低碳水化合物饮食与高血糖关联的横断面研究

朱玉; 李昊伟; 周志豪; 曹承松; 解少煜; 曹洪娟; 张俊青; 周瑜; 李修德; 黄永; 张庄; 杨万水

doi:10.16462/j.cnki.zhjbkz.2023.05.008

低碳水化合物饮食与高血糖关联的横断面研究

doi: 10.16462/j.cnki.zhjbkz.2023.05.008

1.
230032 合肥，安徽医科大学公共卫生学院营养与食品卫生学系
2.
237000 六安，六安市疾病预防控制中心，慢性非传染性疾病防制科

基金项目:

国家自然科学基金 82073651

安徽省自然科学基金 2008085MH262

安徽省自然科学基金 2108085QH357

2021年高校优秀拔尖人才培育资助 gxyqZD2021099

2021年度安徽医科大学科研水平提升计划 2021xkjT007

详细信息

通讯作者:
杨万水，E-mail: wanshuiyang@gmail.com

中图分类号: R587.1
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- 被引次数: 0
出版历程
- 收稿日期: 2022-04-14
- 修回日期: 2022-10-01
- 刊出日期: 2023-05-10

A cross-sectional study of the association between low-carbohydrate diet and fasting hyperglycemia

1.
Department of Nutrition, School of Public Health, Anhui Medical University, Hefei 230032, China
2.
Department of Chronic Non-communicable Diseases Prevention and Control, Lu'an Municipal Center for Disease Control and Prevention, Lu'an 237000, China

Funds:

National Natural Science Foundation of China 82073651

Anhui Natural Science Foundation 2008085MH262

Anhui Natural Science Foundation 2108085QH357

Cultivation of Excellent Top-Notch Talents in Universities in 2021 gxyqZD2021099

Scientific Research Level Improvement Plan to Anhui Medical University 2021xkjT007

More Information

Corresponding author: YANG Wanshu，E-mail: wanshuiyang@gmail.com

摘要

摘要: 目的构建低碳水化合物饮食(low-carbohydrate diet, LCD)依从性得分并评估其与高血糖间的关联。方法在安徽省六安市进行以人群为基础的横断面调查，根据三大宏量营养素及其亚型的供能比构建膳食总LCD得分、植物性LCD及动物性LCD膳食得分。FPG≥6.1 mmol/L定义为高血糖。采用多重logistic回归分析模型计算OR值及其95%CI。结果本次研究最终纳入2 574例研究对象，高血糖者232例，占9.01%。与总LCD依从性得分最低三分位数研究对象相比，最高三分位数研究对象患高血糖的风险更低(OR=0.69，95% CI：0.49~0.99)。植物性LCD(OR=0.61，95% CI: 0.43~0.87)和动物性LCD(OR=0.68，95% CI：0.47~0.98)依从性得分与高血糖的罹患风险呈负相关。替代分析提示：利用饱和脂肪酸(saturated fatty acid, SFA)替代等能量(占总热能的5%)的碳水化合物与降低高血糖风险相关(OR=0.50，95% CI：0.28~0.90)，但单不饱和脂肪酸(monounsaturated fatty acid, MUFA)替代碳水化合物与增加高血糖风险相关(OR=1.69，95% CI：1.06~2.68)。结论总LCD、植物性LCD、动物性LCD饮食与更低的患高血糖的风险相关。在膳食结构中适当减少碳水化合物，同时增加饱和脂肪的摄入与较低的高血糖患病风险有关。
- 低碳水化合物饮食 /
- 高血糖 /
- 横断面研究
Abstract: Objective We developed a low-carbohydrate diet (LCD) score and estimated its association with fasting hyperglycemia. Methods Data from a population-based cross-sectional study in Lu'an City, Anhui Province was used to calculate overall LCD, plant LCD, and animal LCD score, based on the percentage of energy from total carbohydrate, total and subtypes of fat, and total and subtypes of protein. Hyperglycemia was defined as fasting glucose ≥ 6.1 mmol/L. Multivariate logistic regression was used to estimate ORs and 95% CIs. Results Of the 2 574 participants included in this study, 232 (9.01%) had hyperglycemia. When comparing the highest with the lowest tertile, the multivariable-adjusted ORs of hyperglycemia were 0.69(0.49-0.99) for overall LCD score, 0.61(0.43-0.87) for plant LCD score, and 0.68(0.47-0.98) for animal LCD score. The isocaloric substitution of 5% energy from saturated fat for carbohydrate was associated with lower odds of hyperglycemia (OR=0.50, 95% CI: 0.28-0.90), while increasing monounsaturated fat in place of carbohydrate was associated with increased odds of hyperglycemia (OR=1.69, 95% CI: 1.06-2.68). Conclusions Greater adherence to overall LCD, plant LCD, and animal LCD score was associated with lower odds of hyperglycemia. An appropriate reduction in carbohydrate intake, and increase in saturated fat intake might yield a lower risk of hyperglycemia.
- Low-carbohydrate diet /
- Hyperglycemia /
- Cross-sectional study

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图 1 总LCD得分、植物性LCD得分和动物性LCD得分与患空腹高血糖风险的剂量关系

Figure 1. Visualization of the dose-response relationship between overall LCD, plant LCD, animal LCD score and hyperglycemia

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图 2 替代碳水化合物与空腹高血糖的关联性

Figure 2. Association between the substitution of other nutrients for carbohydrate and hyperglycemia

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表 1 血糖正常与高血糖研究对象的基本特征[n(%)]

Table 1. Characteristics of study participants according to status of glucose [n(%)]

变量	合计(N=2 574)	血糖情况		t/$\chi$²/W值	P值
变量	合计(N=2 574)	血糖正常(n=2 342)	高血糖(n=232)	t/$\chi$²/W值	P值
FPG(mmol/L)	5.22±1.14	4.96±0.48	7.72±2.25	18.63	< 0.001
性别					< 0.001
女	1 525(59.25)	1 419(60.59)	106(45.69)	18.80
男	1 049(40.75)	923(39.41)	126(54.31)
年龄组(岁)				206 468	< 0.001 ^a
18~ < 40	748(29.06)	724(30.91)	24(10.34)
40~ < 50	481(18.69)	432(18.45)	49(21.12)
50~ < 60	626(24.32)	558(23.83)	68(29.31)
≥60	719(27.93)	628(26.81)	91(39.22)
BMI(kg/m²)				211 646	< 0.001 ^a
< 18.5	120(4.66)	112(4.78)	8(3.45)
18.5~ < 24.0	1 169(45.42)	1 101(47.01)	68(29.31)
24.0~ < 28.0	905(35.16)	809(34.54)	96(41.38)
≥28.0	380(14.76)	320(13.66)	60(25.86)
教育程度^b				269 703	0.006
小学及以下	1 301(50.60)	1 167(49.87)	134(58.01)
初中	701(27.27)	639(27.31)	62(26.84)
高中及以上	569(22.13)	534(22.82)	53(15.15)
吸烟^b				10.21	0.001
从不吸烟	1 882(73.17)	1 734(74.07)	148(64.07)
曾经或现在吸烟	690(26.83)	607(25.93)	83(35.93)
饮酒^b				22.39	< 0.001
从不饮酒	1 959(76.20)	1 812(77.47)	147(63.36)
曾经或现在饮酒	612(23.80)	527(22.53)	85(36.64)
体力活动^b				283 982	0.177 ^a
Tertile 1	857(33.33)	771(32.95)	86(37.23)
Tertile 2	857(33.33)	782(33.42)	75(32.47)
Tertile 3	857(33.33)	787(33.63)	70(30.30)
地区				0.00	1.000
农村	1 915(74.40)	1 742(74.38)	173(74.57)
城市	659(25.60)	600(25.62)	59(25.43)
糖尿病家族史^b				0.62	0.431
有家族史	184(7.20)	164(7.05)	20(8.70)
无家族史	2 372(92.80)	2 162(92.95)	210(91.30)
总能量				263 092	0.399 ^a
Tertile 1	858(33.33)	789(33.69)	69(29.74)
Tertile 2	858(33.33)	774(33.05)	84(36.21)
Tertile 3	858(33.33)	779(33.26)	79(34.05)
总LCD得分				290 320	0.067 ^a
Tertile 1	830(32.25)	742(31.68)	88(37.93)
Tertile 2	873(33.92)	799(34.12)	74(31.90)
Tertile 3	871(33.84)	801(34.20)	70(30.17)
植物LCD得分				286 225	0.153 ^a
Tertile 1	896(34.81)	809(34.54)	87(37.50)
Tertile 2	778(30.23)	703(30.02)	75(32.33)
Tertile 3	900(34.97)	830(35.44)	70(30.17)
动物LCD得分				297 177	0.012 ^a
Tertile 1	880(34.19)	786(33.56)	94(40.52)
Tertile 2	874(33.95)	795(33.95)	79(34.05)
Tertile 3	820(31.86)	761(32.49)	59(25.43)
注: ^a Wilcoxon秩和检验; ^b研究对象特征数据存在缺失。

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表 2 总LCD得分、植物性LCD得分和动物性LCD得分与空腹高血糖的关联性分析

Table 2. The ORs and 95% CIs of hyperglycemia according to overall LCD, plant LCD, and animal LCD score

低碳水饮食	OR值(95 % CI)				P_趋势 ^a
低碳水饮食	Tertile 1	Tertile 2	Tertile 3	每增加5分	P_趋势 ^a
总LCD
模型1 ^b	1.00	0.78(0.56~1.08)	0.74(0.53~1.02)	0.92(0.83~1.02)	0.103
模型2 ^c	1.00	0.77(0.55~1.08)	0.69(0.49~0.99)	0.90(0.81~1.01)	0.076
植物性LCD
模型1 ^b	1.00	0.99(0.72~1.37)	0.78(0.56~1.09)	0.98(0.86~1.11)	0.740
模型2 ^c	1.00	0.89(0.63~1.25)	0.61(0.43~0.87)	0.87(0.76~1.00)	0.051
动物性LCD
模型1 ^b	1.00	0.83(0.61~1.14)	0.65(0.46~0.91)	0.90(0.83~0.98)	0.018
模型2 ^c	1.00	0.88(0.64~1.23)	0.68(0.47~0.98)	0.92(0.83~1.01)	0.065
注：^a低碳水化合物饮食得分除以5之后以连续性变量进行分析；^b没有调整协变量；^c调整了性别、年龄、BMI、受教育程度、吸烟状况、饮酒状况、体力活动、地区、糖尿病家族史和总能量。

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