摘要
目的探索中国成年居民营养素相关膳食模式与2型糖尿病(type 2 diabetes mellitus,T2DM)发病风险的纵向关联,为糖尿病饮食干预提供参考。方法选取中国健康与营养调查(China Health and Nutrition Survey,CHNS)中1991—2018年参与调查≥2次有完整膳食调查和糖尿病诊断信息者5854人,基于连续3 d 24 h膳食回顾法收集膳食数据,采用降秩回归法(reduced rank regression,RRR)提取与维生素C、维生素E、膳食纤维、锌和镁摄入相关的营养素膳食模式。采用组轨迹模型(group-based trajectory model,GBTM)识别膳食模式的长期变化轨迹。采用两水平Cox比例风险回归模型,评估不同膳食模式轨迹组与T2DM发病风险的关联。结果共提取5种营养素相关膳食模式,选取解释度最高(食物组变异6.30%,反应变量变异39.51%)的模式1为代表,具体特征为豆制品、蔬菜、水果、坚果、猪肉及植物油摄入较高。根据膳食模式1得分的轨迹变化将研究对象分为相对稳定组、波动变化组及持续上升组。调整人口学、生活方式及健康状况等混杂因素后,波动变化组与相对稳定组的T2DM发病风险均显著高于持续上升组,HR值分别为2.94(95%CI:1.43~6.07)和3.63(95%CI:1.75~7.56),差异有统计学意义(P<0.05)。结论膳食模式的长期轨迹特征与T2DM发病风险显著相关。糖尿病相关营养素膳食模式得分呈相对稳定和波动变化趋势的人群,其T2DM发病风险显著高于得分持续上升人群,提示膳食质量长期改善趋势可能与T2DM的发病风险降低存在关联。
Objective To explore the longitudinal association between nutrient-related dietary patterns and the risk of developing type 2 diabetes mellitus(T2DM)among adults in China,provide a reference for diabetes dietary interuention.Methods Data were obtained from the China Health and Nutrition Survey(CHNS)involving 5854 participants who had completed dietary assessments and diabetes mellitus diagnosis information on two or more occasions from 1991 to 2018.Dietary data were collected using a three-day,24-hour dietary recall.Reduced rank regression(RRR)was employed to extract dietary patterns associated with the intake of vitamin C,vitamin E,dietary fiber,zinc,and magnesium.The group-based trajectory model(GBTM)was used to identify long-term changes in dietary patterns.A two-level Cox proportional hazards regression model was used to assess the association between different dietary pattern trajectory groups and the risk of T2DM.Results Five nutrient-related dietary patterns were extracted,with pattern 1 selected as the representative due to its highest explanatory power(6.30%of variation in food groups and 39.51%of variation in response variables).This pattern was characterized by high intakes of soy products,vegetables,fruits,nuts,pork and vegetable oils.Based on the trajectory changes in scores for dietary pattern 1,participants were classified into stable,fluctuating,and consistently increasing groups.After adjusting for confounding factors such as demographics,lifestyle and health status,the risk of T2DM was signifi cantly higher in the"fluctuating group"and"relatively stable group"than in the"continuously rising group",with haz ard ratios of 2.94(95%CI:1.43-6.07)and 3.63(95%CI:1.75-7.56),respectively,indicating statistical significance.Conclusions The long-term trajectory characteristics of dietary patterns are significantly associated with the risk of developing T2DM.The risk of T2DM was significantly higher in individuals with a relatively stable and fluctuating trend in diabetes-related nutrient dietary pattern scores than in those with rising scores,suggesting that a long-term improvement trend in dietary quality may be associated with a lower risk of T2DM.
作者
康喜
周雪飞
牛然
张晓帆
魏艳丽
房玥晖
王惠君
何宇纳
苏畅
刘爱东
KANG Xi;ZHOU Xuefei;NIU Ran;ZHANG Xiaofan;WEI Yanli;FANG Yuehui;WANG Huijun;HE Yuna;SU Chang;LIU Aidong(National Institute for Nutrition and Health,Chinese Center for Disease Control and Prevention,Beijing 100050,China;不详)
出处
《中国预防医学杂志》
2025年第11期1329-1336,共8页
Chinese Preventive Medicine
基金
国家科技重大专项项目(2024ZD0531801)
国家财政项目[营养健康影响因素队列调查及干预(102393220020070000016)]
美国国立卫生研究院国际合作项目(R01HD30880)。
关键词
糖尿病
膳食模式
降秩回归法
轨迹模型
营养素
Diabetes mellitus
Dietary patterns
Reduced-rank regression
Trajectory model
Nutrients
