上海某社区人群代谢综合征与中国健康饮食指数的关系

摘要:

目的探索代谢综合征（metabolic syndrome， MS）与中国健康饮食指数（Chinese healthy eating index， CHEI）的关系，鉴定潜在的有益或高危饮食习惯。

方法结合纳入排除标准，对4 856名来自上海某社区的研究对象进行面访问卷调查，根据食物消费频率计算CHEI总分和各条目分，根据体格检查及血生化检测诊断MS，采用logistic回归模型分析MS及相关指标与CHEI总分及其条目分的关系。

结果本次调查MS的总体患病率为24.71%（200/4 856），患MS组与未患MS组在年龄、BMI、腰围、空腹血糖、三酰甘油、总胆固醇、收缩压、舒张压、糖化血红蛋白、高密度脂蛋白及能量摄入等方面差异具有统计学意义（P<0.05）。调整潜在混杂因素后，CHEI总分越高，中心性肥胖、高舒张压、高糖化血红蛋白、高血糖和MS的患病风险越低（P<0.05）。CHEI中薯类、奶类、豆类、深色蔬菜、水果类、油类和钠的条目分增加可分别降低肥胖、高血压、高血糖、血脂紊乱及MS的患病风险（P<0.05）。

结论整体健康膳食质量（CHEI总分≥80）和增加摄入某些特定膳食类别（薯类、奶类、豆类、深色蔬菜、水果类等）可有效降低上海某郊区人群MS的患病风险。

Abstract:

ObjectiveTo study the association between metabolic syndrome （MS） and Chinese healthy eating index （CHEI）， and to identify the beneficial or adverse effects of diets on MS in a community population of Shanghai.

MethodsBased on the inclusion and exclusion criteria， the data of 4 856 subjects from a community in Shanghai was collected by interview. Total CHEI score and its component score were calculated based on the frequency of food consumption. Physical examination and blood biochemical tests were used to diagnose MS. The logistic regression model was used to analyze the relationship between MS or relative indexes and the total CHEI score or its component score.

ResultsThe study showed the overall prevalence of MS was 24.71%. There were significant differences between MS group and controls （P<0.05） in age， BMI， waist circumference， fasting blood glucose， triglycerides， total cholesterol， systolic blood pressure， diastolic blood pressure， glycated hemoglobin， high-density lipoprotein and energy intake. After adjusting for potential confounders， it showed that the higher total CHEI score， the lower risk of central obesity， increased diastolic blood pressure， increased glycated hemoglobin， hyperglycemic and MS （P<0.05）. The increase in component score of potatoes， milk， beans， dark vegetables， fruits， oil and sodium reduced risk of obesity， hypertension， hyperglycemia， dyslipidemia and MS （P<0.05）.

ConclusionThe quality of healthy diet （CHEI score more than 80） and increased intake of specific dietary components （potatoes， milk， beans， dark vegetables， fruits） reduce the risk of MS effectively.

图  1   CHEI总分及条目分与MS及代谢相关指标的logistic回归分析（森林图）

【注】 校正年龄、性别、退休状况、吸烟状况、饮茶状况、婚姻状况、民族、职业和体力活动的影响。a～d：CHEI总分及各条目分对代谢相关指标包括肥胖、高血压、高血糖及血脂紊乱的影响；e：表示CHEI总分及各条目分对MS的影响。

表  1   一般人口学特征

人口学特征未患MS（N=3656）患MS（N=1200）P值 年龄（岁）a55.83±10.0859.28±8.09<0.001BMI （kg/m2）a23.66±2.8927.29±2.68<0.001腰围（cm）a76.94±8.0485.88±7.57<0.001FBG（mmol/L）a5.45±0.996.69±2.06<0.001LDL（mmol/L）a2.78±0.782.80±0.960.530HDL（mmol/L）a1.41±0.311.17±0.29<0.001TG（mmol/L）a1.53±0.972.60±1.65<0.001TC（mmol/L）a4.89±0.875.14±1.04<0.001SBP（mmHg）a131.25±20.84149.15±20.78<0.001DBP（mmHg）a81.46±10.6888.65±10.68<0.001MET（min/w）a3 711.33±2161.283 765.04±2182.730.456HbAlc（%）a5.83±0.636.51±1.20<0.001能量摄入（kJ/d）a5 768.77±1 754.565 599.44±1 661.510.003性别（女性）b2 461（67.31）771（64.25）0.051退休状况（是）b2 409（65.89）912（76.00）<0.001吸烟状况（是）b720（19.69）265（22.08）0.074饮茶状况（是）b1 123（30.72）403（33.58）0.063婚姻状况（已婚）3 370（92.18）1 122（93.50）0.131小学及以下b1 425（38.98）665（55.42）<0.001初高中b1 965（53.75）503（41.92）民族汉b3 651（99.86）1 198（99.83）0.813中心性肥胖（是）b399（10.91）548（45.67）<0.001轻体力劳动b2 112（57.77）659（54.92）0.041中体力劳动b427（11.68）128（10.67） 【注】 a：均数±标准差；b：括号外为例数，括号内为构成比（%）。

表  2   CHEI总分与MS及代谢相关指标的关联

代谢相关指标连续性CHEIa分类性CHEIOR（95%CI）P值［60，80） vs ［0，60）bOR（95%CI）［80，100］ vs ［0，60）cOR（95%CI）P趋势值 代谢综合征0.984（0.979~0.990）<0.0010.780（0.678~0.897）0.549（0.427~0.705）<0.001模型一0.992（0.987~0.998）0.0120.906（0.784~1.048）0.713（0.550~0.924）中心性肥胖0.985（0.979~0.991）<0.0010.775（0.666~0.902）0.594（0.453~0.779）<0.001模型一0.992（0.985~0.998）0.0110.891（0.761~1.043）0.753（0.569~0.997）收缩压升高0.987（0.983~0.992）<0.0010.813（0.717~0.921）0.575（0.466~0.709）<0.001模型一0.997（0.992~1.002）0.2840.981（0.859~1.120）0.765（0.612~0.957）舒张压升高0.990（0.985~0.995）<0.0010.868（0.759~0.992）0.717（0.573~0.898）0.002模型一0.992（0.986~0.997）0.0040.895（0.780~1.026）0.775（0.614~0.977）三酰甘油升高0.996（0.991~1.001）0.0910.924（0.814~1.048）0.810（0.658~0.996）0.043模型一0.999（0.994~1.004）0.6450.973（0.854~1.108）0.885（0.715~1.096）高密度脂蛋白降低0.989（0.982~0.996）0.0030.951（0.796~1.137）0.445（0.307~0.646）<0.001模型一0.993（0.985~1.001）0.0720.975（0.809~1.175）0.491（0.335~0.719）低密度脂蛋白升高0.999（0.993~1.005）0.7811.063（0.914~1.238）0.824（0.637~1.067）0.481模型一1.000（0.994~1.006）0.9731.104（0.943~1.291）0.837（0.641~1.093）空腹血糖升高0.988（0.982~0.994）<0.0010.821（0.709~0.950）0.535（0.409~0.700）<0.001模型一0.996（0.990~1.002）0.1980.952（0.818~1.109）0.683（0.517~0.902）总胆固醇升高0.999（0.994~1.004）0.7690.988（0.869~1.123）0.961（0.781~1.183）0.722模型一0.999（0.993~1.004）0.6651.014（0.886~1.16）0.954（0.768~1.187）糖化血红蛋白升高0.983（0.976~0.990）<0.0010.754（0.635~0.894）0.462（0.330~0.646）<0.001模型一0.992（0.985~0.999）0.0350.897（0.751~1.072）0.611（0.432~0.864）肥胖0.990（0.986~0.995）<0.0010.883（0.779~0.999）0.692（0.567~0.845）<0.001模型一0.996（0.991~1.001）0.0980.964（0.847~1.097）0.820（0.666~1.009）高血糖0.986（0.980~0.991）<0.0010.787（0.682~0.907）0.503（0.387~0.655）<0.001模型一0.994（0.988~0.999）0.0430.913（0.787~1.059）0.641（0.488~0.842）高血压0.985（0.980~0.990）<0.0010.792（0.698~0.899）0.575（0.470~0.702）<0.001模型一0.998（0.993~1.003）0.4701.010（0.882~1.157）0.842（0.677~1.046）血脂紊乱0.996（0.991~1.001）0.1020.939（0.828~1.065）0.804（0.654~0.988）0.049模型一0.999（0.994~1.004）0.7130.990（0.869~1.127）0.881（0.712~1.090） 【注】 模型一校正年龄、性别、退休状况、吸烟状况、饮茶状况、婚姻状况、民族、职业、体力活动和文化水平的影响。a：连续性CHEI总分对MS及代谢相关指标的影响；b：相对于分类性CHEI总分<60分，60~80分对MS及代谢相关指标的影响；c：相对于分类性CHEI总分<60分，≥80分对MS及代谢相关指标的影响。 [1]

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