李惟怡, 焦莹莹, 张思婷, 洪溪, 王志如, 王柳森, 姜红如, 王邵顺子, 王志宏, 张兵, 丁钢强. 膳食镁摄入与2型糖尿病关系的meta分析[J]. 环境与职业医学, 2022, 39(9): 988-995. DOI: 10.11836/JEOM22072
引用本文: 李惟怡, 焦莹莹, 张思婷, 洪溪, 王志如, 王柳森, 姜红如, 王邵顺子, 王志宏, 张兵, 丁钢强. 膳食镁摄入与2型糖尿病关系的meta分析[J]. 环境与职业医学, 2022, 39(9): 988-995. DOI: 10.11836/JEOM22072
LI Weiyi, JIAO Yingying, ZHANG Siting, HONG Xi, WANG Zhiru, WANG Liusen, JIANG Hongru, WANG Shaoshunzi, WANG Zhihong, ZHANG Bing, DING Gangqiang. Relationship between dietary magnesium intake and risk of type 2 diabetes: A meta-analysis[J]. Journal of Environmental and Occupational Medicine, 2022, 39(9): 988-995. DOI: 10.11836/JEOM22072
Citation: LI Weiyi, JIAO Yingying, ZHANG Siting, HONG Xi, WANG Zhiru, WANG Liusen, JIANG Hongru, WANG Shaoshunzi, WANG Zhihong, ZHANG Bing, DING Gangqiang. Relationship between dietary magnesium intake and risk of type 2 diabetes: A meta-analysis[J]. Journal of Environmental and Occupational Medicine, 2022, 39(9): 988-995. DOI: 10.11836/JEOM22072

膳食镁摄入与2型糖尿病关系的meta分析

Relationship between dietary magnesium intake and risk of type 2 diabetes: A meta-analysis

  • 摘要: 背景

    糖尿病是全球性的疾病负担,镁在糖尿病预防中的作用引起关注,但国内外关于膳食镁对糖尿病发病风险影响的研究结果并不一致。

    目的

    系统评价膳食镁摄入量与糖尿病发病风险的关联。

    方法

    通过计算机系统地对PubMed、Web of Science、中国知网和万方数据库进行检索,查找发表时间于2000年1月1日至2021年12月31日涉及膳食镁摄入和2型糖尿病的前瞻性队列研究。由两名研究者参照纳入、排除标准分别独立对文献进行筛选,根据统一的数据提取表进行资料提取,并利用Newcastle-Ottawa量表(NOS)进行质量评价。应用R 4.0.3软件和Stata/SE 16.0软件进行meta分析以及亚组meta分析,利用Higgins I2统计量对纳入研究进行异质性检验。通过单变量meta回归分析异质性来源。

    结果

    共纳入14篇文献,涉及17项前瞻性队列研究(1065267参与者和40506例患者),NOS评分在8~9之间,平均得分8.6,均属于高质量队列研究。与膳食镁摄入量最低五分位组相比,最高五分位组可降低2型糖尿病发病风险22% (RR=0.78,95%CI:0.73~0.82),并且这一关联并未因研究开展的地理区域、性别、随访时间不同而发生实质性改变。亚组分析显示,与摄入量最低组比较,膳食镁摄入量最高五分位组的以下各人群2型糖尿病发病风险均有所下降,包括:美洲和亚洲分别降低22%和26%(美洲RR=0.78,95%CI: 0.73~0.83; 亚洲RR=0.74,95%CI: 0.63~0.88);女性、男性及未分性别的研究对象分别下降22%、19%和46%,RR及其95%CI分别为0.78(0.73~0.84)、0.81(0.74~0.89)、0.54(0.42~0.68);随访时间不超过10年和10年以上者的2型糖尿病发病风险分别降低26%和20%,RR及其95%CI为0.74(0.65~0.83)、0.80(0.75~0.85)。调整高血压后膳食镁摄入量最高五分位组与最低五分位组相比,2型糖尿病发病风险降低了20%(RR=0.80,95%CI:0.74~0.85)。通过meta回归检验发现,发表年份(P<0.05)与研究对象的性别(P<0.05)可能是异质性的来源。meta分析结果的稳定性较好,但漏斗图对称性的Egger检验结果显示存在发表偏倚。

    结论

    较高的膳食镁摄入可以降低2型糖尿病发病风险。由于很难将镁摄入量对2型糖尿病风险的影响与其他因素分开,今后仍需要开展大规模、临床随机对照试验来直接评估镁对2型糖尿病发病率的影响。

     

    Abstract: Background

    Diabetes is a major contributor to global burden of disease. The role of magnesium in the prevention of diabetes has aroused concern. However, the research results on the impact of dietary magnesium on the risk of diabetes are hitherto inconsistent.

    Objective

    To evaluate the association between dietary magnesium intake and the risk of diabetes through a systematic review.

    Methods

    PubMed, Web of Science, China National Knowledge Infrastructure, Wanfang databases were searched for prospective studies that contained risk estimates for magnesium intake-associated diabetes and were published from January 1, 2000 to December 31, 2021. Two researchers independently screened the literature according to a set of pre-prepared inclusion and exclusion criteria, extracted the data according to an unified data extraction table, and evaluated the quality of included articles with Newcastle-Ottawa Scale (NOS). R 4.0.3 software and Stata SE16.0 software were used for meta-analysis and subgroup meta-analysis, and Higgins I2 statistics were used to test the heterogeneity of the included studies. The sources of heterogeneity were analyzed by univariate meta regression.

    Results

    A total of 14 articles involving 17 prospective cohort studies (1065267 participants and 40506 patients with diabetes) were included in the study. The NOS scores ranged from 8 to 9, with an average of 8.6, indicating that the included studies were classified as being high quality. The highest quintile of magnesium intake group reduced the risk of diabetes by 22% (RR=0.78, 95%CI: 0.73-0.82) compared with the lowest quintile group. This association was not substantially modified by geographic region, sex, or follow-up length. The highest quintile of dietary magnesium intake in the Americas and Asia were associated with 22% and 26% reductions in the risk of type 2 diabetes respectively compared with the lowest quintile group (the Americas, RR=0.78, 95%CI: 0.73-0.84; Asia, RR=0.74, 95%CI: 0.63-0.88); The highest quintile of dietary magnesium intake in female, male and without gender stratified were associated with 22%, 19% and 46% reductions in the risk of type 2 diabetes respectively compared with the lowest quintile group (Female RR=0.78, 95%CI: 0.73-0.84; Male RR=0.81, 95%CI: 0.74-0.89; Both RR=0.54, 95%CI: 0.42-0.68); Compared with the lowest quintile groups, the groups with the highest quintile of dietary magnesium intake with a follow-up time of less than 10 years and more than 10 years reduced the risk of type 2 diabetes by 26% and 20% respectively (≤10 years, RR=0.74, 95%CI: 0.65-0.83; >10 years, RR=0.80, 95%CI: 0.75-0.85). After adjusting for hypertension, the highest quintile of dietary magnesium intake group reduced the risk of type 2 diabetes by 20% compared with the lowest quintile group (RR=0.80, 95%CI: 0.74-0.85). The year of publication (P<0.05) or the sex of the subjects (P<0.05) may be the source of heterogeneity by meta regression test. The results of Egger’s test for funnel plot asymmetry suggested publication bias.

    Conclusion

    The combined data supports a role for high magnesium intake in reducing the risk of type 2 diabetes. Because it is difficult to separate the effect of magnesium intake on diabetes risk from other factors, large-scale and clinical randomized controlled trials are needed to directly assess the impact of magnesium on the incidence rate of diabetes.

     

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