Dietary patterns and cardiovascular disease among adults in Guizhou Province: a cohort study
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摘要:
目的 分析不同膳食模式与心血管疾病(cardiovascular disease, CVD)发病的关系,为CVD的防控提供参考依据。 方法 基于2010年11月建立的贵州省自然人群队列,采取分层整群抽样的方法抽取贵州省12个县(市、区)的≥18岁常住居民9 280人开展基线调查,于2016年12月19日―2020年6月1日对人群进行随访,将完成随访且基线信息和随访结局完整的7 897人纳入分析。采用半定量食物频率法获得人群膳食信息,通过探索性因子分析确定膳食模式,使用Cox比例风险回归模型计算队列人群不同膳食模式和CVD发生的HR值和95% CI。 结果 研究对象基线年龄为(44.46±15.14)岁,累计随访55 698.80人年,中位随访时间6.58年,随访期间221人发生CVD,发病密度为3.97/1 000人年。因子分析确定了油盐模式、蛋白模式、甜食模式、谷蔬模式、水产品模式。调整其他因素后,与各模式的低水平组相比,高水平油盐模式(HR=1.44, 95%CI: 1.02~2.02,P < 0.05)、中水平甜食模式(HR=1.47, 95%CI: 1.04~2.06,P < 0.05)、高水平甜食模式(HR=1.66, 95%CI: 1.17~2.36,P < 0.05)与CVD的发生呈正相关。 结论 油盐膳食模式和甜食膳食模式增加人群CVD的发病风险,限制脂肪、盐及含糖食品的摄入可预防和控制CVD的发生。 Abstract:Objective To explore the relationship between dietary patterns and cardiovascular disease (CVD), so as to provide evidence for the prevention of CVD. Methods Based on the natural population cohort established in November 2010, a total of 9 280 permanent residents over 18 years old in 12 counties and districts of Guizhou Province were selected by the method of stratified cluster sampling for baseline investigation, those participants received followed up from December 19th 2016 to June 1th 2020. Ultimately, 7 897 individual were eligible by successfully followed-up with complete information at baseline and follow-up for the analysis. Dietary information was obtained by the semi-quantitative food frequency method and dietary patterns were sorted with exploratory factor analysis. Cox proportional risk regression model was conducted to analyze the relationship between dietary patterns and CVD, then the hazard ratio (HR) and corresponding 95% confidence interval were calculated. Results The average age of the subjects was (44.46±15.14) years old, during a median duration of 6.58 years (55 698.80 person-years) of follow-up, 221 new case of CVD were found, the incidence rate of CVD was 3.97/1 000 person-years. Five main dietary patterns determined via factor analysis, named oil and salt pattern, protein pattern, sweet pattern, grain-vegetable pattern, aquatic product pattern, respectively. In the Cox proportional risk regression model, after adjusting other factors, the high level of oil and salt pattern was significantly associated with increasing the risk of CVD (HR=1.44, 95%CI: 1.02-2.02, P < 0.05), medium (HR=1.47, 95% CI: 1.04-2.06, P < 0.05) and high level (HR=1.66, 95%CI: 1.17-2.36, P < 0.05) of sweet pattern statistically argument occurrence of CVD compared with the low level of such patterns. Conclusions Oil and salt pattern and sweet pattern can increase the risk of CVD, reducing the intake of fat, salt and sugary foods can prevent and control the occurrence of CVD. -
Key words:
- Cardiovascular disease /
- Dietary patterns /
- Cohort study
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表 1 研究人群基本特征
Table 1. Baseline characteristics of the study participants
特征 Characteristic 合计 ②
Total ②
(n=7 897)非CVD ②
Non-CVD ②
(n=7 676)CVD ②
(n=221)t/χ2值
valueP值
value年龄/岁 Age/years 44.46±15.14 44.16±15.07 54.83±13.68 10.40 < 0.001 性别 Gender 男 Male 3 760 3 651(47.56) 109(49.32) 0.27 0.606 女 Female 4 137 4 025(52.44) 112(50.68) 居住地 Residence place 城市 Urban 2 634 2 573(33.52) 61(27.60) 3.39 0.066 农村 Rural 5 263 5 103(66.48) 160(72.40) 文化程度 Education level 小学及以下 Primary school and below 4 539 4 384(57.11) 155(70.14) 15.23 < 0.001 中学 Junior/senior high school 3 020 2 959(38.55) 61(27.60) 大专及以上 College and above 338 333(4.34) 5(2.26) 吸烟 Smoking 是 Yes 2 267 2 195(28.60) 72(32.58) 1.67 0.197 否 No 5 630 5 481(71.40) 149(67.42) 饮酒 Drinking 是 Yes 2 545 2 477(32.27) 68(30.77) 0.22 0.638 否 No 5 352 5 199(67.73) 153(69.23) 体力活动 ①/(MET-h·wk-1) Physical activity ①/(MET-h·wk-1) 64.00(20.00, 162.00) 63.16(20.00, 162.00) 72.00(25.67, 167.00) 1.15 0.250 BMI/(kg·m-2) 22.89±3.36 22.88±3.36 23.06±3.29 0.79 0.432 SBP/mmHg 125.28±21.02 124.97±20.79 135.92±25.79 7.66 < 0.001 DBP/mmHg 78.33±11.96 78.18±11.87 83.22±14.02 6.17 < 0.001 FBG/(mmol·L-1) 5.26±1.28 5.26±1.27 5.41±1.54 1.78 0.075 心率/(次·min-1) Heart rate/(beats per minute) 77.50±11.30 77.45±11.36 79.21±8.80 2.28 0.022 注:CVD, 心血管疾病;MET, 代谢当量;BMI, 体质指数;SBP, 收缩压;DBP, 舒张压;FBG, 空腹血糖。
①采用Mann-Whitney U检验。②以人数(占比/%)/x±s/[M(P25, P75)]表示。
Note: CVD, cardiovascular disease; MET, metabolic equivalent; BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; FBG, fasting blood glucose.
①Mann-Whitney U test was used. ② Number of people (proportion /%) or x±s or [M(P25, P75)].表 2 各类膳食模式组分及因子载荷
Table 2. Components of dietary patterns and factor loadings
特征 Characteristic 因子载荷 Factor loadings 油盐模式
Oil and salt pattern蛋白模式
Protein pattern甜食模式
Sweet pattern谷蔬模式
Grain-vegetable pattern水产品模式
Aquatic product pattern食盐 Salt 0.80 ― ― ― ― 烹调油 Cooking oil 0.74 ― ― ― ― 酱油 Soy sauce 0.73 ― ― ― ― 咸泡菜 Pickle 0.45 ― ― ― 0.264 豆制品 Bean products ― 0.65 ― ― ― 蛋类 Eggs ― 0.55 ― ― ― 新鲜水果 Fresh fruits ― 0.55 ― 0.20 ― 奶制品 Dairy ― 0.49 ― -0.23 ― 碳酸饮料 Carbonated beverages ― ― 0.77 ― ― 糕点 Cakes and pastries ― ― 0.70 ― ― 果蔬味饮料 Fruit and vegetable flavored drink ― ― 0.48 ― ― 油炸食品 Fried food ― 0.28 0.34 ― ― 薯类 Tubers ― 0.28 0.31 ― ― 新鲜蔬菜 Fresh vegetable ― ― ― 0.75 ― 粮谷 Grain ― ― ― 0.75 ― 水产品 Aquatic product ― ― ― ― 0.75 鸡鸭鹅肉 Poultry meat ― 0.25 ― ― 0.60 猪牛羊肉 Animal meat ― 0.37 ― 0.25 0.46 特征根 Eigenvalues 2.38 1.93 1.46 1.12 1.05 方差贡献率/% Variance contribution rate/% 10.80 9.55 8.78 7.63 7.40 累计方差贡献率/% Cumulative variance contribution rate/% 10.80 20.35 29.12 36.75 44.15 注:“―”表示仅显示因子载荷绝对值超过0.20的食物。
Note:“―” means only foods with factor loading greater than 0.20 were listed表 3 不同膳食模式人群基本特征
Table 3. Baseline characteristics of study participants in different dietary patterns
特征 Characteristic 油盐模式 ② Oil and salt pattern ② χ2/F值
valueP值
value低 Low
(n=2 632)中 Medium
(n=2 633)高 High
(n=2 632)年龄/岁 Age/years 43.13±15.08 44.43±15.05 45.81±15.18 20.74 < 0.001 性别 Gender 男 Male 1 245(47.30) 1 232(46.79) 1 283(48.75) 2.17 0.338 女 Female 1 387(52.70) 1 401(53.21) 1 349(51.25) 居住地 Residence place 城市 Urban 769(29.22) 866(32.89) 999(37.96) 45.59 < 0.001 农村 Rural 1 863(70.78) 1 767(67.11) 1 633(62.04) 文化程度 Education level 小学及以下 Primary school and below 1 506(57.22) 1 553(58.98) 1 480(56.23) 12.41 0.015 中学 Junior/senior high school 1 014(38.53) 991(37.64) 1 015(38.56) 大专及以上 College and above 112(4.25) 89(3.38) 137(5.21) 吸烟 Smoking 是 Yes 726(27.58) 746(28.33) 795(30.21) 4.69 0.096 否 No 1 906(72.42) 1 887(71.67) 1 837(69.79) 饮酒 Drinking 是 Yes 802(30.47) 793(30.12) 950(36.09) 27.10 < 0.001 否 No 1 830(69.53) 1 840(69.88) 1 682(63.91) 体力活动 ①/(MET-h·wk-1) Physical activity ①/(MET-h·wk-1) 64.00(20.00, 178.50) 60.67(17.33, 158.00) 64.00(20.67, 144.00) 6.06 0.048 BMI/(kg·m-2) 22.74±3.39 22.92±3.29 23.00±3.40 4.09 0.017 SBP/mmHg 125.23±20.82 124.59±20.90 126.03±21.33 3.13 0.044 DBP/mmHg 78.10±11.91 78.20±11.78 78.69±12.18 1.83 0.161 FBG/(mmol·L-1) 5.25±1.26 5.31±1.24 5.22±1.33 3.37 0.034 心率/(次·min-1) Heart rate/(beats per minute) 77.20±9.97 77.54±12.97 77.78±10.74 1.75 0.173 特征 Characteristic 蛋白模式 ② Protein pattern ② rowspan="2"χ2/F值
valueP值
value低 Low
(n=2 632)中 Medium
(n=2 633)高 High
(n=2 632)年龄/岁 Age/years 46.16±15.47 44.52±14.89 42.68±15.14 35.25 < 0.001 性别 Gender 男 Male 1 290(49.01) 1 268(48.16) 1 202(45.67) 6.37 0.041 女 Female 1 342(50.99) 1 365(51.84) 1 430(54.33) 居住地 Residence place 城市 Urban 560(21.28) 877(33.31) 1 197(45.48) 346.77 < 0.001 农村 Rural 2 072(78.72) 1 756(66.69) 1 435(54.52) 文化程度 Education level 小学及以下 Primary school and below 1 783(67.74) 1 564(59.40) 1 192(45.29) 342.06 < 0.001 中学 Junior/senior high school 796(30.24) 995(37.79) 1 229(46.69) 大专及以上 College and above 53(2.02) 74(2.81) 211(8.02) 吸烟 Smoking 是 Yes 686(26.06) 787(29.89) 794(30.17) 13.53 0.001 否 No 1 946(73.94) 1 846(70.11) 1 838(69.83) 饮酒 Drinking 是 Yes 782(29.71) 828(31.45) 935(35.52) 21.46 < 0.001 否 No 1 850(70.29) 1 805(68.55) 1 697(64.48) 体力活动 ①/(MET-h·wk-1) Physical activity ①/(MET-h·wk-1) 64.00(16.00, 168.00) 70.00(22.00, 164.00) 56.00(20.00, 152.00) 4.42 0.11 BMI/(kg·m-2) 22.71±3.28 22.75±3.34 23.2±3.44 16.89 < 0.001 SBP/mmHg 126.53±22.31 125.21±20.43 124.11±20.20 8.78 < 0.001 DBP/mmHg 78.29±12.37 78.30±11.85 78.4±11.66 0.06 0.941 FBG/(mmol·L-1) 5.33±1.17 5.23±1.31 5.22±1.34 6.71 0.001 心率/(次·min-1) Heart rate/(beats per minute) 76.77±10.82 77.66±12.02 78.07±10.98 9.17 < 0.001 特征 Characteristic 甜食模式 ② Sweet pattern ② χ2/F值
valueP值
value低 Low
(n=2 632)中 Medium
(n=2 633)高 High
(n=2 632)年龄/岁 Age/years 45.46±14.93 46.27±14.96 41.65±15.13 71.28 < 0.001 性别 Gender 男 Male 1 263(47.99) 1 245(47.28) 1 252(47.57) 0.26 0.877 女 Female 1 369(52.01) 1 388(52.72) 1 380(52.43) 居住地 Residence place 城市 Urban 588(22.34) 789(29.97) 1 257(47.76) 402.89 < 0.001 农村 Rural 2 044(77.66) 1 844(70.03) 1 375(52.24) 文化程度 Education level 小学及以下 Primary school and below 1 543(58.62) 1 740(66.08) 1 256(47.72) 201.23 < 0.001 中学 Junior/senior high school 977(37.12) 834(31.68) 1 209(45.94) 大专及以上 College and above 112(4.26) 59(2.24) 167(6.34) 吸烟 Smoking 是 Yes 617(23.44) 797(30.27) 853(32.41) 56.41 < 0.001 否 No 2 015(76.56) 1 836(69.73) 1 779(67.59) 饮酒 Drinking 是 Yes 778(29.56) 862(32.74) 905(34.39) 14.5 0.001 否 No 1 854(70.44) 1 771(67.26) 1 727(65.61) 体力活动 ①/(MET-h·wk-1) Physical activity ①/(MET-h·wk-1) 60.67(13.33, 164.00) 80.00(24.00, 180.00) 56.00(20.92, 137.00) 42.61 < 0.001 BMI/(kg·m-2) 22.86±3.46 22.81±3.27 23.00±3.35 2.23 0.107 SBP/mmHg 125.25±21.53 127.02±21.44 123.59±19.93 17.53 < 0.001 DBP/mmHg 78.18±12.68 78.75±11.96 78.06±11.20 2.47 0.084 FBG/(mmol·L-1) 5.39±1.35 5.23±1.13 5.16±1.33 22.88 < 0.001 心率/(次·min-1) Heart rate/(beats per minute) 77.51±12.21 77.37±10.06 77.63±11.53 0.34 0.710 特征 Characteristic 谷蔬模式 ② Grain-vegetable pattern ② χ2/F值
valueP值
value低 Low
(n=2 632)中 Medium
(n=2 633)高 High
(n=2 632)年龄/岁 Age/years 45.94±16.43 44.15±14.80 43.29±13.98 21.21 < 0.001 性别 Gender 男 Male 1 086(41.26) 1 234(46.87) 1 440(54.71) 96.33 < 0.001 女 Female 1 546(58.74) 1 399(53.13) 1 192(45.29) 居住地 Residence place 城市 Urban 1 184(44.98) 773(29.36) 677(25.72) 248.05 < 0.001 农村 Rural 1 448(55.02) 1 860(70.64) 1 955(74.28) 文化程度 Education level 小学及以下 Primary school and below 1 447(54.98) 1 551(58.90) 1 541(58.55) 69.82 < 0.001 中学 Junior/senior high school 1 003(38.11) 996(37.83) 1 021(38.79) 大专及以上 College and above 182(6.91) 86(3.27) 70(2.66) 吸烟 Smoking 是 Yes 638(24.24) 764(29.02) 865(32.86) 48.02 < 0.001 否 No 1 994(75.76) 1 869(70.98) 1 767(67.14) 饮酒 Drinking 是 Yes 730(27.74) 858(32.59) 957(36.36) 45.05 < 0.001 否 No 1 902(72.26) 1 775(67.41) 1 675(63.64) 体力活动 ①/(MET-h·wk-1) Physical activity ①/(MET-h·wk-1) 40.00(12.00, 101.33) 64.00(22.00, 154.00) 98.63(32.00, 224.00) 386.66 < 0.001 BMI/(kg·m-2) 22.93±3.41 22.85±3.31 22.88±3.37 0.32 0.727 SBP/mmHg 125.68±21.78 125.37±21.21 124.80±20.03 1.20 0.300 DBP/mmHg 78.48±12.18 78.37±11.97 78.14±11.74 0.57 0.567 FBG/(mmol·L-1) 5.23±1.26 5.22±1.18 5.32±1.38 4.63 0.010 心率/(次·min-1) Heart rate/(beats per minute) 77.41±10.29 78.14±11.42 76.96±12.09 7.35 0.001 特征 Characteristic 水产品模式 ② Aquatic product pattern ② χ2/F值
valueP值
value低 Low
(n=2 632)中 Medium
(n=2 633)高 High
(n=2 632)年龄/岁 Age/years 45.89±15.11 44.56±15.28 42.92±14.87 25.67 < 0.001 性别 Gender 男 Male 1 115(42.36) 1 248(47.40) 1 397(53.08) 60.64 < 0.001 女 Female 1 517(57.64) 1 385(52.60) 1 235(46.92) 居住地 Residence place 城市 Urban 847(32.18) 783(29.74) 1 004(38.15) 44.31 < 0.001 农村 Rural 1 785(67.82) 1 850(70.26) 1 628(61.85) 文化程度 Education level 小学及以下 Primary school and below 1 787(67.90) 1 597(60.65) 1 155(43.88) 429.57 < 0.001 中学 Junior/senior high school 802(30.47) 973(36.95) 1 245(47.30) 大专及以上 College and above 43(1.63) 63(2.40) 232(8.82) 吸烟 Smoking 是 Yes 701(26.63) 767(29.13) 799(30.36) 9.26 0.010 否 No 1 931(73.37) 1 866(70.87) 1 833(69.64) 饮酒 Drinking 是 Yes 668(25.38) 832(31.60) 1 045(39.70) 124.33 < 0.001 否 No 1 964(74.62) 1 801(68.40) 1 587(60.30) 体力活动 ①/(MET-h·wk-1) Physical activity ①/(MET-h·wk-1) 62.00(16.00, 168.00) 70.00(24.00, 168.00) 56.00(18.67, 144.00) 11.99 0.002 BMI/(kg·m-2) 22.72±3.23 22.75±3.31 23.20±3.51 16.85 < 0.001 SBP/mmHg 125.77±21.39 126.06±21.08 124.02±20.53 7.26 0.001 DBP/mmHg 78.35±11.87 78.17±12.24 78.46±11.78 0.39 0.676 FBG/(mmol·L-1) 5.13±1.25 5.22±1.11 5.42±1.44 35.54 < 0.001 心率/(次·min-1) Heart rate/(beats per minute) 77.13±10.51 77.69±11.36 77.70±11.98 2.16 0.115 注:CVD, 心血管疾病;MET, 代谢当量;BMI, 体质指数;SBP, 收缩压;DBP, 舒张压;FBG, 空腹血糖。
①采用Mann-Whitney U检验。②以人数(占比/%)/x±s/[M(P25, P75)]表示。
Note: CVD, cardiovascular disease; MET, metabolic equivalent; BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; FBG, fasting blood glucose.
①Mann-Whitney U test was used. ② Number of people (proportion /%) or x±s or [M(P25, P75)].表 4 不同膳食模式与心血管疾病关系的Cox回归分析
Table 4. Cox regression analysis of the relationship between different dietary patterns and cardiovascular disease
特征 Characteristic 发病人数
Number of cases随访人年
Number of person-years发病密度/(千·人年-1)
Incidence density (No. per 1 000 person-years)HR值value(95% CI) 模型1
Model 1模型2
Model 2模型3
Model 3油盐模式 Oil and salt pattern 低 Low 61 19 002.16 3.21 1.00 1.00 1.00 中 Medium 77 18 619.04 4.14 1.29(0.92~1.80) 1.32(0.94~1.85) 1.33(0.94~1.87) 高 High 83 18 077.60 4.59 1.39(1.00~1.95) ① 1.43(1.02~2.00) ① 1.44(1.02~2.02) ① P趋势 Ptrend 0.066 0.049 0.049 蛋白模式 Protein pattern 低 Low 83 18 560.81 4.47 1.00 1.00 1.00 中 Medium 69 18 687.21 3.69 0.90(0.65~1.24) 0.90(0.65~1.25) 0.90(0.65~1.25) 高 High 69 18 450.78 3.74 1.03(0.74~1.43) 1.03(0.74~1.44) 0.99(0.71~1.39) P趋势 Ptrend 0.796 0.787 0.984 甜食模式 Sweet pattern 低 Low 58 18 952.20 3.06 1.00 1.00 1.00 中 Medium 85 18 322.19 4.64 1.48(1.06~2.06) ① 1.45(1.04~2.03) ① 1.47(1.04~2.06) ① 高 High 78 18 424.41 4.23 1.71(1.21~2.42) ① 1.70(1.20~2.41) ① 1.66(1.17~2.36) ① P趋势 Ptrend 0.008 0.008 0.014 谷蔬模式 Grain-vegetable pattern 低 Low 65 18 569.27 3.50 1.00 1.00 1.00 中 Medium 82 18 691.99 4.39 1.34(0.97~1.87) 1.30(0.94~1.82) 1.29(0.92~1.80) 高 High 74 18 437.54 4.01 1.30(0.93~1.84) 1.26(0.89~1.79) 1.26(0.88~1.79) P趋势 Ptrend 0.156 0.227 0.234 水产品模式 Aquatic product pattern 低 Low 81 18 711.98 4.33 1.00 1.00 1.00 中 Medium 90 18 492.22 4.87 1.20(0.89~1.62) 1.19(0.89~1.61) 1.19(0.88~1.61) 高 High 50 18 494.60 2.70 0.72(0.50~1.03) 0.73(0.51~1.05) 0.72(0.50~1.04) P趋势 Ptrend 0.065 0.058 0.055 注:模型1,调整年龄、性别、文化程度、居住地;模型2,在模型1的基础上调整吸烟、饮酒、运动;模型3,在模型2的基础上调整体质指数、收缩压、舒张压、空腹血糖、心率。
①代表P<0.05。
Note: Model 1, adjusted age, gender, education level and residence place; Model 2, based on model1and further adjusted for smoking, drinking, physical activity; Model 3, based on model 2 and further adjusted for body mass index, systolic blood pressure, diastolic blood pressure, fasting blood glucose and heat rate.
① P<0.05.表 5 膳食模式与心血管疾病发病关系的敏感性分析
Table 5. Sensitivity analysis of the relationship between dietary patterns and cardiovascular disease incidence
膳食模式 Dietary pattern 删除时间<5年人群
The group followed-up < 5 years was deleted删除基线年龄>80岁人群
The group with baseline age >80 years old was deleted删除基线年龄<35岁人群
The group with baseline age < 35 years old was deleted油盐模式 Oil and salt pattern 低 Low 1.00 1.00 1.00 中 Medium 1.39(0.82~2.34) 1.32(0.94~1.87) 1.17(0.81~1.68) 高 High 1.82(1.09~3.02) ① 1.44(1.02~2.02) ① 1.42(1.01~2.02) ① 蛋白模式 Protein pattern 低 Low 1.00 1.00 1.00 中 Medium 0.98(0.60~1.62) 0.89(0.64~1.24) 0.93(0.66~1.30) 高 High 1.21(0.74~1.99) 1.01(0.72~1.42) 1.07(0.75~1.52) 甜食模式 Sweet pattern 低 Low 1.00 1.00 1.00 中 Medium 1.29(0.75~2.21) 1.45(1.03~2.04) ① 1.41(1.01~2.00) ① 高 High 2.01(1.20~3.35) ① 1.65(1.16~2.35) ① 1.57(1.09~2.28) ① 谷蔬模式 Grain-vegetable pattern 低 Low 1.00 1.00 1.00 中 Medium 1.30(0.80~2.13) 1.29(0.92~1.81) 1.31(0.93~1.86) 高 High 1.18(0.70~2.00) 1.24(0.88~1.77) 1.16(0.80~1.69) 水产品模式 Aquatic product pattern 低 Low 1.00 1.00 1.00 中 Medium 1.09(0.69~1.72) 1.19(0.87~1.61) 1.37(0.99~1.89) 高 High 0.72(0.42~1.22) 0.74(0.51~1.06) 0.79(0.53~1.17) 注:① P<0.05。
Note: ① P<0.05. -
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