG：

Fasting plasma glucose

空腹血糖

LDL-C:

低密度脂蛋白胆固醇：

Low density lipoprotein cholesterol

低密度脂蛋白胆固醇

HDL-C:

高密度脂蛋白胆固醇：

High density lipoprotein cholesterol

高密度脂蛋白胆固醇

WC:

卫生间：

Waist circumference

腰围

WHR:

WHR：

Waist-hip ratio

腰臀比

BFM:

BFM：

Body fat mass

体脂肪量

SMM:

SMM公司：

Skeletal muscle mass

骨骼肌质量

PBF:

PBF：

Percent body fat

体脂百分比

CVD:

心血管疾病：

Cardiovascular disease

心血管疾病

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Download referencesAcknowledgementsThe authors thank the PERSIAN cohort Study collaborators and of Kermanshah University of Medical Sciences. The Iranian Ministry of Health and Medical Education has also contributed to the funding used in the PERSIAN Cohort through Grant no 700/534.FundingThis work is financially supported by Kermanshah University of Medical Sciences (Grant No.

下载参考文献致谢作者感谢波斯队列研究合作者和科尔曼沙赫医科大学。伊朗卫生和医学教育部也通过拨款700/534为波斯队列中使用的资金做出了贡献。资助这项工作得到了科尔曼沙赫医科大学（拨款号：。

4020789). The funders played no role in the study design, data collection, data analysis, interpretation or writing of the report.Author informationAuthors and AffiliationsResearch Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, IranFarid Najafi, Mehdi Moradinazar, Fatemeh Khosravi Shadmani, Yahya Pasdar, Mitra Darbandi & Seyed Ramin GhasemiSocial Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, IranYahya SalimiStudent Research Committee, Department of Epidemiology, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, IranSeyed Ramin GhasemiAuthorsFarid NajafiView author publicationsYou can also search for this author in.

4020789）。资助者在研究设计，数据收集，数据分析，解释或撰写报告方面没有发挥任何作用。作者信息作者和附属机构健康环境决定因素研究中心（RCEDH），科尔曼沙医科大学健康研究所，科尔曼沙，伊朗纳贾菲，梅赫迪·莫拉迪纳扎尔，法特梅·科斯拉维·沙德马尼，叶海亚·帕斯达尔，米特拉·达班迪和赛义德·拉明·加半社会发展和健康促进研究中心，科尔曼沙医科大学健康研究所，科尔曼沙，伊朗尼亚海亚·萨利姆学生研究委员会，科尔曼沙医科大学公共卫生学院流行病学系，科尔曼沙ID NajafiView作者出版物您也可以在中搜索此作者。

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PubMed Google ScholarContributionsFN, designed the study in collaboration with YP, SRG, MMn, FKS and YS. SRG and MD performed data cleaning. FN and SRG made the statistical analyses in collaboration with MMn, FKS, YS and YP. FN and SRG are the primary authors in the writing of the manuscript.

PubMed Google ScholarContributionsFN与YP，SRG，MMn，FKS和YS合作设计了这项研究。SRG和MD执行了数据清理。FN和SRG与MMn，FKS，YS和YP合作进行了统计分析。FN和SRG是手稿撰写的主要作者。

All authors critically revised and substantially contributed throughout the writing the manuscript. All authors read and approved the final manuscript.Corresponding authorCorrespondence to.

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Reprints and permissionsAbout this articleCite this articleNajafi, F., Moradinazar, M., Khosravi Shadmani, F. et al. The incidence of diabetes mellitus and its determining factors in a Kurdish population: insights from a cohort study in western Iran.

转载和许可本文引用本文Najafi，F.，Moradinazar，M.，Khosravi Shadmani，F。等人。库尔德人糖尿病的发病率及其决定因素：来自伊朗西部队列研究的见解。

Sci Rep 14, 15761 (2024). https://doi.org/10.1038/s41598-024-66795-3Download citationReceived: 15 February 2024Accepted: 03 July 2024Published: 09 July 2024DOI: https://doi.org/10.1038/s41598-024-66795-3Share this articleAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard.

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KeywordsDiabetes mellitusIncidenceCohortRaNCDIran

关键词糖尿病并发症队列

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