摘要:

目的探索代謝綜合征（metabolic syndrome， MS）與中國健康飲食指數(shù)（Chinese healthy eating index， CHEI）的關(guān)系，鑒定潛在的有益或高危飲食習(xí)慣。

方法結(jié)合納入排除標(biāo)準(zhǔn)，對(duì)4 856名來自上海某社區(qū)的研究對(duì)象進(jìn)行面訪問卷調(diào)查，根據(jù)食物消費(fèi)頻率計(jì)算CHEI總分和各條目分，根據(jù)體格檢查及血生化檢測(cè)診斷MS，采用logistic回歸模型分析MS及相關(guān)指標(biāo)與CHEI總分及其條目分的關(guān)系。

結(jié)果本次調(diào)查MS的總體患病率為24.71%（200/4 856），患MS組與未患MS組在年齡、BMI、腰圍、空腹血糖、三酰甘油、總膽固醇、收縮壓、舒張壓、糖化血紅蛋白、高密度脂蛋白及能量攝入等方面差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。調(diào)整潛在混雜因素后，CHEI總分越高，中心性肥胖、高舒張壓、高糖化血紅蛋白、高血糖和MS的患病風(fēng)險(xiǎn)越低（P<0.05）。CHEI中薯類、奶類、豆類、深色蔬菜、水果類、油類和鈉的條目分增加可分別降低肥胖、高血壓、高血糖、血脂紊亂及MS的患病風(fēng)險(xiǎn)（P<0.05）。

結(jié)論整體健康膳食質(zhì)量（CHEI總分≥80）和增加攝入某些特定膳食類別（薯類、奶類、豆類、深色蔬菜、水果類等）可有效降低上海某郊區(qū)人群MS的患病風(fēng)險(xiǎn)。

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.

圖  1   CHEI總分及條目分與MS及代謝相關(guān)指標(biāo)的logistic回歸分析（森林圖）

【注】 校正年齡、性別、退休狀況、吸煙狀況、飲茶狀況、婚姻狀況、民族、職業(yè)和體力活動(dòng)的影響。a～d：CHEI總分及各條目分對(duì)代謝相關(guān)指標(biāo)包括肥胖、高血壓、高血糖及血脂紊亂的影響；e：表示CHEI總分及各條目分對(duì)MS的影響。

表  1   一般人口學(xué)特征

人口學(xué)特征未患MS（N=3656）患MS（N=1200）P值 年齡（歲）a55.83±10.0859.28±8.09<0.001BMI （kg/m2）a23.66±2.8927.29±2.68<0.001腰圍（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能量攝入（kJ/d）a5 768.77±1 754.565 599.44±1 661.510.003性別（女性）b2 461（67.31）771（64.25）0.051退休狀況（是）b2 409（65.89）912（76.00）<0.001吸煙狀況（是）b720（19.69）265（22.08）0.074飲茶狀況（是）b1 123（30.72）403（33.58）0.063婚姻狀況（已婚）3 370（92.18）1 122（93.50）0.131小學(xué)及以下b1 425（38.98）665（55.42）<0.001初高中b1 965（53.75）503（41.92）民族漢b3 651（99.86）1 198（99.83）0.813中心性肥胖（是）b399（10.91）548（45.67）<0.001輕體力勞動(dòng)b2 112（57.77）659（54.92）0.041中體力勞動(dòng)b427（11.68）128（10.67） 【注】 a：均數(shù)±標(biāo)準(zhǔn)差；b：括號(hào)外為例數(shù)，括號(hào)內(nèi)為構(gòu)成比（%）。

表  2   CHEI總分與MS及代謝相關(guān)指標(biāo)的關(guān)聯(lián)

代謝相關(guān)指標(biāo)連續(xù)性CHEIa分類性CHEIOR（95%CI）P值［60，80） vs ［0，60）bOR（95%CI）［80，100］ vs ［0，60）cOR（95%CI）P趨勢(shì)值 代謝綜合征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）收縮壓升高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）舒張壓升高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）總膽固醇升高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）糖化血紅蛋白升高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）高血壓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）血脂紊亂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】 模型一校正年齡、性別、退休狀況、吸煙狀況、飲茶狀況、婚姻狀況、民族、職業(yè)、體力活動(dòng)和文化水平的影響。a：連續(xù)性CHEI總分對(duì)MS及代謝相關(guān)指標(biāo)的影響；b：相對(duì)于分類性CHEI總分<60分，60~80分對(duì)MS及代謝相關(guān)指標(biāo)的影響；c：相對(duì)于分類性CHEI總分<60分，≥80分對(duì)MS及代謝相關(guān)指標(biāo)的影響。 [1]

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