基于前瞻性队列研究植物性食物摄入与2型糖尿病发生风险的关联

徐铭婧; 应涛; 朱洋; 何更生; 刘雨薇

doi:10.11836/JEOM23395

基于前瞻性队列研究植物性食物摄入与2型糖尿病发生风险的关联

Plant foods intake and risk of type 2 diabetes: Findings from a registry-based prospective cohort study

摘要

摘要:
背景现阶段，生活方式干预或饮食调整目前仍然是2型糖尿病（T2D）一级预防和管理的基石。
目的探究植物性食物摄入与T2D发生风险的关系。
方法系基于上海社区自然人群队列（SSACB）松江区居民开展的前瞻队列研究。基线调查时用经验证的食物频率问卷评估不同类型食物摄入状况并计算植物性膳食指数（PDI）、健康植物性膳食指数（hPDI）和不健康植物性膳食指数（uPDI），借由绑定了居民医疗保险卡的电子信息系统获取队列建立后经医生诊断空腹血糖≥7.0 mmol·L⁻¹或2 h口服葡萄糖耐量试验≥11.1 mmol·L⁻¹或糖化血红蛋白≥6.5%或具备典型的高血糖（危象）症状及随机血糖≥ 11.1 mmol·L⁻¹的或存在用药记录的新发糖尿病病例。采用多因素校正的Cox比例风险回归模型，结合限制性立方样条分析膳食摄入与T2D发生风险之间的关联。
结果队列中共有29016名松江区居民被纳入分析基线年龄的\bar\mathitx\pms为（55.3±11.6）岁，截至2022年9月21日，中位随访时间5.688年。结果显示，当地居民植物性食物（未加工）摄入与新发T2D呈负相关HR（95%CI）：0.983（0.969~0.998）；其中，植物性食物每日摄入量最低四分位数组（＜500.9 g）的T2D发生风险高于每日摄入量最高四分位数组（≥859.3 g）HR（95%CI）：1.250（1.012~1.544）；未发现动物性食物HR（95%CI）： 1.006（0.987~1.026）和加工食品HR（95%CI）：0.978（0.944~1.014）摄入与T2D发生风险相关。用等量（50 g）的植物性食物替代动物性食物HR（95%CI）：0.982（0.968~0.996）或加工食品HR（95%CI）：0.983（0.969~0.998），T2D的发生风险下降。此外，居民PDI（P_非线性=0.023）、hPDI（P_非线性=0.016）与新发T2D之间存在非线性相关。
结论植物性食物，特别是健康植物性食物摄入与新发T2D风险降低相关。

Abstract:
Background Lifestyle intervention or dietary modification has been the cornerstone of primary prevention and management of type 2 diabetes (T2D).
Objective To investigate the associations of plant foods intake with the risk of incident T2D.
Methods Based on a general population cohort, the Shanghai Suburban Adult Cohort and Biobank (SSACB), dietary data were collected for each participant in Songjiang District of Shanghai at enrollment with a validated Food Frequency Questionnaire (FFQ), and plant-based diet index (PDI), healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI) were calculated. Incident T2D cases were identified according to physician diagnosis (fasting blood glucose ≥7.0 mmol·L⁻¹, or 2 h value during a 75-g oral glucose tolerance test ≥11.1 mmol·L⁻¹, or glycosylated hemoglobin ≥6.5%, or with typical symptoms of hyperglycemia or hyperglycemic crisis, accompanied by a random plasma glucose ≥11.1 mmol·L⁻¹) or medication records, obtained from the electronic information system for residents' medical insurance. Multivariable-adjusted Cox proportional hazards models and restricted cubic splines were used to evaluate the associations of foods from different sources with the risk of incident T2D.
Results A total of 29016 participants age at baseline (55.3±11.6) years with a median follow-up duration of 5.688 years until 21 September 2022 were included. Plant foods (unprocessed) intake was associated with a decreased risk of incident T2D HR (95%CI): 0.983 (0.969, 0.998). In comparison with participants in the highest quartile (≥859.3 g) of plant foods daily intake, the risk of incident T2D for those in the lowest quartile (<500.9 g) was higher HR (95%CI): 1.250 (1.012, 1.544). No significant associations of animal foods HR (95%CI): 1.006 (0.987, 1.026) and processed foods HR (95%CI): 0.978 (0.944, 1.014) intakes were found with the risk of incident T2D. Replacing 50 g animal foods HR (95%CI): 0.982 (0.968, 0.996) or processed foods HR (95%CI): 0.983 (0.969, 0.998) with 50 g plant foods was associated with significantly decreased risks of incident T2D. Additionally, non-linear associations of PDI (P_nonlinear=0.023) and hPDI (P_nonlinear=0.016) with the risk of incident T2D were found in the SSACB.
Conclusion Plant foods intake, especially healthful plant foods intake, is significantly associated with a decreased risk of incident T2D.

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