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Article(id=1240633240537592697, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240633237542851387, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202311190, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1699459200000, receivedDateStr=2023-11-09, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773719614395, onlineDateStr=2026-03-17, pubDate=1716566400000, pubDateStr=2024-05-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773719614395, onlineIssueDateStr=2026-03-17, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773719614395, creator=13701087609, updateTime=1773719614395, updator=13701087609, issue=Issue{id=1240633237542851387, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='10', pageStart='1729', pageEnd='1920', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773719613680, creator=13701087609, updateTime=1773720039302, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240635022806405370, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240633237542851387, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240635022806405371, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240633237542851387, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1780, endPage=1786, ext={EN=ArticleExt(id=1240633241984627589, articleId=1240633240537592697, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Associations of dietary intake of n-3 polyunsaturated fatty acids and type 2 diabetes in residents of Chongqing City, columnId=1240375107953161116, journalTitle=Modern Preventive Medicine, columnName=Nutrition and Foold Hygiene, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the relationship between dietary intake of n-3 polyunsaturated fatty acids (n-3 PUFA) and the incidence of type 2 diabetes mellitus (T2DM) among residents in selected districts of Chongqing,and to provide recommendations for the prevention of T2DM.

Methods

Using cross-sectional survey data collected in Chongqing as part of the 2021 China National Nutrition and Health Survey (CNNHS), and in combination with energy and nutrient intake calculated from the Chinese Food Composition Tables, single-factor and multi-factor Logistic regression models were employed to investigate the association between n-3 PUFA intake and the incidence of T2DM.

Results

This study included a total of 1 511 participants, of which 280 were diagnosed with T2DM, accounting for 18.80% of the total. When compared to participants in the lowest quartile of animal-derived n-3 PUFA intake, those in the highest quartile had a significantly lower risk of developing T2DM (OR=0.61, 95%CI: 0.42-0.88). The results from adjusted Model 1 were consistent with those of Model 2 (Model 1: OR=0.64, 95%CI: 0.44-0.94; Model 2: OR=0.66, 95%CI: 0.44-0.98). Notably, in Model 2, the risk of developing T2DM was even lower in the Q4 group of plant-derived n-3 PUFA compared to Q1 (OR=0.48, 95%CI: 0.24-0.98).

Conclusion

The dietary intake of animal-derived n-3 PUFA and plant-derived n-3 PUFA is negatively correlated with the incidence of T2DM. The association between animal-derived n-3 PUFA and T2DM weakens after adjusting for confounding factors, with the highest quartile of plant-derived n-3 PUFA showing the strongest protective effect against T2DM.

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目的

分析重庆市居民膳食n-3多不饱和脂肪酸与2型糖尿病发病关系，为2型糖尿病防治措施提供参考。

方法

利用中国居民营养与健康随访研究（2021）CNNHS在重庆市收集的横断面调查数据，结合中国食物成分表计算能量与营养素摄入量，使用单因素和多因素Logistic回归模型分析n-3多不饱和脂肪酸摄入与2型糖尿病的关联。

结果

本次研究最终纳入1 511例研究对象，2型糖尿病患者共280例，占18.80%。与动物性来源n-3多不饱和脂肪酸最低四分位数的研究对象相比，较高四分位数研究对象患糖尿病的风险更低（OR=0.61，95%CI：0.42~0.88），调整后的模型1与模型2结果相似（模型1，OR=0.64，95%CI：0.44~0.94；模型2，OR=0.66，95%CI：0.44~0.98）。其中，模型2中摄入植物性来源n-3多不饱和脂肪酸较高者患糖尿病的风险更低（OR=0.48，95%CI：0.24~0.98）。

结论

膳食中动物性来源n-3 PUFA和植物性来源n-3 PUFA与2型糖尿病发病呈负相关，动物性来源n-3 PUFA与2型糖尿病相关性在调整混杂因素后减弱，但摄入植物性来源n-3 PUFA较高对糖尿病发病的保护作用最强。

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李继斌，E-mail：
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=qhF53dYjJ9EF56IPrxcz2g==, magXml=xW4ulyPmlOARiGezurYNpw==, pdfUrl=null, pdf=Y29jstQQT27SZk1/fof+xw==, pdfFileSize=607167, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=GHM30de/pQSpZ1WLTNiIng==, mapNumber=null, authorCompany=null, fund=null, authors=

赖英旭（1999—），男，硕士在读，研究方向：营养与慢性病

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赖英旭（1999—），男，硕士在读，研究方向：营养与慢性病

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赖英旭（1999—），男，硕士在读，研究方向：营养与慢性病

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Journal of Food Science, 2021, 86(3): 1058-1065., articleTitle=Dietary low ratio of n-6/n-3 polyunsaturated fatty acids improve type 2 diabetes mellitus via activating brown adipose tissue in male mice, refAbstract=null)], funds=[Fund(id=1240633248028618985, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633240537592697, awardId=wlkfz202206, language=CN, fundingSource=国家卫健委微量元素与营养重点实验室(wlkfz202206), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1240633243536520149, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633240537592697, xref=1., ext=[AuthorCompanyExt(id=1240633243544908758, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633240537592697, companyId=1240633243536520149, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Public Health, Chongqing Medical University, Chongqing, Chongqing 400016, China), AuthorCompanyExt(id=1240633243553297368, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633240537592697, companyId=1240633243536520149, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.重庆医科大学公共卫生学院，重庆 400016)]), AuthorCompany(id=1240633243662349279, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633240537592697, xref=2., ext=[AuthorCompanyExt(id=1240633243670737888, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633240537592697, companyId=1240633243662349279, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.重庆市疾病预防控制中心)])], figs=[ArticleFig(id=1240633247315587229, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633240537592697, language=EN, label=Table 1, caption=

Basic characteristics of research subjects with Non-Type 2 Diabetes and Type 2 Diabetes [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
因素非糖尿病(n=1 231)糖尿病(n=280)χ2/tP值
性别3.4190.06
男性554(45.00)109(38.93)
女性677(55.0)171(61.07)
年龄(岁,)59.08±14.4263.17±12.81-4.803<0.001
年龄(岁)22.751<0.001
<60656(53.29)105(37.50)
≥60575(46.71)175(62.50)
婚姻0.6210.431
已婚1 060(86.11)236(84.29)
未婚、离异、丧偶171(13.89)44(15.71)
文化程度6.7120.082
小学以下205(16.65)53(18.93)
小学635(51.58)160(57.14)
初中250(20.31)44(15.71)
高中及以上141(11.45)23(8.21)
吸烟5.8020.016
否933(75.79)231(82.50)
是298(24.21)49(17.50)
饮酒12.0460.001
否964(78.31)245(87.50)
是267(21.67)35(12.50)
体育锻炼0.0390.843
否1 117(90.74)253(90.36)
是114(9.26)27(9.64)
糖尿病家族史10.7560.003
无1 194(96.99)260(92.86)
有37(3.01)20(7.14)
BMI(kg/m2)14.8340.002
<18.532(2.60)7(2.50)
18.5~23.9570(46.30)99(35.36)
24.0~27.9448(36.39)112(40.00)
≥28.0181(14.70)62(22.14)
高血压3.4660.063
否704(57.19)143(51.07)
是527(42.81)137(48.93)
血脂异常26.043<0.001
否832(67.59)144(51.43)
是399(32.41)136(48.57)
空腹血糖(mmol/L,mean ± sd)5.44±0.599.60±3.57-38.623<0.001
), ArticleFig(id=1240633247395279018, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633240537592697, language=CN, label=表1, caption=

非2型糖尿病与2型糖尿病研究对象基本特征[n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
因素非糖尿病(n=1 231)糖尿病(n=280)χ2/tP值
性别3.4190.06
男性554(45.00)109(38.93)
女性677(55.0)171(61.07)
年龄(岁,)59.08±14.4263.17±12.81-4.803<0.001
年龄(岁)22.751<0.001
<60656(53.29)105(37.50)
≥60575(46.71)175(62.50)
婚姻0.6210.431
已婚1 060(86.11)236(84.29)
未婚、离异、丧偶171(13.89)44(15.71)
文化程度6.7120.082
小学以下205(16.65)53(18.93)
小学635(51.58)160(57.14)
初中250(20.31)44(15.71)
高中及以上141(11.45)23(8.21)
吸烟5.8020.016
否933(75.79)231(82.50)
是298(24.21)49(17.50)
饮酒12.0460.001
否964(78.31)245(87.50)
是267(21.67)35(12.50)
体育锻炼0.0390.843
否1 117(90.74)253(90.36)
是114(9.26)27(9.64)
糖尿病家族史10.7560.003
无1 194(96.99)260(92.86)
有37(3.01)20(7.14)
BMI(kg/m2)14.8340.002
<18.532(2.60)7(2.50)
18.5~23.9570(46.30)99(35.36)
24.0~27.9448(36.39)112(40.00)
≥28.0181(14.70)62(22.14)
高血压3.4660.063
否704(57.19)143(51.07)
是527(42.81)137(48.93)
血脂异常26.043<0.001
否832(67.59)144(51.43)
是399(32.41)136(48.57)
空腹血糖(mmol/L,mean ± sd)5.44±0.599.60±3.57-38.623<0.001
), ArticleFig(id=1240633247508525237, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633240537592697, language=EN, label=Table 2, caption=

Correlation between quartiles of Dietary n-3PUFA and other exposure factors in study subjects

, figureFileSmall=null, figureFileBig=null, tableContent=
因素膳食n-3PUFAχ2P值
Q1,n(%)Q2,n(%)Q3,n(%)Q4,n(%)
性别20.703<0.001
男性140(37.04)155(41.01)169(44.71)199(52.79)
女性238(62.96)223(58.99)209(55.29)178(47.21)
年龄(岁)9.8200.020
<60164(43.39)199(52.65)199(52.65)199(52.79)
≥60214(56.61)179(47.35)179(47.35)178(47.21)
婚姻13.1830.004
已婚310(82.01)320(84.67)323(85.45)343(90.98)
未婚、离异、丧偶68(17.99)58(15.33)55(14.55)34(9.02)
文化程度52.909<0.001
小学以下98(25.93)74(19.58)48(12.70)38(10.08)
小学195(51.59)199(52.65)199(52.65)202(53.58)
初中48(12.70)72(19.04)89(23.54)85(22.55)
高中及以上37(9.79)33(8.73)42(11.11)52(13.79)
吸烟6.4750.091
否303(80.16)296(78.31)291(76.98)274(72.68)
是75(19.84)82(21.69)87(23.02)103(27.32)
饮酒5.7240.126
否313(82.80)310(82.01)296(78.31)290(76.92)
是65(17.20)68(17.99)82(21.69)87(23.08)
体育锻炼4.7180.194
否338(89.42)353(93.39)338(89.42)341(90.45)
是40(10.58)25(6.61)40(10.58)36(9.55)
糖尿病家族史9.4140.024
否372(98.41)366(96.83)358(94.71)358(94.96)
是6(1.59)12(3.17)20(5.29)19(5.04)
BMI(kg/m2)2.1570.989
<18.512(3.17)10(2.65)9(2.38)8(2.12)
18.5~23.9171(45.24)166(43.92)170(44.97)162(42.97)
24.0~27.9133(35.19)139(36.77)141(37.30)147(38.99)
≥28.062(16.40)63(16.67)58(15.34)60(15.92)
高血压6.4640.091
否208(55.03)217(57.41)228(60.31)194(51.46)
是170(44.97)161(42.59)150(39.69)183(48.54)
血脂异常4.8240.185
否236(62.43)261(69.05)236(62.43)243(64.46)
是142(37.57)117(30.95)142(37.57)134(35.54)
), ArticleFig(id=1240633247617577148, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633240537592697, language=CN, label=表2, caption=

研究对象膳食n-3PUFA四分位数与其他暴露因素的相关性

, figureFileSmall=null, figureFileBig=null, tableContent=
因素膳食n-3PUFAχ2P值
Q1,n(%)Q2,n(%)Q3,n(%)Q4,n(%)
性别20.703<0.001
男性140(37.04)155(41.01)169(44.71)199(52.79)
女性238(62.96)223(58.99)209(55.29)178(47.21)
年龄(岁)9.8200.020
<60164(43.39)199(52.65)199(52.65)199(52.79)
≥60214(56.61)179(47.35)179(47.35)178(47.21)
婚姻13.1830.004
已婚310(82.01)320(84.67)323(85.45)343(90.98)
未婚、离异、丧偶68(17.99)58(15.33)55(14.55)34(9.02)
文化程度52.909<0.001
小学以下98(25.93)74(19.58)48(12.70)38(10.08)
小学195(51.59)199(52.65)199(52.65)202(53.58)
初中48(12.70)72(19.04)89(23.54)85(22.55)
高中及以上37(9.79)33(8.73)42(11.11)52(13.79)
吸烟6.4750.091
否303(80.16)296(78.31)291(76.98)274(72.68)
是75(19.84)82(21.69)87(23.02)103(27.32)
饮酒5.7240.126
否313(82.80)310(82.01)296(78.31)290(76.92)
是65(17.20)68(17.99)82(21.69)87(23.08)
体育锻炼4.7180.194
否338(89.42)353(93.39)338(89.42)341(90.45)
是40(10.58)25(6.61)40(10.58)36(9.55)
糖尿病家族史9.4140.024
否372(98.41)366(96.83)358(94.71)358(94.96)
是6(1.59)12(3.17)20(5.29)19(5.04)
BMI(kg/m2)2.1570.989
<18.512(3.17)10(2.65)9(2.38)8(2.12)
18.5~23.9171(45.24)166(43.92)170(44.97)162(42.97)
24.0~27.9133(35.19)139(36.77)141(37.30)147(38.99)
≥28.062(16.40)63(16.67)58(15.34)60(15.92)
高血压6.4640.091
否208(55.03)217(57.41)228(60.31)194(51.46)
是170(44.97)161(42.59)150(39.69)183(48.54)
血脂异常4.8240.185
否236(62.43)261(69.05)236(62.43)243(64.46)
是142(37.57)117(30.95)142(37.57)134(35.54)
), ArticleFig(id=1240633247747600586, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633240537592697, language=EN, label=Table 3, caption=

Association analysis of n-3 PUFA, animal source n-3 PUFA, and plant source n-3 PUFA with Type 2 Diabetes

, figureFileSmall=null, figureFileBig=null, tableContent=
n-3多不饱和脂肪酸OR(95%CI)
Q1Q2Q3Q4
总n-3 PUFA
未调整模型a10.94(0.65~1.38)1.35(0.94~1.94)1.10(0.76~1.59)
模型1b11.00(0.68~1.47)1.45(1.00~2.08)1.17(0.80~1.70)
模型2c10.89(0.56~1.42)1.04(0.59~1.83)0.63(0.31~1.28)
动物性来源n-3 PUFA
未调整模型a10.61(0.42~0.88)0.72(0.50~1.04)0.93(0.65~1.31)
模型1b10.64(0.44~0.94)0.80(0.56~1.16)1.04(0.73~1.48)
模型2c10.66(0.44~0.98)0.85(0.58~1.26)1.09(0.72~1.66)
植物性来源n-3 PUFA
未调整模型a10.96(0.66~1.41)1.29(0.90~1.85)1.06(0.73~1.54)
模型1b11.00(0.69~1.47)1.35(0.93~1.94)1.12(0.77~1.63)
模型2c10.81(0.51~1.30)0.83(0.46~1.48)0.48(0.24~0.98)
), ArticleFig(id=1240633247856652500, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633240537592697, language=CN, label=表3, caption=

n-3 PUFA、动物性来源n-3 PUFA、植物性来源n-3 PUFA与T2DM的关联性分析

, figureFileSmall=null, figureFileBig=null, tableContent=
n-3多不饱和脂肪酸OR(95%CI)
Q1Q2Q3Q4
总n-3 PUFA
未调整模型a10.94(0.65~1.38)1.35(0.94~1.94)1.10(0.76~1.59)
模型1b11.00(0.68~1.47)1.45(1.00~2.08)1.17(0.80~1.70)
模型2c10.89(0.56~1.42)1.04(0.59~1.83)0.63(0.31~1.28)
动物性来源n-3 PUFA
未调整模型a10.61(0.42~0.88)0.72(0.50~1.04)0.93(0.65~1.31)
模型1b10.64(0.44~0.94)0.80(0.56~1.16)1.04(0.73~1.48)
模型2c10.66(0.44~0.98)0.85(0.58~1.26)1.09(0.72~1.66)
植物性来源n-3 PUFA
未调整模型a10.96(0.66~1.41)1.29(0.90~1.85)1.06(0.73~1.54)
模型1b11.00(0.69~1.47)1.35(0.93~1.94)1.12(0.77~1.63)
模型2c10.81(0.51~1.30)0.83(0.46~1.48)0.48(0.24~0.98)
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重庆市居民膳食n-3多不饱和脂肪酸摄入与2型糖尿病相关性研究
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赖英旭 1, 2 , 罗书全 2 , 陈京蓉 2 , 李继斌 1
现代预防医学 | 营养与食品卫生 2024,51(10): 1780-1786
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现代预防医学 | 营养与食品卫生 2024, 51(10): 1780-1786
重庆市居民膳食n-3多不饱和脂肪酸摄入与2型糖尿病相关性研究
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赖英旭1, 2, 罗书全2, 陈京蓉2, 李继斌1
作者信息
  • 1.重庆医科大学公共卫生学院，重庆 400016
  • 2.重庆市疾病预防控制中心

    • 赖英旭（1999—），男，硕士在读，研究方向：营养与慢性病

通讯作者:

李继斌，E-mail：
Associations of dietary intake of n-3 polyunsaturated fatty acids and type 2 diabetes in residents of Chongqing City
Ying-xu LAI1, 2, Shu-quan LUO2, Jing-rong CHEN2, Ji-bin LI1
Affiliations
  • School of Public Health, Chongqing Medical University, Chongqing, Chongqing 400016, China
出版时间: 2024-05-25 doi: 10.20043/j.cnki.MPM.202311190
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摘要
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目的

分析重庆市居民膳食n-3多不饱和脂肪酸与2型糖尿病发病关系，为2型糖尿病防治措施提供参考。

方法

利用中国居民营养与健康随访研究（2021）CNNHS在重庆市收集的横断面调查数据，结合中国食物成分表计算能量与营养素摄入量，使用单因素和多因素Logistic回归模型分析n-3多不饱和脂肪酸摄入与2型糖尿病的关联。

结果

本次研究最终纳入1 511例研究对象，2型糖尿病患者共280例，占18.80%。与动物性来源n-3多不饱和脂肪酸最低四分位数的研究对象相比，较高四分位数研究对象患糖尿病的风险更低（OR=0.61，95%CI：0.42~0.88），调整后的模型1与模型2结果相似（模型1，OR=0.64，95%CI：0.44~0.94；模型2，OR=0.66，95%CI：0.44~0.98）。其中，模型2中摄入植物性来源n-3多不饱和脂肪酸较高者患糖尿病的风险更低（OR=0.48，95%CI：0.24~0.98）。

结论

膳食中动物性来源n-3 PUFA和植物性来源n-3 PUFA与2型糖尿病发病呈负相关，动物性来源n-3 PUFA与2型糖尿病相关性在调整混杂因素后减弱，但摄入植物性来源n-3 PUFA较高对糖尿病发病的保护作用最强。

n-3多不饱和脂肪酸  /  2型糖尿病  /  横断面研究
Objective

To analyze the relationship between dietary intake of n-3 polyunsaturated fatty acids (n-3 PUFA) and the incidence of type 2 diabetes mellitus (T2DM) among residents in selected districts of Chongqing,and to provide recommendations for the prevention of T2DM.

Methods

Using cross-sectional survey data collected in Chongqing as part of the 2021 China National Nutrition and Health Survey (CNNHS), and in combination with energy and nutrient intake calculated from the Chinese Food Composition Tables, single-factor and multi-factor Logistic regression models were employed to investigate the association between n-3 PUFA intake and the incidence of T2DM.

Results

This study included a total of 1 511 participants, of which 280 were diagnosed with T2DM, accounting for 18.80% of the total. When compared to participants in the lowest quartile of animal-derived n-3 PUFA intake, those in the highest quartile had a significantly lower risk of developing T2DM (OR=0.61, 95%CI: 0.42-0.88). The results from adjusted Model 1 were consistent with those of Model 2 (Model 1: OR=0.64, 95%CI: 0.44-0.94; Model 2: OR=0.66, 95%CI: 0.44-0.98). Notably, in Model 2, the risk of developing T2DM was even lower in the Q4 group of plant-derived n-3 PUFA compared to Q1 (OR=0.48, 95%CI: 0.24-0.98).

Conclusion

The dietary intake of animal-derived n-3 PUFA and plant-derived n-3 PUFA is negatively correlated with the incidence of T2DM. The association between animal-derived n-3 PUFA and T2DM weakens after adjusting for confounding factors, with the highest quartile of plant-derived n-3 PUFA showing the strongest protective effect against T2DM.

n-3 polyunsaturated fatty acids  /  Type 2 diabetes mellitus  /  Cross-sectional study
赖英旭, 罗书全, 陈京蓉, 李继斌. 重庆市居民膳食n-3多不饱和脂肪酸摄入与2型糖尿病相关性研究. 现代预防医学, 2024 , 51 (10) : 1780 -1786 . DOI: 10.20043/j.cnki.MPM.202311190
Ying-xu LAI, Shu-quan LUO, Jing-rong CHEN, Ji-bin LI. Associations of dietary intake of n-3 polyunsaturated fatty acids and type 2 diabetes in residents of Chongqing City[J]. Modern Preventive Medicine, 2024 , 51 (10) : 1780 -1786 . DOI: 10.20043/j.cnki.MPM.202311190
正文
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2型糖尿病(type 2 diabetes mellitus,T2DM)是一种主要以胰岛素抵抗为特征的代谢性疾病，已成为全球关注的公共卫生问题。据2021年的统计数据，全球20~79岁人群的糖尿病患病率估计为 10.5%，到2045年将上升到12.2%[1]。在中国，现约有1.41亿糖尿病患者[2]。T2DM的发病主要涉及遗传、环境和其他危险因素之间的复杂相互作用，膳食因素在其中发挥着关键作用，已有多项研究[3-5]提供了营养素和膳食模式在T2DM发病中的影响。
n-3多不饱和脂肪酸（n-3 polyunsaturated fatty acids, n-3 PUFA），通常被称为Omega-3脂肪酸，长期以来一直是备受关注的必须脂肪酸之一。这类脂肪酸主要包括α-亚麻酸（alpha-linolenic acid, ALA）、二十碳五烯酸（eicosapentaenoic acid, EPA）和二十二碳六烯酸（docosahexaenoic acid, DHA）。ALA主要存在于植物性食品如亚麻籽和核桃中。而EPA和DHA主要来源于海洋生物，尤其是深海鱼类，这些脂肪酸也可以通过膳食补充剂的形式摄入。由于Omega-3脂肪酸具有多种生理功能，已有研究提供了关于其对T2DM有益影响的证据[6-7]。然而，在一些研究中，没有发现明显的关联[8]。基于以上背景，本文旨在探讨Omega-3脂肪酸与T2DM之间的关系，研究膳食摄入Omega-3脂肪酸对T2DM发病的影响。
1　对象与方法
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1.1　资料来源
数据来源于重庆市2021年中国居民营养与健康随访研究（CNNHS），CNNHS采用多阶段整群随机抽样方法，在重庆选取了江津区、奉节县两个监测点，每个监测点抽取6个村居委，每个村居委抽取75户居民，对其中的25户进行食物频率问卷调查，此外还进行了问卷调查、体格检测等。排除了①患有重大身体、精神疾患。②经动员后仍不愿参与者。调查对象均签署了知情同意书。本项目通过中国疾病预防控制中心营养与健康所伦理审查（2021-011）。
1.2　研究对象
2021年参加中国居民营养与健康随访研究的1 708名重庆市居民。本研究根据以下条件标准排除研究对象：①膳食、生化数据缺失者。②能量摄入异常，日均能量摄入≥5 500 kcal/d或≤400 kcal/d。③怀孕或哺乳期女性。共剔除197人，最后纳入1 511名研究对象。
1.3　研究方法
1.3.1　膳食调查
经由通过统一培训的专业人员入户进行一对一家庭询问调查，采用食物频率问卷（Food Frequency Questionnaire,FFQ）收集研究对象过去12个月12大类75项常见食物类别的摄入情况，根据食物摄入频率和每次食物量得出日均食物摄入量，结合中国食物成分表计算研究对象能量、宏量营养素及脂肪酸摄入量。家庭食用油的摄入量通过询问获得。
1.3.2　非膳食调查
非膳食调查内容包括：①一般人口学统计资料包括性别、年龄等；②体格检查：身高、体重等；③生活习惯：饮酒、吸烟等；④疾病史；⑤生化指标检测：空腹血糖等。
1.3.3　2型糖尿病诊断标准
采用1999年WHO发布的T2DM诊断标准作为依据，符合下列条件之一则判定为T2DM：①空腹血糖≥7.0 mmol/L。②口服葡萄糖耐量试验2h血糖≥11.1 mmol/L。③自我报告既往被社区/乡镇以上医院诊断为2型糖尿病。
1.3.4　统计学分析
采用Stata 17.0统计软件进行分析。服从正态性的计量资料以描述，两组间差异使用t检验，多组间差异使用单因素方差分析。不符合正态分布的计量资料使用中位数及四分位数表示，采用Wilcoxon秩和检验进行组间比较。分类变量以频数或构成比表示，组间差异采用χ2检验。根据n-3多不饱和脂肪酸的摄入量由低到高以四分位（Q1~Q4）表示，使用Logistic回归模型，以T2DM作为因变量，n-3多不饱和脂肪酸作为自变量，校正T2DM危险因素，计算OR值和95%CI。检验水准α=0.05。
1.3.5　质量控制
①问卷调查：国家级项目组对调查方案与问卷进行了论证与修订，并进行预调查，省级质控组对调查进行质量控制，具有专业资质人员经统一培训后入户进行面对面询问调查。②膳食调查：采用食物频率问卷法入户进行膳食调查，调查完成后由调查人员补充食物编码及其他信息，并核准内容。③体格测量：由社区医院对调查对象集中进行测量，体成分指标使用便携式体成分测量仪测量（InBody H20B）进行测量。④生化指标：实验室负责人组织完成现场检测项目质控品的考核，除全血血红蛋白由随访点实验室检测外，其余指标均由国家级实验室统一检测。
2　结果
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2.1　研究对象基本情况
本研究共纳入1 511名研究对象，其中男性663例，占43.88%，女性848例，占56.12%。年龄范围为18~94岁，平均年龄（59.84±14.22）岁。男性平均年龄（60.13±14.61）岁，女性平均年龄（59.62±13.91）岁。两组在年龄、BMI、糖尿病家族史、血脂异常、吸烟和饮酒习惯方面存在统计学差异（P<0.05）。性别、婚姻状况、文化程度、体育锻炼和高血压患病上，两组间差异无统计显著性。结果见表1。
2.2　膳食n-3多不饱和脂肪酸摄入情况
本研究人群总能量与总n-3 PUFA日均摄入量分别为（1 892.09±875.53） kcal、（5.66±3.53） g/d。单因素分析结果显示，不同性别、年龄、婚姻状况、文化程度、糖尿病家族史的研究对象n-3 PUFA摄入存在显著差异。结果见表2。
2.3　膳食n-3 PUFA与罹患2型糖尿病的关联
在未调整协变量的模型中，与动物性来源n-3 PUFA最低四分位数的研究对象相比，较高四分位数研究对象患T2DM的风险更低(OR=0.61,95%CI:0.42~0.88)，在调整了模型1（仅调整年龄）和模型2（调整了性别、体质指数、是否饮酒、是否吸烟、糖尿病家族史、婚姻状况、是否锻炼、教育水平、区域、甘油三酯、能量）中同样发现了类似的结果(模型1：OR=0.64,95%CI:0.44~0.94;模型2：OR=0.66,95%CI:0.44~0.98)。模型2中，与Q1相比，Q4组植物性来源n-3 PUFA患T2DM的风险更低(OR=0.48,95%CI:0.24~0.98)。虽然在完全调整模型中发现最高四分位数n-3 PUFA与最低分位数相比显示最高四分位数n-3多不饱和脂肪酸是T2DM发病的保护因素，但是没有显著性(OR=0.63,95%CI:0.31~1.28)。见表3。
3　讨论
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在2017年发布的中国2型糖尿病合并血脂异常防治专家共识中提到增加蔬菜水果粗纤维食物以及富含n-3 PUFA的鱼类的摄入有助于T2DM患者的血脂管理[9]。本研究发现膳食中动物性来源n-3 PUFA和植物性来源n-3 PUFA与T2DM发病呈负相关，动物性来源n-3 PUFA与T2DM的这种关联在调整混杂因素后减弱，在最高四分位数水平上并未发现与T2DM发病存在关联。最高四分位数植物性来源n-3 PUFA对T2DM发病的保护作用最强。而在总的n-3 PUFA中没有发现与T2DM发病的关联。
已有研究证实膳食n-3 PUFA摄入对心血管疾病具有保护作用，但与T2DM的关系仍具争论。在一项社区人群研究中[10]，在调整混杂因素后，结果发现超重/肥胖女性n-3 PUFA摄入水平与糖尿病呈负向关联。Jiang等人[11]分析了美国人群中n-3 PUFA各亚型摄入与T2DM风险间的关系，发现与摄入量最低分位数组相比，EPA、DHA及ALA最高分位数组的T2DM风险分别下降了32%、18%与57%。但在另一项关于中国人群的队列研究[12]中发现，摄入海洋来源n-3 PUFA与T2DM风险增加相关。荟萃分析[13]结果还表明补充鱼油对被发现只对T2DM患者血脂控制有利，而并未改善血糖水平。以上研究所得结论不同可能是由于膳食结构不同造成的。本研究结果支持EPA和DHA摄入量与较低T2DM风险有关。
根据本研究的发现，Q2组动物性来源 n-3 PUFA 与T2DM发病呈负相关。然而，随着动物性来源 n-3 PUFA 摄入水平的进一步增加，在Q3与Q4组中并未观察到动物性来源 n-3 PUFA 与T2DM发病的关联。这暗示在动物性来源 n-3 PUFA 摄入水平增加的同时，可能存在其他因素对其保护作用产生削弱效应。考虑到动物性来源 n-3 PUFA 主要来自水产品，而水产品往往受到不同程度的重金属污染，其中包括汞等物质[14]。这可能解释了为什么在更高摄入水平的动物性来源 n-3 PUFA 中未能观察到其与T2DM发病的相关性。此观点得到了Wang等人的研究支持[15]，他们发现血液中高金属水平与妊娠期糖尿病风险增加有关，其中汞是主要驱动因素，而镍、铅和砷在一定程度上也有影响。因此，这可能表明动物性来源 n-3 PUFA 摄入量增加所带来的汞摄入增加可能导致其保护作用降低，进而未能在更高摄入水平上观察到其与T2DM发病的关联。
一项针对挪威女性的大型前瞻性队列研究[16]结果与本研究相似，显示最高摄入水平下的n-3 PUFA（≥0.40 g/d）与T2DM风险无关（HR=1.08,95%CI: 0.95~1.23），但瘦鱼类摄入与T2DM风险降低有关（HR=0.71,95%CI: 0.53~0.95）。
ALA与T2DM的关系也存在争议。一项分析ALA与T2DM关系的系统评价发现ALA与空腹胰岛素增加约7%有关，但未发现与T2DM发病间的关联[17]。而另在一项荟萃分析[18]中，研究者发现ALA与T2DM发病风险降低有关（RR=0.955,95%CI: 0.930~0.983）。此外，在近期发表的一项n-3 PUFA与多种心血管疾病关系的研究[19]中，研究人员同样发现了ALA与T2DM存在的负向关联。有研究[20]通过补充鱼油对肥胖和超重人群进行为期12周的干预，发现能够通过鱼油的摄入能够减少与胰岛素抵抗相关的激酶从而减轻胰岛素抵抗，降低T2DM发病风险。本研究结果发现植物性来源n-3 PUFA，ALA与T2DM负相关，与上述研究结论一致。
有关n-3 PUFA影响T2DM发病的机制仍未完全阐明，其对机体的抗炎作用可能是重要原因，作用机制包括抑制炎症基因表达、调节信号通路和受体的相互作用。n-3 PUFA能够抑制炎症基因的表达。富含亚麻籽油的饮食能够通过抗炎和调节大鼠肠道微生物群降低T2DM的严重程度[21]。朱媛媛等人[22]发现高脂亚麻籽油喂养的小鼠与其他种类高脂喂养小鼠相比血糖水平显著下降，同时还下调了TLR4等炎症通路相关基因的表达。TLR4信号通路在代谢性炎症与胰岛素抵抗中起着关键作用，针对TLR4和AP1的抗炎干预可以改善小鼠高脂饮食引起的系统性和肝脏炎症、肥胖和胰岛素抵抗[23-25]。此外，EPA和DHA具有显著的抗炎作用，能够通过NF-κB和MAPKs通路抑制巨噬细胞炎症基因如COX-2、INOS、IL-6和IL-1β等的表达并减少巨噬细胞中NO的生成进而调节炎症[26-29]。n-6/n-3 PUFA比例与T2DM间的关系也受到了人们的关注，其中，较低的n-6/n-3 PUFA比例可能对健康有益[30-32]。Fu等探讨了膳食中n-6/n-3 PUFA比例与妊娠期糖尿病发生风险之间的关系[33]，结果发现相较于对照组，GDM组的n-6/n-3 PUFA比例更高，且有显著差异，高n-6/n-3 PUFA比例与妊娠期糖尿病的关联是显著的（OR=4.29,95%CI: 1.30~14.12）。在另一项荟萃分析中[34]，结果显示低比例n-6/n-3 PUFA膳食干预降低了血清胰岛素水平和胰岛素抵抗指数。Yue等人[35]研究了不同比例n-6/n-3 PUFA对小鼠棕色脂肪组织和T2DM的影响，发现在小鼠中较低的n-6/n-3 PUFA饮食可以通过激活棕色脂肪组织来改善T2DM的相关症状。
本研究是一项横断面研究，不能揭示n-3 PUFA与T2DM发病的因果关系。本研究人群均来自重庆周边区县，经济水平较低，不能反映总人群特点，因此还需更大样本队列研究来揭示n-3 PUFA与T2DM发病间的因果关系。此外，由于本研究中的居民摄入食用油数据是通过询问法而非称重法获得的，因此在计算食用油摄入量时还存在一定偏差。
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  • 国家卫健委微量元素与营养重点实验室(wlkfz202206)
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2024年第51卷第10期
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doi: 10.20043/j.cnki.MPM.202311190
  • 接收时间：2023-11-09
  • 首发时间：2026-03-17
  • 出版时间：2024-05-25
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  • 收稿日期：2023-11-09
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    1.重庆医科大学公共卫生学院，重庆 400016
    2.重庆市疾病预防控制中心

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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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