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Article(id=1241067204658131908, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241067197318091153, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202411508, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1732636800000, receivedDateStr=2024-11-27, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773823079503, onlineDateStr=2026-03-18, pubDate=1741536000000, pubDateStr=2025-03-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773823079503, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773823079503, creator=13701087609, updateTime=1773823079503, updator=13701087609, issue=Issue{id=1241067197318091153, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='5', pageStart='769', pageEnd='960', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773823077754, creator=13701087609, updateTime=1773823268053, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241067995544482681, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241067197318091153, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241067995544482682, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241067197318091153, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=795, endPage=800, ext={EN=ArticleExt(id=1241067207719972926, articleId=1241067204658131908, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Study on the impact of serum vitamin C levels on metabolic syndrome in adults, columnId=1240413921954295836, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the impact of serum vitamin C levels on metabolic syndrome in adults based on NHANES 2017-2018 data.

Methods

A total of 2 094 adults from the NHANES 2017-2018 dataset were included, with serum vitamin C levels as the primary exposure variable and metabolic syndrome, diagnosed according to the standards of the International Diabetes Federation and the American Heart Association, as the outcome variable. A multivariable logistic regression model was utilized to analyze the association between these variables, with subgroup analyses conducted for gender, age, and other factors.

Results

The risk of metabolic syndrome decreased with increasing serum vitamin C levels (P trend < 0.001). Compared to the lowest quartile of serum vitamin C levels (Q1), the highest quartile (Q4) exhibited a relatively lower risk of metabolic syndrome (OR=0.66, 95%CI:0.48-0.92). Subgroup analyses by gender and age indicated a more pronounced protective effect in women and individuals under 50 years of age; women in the highest serum vitamin C level group had a lower risk of metabolic syndrome (Q4 group: OR=0.42,95%CI: 0.28-0.63). Additionally, individuals under 50 years of age in the second and highest serum vitamin C level groups also had reduced risks of metabolic syndrome (Q3 group: OR=0.41, 95%CI: 0.25-0.68; Q4 group: OR=0.19, 95%CI: 0.13-0.30).

Conclusion

This study suggests that higher serum vitamin C levels may be associated with a lower risk of metabolic syndrome in adults, with a more pronounced effect observed in women and individuals under 50 years of age.

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目的

基于NHANES 2017—2018数据探讨血清维生素C水平对成年人代谢综合征的影响。

方法

以来自NHANES 2017—2018数据集中的2 094名成年人为研究对象，以血清维生素C水平为主要暴露变量，以国际糖尿病联盟和美国心脏协会的标准诊断的代谢综合征为结局变量，采用多变量logistic回归模型分析二者的关联，并对性别、年龄等进行亚组分析。

结果

代谢综合征风险随着血清维生素C水平升高而降低（P趋势<0.001），与血清维生素C水平最低四分位数（Q1）组相比，最高四分位数（Q4）组的代谢综合征风险相对较低（OR=0.66, 95%CI: 0.48～0.92）。性别和年龄亚组分析表明：女性和50岁以下年龄组人群中保护效应更明显；血清维生素C水平最高组的女性代谢综合征风险较低（Q4组：OR=0.42, 95%CI: 0.28～0.63）；血清维生素C水平次高和最高的50岁以下年龄组人群的代谢综合征风险较低（Q3组：OR=0.41, 95%CI: 0.25～0.68；Q4组：OR=0.19, 95%CI: 0.13～0.30）。

结论

本研究表明，较高的血清维生素C水平可能与较低的成年人代谢综合征风险相关，该效应在女性和50岁以下群体中更为明显。

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成果，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=y2jtPXQpRDn5BLa7S/65Yg==, magXml=zM1uCX1Zhle8htE4QCU8ug==, pdfUrl=null, pdf=5IRZqvZYqCq0WwWANEUIqw==, pdfFileSize=612007, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=WvihUmsv3uhCSfSQ1wxPIQ==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=iPzoYgMkl2+fX/G8rSXW8w==, mapNumber=null, authorCompany=null, fund=null, authors=

张吕宁（1999—），男，硕士在读，研究方向：营养与食品卫生学

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张吕宁（1999—），男，硕士在读，研究方向：营养与食品卫生学

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Characteristics of the study population ［M（P25，P75），n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
特征总计 (n=2 094)是否患有MS统计量P值
否（n=1 312）是（n=782）
年龄（岁）50 (33, 62)46 (30, 59)56 (44, 68)15.20<0.001
性别16.80<0.001
男性1 027 (49.04)657 (50.10)370 (47.31)
女性1 067 (50.96)655 (49.90)412 (52.69)
种族24.39<0.001
墨西哥裔美国人314 (15.00)172 (13.11)142 (18.16)
其他西班牙裔186 (8.88)103 (7.85)83 (10.61)
非西班牙裔黑人470 (22.45)325 (24.77)145 (18.54)
非西班牙裔白人718 (34.29)441 (33.62)277 (35.42)
其他种族406 (19.38)271 (20.65)135 (17.26)
婚姻状况35.60<0.001
已婚/同居1 249 (59.65)780 (59.48)469 (59.85)
丧偶/离婚/分居451 (21.54)241 (18.37)210 (26.86)
未婚394 (18.81)291 (22.18)103 (13.18)
教育程度44.02<0.001
高中以下341 (16.29)209 (15.93)132 (16.88)
高中474 (22.64)285 (21.72)189 (24.17)
高中以上1 279 (61.07)818 (62.34)461 (59.08)
家庭每月贫困水平4.490.106
≤1.3600 (28.66)358 (27.29)242 (30.95)
1.3～1.85346 (16.52)212 (16.16)134 (17.13)
>1.851 148 (54.82)742 (56.55)406 (51.92)
BMI（kg/m2）19.54<0.001
<25534 (25.52)377 (28.75)157 (20.08)
25～30789 (37.69)497 (37.89)292 (37.35)
≥30771 (36.79)438 (33.36)333 (42.58)
吸烟状况23.62<0.001
是1 212 (57.87)813 (61.97)399 (51.02)
否882 (42.13)499 (38.03)383 (48.98)
饮酒状况0.320.850
是1 809 (86.39)1 130 (86.12)679 (86.83)
否285 (13.61)190 (13.88)103 (13.17)
体力活动83.73<0.001
有532 (25.42)422 (32.18)110 (14.07)
无1 562 (74.58)890 (67.82)672 (85.93)
高血压187.11<0.001
是465 (22.21)165 (12.58)300 (38.39)
否1 629 (77.79)1 147 (87.42)482 (61.61)
糖尿病196.91<0.001
是398 (19.01)127 (9.68)271 (34.65)
糖尿病前期1 287 (61.47)829 (63.20)458 (58.57)
否409 (19.52)356 (27.12)53 (6.78)
血清维生素C水平（mg/L）40.99<0.001
Q1 (0.30～5.17)524 (25.02)288 (21.95)236 (30.18)
Q2 (5.17 ～8.81)524 (25.02)299 (22.79)225 (28.78)
Q3 (8.81～11.40)523 (24.97)355 (27.07)168 (21.49)
Q4 (11.40～63.20)523 (24.97)370 (28.20)153 (19.56)
), ArticleFig(id=1241067221716365929, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067204658131908, language=CN, label=表1, caption=

研究人群特征［M（P25，P75），n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
特征总计 (n=2 094)是否患有MS统计量P值
否（n=1 312）是（n=782）
年龄（岁）50 (33, 62)46 (30, 59)56 (44, 68)15.20<0.001
性别16.80<0.001
男性1 027 (49.04)657 (50.10)370 (47.31)
女性1 067 (50.96)655 (49.90)412 (52.69)
种族24.39<0.001
墨西哥裔美国人314 (15.00)172 (13.11)142 (18.16)
其他西班牙裔186 (8.88)103 (7.85)83 (10.61)
非西班牙裔黑人470 (22.45)325 (24.77)145 (18.54)
非西班牙裔白人718 (34.29)441 (33.62)277 (35.42)
其他种族406 (19.38)271 (20.65)135 (17.26)
婚姻状况35.60<0.001
已婚/同居1 249 (59.65)780 (59.48)469 (59.85)
丧偶/离婚/分居451 (21.54)241 (18.37)210 (26.86)
未婚394 (18.81)291 (22.18)103 (13.18)
教育程度44.02<0.001
高中以下341 (16.29)209 (15.93)132 (16.88)
高中474 (22.64)285 (21.72)189 (24.17)
高中以上1 279 (61.07)818 (62.34)461 (59.08)
家庭每月贫困水平4.490.106
≤1.3600 (28.66)358 (27.29)242 (30.95)
1.3～1.85346 (16.52)212 (16.16)134 (17.13)
>1.851 148 (54.82)742 (56.55)406 (51.92)
BMI（kg/m2）19.54<0.001
<25534 (25.52)377 (28.75)157 (20.08)
25～30789 (37.69)497 (37.89)292 (37.35)
≥30771 (36.79)438 (33.36)333 (42.58)
吸烟状况23.62<0.001
是1 212 (57.87)813 (61.97)399 (51.02)
否882 (42.13)499 (38.03)383 (48.98)
饮酒状况0.320.850
是1 809 (86.39)1 130 (86.12)679 (86.83)
否285 (13.61)190 (13.88)103 (13.17)
体力活动83.73<0.001
有532 (25.42)422 (32.18)110 (14.07)
无1 562 (74.58)890 (67.82)672 (85.93)
高血压187.11<0.001
是465 (22.21)165 (12.58)300 (38.39)
否1 629 (77.79)1 147 (87.42)482 (61.61)
糖尿病196.91<0.001
是398 (19.01)127 (9.68)271 (34.65)
糖尿病前期1 287 (61.47)829 (63.20)458 (58.57)
否409 (19.52)356 (27.12)53 (6.78)
血清维生素C水平（mg/L）40.99<0.001
Q1 (0.30～5.17)524 (25.02)288 (21.95)236 (30.18)
Q2 (5.17 ～8.81)524 (25.02)299 (22.79)225 (28.78)
Q3 (8.81～11.40)523 (24.97)355 (27.07)168 (21.49)
Q4 (11.40～63.20)523 (24.97)370 (28.20)153 (19.56)
), ArticleFig(id=1241067221829612144, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067204658131908, language=EN, label=Table 2, caption=

Logistic analysis of serum vitamin C level and metabolic syndrome in adults

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变量模型1模型2模型3
OR(95%CI)P值OR(95%CI)P 值OR(95%CI)P 值
Q1refrefref
Q20.92 (0.72～1.17)0.4941.06 (0.79～1.43)0.7051.00 (0.73～1.36)0.982
Q30.58 (0.45～0.74)<0.0010.69 (0.51～0.93)0.0170.69 (0.51～0.95)0.023
Q40.50 (0.39～0.65)<0.0010.63 (0.46～0.86)0.0040.66 (0.48～0.92)0.014
P 趋势<0.001<0.0010.002
), ArticleFig(id=1241067222001578613, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067204658131908, language=CN, label=表2, caption=

血清中维生素C水平与成年人MS的logistic回归分析

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变量模型1模型2模型3
OR(95%CI)P值OR(95%CI)P 值OR(95%CI)P 值
Q1refrefref
Q20.92 (0.72～1.17)0.4941.06 (0.79～1.43)0.7051.00 (0.73～1.36)0.982
Q30.58 (0.45～0.74)<0.0010.69 (0.51～0.93)0.0170.69 (0.51～0.95)0.023
Q40.50 (0.39～0.65)<0.0010.63 (0.46～0.86)0.0040.66 (0.48～0.92)0.014
P 趋势<0.001<0.0010.002
), ArticleFig(id=1241067222173545084, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067204658131908, language=EN, label=Table 3, caption=

Analysis of the correlation between serum vitamin C and metabolic syndrome in different gender, age and BMI

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分组Q1Q2 OR（95%CI）P值Q3 OR（95%CI）P值Q4 OR（95%CI）P值交互作用P值
性别0.117
男性ref0.73 (0.49～1.08)0.6470.56 (0.39～1.81)0.8170.72 (0.43～1.21)0.259
女性ref1.01 (0.68～1.50)0.9760.78 (0.54～1.13)0.9940.42 (0.28～0.63)0.001
年龄（岁）<0.001
<50ref0.71 (0.48～1.04)0.3820.41 (0.25～0.68)<0.0010.19 (0.13～0.30)<0.001
≥50ref1.85 (1.19～2.86)0.0031.46 (0.92～2.33)0.2750.86 (0.52～1.42)0.403
BMI（kg/m2）0.091
<25ref0.57 (0.30～1.07)0.0820.68 (0.37～1.21)0.1901.40 (0.81～2.40)0.227
25～30ref0.72 (0.36～1.41)0.3460.69 (0.34～1.35)0.2850.60 (0.29～1.18)0.143
≥30ref0.68 (0.46～1.01)0.0600.96 (0.66～1.40)0.8351.06 (0.74～1.52)0.749
), ArticleFig(id=1241067222290985605, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067204658131908, language=CN, label=表3, caption=

不同性别、年龄、BMI血清维生素C与MS的相关性分析

, figureFileSmall=null, figureFileBig=null, tableContent=
分组Q1Q2 OR（95%CI）P值Q3 OR（95%CI）P值Q4 OR（95%CI）P值交互作用P值
性别0.117
男性ref0.73 (0.49～1.08)0.6470.56 (0.39～1.81)0.8170.72 (0.43～1.21)0.259
女性ref1.01 (0.68～1.50)0.9760.78 (0.54～1.13)0.9940.42 (0.28～0.63)0.001
年龄（岁）<0.001
<50ref0.71 (0.48～1.04)0.3820.41 (0.25～0.68)<0.0010.19 (0.13～0.30)<0.001
≥50ref1.85 (1.19～2.86)0.0031.46 (0.92～2.33)0.2750.86 (0.52～1.42)0.403
BMI（kg/m2）0.091
<25ref0.57 (0.30～1.07)0.0820.68 (0.37～1.21)0.1901.40 (0.81～2.40)0.227
25～30ref0.72 (0.36～1.41)0.3460.69 (0.34～1.35)0.2850.60 (0.29～1.18)0.143
≥30ref0.68 (0.46～1.01)0.0600.96 (0.66～1.40)0.8351.06 (0.74～1.52)0.749
), ArticleFig(id=1241067222391648906, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067204658131908, language=EN, label=Table 4, caption=

Sensitivity analysis of the association between serum vitamin C and metabolic syndrome

, figureFileSmall=null, figureFileBig=null, tableContent=
分组增加慢性肾病变量去除饮酒变量增加慢性肾病变量和去除饮酒变量
OR(95%CI)P值OR(95%CI)P值OR(95%CI)P值
Q1refrefref
Q20.99(0.73～1.35)0.9820.99(0.73～1.35)0.9610.60(0.41～0.87)0.960
Q30.70(0.50～0.96)0.0240.69(0.50～0.95)0.0260.62(0.44～0.89)0.026
Q40.66(0.48～0.92)0.0140.66(0.48～0.92)0.0150.66(0.48～0.92)0.015
), ArticleFig(id=1241067222488117905, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067204658131908, language=CN, label=表4, caption=

血清维生素C与MS关联的敏感性分析

, figureFileSmall=null, figureFileBig=null, tableContent=
分组增加慢性肾病变量去除饮酒变量增加慢性肾病变量和去除饮酒变量
OR(95%CI)P值OR(95%CI)P值OR(95%CI)P值
Q1refrefref
Q20.99(0.73～1.35)0.9820.99(0.73～1.35)0.9610.60(0.41～0.87)0.960
Q30.70(0.50～0.96)0.0240.69(0.50～0.95)0.0260.62(0.44～0.89)0.026
Q40.66(0.48～0.92)0.0140.66(0.48～0.92)0.0150.66(0.48～0.92)0.015
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血清维生素C水平对成人代谢综合征的影响研究
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张吕宁 1 , 汪晓语 2 , 陈梦雪 2 , 李蕊瑞 1 , 熊静远 1 , 成果 2, 3
现代预防医学 | 流行病与统计方法 2025,52(5): 795-800
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现代预防医学 | 流行病与统计方法 2025, 52(5): 795-800
血清维生素C水平对成人代谢综合征的影响研究
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张吕宁1, 汪晓语2, 陈梦雪2, 李蕊瑞1, 熊静远1, 成果2, 3
作者信息
  • 1.四川大学华西公共卫生学院/华西第四医院，四川 成都 610041
  • 2.四川大学华西第二医院妇儿营养中心，四川 成都 610041
  • 3.四川大学华西护理学院，四川 成都 610041

    • 张吕宁（1999—），男，硕士在读，研究方向：营养与食品卫生学

通讯作者:

成果，E-mail:
Study on the impact of serum vitamin C levels on metabolic syndrome in adults
Lv-ning ZHANG1, Xiao-yu WANG2, Meng-xue CHEN2, Rui-rui LI1, Jing-yuan XIONG1, Guo CHENG2, 3
Affiliations
  • West China School of Public Health, Sichuan University / West China Fourth Hospital, Chengdu, Sichuan 610041, China
出版时间: 2025-03-10 doi: 10.20043/j.cnki.MPM.202411508
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摘要
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目的

基于NHANES 2017—2018数据探讨血清维生素C水平对成年人代谢综合征的影响。

方法

以来自NHANES 2017—2018数据集中的2 094名成年人为研究对象，以血清维生素C水平为主要暴露变量，以国际糖尿病联盟和美国心脏协会的标准诊断的代谢综合征为结局变量，采用多变量logistic回归模型分析二者的关联，并对性别、年龄等进行亚组分析。

结果

代谢综合征风险随着血清维生素C水平升高而降低（P趋势<0.001），与血清维生素C水平最低四分位数（Q1）组相比，最高四分位数（Q4）组的代谢综合征风险相对较低（OR=0.66, 95%CI: 0.48～0.92）。性别和年龄亚组分析表明：女性和50岁以下年龄组人群中保护效应更明显；血清维生素C水平最高组的女性代谢综合征风险较低（Q4组：OR=0.42, 95%CI: 0.28～0.63）；血清维生素C水平次高和最高的50岁以下年龄组人群的代谢综合征风险较低（Q3组：OR=0.41, 95%CI: 0.25～0.68；Q4组：OR=0.19, 95%CI: 0.13～0.30）。

结论

本研究表明，较高的血清维生素C水平可能与较低的成年人代谢综合征风险相关，该效应在女性和50岁以下群体中更为明显。

血清维生素C  /  代谢综合征  /  NHANES  /  相关性研究
Objective

To investigate the impact of serum vitamin C levels on metabolic syndrome in adults based on NHANES 2017-2018 data.

Methods

A total of 2 094 adults from the NHANES 2017-2018 dataset were included, with serum vitamin C levels as the primary exposure variable and metabolic syndrome, diagnosed according to the standards of the International Diabetes Federation and the American Heart Association, as the outcome variable. A multivariable logistic regression model was utilized to analyze the association between these variables, with subgroup analyses conducted for gender, age, and other factors.

Results

The risk of metabolic syndrome decreased with increasing serum vitamin C levels (P trend < 0.001). Compared to the lowest quartile of serum vitamin C levels (Q1), the highest quartile (Q4) exhibited a relatively lower risk of metabolic syndrome (OR=0.66, 95%CI:0.48-0.92). Subgroup analyses by gender and age indicated a more pronounced protective effect in women and individuals under 50 years of age; women in the highest serum vitamin C level group had a lower risk of metabolic syndrome (Q4 group: OR=0.42,95%CI: 0.28-0.63). Additionally, individuals under 50 years of age in the second and highest serum vitamin C level groups also had reduced risks of metabolic syndrome (Q3 group: OR=0.41, 95%CI: 0.25-0.68; Q4 group: OR=0.19, 95%CI: 0.13-0.30).

Conclusion

This study suggests that higher serum vitamin C levels may be associated with a lower risk of metabolic syndrome in adults, with a more pronounced effect observed in women and individuals under 50 years of age.

Serum vitamin C  /  Metabolic syndrome  /  NHANES  /  Correlation study
张吕宁, 汪晓语, 陈梦雪, 李蕊瑞, 熊静远, 成果. 血清维生素C水平对成人代谢综合征的影响研究. 现代预防医学, 2025 , 52 (5) : 795 -800 . DOI: 10.20043/j.cnki.MPM.202411508
Lv-ning ZHANG, Xiao-yu WANG, Meng-xue CHEN, Rui-rui LI, Jing-yuan XIONG, Guo CHENG. Study on the impact of serum vitamin C levels on metabolic syndrome in adults[J]. Modern Preventive Medicine, 2025 , 52 (5) : 795 -800 . DOI: 10.20043/j.cnki.MPM.202411508
正文
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代谢综合征（metabolic syndrome, MS）是一类以腹部肥胖、高血糖、高血压和异常脂质代谢为主要临床表现的代谢性疾病，与心血管疾病、2型糖尿病及其他代谢相关疾病的风险显著相关[1]。其发病率逐年上升，给全球医疗体系带来了沉重的经济负担[2]，为此，探索行之有效的营养干预策略具有重要的公共卫生学意义。
维生素C（抗坏血酸）是一种膳食来源的强效抗氧化剂[3]。多项研究表明，维生素C在维持代谢健康方面可能发挥重要作用[4]。尽管已有研究发现膳食维生素C与MS风险之间存在关联[5-6]，但与膳食数据相比，血清维生素C水平更能准确反映体内的实际维生素C水平，更能反映其与疾病的真实关联。因此，本研究旨在利用NHANES 2017—2018数据，探讨血清维生素C水平与成年人MS的相关性，以期为MS的防控提供参考。
1　材料与方法
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1.1　研究人群
本研究采用2017—2018年美国国家健康与营养调查（National Health and Nutrition Examination Survey, NHANES）数据，数据可以在NHANES官方网站（http://www.cdc.gov/nchs/nhanes.htm）免费获取。其中包含9 254名完成访谈和体检的参与者的数据，排除年龄小于18岁、血清维生素C数据或MS有关数据缺失的研究对象后，共纳入2 094名符合条件的研究对象，筛选流程见图1。
1.2　研究变量
NHANES调查通过问卷调查、体格检查、血液样本分析收集了研究对象的腰围、血压、空腹血糖以及血脂水平（甘油三酯和高密度脂蛋白胆固醇）信息。MS的诊断依据国际糖尿病联盟和美国心脏协会联合制定的诊断标准，具体为满足以下5项条件中的3项及以上：（1）腰围≥102 cm（男性）或≥88 cm（女性）；（2）血压≥130/85 mm Hg；（3）空腹血糖≥5.6 mmol/L；（4）甘油三酯≥1.7 mmol/L；（5）高密度脂蛋白胆固醇（HDL～C）<1.0 mmol/L（男性）或<1.3 mmol/L（女性）[7]。
血清维生素C测定采用等度超高效液相色谱（UPLC）结合电化学检测法，全部样品均由标准化方法采集和检测。
1.3　协变量评估
本研究中纳入的协变量包括性别、年龄、婚姻状况、种族、教育水平、家庭每月贫困水平类别、是否患有糖尿病、是否患有高血压、是否吸烟、身体质量指数（body mass index, BMI）、体力活动以及饮酒情况。
1.4　统计分析
本研究采用R软件的Mice包，用随机森林法插补缺失值（本研究的各变量的缺失数据占比均小于12%），将研究对象按照血清维生素C水平的四分位数值划分为四组，计算了不同血清维生素C水平组中MS的患病率。连续资料若符合正态分布则以（）表示，使用单因素方差分析或t检验比较组间差异，对不符合正态分布的连续资料采用［M（P25，P75）］进行描述；分类变量用频率频数和构成比表示，并使用χ2 检验或Fisher 确切概率法进行比较；等级资料采用Wilcoxon秩和检验分析。采用多变量logistic回归模型探讨血清维生素C水平与MS之间的关联，以最低四分位数组为参照。模型1未做协变量调整；模型2调整了性别、年龄、种族、教育水平、体力活动、吸烟状况、饮酒情况和BMI；模型3在模型2的基础上进一步调整了糖尿病和高血压。进一步对性别、年龄、BMI做了亚组分析，其中，以年龄中位数分年龄亚组，其年龄范围分别是18～50岁和51～80岁；参考世界卫生组织提出的BMI标准进行分组，由于体重过轻组人数较少（29人），遂以25 kg/m2和30 kg/m2为分界值，以BMI<25 kg/m2、25 kg/m2≤BMI<30 kg/m2、BMI≥30 kg/m2分为三组。本研究还进行了敏感性分析以评估结果的稳定性。所有分析均在R软件4.3.1版中进行，检验水准α=0.05。
2　结果
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2.1　纳入对象基线特征
本研究共纳入2 094名研究对象，年龄范围为18～80岁，中位年龄为50岁，女性1 067人（50.96%），男性1 027人（49.04%），其中有782人（37.34%）被诊断为MS。MS患者的血清维生素C水平（8.07 mg/L）显著低于非MS组（9.06 mg/L），年龄显著高于未患组（P<0.001），高血压和糖尿病的患病率高于未患组（均P<0.001），BMI、吸烟状况低于未患组（均P<0.001）。见表1。
2.2　血清中维生素C水平对成年人MS影响的多因素logistic回归分析
与血清维生素C最低四分位数（Q1）组相比，模型1中，最高四分位数（Q4）组的成年人MS的OR值为0.50（95%CI: 0.39～0.65, P<0.001），模型2中，Q4组的成年人MS的OR值为0.63（95%CI:0.46～0.86, P=0.004），模型3中，Q4组的成年人MS的OR值为0.66（95%CI: 0.48～0.92, P=0.014）。趋势性检验结果表明血清维生素C水平越高，MS的风险越低。见表2。
2.3　亚组分析
亚组分析发现，与血清维生素C Q1组相比，性别分层中，女性Q4组显著降低MS风险（OR=0.42, 95%CI: 0.28～0.63, P=0.001）。年龄分层中，50岁以下组中，Q3和Q4组分别显著降低MS风险（Q3组OR=0.41, 95%CI: 0.25～0.68, P<0.001；Q4组OR=0.19, 95%CI: 0.13～0.30, P<0.001）。交互作用分析结果显示，年龄可影响对血清维生素C水平与MS风险之间的关联。见表3。
2.4　敏感性分析
结果显示，增加慢性肾病变量后，Q4组的OR值为0.66（95%CI: 0.48～0.92, P=0.014）。去除饮酒变量后，Q3、Q4组OR值分别为0.69（95%CI: 0.50～0.95, P=0.026）、0.66（95%CI: 0.48～0.92, P= 0.015）。同时调整这两变量后，Q4组与最低组相比，MS风险降低34%（95%CI: 0.48～0.92, P=0.015），上述证据支持本研究结果的稳健性。见表4。
3　讨论
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本研究结果表明，较高的血清维生素C水平与MS风险显著降低相关，尤其在女性和50岁以下群体中更为明显。这一发现进一步支持了维生素C作为抗氧化剂在防控MS风险中的重要意义[8]。Sunmin Park等[9]在韩国的一项包含12 317名成人的横断面研究中发现，较高的维生素C水平，特别是在女性中，与较低的MS患病率相关。一项在新西兰进行的随机对照研究发现，持续两周额外补充维生素C 1 000 mg/d能改善MS患者的代谢指标，提高MS患者的免疫力[10]。本研究基于美国NHANES数据库，利用血清学检测数据，纳入了多元种族样本，在理化检验水平上直观反映出维生素C的水平，进一步支持了维生素C在降低代谢综合征风险中的作用，尤其在女性和50岁以下群体中效果显著。
已有研究显示，维生素C不仅能通过清除体内自由基来减轻氧化应激，还能通过增强细胞的抗氧化能力来改善胰岛素敏感性，从而降低MS的发生风险[11]。氧化应激是MS的核心病理机制之一[12]。Swastika等[13]的研究指出，维生素C能够通过抑制活性氧（reactive oxygen species, ROS）的生成，降低脂质过氧化和低密度脂蛋白的氧化，从而预防血脂异常和动脉硬化，降低MS的发生风险。此外，维生素C在减轻慢性低度炎症方面也显示出积极作用。研究显示，维生素C可改善肠道屏障功能，减少内毒素（Lipopolysaccharide, LPS）的吸收，通过抑制核因子激活的B细胞k-轻链增强（nuclear Factor kappa-light-chain-enhancer of activated B cells, NF-κB）通路，降低炎症因子如肿瘤坏死因子-α（tumor necrosis factor-α,TNF-α）和白细胞介素-6（IL-6）的表达，从而减轻炎症反应[14]。维生素C可通过减轻慢性炎症，改善胰岛素抵抗、脂肪组织炎症和内脏脂肪蓄积等MS的关键病理过程，调节代谢平衡，降低血糖、血脂及血压水平，从而有效降低代谢综合征的发生风险[15]。
本研究的亚组分析发现，维生素C的保护作用在女性和50岁以下人群中更为显著。女性体内的雌激素具备显著的抗炎保护作用，可以有效减轻由氧化应激引起的炎症反应[16]。雌激素可上调超氧化物歧化酶（superoxide dismutase, SOD）和谷胱甘肽过氧化物酶（glutathione peroxidase, GSH-Px）的表达，从而减少氧化应激对细胞的损伤，这些机制可能间接增强了维生素C等抗氧化剂的效果[17]。Khaw等人[18]也发现年轻人体内的维生素C水平与代谢健康的关联更为明显。这可能是因为年轻人的基础代谢率和细胞修复能力更强，因此维生素C在年轻人中的生物利用度和健康效果更明显[19]。
增加慢性肾病变量和去除饮酒情况的敏感性分析发现，在排除饮酒变量后，血清维生素C与MS的负相关性依然显著，血清维生素C的保护作用依旧明显，表明本研究结果具有稳健性。既往研究表明，慢性肾病患者的氧化应激水平显著升高，补充维生素C可以显著降低氧化应激标志物，从而对这些患者产生更强的保护作用[20]。此外，饮酒会显著消耗体内的维生素C储备，增加氧化应激负担[21]。
本研究的优点在于其基于有代表性的全国性数据，调整了多种潜在的混杂因素，增强了研究结果的可靠性和外部效度。但是本研究仍存在一些局限性。首先，由于本研究为横断面设计，无法确立因果关系，未来需要进行前瞻性研究对结果进一步验证。其次，尽管考虑了多种潜在混杂因素，但仍可能存在未调整的偏倚影响结果的准确性。最后，本研究结果主要基于美国人群，未来在不同地区人群中验证发现的普遍性也是必要的。
综上所述，本研究结果支持维生素C在改善代谢健康中的重要作用。未来的研究应进一步探讨血清维生素C降低MS风险的具体机制，以及其在不同人群中的影响，以期为从营养角度制定防控MS的公共健康策略提供参考。
基金
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  • 国家自然科学基金面上项目(82173512)
文献
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参考文献 引证文献
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2025年第52卷第5期
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doi: 10.20043/j.cnki.MPM.202411508
  • 接收时间：2024-11-27
  • 首发时间：2026-03-18
  • 出版时间：2025-03-10
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  • 收稿日期：2024-11-27
基金
国家自然科学基金面上项目(82173512)
作者信息
    1.四川大学华西公共卫生学院/华西第四医院，四川 成都 610041
    2.四川大学华西第二医院妇儿营养中心，四川 成都 610041
    3.四川大学华西护理学院，四川 成都 610041

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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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