A case-control study of empirical dietary index for insulin resistance and risk of gastric precancerous lesions
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摘要:
目的 探讨促胰岛素抵抗膳食指数(empirical dietary index for insulin resistance, EDIR)与胃癌前病变(gastric precancerous lesions, GPL)患病风险的关系，为GPL人群的膳食防控提供流行病学依据。 方法 2021年9月―2022年7月在安徽医科大学第一附属医院招募102例GPL患者作为病例组，204例非萎缩性胃炎患者(non-atrophic gastritis, NAG)或正常胃黏膜者作为对照组，进行非匹配病例对照研究。 结果 病例组EDIR评分高于对照组，且差异有统计学意义(Z=-2.141, P=0.032)；与对照组相比，病例组的精谷物摄入量更高(Z=-2.475, P=0.013)；在对混杂因素进行调整后，较高的EDIR[Quartile 2: OR(95% CI): 4.36(1.61~11.84), P=0.003]与GPL风险的增加呈正相关。 结论 较高的EDIR评分和高精谷物摄入会增加GPL患病风险。 -
关键词:
- 促胰岛素抵抗膳食指数 /
- 胰岛素抵抗 /
- 胃癌前病变 /
- 病例对照研究 /
- 精谷物
Abstract:Objective To explore the relationship between empirical dietary index for insulin resistance (EDIR) and the risk of gastric precancerous lesions (GPL) and provide epidemiological basis for dietary prevention and control of GPL. Methods From September 2021 to July 2022, 102 patients with GPL, 204 with non-atrophic gastritis (NAG) or normal gastric mucosa patients were selected for a non-matched case-control study in the First Affiliated Hospital of Anhui Medical University. Then EDIR were applied to unmatched cases-control studies. Results The EDIR score of the case group was higher than that of the control group, and the difference was statistically significant (Z=-2.141, P=0.032); Compared with the control group, the refined grain intake (Z=-2.475, P=0.013) was higher in the case group; After adjustment for confounders, the higher EDIR[Quartile 2: OR(95% CI): 4.36(1.61~11.84), P=0.003] was positively associated with an increased risk of GPL. Conclusions Higher EDIR scores and high intake of refined grains increase the risk of developing GPL. -
图 1 EDIR评分及食物组分布情况图
EDIR: 促胰岛素抵抗膳食指数；A：病例组和对照组的EDIR评分；B：病例组和对照组的精谷物摄入量。
Figure 1. EDIR score and distribution of food groups
EDIR: empirical dietary index for insulin resistance; A: EDIR scores in case group and control group; B: refined grain intake in case group and control group.
表 1 EDIR食物组得分构成
Table 1. EDIR food groups score composition
EDIR食物组变量Variable EDIR food groups 权重Weight 正相关 Positive correlation 精谷物 Refined grain 0.000 31 红肉 Red meat 0.000 41 其他水产品 Other aquatic products 0.003 90 其他蔬菜 Other vegetables 0.000 42 负相关 Negative correlation 绿叶蔬菜 Green leafy vegetables -0.000 28 深黄色蔬菜 Dark yellow vegetables -0.003 70 米酒 Rice wine -0.002 00 截距 Intercept -0.015 00 注：EDIR, 促胰岛素抵抗膳食指数。
Note: EDIR, empirical dietary index for insulin resistance.
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表 2 一般人口学特征
Table 2. General demographic characteristics
变量 Variable 病例组
Case group①
(n=102)对照组
Control group①
(n=204)χ2/Z值 value P值 value 年龄组/岁 Age group/years 15.893 ＜0.001 18~＜45 10(9.8) 56(27.5) 45~＜60 53(52.0) 102(50.0) 60~＜80 39(38.2) 46(22.5) 性别 Gender 4.106 0.043 男性 Male 63(61.8) 101(49.5) 女性 Female 39(38.2) 103(50.5) 文化水平 Educational level 1.972 0.373 小学及以下 Primary school and below 46(45.1) 76(37.3) 初中/高中 Middle school/high school 36(35.3) 87(42.6) 大专及以上 College and above 20(19.6) 41(20.1) 家庭人均年收入/元 Per capita annual household income/ yuan 4.969 0.083 ＜20 000 35(34.4) 50(24.5) 20 000~＜30 000 49(48.0) 125(61.3) ≥30 000 18(17.6) 29(14.2) 职业 Occupation 6.786 0.079 体力工人 Blue-collar worker 14(13.7) 30(14.7) 农民 Peasant 35(34.3) 43(21.1) 办公室职员 Office staff 27(26.5) 60(29.4) 其他 Others 26(25.5) 71(34.8) 婚姻状况 Marital status 1.311 0.252 已婚 Married 93(91.2) 193(94.6) 未婚/离异/丧偶 Unmarried/divorced or widowed 9(8.8) 11(5.4) 吸烟 Smoking 0.605 0.437 是 Yes 36(35.3) 63(30.9) 否 No 66(64.7) 141(69.1) 饮酒 Drinking 1.059 0.303 是 Yes 38(37.3) 64(31.4) 否 No 64(62.7) 140(68.6) 饮茶 Drink tea 1.018 0.313 是 Yes 41(40.2) 70(34.3) 否 No 61(59.8) 134(65.7) 高血压 Hypertension 4.449 0.035 是 Yes 39(38.2) 54(26.5) 否 No 63(61.8) 150(73.5) 糖尿病 Diabetes 5.987 0.014 是 Yes 16(15.7) 14(6.9) 否 No 86(84.3) 190(93.1) BMI/(kg·m-2) 2.577 0.462 ＜18.5 3(2.9) 10(4.9) 18.5~＜24.0 44(43.2) 101(49.5) 24.0~＜28.0 42(41.2) 75(36.8) ≥28.0 13(12.7) 18(8.8) Hp 5.767 0.016 阳性 Positive 35(34.3) 44(21.6) 阴性 Negative 67(65.7) 160(78.4) FPG/(mmol·L-1) 4.93(4.50, 5.56) 4.70(4.34, 5.06) -2.695 0.007 TG/(mmol·L-1) 1.47(1.08, 1.98) 1.23(0.90, 1.85) -2.395 0.017 HDL-C/(mmol·L-1) 1.02(0.86, 1.21) 1.07(0.87, 1.24) 0.325 0.325 LDL-C/(mmol·L-1) 2.53(1.90, 3.06) 2.39(1.92, 2.91) -0.914 0.361 TG/HDL-C 1.46(1.02, 2.25) 1.19(0.73, 1.98) -2.173 0.030 营养/每 1 000 kcal Nutrient/per 1 000 kcal 总能量 Energy(/(kcal·day-1) 2 516.30(1 844.25, 3 156.77) 2 401.66(1 896.87, 3 060.12) -0.195 0.846 蛋白质 Protein/(g·d-1) 36.99(31.54, 41.91) 38.79(35.33, 43.63) 2.564 0.010 脂肪 Fat/(g·d-1) 23.35(19.32, 29.15) 25.50(20.49, 31.21) 2.198 0.028 碳水化合物 Carbohydrate/(g·d-1) 176.98(162.39, 188.71) 169.6(155.05, 186.22) -2.159 0.031 纤维 Fiber/(g·d-1) 3.87(2.95, 5.57) 4.21(3.05, 6.29) 1.362 0.173 注：Hp，幽门螺旋杆菌；FPG，空腹血糖；TG，三酰甘油；HDL-C，高密度脂蛋白胆固醇；LDL-C，低密度脂蛋白胆固醇; 其他职业：包括个体户、商人、自由职业、家庭主妇等。
①以人数(占比/%)或M(P25, P75)表示。
Note: Hp, Helicobacter pylori; FPG, fasting plasma glucose; TG, triglyceride; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; Other occupations: including self-employed, businessmen, freelancers, housewives, etc.
① Number of people (proportion/%) or M(P25, P75).
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表 3 EDIR与GPL风险的多模型调整分析
Table 3. Multi-model adjustment analysis of EDIR and GPL risk
EDIR Quartile 1
(＜0.06)Quartile 2 ⑤
(0.06~＜0.12)Quartile 3 ⑤
(0.12~＜0.19)Quartile 4 ⑤
(≥0.19)Ptrend值 value 病例/对照 Case/Control 9/51 33/51 28/51 32/51 模型1 Model 1 ① 1.00 3.92(1.63~9.43) 0.90(0.47~1.74) 1.21(0.62~2.36) 0.022 模型2 Model 2 ② 1.00 4.47(1.79~11.16) 0.94(0.48~1.86) 1.23(0.62~2.45) 0.013 模型3 Model 3 ③ 1.00 4.31(1.71~10.86) 0.87(0.43~1.75) 1.16(0.57~2.34) 0.020 模型4 Model 4 ④ 1.00 4.36(1.61~11.84) 0.86(0.40~1.83) 1.17(0.56~2.43) 0.031 注：EDIR，促胰岛素抵抗膳食指数；GPL，胃癌前病变。
①调整性别、年龄；②在模型1的基础上调整家庭人均年收入、职业、BMI、高血压、糖尿病；③在模型2的基础上调整FPG、TG、TG/HDL-C、Hp；④在模型3的基础上调整蛋白质、碳水化合物、脂肪；⑤ OR(95% CI)。Note: EDIR，empirical dietary index for insulin resistance；GPL，gastric precancerous lesions.
① Adjust gender, age; ② Adjusted per capita annual household income, occupation, BMI, hypertension and diabetes on the basis of model 1; ③ Adjust FPG, TG, TG/HDL-C, Helicobacter pylori on the basis of model 2; ④ Protein, carbohydrate and fat were adjusted on the basis of model 3; ⑤ OR(95% CI).
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表 4 亚组间EDIR与GPL风险的多模型调整分析
Table 4. Multi-model adjustment analysis of EDIR and GPL risk among subgroups
EDIR Quartile 1
(＜0.06)Quartile 2 ①
(0.06~＜0.12)Quartile 3 ①
(0.12~＜0.19)Quartile 4 ①
(≥0.19)Ptrend
值valuePinteraction
值value病例/对照 Case/control 9/51 33/51 28/51 32/51 性别 Gender 0.904 男性 Male 1.00 7.59(1.55~37.21) 0.57(0.21~1.54) 1.09(0.44~2.72) 0.191 女性 Female 1.00 3.28(0.63~17.07) 1.62(0.37~7.15) 1.81(0.42~7.87) 0.204 高血压 Hypertension 0.785 是 Yes 1.00 1.15(0.22~6.01) 0.79(0.18~3.51) 1.32(0.33~5.35) 0.972 否 No 1.00 8.07(1.85~35.18) 0.86(0.34~2.20) 1.10(0.44~2.73) 0.032② Hp 0.150 阳性 Positive 1.00 8.20(1.25~53.71) 1.02(0.19~5.57) 2.20(0.41~11.68) 0.064 阴性 Negative 1.00 3.62(0.98~13.38) 0.80(0.32~2.01) 1.00(0.42~2.37) 0.195 注：模型采用多变量logistic回归分析；调整性别、年龄、家庭人均年收入、职业、BMI、高血压、糖尿病、FPG、TG、TG/HDL-C、Hp、蛋白质、碳水化合物、脂肪。
① OR(95% CI); ② P＜0.05。Note: Multivariate logistic regression analysis was used for the model; Adjusted for sex, age, per capita annual household income, occupation, BMI, hypertension, diabetes, FPG, TG, TG/HDL-C, Helicobacter pylori, protein, carbohydrate, fat.
①OR(95% CI); ② P＜0.05.
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