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Article(id=1241771803199213592, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241771801366299468, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202405452, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1716912000000, receivedDateStr=2024-05-29, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773991068879, onlineDateStr=2026-03-20, pubDate=1729785600000, pubDateStr=2024-10-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773991068879, onlineIssueDateStr=2026-03-20, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773991068879, creator=13701087609, updateTime=1773991068879, updator=13701087609, issue=Issue{id=1241771801366299468, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='20', pageStart='3649', pageEnd='3840', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773991068450, creator=13701087609, updateTime=1773991676896, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241774353457681403, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241771801366299468, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241774353457681404, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241771801366299468, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=3695, endPage=3701, ext={EN=ArticleExt(id=1241771803920633884, articleId=1241771803199213592, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Analysis study of the burden and changing trend of ischemic heart disease attributed to dietary risks in China, 1990-2021, columnId=null, journalTitle=Modern Preventive Medicine, columnName=null, runingTitle=null, highlight=null, articleAbstract=
Objective

To describe and analyze the burden and changing trends of ischemic heart disease(IHD)attributed to dietary risks in China from 1990 to 2021, and to provide a scientific basis for the prevention and control of IHD in China.

Methods

Standardized DALY rates and standardized mortality rates for IHD in China from 1990 to 2021 were extracted from the Global Burden of Disease database(GBD 2021).

Results

In 2021, the standardized DALYs rate and mortality rate of IHD attributed to dietary risks in China were 820.87 and 44.26 per 100,000 respectively, showing a decrease of 14.45% and 5.24% compared to 1990. China’s rates were only higher than regions with high sociodemographic index and lower than global and other regional levels.Dietary risks were significantly higher in males compared to females, with the main risk factors being high-sodium diet, lowwholegrain diet, and high omega-6 polyunsaturated fatty acid diet.Both DALYs rate and mortality rate increased significantly with age.The overall trend from 1990 to 2021 shows a decline in the standardized DALYs rate and mortality rate of IHD attributed to dietary factors in China, with an Average Annual Percentage Change(AAPC) of 0.54% and 0.24% respectively.

Conclusion

The burden of disease and mortality rate of IHD attributable to dietary risks in China have shown an overall declining trend. However, the disease burden attributable to dietary risks is higher in males than in females, and higher in those aged 70 and above compared to those under 70. The burden of IHD attributable to dietary risks is expected to continue rising. To alleviate the burden of IHD, it is essential to enhance health education for males and middle-aged and elderly populations, increasing their awareness of IHD prevention and control. This can be achieved by promoting healthy eating habits and lifestyle practices to improve physical fitness management.

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目的

阐明1990—2021年我国归因于饮食风险的缺血性心脏病（Ischemic Heart Disease，IHD）疾病负担状况及其发展变化。

方法

采用Jointpoint 回归模型，通过每年变化百分比和平均每年变化百分比，从全球疾病负担数据库中提取中国归因于饮食因素的IHD伤残调整寿命年(DALYs)率和死亡率。

结果

2021年中国归因于饮食风险的IHD标化DALYs率和死亡率分别为820.87/10万(比1990年下降14.45%)和44.26/10万(比1990年下降5.24%)。男性的饮食风险远高于女性，1990年男性标化DALYs率是女性的1.36倍，2021年为1.99倍。主要的饮食风险因素包括高钠饮食、低全谷类饮食和多Ω-6不饱和脂肪酸饮食，且DALYs率和死亡率随年龄增长而大幅增加。1990—2021年中国归因于饮食因素的IHD的标化DALYs率和死亡率均呈下降（AAPC分别为-0.54%和-0.24%）。

结论

我国归因于饮食风险的IHD的疾病负担和死亡率总体呈下降趋势，男性归因于饮食风险的IHD的疾病负担高于女性，70岁及以上的人群疾病负担高于70岁以下人群，归因于饮食风险的IHD的疾病负担预计将持续上升。为减轻IHD疾病负担，应该对男性和中老年人群加强健康教育，以提高对IHD防治的知晓度，可以通过提倡健康饮食和生活习惯加强体质管理。

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张鹭鹭，E-mail：
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朱梦兰（1993—），女，硕士在读，研究方向：公共卫生

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journalId=1227665162245664772, articleId=1241771803199213592, language=CN, orderNo=4, keyword=伤残调整寿命年), Keyword(id=1241771811420049650, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803199213592, language=CN, orderNo=5, keyword=Jointpoint回归模型)], refs=[Reference(id=1241771816184779204, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803199213592, doi=null, pmid=null, pmcid=null, year=2021, volume=33, issue=10, pageStart=1943, pageEnd=1956.e2, url=null, language=null, rfNumber=[1], rfOrder=0, authorNames=Wang WX, Hu ML, Liu H, journalName=Cell Metabolism, refType=null, unstructuredReference=Wang WX, Hu ML, Liu H, et al. 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(In Chinese), articleTitle=Analysis of family influencing factors of dietary behavior patterns in children and adolescents, refAbstract=null), Reference(id=1241771821360550650, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803199213592, doi=null, pmid=null, pmcid=null, year=2024, volume=27, issue=9, pageStart=1126, pageEnd=1133, 1148, url=null, language=null, rfNumber=[22], rfOrder=29, authorNames=李子悦, 方珈文, 林凯程, journalName=中国全科医学, refType=null, unstructuredReference=李子悦，方珈文，林凯程．1990—2019年中国归因于高体质指数的2型糖尿病疾病负担分析与预测研究[J]．中国全科医学，2024，27（9）：1126-1133, 1148．, articleTitle=1990—2019年中国归因于高体质指数的2型糖尿病疾病负担分析与预测研究, refAbstract=null), Reference(id=1241771821486379780, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803199213592, doi=null, pmid=null, pmcid=null, year=2024, volume=27, issue=9, pageStart=1126, pageEnd=1133, 1148, url=null, language=null, rfNumber=[22], rfOrder=30, authorNames=Li ZY, Fang JW, Lin KC, journalName=Chinese General Practice, refType=null, unstructuredReference=Li ZY, Fang JW, Lin KC.Analysis and prediction study of type 2 diabetes disease burden attributed to high physical fitness index in China from 1990 to 2019[J]. 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(In Chinese), articleTitle=Analysis and prediction study of type 2 diabetes disease burden attributed to high physical fitness index in China from 1990 to 2019, refAbstract=null), Reference(id=1241771821620597513, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803199213592, doi=null, pmid=null, pmcid=null, year=2021, volume=13, issue=6, pageStart=633, pageEnd=636, url=null, language=null, rfNumber=[23], rfOrder=31, authorNames=曹维杰, 包玉倩, journalName=中华糖尿病杂志, refType=null, unstructuredReference=曹维杰，包玉倩．碳水化合物和心血管疾病危险因素的研究进展[J]．中华糖尿病杂志，2021，13（6）：633-636．, articleTitle=碳水化合物和心血管疾病危险因素的研究进展, refAbstract=null), Reference(id=1241771821759009552, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803199213592, doi=null, pmid=null, pmcid=null, year=2021, volume=13, issue=6, pageStart=633, pageEnd=636, url=null, language=null, rfNumber=[23], rfOrder=32, authorNames=Cao WJ, Bao YQ, journalName=Chinese Journal of Diabetes Mellitus, refType=null, unstructuredReference=Cao WJ,Bao YQ. Advances in research on carbohydrate and risk factors of cardiovascular disease[J]. Chinese Journal of Diabetes Mellitus, 2021, 13(6): 633-636. (In Chinese), articleTitle=Advances in research on carbohydrate and risk factors of cardiovascular disease, refAbstract=null)], funds=[Fund(id=1241771816029589942, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803199213592, awardId=72174204, language=CN, fundingSource=国家自然科学基金(72174204), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241771807024418888, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803199213592, xref=1., ext=[AuthorCompanyExt(id=1241771807037001801, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803199213592, companyId=1241771807024418888, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Health Services, Faculty of Health Services, Naval Medical University(Second Military Medical University)，Shanghai 200433，China), AuthorCompanyExt(id=1241771807045390410, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803199213592, companyId=1241771807024418888, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.海军军医大学卫生勤务学系卫生勤务学教研室，上海 200433)]), AuthorCompany(id=1241771807162830925, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803199213592, xref=2., ext=[AuthorCompanyExt(id=1241771807183802447, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803199213592, companyId=1241771807162830925, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.解放军第74集团军医院眼耳鼻喉科)])], figs=[ArticleFig(id=1241771811717845255, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803199213592, language=EN, label=Fig.1, caption=Age-standardized DALY Rates (1A) and Mortality Rates (1B) of IHD Attributable to Dietary Risks from 1990 to 2021, figureFileSmall=9yWSdrbc2gc5y0E6sEG5sg==, figureFileBig=uP68V9r98j6I5KAHu/QbHQ==, tableContent=null), ArticleFig(id=1241771811852062993, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803199213592, language=CN, label=图1, caption=1990—2021年因于饮食风险的IHD标化DALYs率（1A）和死亡率（1B）

注：SDI：社会人口学指数；DALYs：伤残调整生命年。

, figureFileSmall=9yWSdrbc2gc5y0E6sEG5sg==, figureFileBig=uP68V9r98j6I5KAHu/QbHQ==, tableContent=null), ArticleFig(id=1241771812208578849, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803199213592, language=EN, label=Fig.2, caption=Gender Differences in Disease Burden and Trends of IHD Attributable to Dietary Risks, figureFileSmall=Ac4EwMqcNqwaR8398u1/rA==, figureFileBig=h5ILSnxiTJe6MyTio9N4dQ==, tableContent=null), ArticleFig(id=1241771812447654186, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803199213592, language=CN, label=图2, caption=归因于饮食风险导致IHD疾病负担和变化趋势的性别差异

注：A为不同性别的标化DALYs率的变化趋势B为不同性别的标化死亡率变化趋势。

, figureFileSmall=Ac4EwMqcNqwaR8398u1/rA==, figureFileBig=h5ILSnxiTJe6MyTio9N4dQ==, tableContent=null), ArticleFig(id=1241771812674146610, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803199213592, language=EN, label=Fig.3, caption=Disease Burden and Mortality Rates of IHD Attributable to Dietary Risks Across Different Age Groups in 1990 (A) and 2021 (B), figureFileSmall=2GIC/+9LimpP+hZth32sxA==, figureFileBig=BCLpITSP0FB02Io1Oc4rmA==, tableContent=null), ArticleFig(id=1241771813022273853, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803199213592, language=CN, label=图3, caption=1990年（A）和2021年（B）归因于饮食风险IHD各年龄组疾病负担及死亡率, figureFileSmall=2GIC/+9LimpP+hZth32sxA==, figureFileBig=BCLpITSP0FB02Io1Oc4rmA==, tableContent=null), ArticleFig(id=1241771814523834696, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803199213592, language=EN, label=Fig.4, caption=Analysis of Disease Burden and Mortality Rates of IHD Attributable to Dietary Risks in 1990 (A) and 2021 (B), figureFileSmall=SVGPubEqlbPj6e6pg+eebA==, figureFileBig=3cAn/2CGm9KGwkjMB1woyw==, tableContent=null), ArticleFig(id=1241771814699995477, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803199213592, language=CN, label=图4, caption=1990年（A）和2021年（B）归因于饮食风险的IHD疾病负担分析的和死亡率, figureFileSmall=SVGPubEqlbPj6e6pg+eebA==, figureFileBig=3cAn/2CGm9KGwkjMB1woyw==, tableContent=null), ArticleFig(id=1241771814817435995, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803199213592, language=EN, label=Fig.5, caption=Age-standardized DALY Rates (A) and Age-standardized Mortality Rates (B) of IHD Attributable to Dietary Risks from 1990 to 2021, figureFileSmall=Lj3xhZX8Bsj6m+IZAzRl8w==, figureFileBig=g++iwycMlds5I/Od9AxHwQ==, tableContent=null), ArticleFig(id=1241771815001985388, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803199213592, language=CN, label=图5, caption=1990—2021年归因于饮食风险IHD标化DALYs率（A）和标化死亡率（B）

注：*代表P<0.05，有统计学意义。

, figureFileSmall=Lj3xhZX8Bsj6m+IZAzRl8w==, figureFileBig=g++iwycMlds5I/Od9AxHwQ==, tableContent=null), ArticleFig(id=1241771815144591734, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803199213592, language=EN, label=Table 1, caption=

Disease Burden and Change Rates of IHD Attributable to Dietary Risks Across Different Age Groups in 1990 and 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
年龄段DALYs率（/10万）死亡率（（/10万））
19902021变化率（%）19902021变化率（%）
<30180.89145.51-19.562.842.28-19.78
30~34303.77253.08-16.695.224.32-17.24
35~39524.23406.74-22.419.827.57-22.97
40~44844.13637.55-24.4717.3913.09-24.73
45~491 049.16750.27-28.4924.0017.05-28.95
50~541 602.671 070.95-33.1841.2927.31-33.84
55~592 152.071 426.54-33.7162.8841.23-34.43
60~642 669.971 996.13-25.2490.0467.03-25.56
65~693 526.062 739.86-22.30140.66108.44-22.91
70~744 400.103 923.26-10.84213.54189.33-11.33
75~795 521.905 289.10-4.22335.90322.14-4.10
80~847 554.838 127.647.58591.12640.518.36
85~8911 058.8113 194.0219.311 090.811 315.0820.56
90~9418 159.3120 349.9312.062 076.832 334.2712.40
≥9525 116.1626 198.014.313 011.783 180.005.59
标准化年龄959.47820.87-14.4546.7144.26-5.24
全年龄660.131 136.4372.1524.9656.57126.66
), ArticleFig(id=1241771815241060736, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803199213592, language=CN, label=表1, caption=

1990年和2021年归因于饮食风险IHD各年龄组疾病负担及变化率

, figureFileSmall=null, figureFileBig=null, tableContent=
年龄段DALYs率（/10万）死亡率（（/10万））
19902021变化率（%）19902021变化率（%）
<30180.89145.51-19.562.842.28-19.78
30~34303.77253.08-16.695.224.32-17.24
35~39524.23406.74-22.419.827.57-22.97
40~44844.13637.55-24.4717.3913.09-24.73
45~491 049.16750.27-28.4924.0017.05-28.95
50~541 602.671 070.95-33.1841.2927.31-33.84
55~592 152.071 426.54-33.7162.8841.23-34.43
60~642 669.971 996.13-25.2490.0467.03-25.56
65~693 526.062 739.86-22.30140.66108.44-22.91
70~744 400.103 923.26-10.84213.54189.33-11.33
75~795 521.905 289.10-4.22335.90322.14-4.10
80~847 554.838 127.647.58591.12640.518.36
85~8911 058.8113 194.0219.311 090.811 315.0820.56
90~9418 159.3120 349.9312.062 076.832 334.2712.40
≥9525 116.1626 198.014.313 011.783 180.005.59
标准化年龄959.47820.87-14.4546.7144.26-5.24
全年龄660.131 136.4372.1524.9656.57126.66
), ArticleFig(id=1241771815350112649, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803199213592, language=EN, label=Table 2, caption=

Analysis of Disease Burden and Mortality Rates of IHD Attributable to Dietary Risks in 1990 and 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
风险种类标化DALYs（/10万）标化死亡率（/10万）
1990202119902021
女性男性总体女性男性总体女性男性总体女性男性总体
高钠饮食204.52335.47264.63158.5378.69260.1410.1216.5712.778.8520.1113.60
低全谷物饮食202.37292.77245.16162.72347.09249.269.4313.2611.018.9917.2612.47
多Ω-6不饱和脂肪酸饮食160.18214.56185.85120.78231.84172.547.639.968.586.9112.069.05
低坚果和种子饮食181.74233.08205.7786.75163.38122.308.6210.859.505.038.576.47
低水果饮食158.83213.96185.3555.75117.6385.997.129.248.012.664.863.66
高红肉饮食33.4647.6140.4953.31120.3384.791.291.761.503.086.024.30
低纤维饮食130.42163.22146.5768.8481.0574.905.876.986.343.994.294.12
低豆类饮食63.0193.8477.4946.4584.8765.323.034.383.582.493.753.06
低海鲜Ω-3脂肪酸饮食181.73199.74190.4537.3383.0058.488.589.218.822.184.373.08
低蔬菜饮食53.1672.8462.484.9710.997.562.503.342.850.360.740.51
高反式脂肪酸饮食3.737.095.273.737.095.270.230.400.300.230.400.30
高加工肉饮食0.700.870.781.312.311.810.030.030.030.050.080.07
高含糖饮料饮食0.310.380.350.711.41.050.010.010.010.030.050.04
), ArticleFig(id=1241771815496913298, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803199213592, language=CN, label=表2, caption=

1990年和2021年归因于饮食风险的IHD疾病负担分析的和死亡率

, figureFileSmall=null, figureFileBig=null, tableContent=
风险种类标化DALYs（/10万）标化死亡率（/10万）
1990202119902021
女性男性总体女性男性总体女性男性总体女性男性总体
高钠饮食204.52335.47264.63158.5378.69260.1410.1216.5712.778.8520.1113.60
低全谷物饮食202.37292.77245.16162.72347.09249.269.4313.2611.018.9917.2612.47
多Ω-6不饱和脂肪酸饮食160.18214.56185.85120.78231.84172.547.639.968.586.9112.069.05
低坚果和种子饮食181.74233.08205.7786.75163.38122.308.6210.859.505.038.576.47
低水果饮食158.83213.96185.3555.75117.6385.997.129.248.012.664.863.66
高红肉饮食33.4647.6140.4953.31120.3384.791.291.761.503.086.024.30
低纤维饮食130.42163.22146.5768.8481.0574.905.876.986.343.994.294.12
低豆类饮食63.0193.8477.4946.4584.8765.323.034.383.582.493.753.06
低海鲜Ω-3脂肪酸饮食181.73199.74190.4537.3383.0058.488.589.218.822.184.373.08
低蔬菜饮食53.1672.8462.484.9710.997.562.503.342.850.360.740.51
高反式脂肪酸饮食3.737.095.273.737.095.270.230.400.300.230.400.30
高加工肉饮食0.700.870.781.312.311.810.030.030.030.050.080.07
高含糖饮料饮食0.310.380.350.711.41.050.010.010.010.030.050.04
), ArticleFig(id=1241771815605965208, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803199213592, language=EN, label=Table 3, caption=

Analysis of Dietary Risks Attributable to Trends in IHD Disease Burden

, figureFileSmall=null, figureFileBig=null, tableContent=
变量地区指标时间（年）变化值(95%CI)(%)
标化DALYs率中国APC1990—1998-0.93a(-1.1~-0.76)
1998—20012.32a(0.44~4.22)
2001—20043.86a(2.1~5.65)
2004—2007-2.63a(-4.44~-0.79)
2011—2021-2.20a(-2.36~-2.04)
AAPC1990—2021-0.54a(-0.85~-0.24)
高SDI区域APC1990—1994-2.92a(-3.32~-2.52)
1994—2011-3.72a(-3.77~-3.67)
2011—2021-2.40a(-2.65~-2.14)
AAPC1990—2021-3.19a(-3.29~-3.1)
标化死亡率中国APC1990—1998-0.77a(-1.04~-0.51)
1998—20044.3a(3.81~4.82)
2004—2007-2.27a(-4.37~-0.13)
2007—20110.99(-0.18~2.18)
2011—2021-2.32a(-2.54~-2.1)
AAPC1990—2021-0.24(-0.51~0.04)
高SDI区域APC1990—2013-3.84a(-3.93~-3.75)
2013—20160.28(-4.48~5.28)
2016—2019-6.0a(-9.45~-2.45)
2019—2021-1.59a(-2.15~-1.03)
AAPC1990—2021-3.52a(-4.06~-2.97)
), ArticleFig(id=1241771815761154469, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771803199213592, language=CN, label=表3, caption=

归因于IHD疾病负担变化趋势分析的饮食风险

, figureFileSmall=null, figureFileBig=null, tableContent=
变量地区指标时间（年）变化值(95%CI)(%)
标化DALYs率中国APC1990—1998-0.93a(-1.1~-0.76)
1998—20012.32a(0.44~4.22)
2001—20043.86a(2.1~5.65)
2004—2007-2.63a(-4.44~-0.79)
2011—2021-2.20a(-2.36~-2.04)
AAPC1990—2021-0.54a(-0.85~-0.24)
高SDI区域APC1990—1994-2.92a(-3.32~-2.52)
1994—2011-3.72a(-3.77~-3.67)
2011—2021-2.40a(-2.65~-2.14)
AAPC1990—2021-3.19a(-3.29~-3.1)
标化死亡率中国APC1990—1998-0.77a(-1.04~-0.51)
1998—20044.3a(3.81~4.82)
2004—2007-2.27a(-4.37~-0.13)
2007—20110.99(-0.18~2.18)
2011—2021-2.32a(-2.54~-2.1)
AAPC1990—2021-0.24(-0.51~0.04)
高SDI区域APC1990—2013-3.84a(-3.93~-3.75)
2013—20160.28(-4.48~5.28)
2016—2019-6.0a(-9.45~-2.45)
2019—2021-1.59a(-2.15~-1.03)
AAPC1990—2021-3.52a(-4.06~-2.97)
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1990—2021中国归因于饮食风险的缺血性心脏病负担及变化趋势
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朱梦兰 1, 2 , 靳文瑜 1 , 伍晨楠 1 , 刘同同 1 , 张鹭鹭 1
现代预防医学 | 营养与食品卫生 2024,51(20): 3695-3701
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现代预防医学 | 营养与食品卫生 2024, 51(20): 3695-3701
1990—2021中国归因于饮食风险的缺血性心脏病负担及变化趋势
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朱梦兰1, 2, 靳文瑜1, 伍晨楠1, 刘同同1, 张鹭鹭1
作者信息
  • 1.海军军医大学卫生勤务学系卫生勤务学教研室，上海 200433
  • 2.解放军第74集团军医院眼耳鼻喉科

    • 朱梦兰（1993—），女，硕士在读，研究方向：公共卫生

通讯作者:

张鹭鹭，E-mail：
Analysis study of the burden and changing trend of ischemic heart disease attributed to dietary risks in China, 1990-2021
Meng-lan ZHU1, 2, Wen-yu JIN1, Chen-nan WU1, Tong-tong LIU1, Lu-lu ZHANG1
Affiliations
  • Department of Health Services, Faculty of Health Services, Naval Medical University(Second Military Medical University)，Shanghai 200433，China
出版时间: 2024-10-25 doi: 10.20043/j.cnki.MPM.202405452
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摘要
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目的

阐明1990—2021年我国归因于饮食风险的缺血性心脏病（Ischemic Heart Disease，IHD）疾病负担状况及其发展变化。

方法

采用Jointpoint 回归模型，通过每年变化百分比和平均每年变化百分比，从全球疾病负担数据库中提取中国归因于饮食因素的IHD伤残调整寿命年(DALYs)率和死亡率。

结果

2021年中国归因于饮食风险的IHD标化DALYs率和死亡率分别为820.87/10万(比1990年下降14.45%)和44.26/10万(比1990年下降5.24%)。男性的饮食风险远高于女性，1990年男性标化DALYs率是女性的1.36倍，2021年为1.99倍。主要的饮食风险因素包括高钠饮食、低全谷类饮食和多Ω-6不饱和脂肪酸饮食，且DALYs率和死亡率随年龄增长而大幅增加。1990—2021年中国归因于饮食因素的IHD的标化DALYs率和死亡率均呈下降（AAPC分别为-0.54%和-0.24%）。

结论

我国归因于饮食风险的IHD的疾病负担和死亡率总体呈下降趋势，男性归因于饮食风险的IHD的疾病负担高于女性，70岁及以上的人群疾病负担高于70岁以下人群，归因于饮食风险的IHD的疾病负担预计将持续上升。为减轻IHD疾病负担，应该对男性和中老年人群加强健康教育，以提高对IHD防治的知晓度，可以通过提倡健康饮食和生活习惯加强体质管理。

IHD  /  饮食风险  /  疾病负担  /  伤残调整寿命年  /  Jointpoint回归模型
Objective

To describe and analyze the burden and changing trends of ischemic heart disease(IHD)attributed to dietary risks in China from 1990 to 2021, and to provide a scientific basis for the prevention and control of IHD in China.

Methods

Standardized DALY rates and standardized mortality rates for IHD in China from 1990 to 2021 were extracted from the Global Burden of Disease database(GBD 2021).

Results

In 2021, the standardized DALYs rate and mortality rate of IHD attributed to dietary risks in China were 820.87 and 44.26 per 100,000 respectively, showing a decrease of 14.45% and 5.24% compared to 1990. China’s rates were only higher than regions with high sociodemographic index and lower than global and other regional levels.Dietary risks were significantly higher in males compared to females, with the main risk factors being high-sodium diet, lowwholegrain diet, and high omega-6 polyunsaturated fatty acid diet.Both DALYs rate and mortality rate increased significantly with age.The overall trend from 1990 to 2021 shows a decline in the standardized DALYs rate and mortality rate of IHD attributed to dietary factors in China, with an Average Annual Percentage Change(AAPC) of 0.54% and 0.24% respectively.

Conclusion

The burden of disease and mortality rate of IHD attributable to dietary risks in China have shown an overall declining trend. However, the disease burden attributable to dietary risks is higher in males than in females, and higher in those aged 70 and above compared to those under 70. The burden of IHD attributable to dietary risks is expected to continue rising. To alleviate the burden of IHD, it is essential to enhance health education for males and middle-aged and elderly populations, increasing their awareness of IHD prevention and control. This can be achieved by promoting healthy eating habits and lifestyle practices to improve physical fitness management.

IHD  /  Dietaryrisks  /  Burden of disease  /  Disability-adjusted life years  /  Jointpoint regression model
朱梦兰, 靳文瑜, 伍晨楠, 刘同同, 张鹭鹭. 1990—2021中国归因于饮食风险的缺血性心脏病负担及变化趋势. 现代预防医学, 2024 , 51 (20) : 3695 -3701 . DOI: 10.20043/j.cnki.MPM.202405452
Meng-lan ZHU, Wen-yu JIN, Chen-nan WU, Tong-tong LIU, Lu-lu ZHANG. Analysis study of the burden and changing trend of ischemic heart disease attributed to dietary risks in China, 1990-2021[J]. Modern Preventive Medicine, 2024 , 51 (20) : 3695 -3701 . DOI: 10.20043/j.cnki.MPM.202405452
正文
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缺血性心脏病（Ischemic Heart Disease，IHD）是全球最主要的致病和死亡原因，是负担最重的心血管疾病[1]。该病以心脏冠状动脉缺血和继发心肌损害为特征，每年导致超过800万人死亡，给患者带来沉重疾病负担[2-3]。不健康饮食导致的死亡人数比全球任何其他风险都多，是IHD疾病负担的主要危险因素之一[4-5]。饮食风险导致的IHD残疾调整生命年（Disability-Adjusted Life Years，DALYs）率为990.2/10万，死亡率为77.9/10万[6]。随着居民不健康生活方式的持续增加，预计IHD的绝对疾病负担将继续上升[7-8]。其中饮食风险直接影响心血管疾病，相比其他风险因素有较强干预性和较低成本，对预防心血管疾病有显著益处[9-10]。
饮食具有复杂性和多样性，涉及种类、性别、年龄等多个方面的差异[5]。本研究分析归因于饮食风险的IHD疾病负担及其变化趋势，有助于制定精准的干预和管理策略，减少疾病负担，提升公众健康水平。
1　数据与方法
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1.1　数据来源
数据来自全球疾病负担数据库（Global Burden of Disease, GBD）（https://vizhub.healthdata.org）。GBD收集了全球疾病、伤害和风险因素，并对195个国家和地区的25岁或以上成年人中13种饮食因素对非传染性疾病负担和死亡率的影响进行了量化研究[5]。本研究对GBD2021进行数据筛选（https://vizhub.healthdata.org/gbd-results/），选择区域为“China”、“Global”及“社会人口指数（Social Demographic Index，SDI）区域”，死亡原因为“Ischemic Heart Disease”，危险因素为“dietary risks”，指标为“DALYs”、“Deaths”，年龄为“Age-standardized”及15个年龄组“<30、30~34、35~39……90~94、>95岁”，年份为“1990—2021年”。
1.2　观察指标
本研究采用DALYs率对疾病负担进行评估，用死亡率描述疾病死亡情况，并对相关指标进行年龄标准化，变化率=（2021年指标值-1990年指标值）/1990年指标值×100%。男女比例=男指数数值/女指数数值。
1.3　统计学分析
采用Excel 2021从区域分组、年龄分组、风险种类及趋势进行描述分析。采用Joinpoint 5.1.0软件对1990—2021年中国归因于饮食风险的IHD疾病DALYs率和标化死亡率的变化趋势进行分析，计算出年度变动百分比（Annual Percentage Change，APC）、平均年度变动百分比（Average Annual Percentage Change, AAPC）[11-13]。
2　结果
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2.1　中国IHD疾病负担及变化趋势
DALYs率从1990年的959.47/10万下降至2021年820.87/10 万，下降幅度为14.45%；标化死亡率从1990年的46.71/10万下降至2021年的44.26/10万，下降幅度为5.24%，见图1。
2.2　不同性别的IHD疾病负担及变化趋势
1990—2021年，中国男性和女性归因于饮食风险IHD的标化DALYs率有波动性下降的趋势。分别从1990年的1 118.95/10万、822.71/10万下降至2021年的1 121.13/10万、563.17/10万。男性标化死亡率从1990年的55.06/10万上升到2021年的60.32/10万。女性从1990年的41.15/10万人减少到2021年的32.93/10万人。无论是标化DALYs率还是标化死亡率，男性/女性的比值逐年增加，变化范围分别为1.36~1.99和1.34~1.83。见图2。
2.3　归因于饮食风险的IHD疾病负担年龄差异
2021年不同年龄归因于饮食风险的IHD随着年龄的增长，其DALYs率和死亡率在明显的增加。45岁以下处于较低水平，在70岁后迅速增加，≥95岁年龄组人群DALYs率最高（26 198.01/10万）。30岁以下的死亡率基本为0，80岁以后上升较快，在95岁以上达到最高峰（3 180/10万）。70岁及以上人口的标化DALYs率和死亡率分别为6 263.14/10万和459.67/10万，远高于70岁以下人群DALYs率和死亡率（667.18/10万和19.68/10万），P<0.05。年龄分层的风险类型与总体人群结构不一致，DALYs率和死亡率排名前三位的80岁以上人群中，低全谷物饮食、高钠饮食、多Ω-6不饱和脂肪酸饮食是主要风险类型。见图4。
相比1990年，2021年标化DALYs率和死亡率分别下降-14.45%和-5.24%，但是全年龄的DALYs率和死亡率上升了72.15%和126.66%。80岁以下的DALYs率和死亡率都有不同程度的下降，80岁以上的DALYs率和死亡率都在上升，见表1。
2.4　不同种类饮食风险的IHD疾病负担状况
归因于饮食风险的IHD疾病负担前三大风险因素分别是高钠饮食（260.14/10万、13.6/10万）、低全谷物饮食（249.26/10万、12.47/10万）和低Ω-6多不饱和脂肪酸饮食（172.54/10万、9.05/10万）。男性在各种类饮食风险的标化DALYs和死亡率均高于女性，（P<0.05）。见图3和表2。
低Ω-6多不饱和脂肪酸饮食从1990年的第5位上升到第3位，高红肉饮食从第10位上升至第6位，低海鲜Ω-3脂肪酸饮食从第4位下降至第9位。但是值得注意的是高红肉饮食、高加工肉饮食和高含糖饮料饮食位次没有变化，但是标化DALYs和死亡率均有上升，见图4和表2。
2.5　1990—2021归因于饮食风险的IHD疾病负担变化趋势
1990—2021年中国归因于饮食风险的IHD标化DALYs率和死亡率略有下降（AAPC分别为-0.54%和-0.24%）。
1990—2021年标化DALYs率与死亡率变化拐点一致，具有统计学意义的拐点有5个（P<0.05），分别为1998、2001、2004、2007、2011年，且在1998—2004年度均呈年均递增趋势，其中又以2001—2004年度增速最快。然后是递减，在2007—2011年又开始上升，从2011到现在是一个递减的态势。见图4和表2。
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研究结果显示，1990—2021年，我国归因于饮食因素的IHD疾病负担和死亡率在数值上低于全球和其他SDI区域。但是与同期高SDI区域趋势相比，我国经年龄调整后的归因于饮食风险的IHD疾病负担已超过高SDI区域，并且呈现逐渐加重的趋势[14]。
这与我国社会经济发展过程中，人们饮食习惯转向摄入更多动物源性食品、精制谷物和深加工食品有关，从而增加了IHD的患病风险 [15]。本研究结果显示1990—2021年，我国归因于饮食因素的IHD 标化DALYs率和死亡率呈波浪式下降，但全年龄的呈上升趋势。这一趋势主要是由于年龄标准化消除了人口老龄化的影响，同时医疗技术的进步推迟了疾病的发病年龄，从而降低了标化DALYs率和死亡率[16]。
从1990—2021年男性在不同年龄、不同风险种类的疾病负担均高于女性，而且呈进一步发展的趋势。部分原因是由于男性和女性在饮食习惯和健康行为模式上有较大差异。女性更加关注健康、选择最佳饮食和积极护理，男性通常有抽烟和喝酒的生活习惯[14]，并且在工作聚餐中更容易接触高盐高脂的饮食[17]。
从1900年到2021年，80岁以下比80岁及以上的疾病负担和死亡率都在上升，而且老年人比年轻人有更高的饮食风险。除了老龄化和医疗技术进步的缘故，饮食风险会随着年龄的增长逐渐累积；另一方面，老年人自身免疫力下降有伴随基础性疾病下，IHD相关的饮食风险也会增加[6]。因此老年人群应成为IHD防治的重点对象，有针对性地制定营养教育计划、协助减少不健康要素的摄取[18]。
2021年中国饮食风险排名与1990年的排名变化不大，前两位都是高钠饮食和低全谷物饮食。全球全谷物、水果和钠不良摄入占非传染病死亡的50%以上，占DALYs的66%[5]。同时各别种类的饮食风险增加明显，例如红肉、加工肉和含糖饮料[18]。
在中国，为提高国民整体健康水平，政府推出了《健康中国行动（2021—2030年）》的具体健康饮食指导[19]，并制定的《健康中国2030规划纲要》提出了全方位的健康规划[20]，旨在通过膳食宝塔，适当增加不饱和脂肪酸、蛋白质和膳食纤维的摄入，增加食物多样化。然而，我国的饮食干预IHD仍面临较大的挑战。
目前大多数饮食干预IHD观察到的效果远远低于世界卫生组织推荐的水平[6]，这深受家庭因素、工作环境和饮食文化的影响[21]。其次，饮食干预没有较少考虑年龄和要素的差异。种种因素导致中国在1990至2021年间，由饮食因素引起的IHD标化DALYs率和死亡率呈波浪式下降的同时，饮食风险带来的IHD负担依然存在，并有逐渐加重的趋势[22]。饮食是一个复杂过程，专注于促进当前摄入健康的饮食成分（全谷物、豆类、坚果、低蔬菜等）的饮食政策，减少不健康要素（如钠、碳水化合物）摄入总量不仅可以改善血压、血脂、血糖，还有助于节省成本[23]。
本研究使用GBD数据库对中国整体归因于饮食风险的IHD疾病负担进行分析，未考虑各区域存在的差异。此外，GBD数据基于统计学模型对数据进行估计，与真实结果可能存在偏移，有待利用中国真实监测数据进一步分析。
综上，1990—2021年中国归因于饮食风险、不同性别和年龄差异的IHD标化DALYs和死亡率负担均呈下降趋势，而男性和中老年是IHD的重点关注对象，警惕红肉、加工肉和含糖饮料等不健康要素的摄入，同时低龄段潜在的疾病风险也应引起重视。随着次亚健康的饮食方式进展，进一步增重IHD疾病负担和死亡风险。为改善IHD，应关注IHD的早期预防，加强患者及重点人群的健康管理，提倡健康饮食和生活习惯。
基金
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  • 国家自然科学基金(72174204)
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2024年第51卷第20期
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doi: 10.20043/j.cnki.MPM.202405452
  • 接收时间：2024-05-29
  • 首发时间：2026-03-20
  • 出版时间：2024-10-25
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  • 收稿日期：2024-05-29
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    1.海军军医大学卫生勤务学系卫生勤务学教研室，上海 200433
    2.解放军第74集团军医院眼耳鼻喉科

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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