我国15个省份成年人膳食镁摄入对糖尿病发病风险的影响
Effects of dietary magnesium intake on risk of diabetes in Chinese adults in 15 provincial-level administrative regions
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摘要:
背景 目前国内外关于膳食镁与糖尿病风险关联的研究结果尚不一致，我国的前瞻性研究也相对较少且研究人群较为局限。
目的 探讨我国15个省（自治区、直辖市）成年人膳食镁摄入量与糖尿病风险的关联，为修订中国居民膳食镁参考摄入量提供一定的科学依据。
方法 选取2009、2015和2018年“中国健康与营养调查”中至少参加两次随访调查、有完整调查数据且基线未患糖尿病的8061名18~64岁成年居民作为研究对象，利用连续“3天24小时”膳食回顾和家庭食用油和调味品称重收集的食物消费数据，结合食物成分表计算得到平均每日膳食镁摄入量。分别采用多因素Cox比例风险回归模型和限制性立方样条（RCS）模型分析不同膳食镁摄入水平与糖尿病风险的关联及其剂量-反应关系。依据《中国2型糖尿病防治指南（2020版）》标准定义糖尿病。
结果 共追访47237.46人年，平均追访5.86年，其中8061名研究对象中，糖尿病发病率为8.86%。与镁摄入量最高五分位（Q5）的研究对象相比，膳食镁摄入量越低的人群中，女性、高收入、高文化程度、居住在城市、低身体活动水平的成年居民占比越高，其能量、膳食纤维和膳食钙摄入量也更低。调整人口学特征、生活方式和膳食因素后，Cox比例风险回归模型结果显示，与最低五分位膳食镁摄入量（中位数：168.82 mg·d−1）人群相比，第二（中位数：220.96 mg·d−1）、第三（中位数：263.01 mg·d−1）和第四（中位数：312.33 mg·d−1）五分位组人群发生糖尿病风险分别降低45%（
HR =0.55，95%CI ：0.43~0.71）、39%（HR =0.61，95%CI ：0.47~0.78）和34%（HR =0.66，95%CI ：0.51~0.78）。RCS分析结果显示，膳食镁摄入与糖尿病风险总体呈“U型”曲线，以镁摄入量第5百分位数为参考，膳食镁摄入量低于240 mg·d−1时，随着镁摄入量的增加，糖尿病发病风险逐渐降低；240 mg·d−1时，风险最低；240~400 mg·d−1时，风险略有增加；当摄入量大于650 mg·d−1时，膳食镁与糖尿病风险关联无统计学意义。结论 本研究结果提示膳食镁摄入量与糖尿病风险有关，当膳食镁摄入量低于240 mg·d−1时，膳食镁与糖尿病风险呈负相关，且呈非线性关联。
Abstract:Background At present, domestic and foreign studies on the association between dietary magnesium and diabetes risk are not consistent, and there are relatively few prospective studies in China and the study population is relatively limited.
Objective To explore the association between dietary magnesium intake and diabetes risk in Chinese adults in 15 provinces (autonomous regions, municipalities), and to provide a scientific basis for revising dietary magnesium intake reference for Chinese residents.
Methods A total of 8061 adults aged 18-64 who participated in at least two follow-up surveys in the China Health and Nutrition Survey in 2009, 2015, and 2018, had complete survey data, and did not report diabetes at baseline were selected as subjects. Food consumption data were collected from 3-day 24-hour dietary recalls and by weighing household cooking oil and condiments. The average daily dietary magnesium intake was calculated based on the food composition table. Multiple Cox proportional risk regression model and restricted cubic spline (RCS) model were used to analyze the association and dose-response relationship between dietary magnesium intake and diabetes risk. Diabetes was defined according to the
Chinese Guidelines for the Prevention and Treatment of Type 2 Diabetes (2020 edition) .Results A total of 47237.46 person-years were followed up, with an average follow-up of 5.86 years. Among 8061 subjects, the incidence rate was 8.86%. Compared with those in the top quintile of magnesium intake (Q5), those with lower dietary magnesium intake were more likely to be female, have higher income, higher education, live in urban areas, and have lower intakes of energy, dietary fiber, and dietary calcium. After adjusting for demographic characteristics, lifestyle, and dietary factors, compared with adults in the lowest quintile of dietary magnesium intake, the results of Cox proportional risk regression model showed that the second (median: 220.96 mg·d−1), third (median: 263.01 mg·d−1), and fourth (median: 312.33mg·d−1) quintile dietary magnesium intake reduced the risk of diabetes by 45% (
HR =0.55, 95%CI : 0.43-0.71), 39% (HR =0.61, 95%CI : 0.47-0.78), and 34% (HR =0.66, 95%CI : 0.51-0.78), respectively. The results of RCS analysis showed that dietary magnesium intake and the risk of diabetes were U-shaped overall. Taking the 5th percentile magnesium intake as reference, when dietary magnesium intake was lower than 240 mg·d−1, the risk of diabetes gradually decreased with the increase of magnesium intake; the risk was the lowest at 240 mg·d−1, followed by a slight increase in risk at 240-400 mg·d−1; and no statistical difference presented in the association between dietary magnesium and diabetes risk after 650 mg·d−1.Conclusion The study findings suggest an association between dietary magnesium intake and diebetes risk. The association is negative and non-linear when dietary magnesium intake is below 240 mg·d−1.
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