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Article(id=1324051055809528467, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324050876230415089, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202511079, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1762444800000, receivedDateStr=2025-11-07, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793607971384, onlineDateStr=2026-11-02, pubDate=1781020800000, pubDateStr=2026-06-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793607971384, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793607971384, creator=13701087609, updateTime=1793607971384, updator=13701087609, issue=Issue{id=1324050876230415089, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='11', pageStart='1921', pageEnd='2112', issueExtLink='null', onlineDate='null', pubDate='1781020800000', pubDateStr='2026-06-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793607928569, creator='13701087609', updateTime=1793670049253, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324311429322507008, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324050876230415089, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324311429322507009, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324050876230415089, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=1947, endPage=1953, ext={EN=ArticleExt(id=1324051056258318996, articleId=1324051055809528467, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Association between comprehensive dietary antioxidant index and insulin resistance index: the mediating role of obesity—a cross-sectional study based on NHANES, columnId=1240413921954295836, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the association between the comprehensive dietary antioxidant index (CDAI) and the homeostatic model assessment of insulin resistance (HOMA-IR), and to evaluate the mediating effect of obesity in this association.

Methods

Data were derived from the 2005—2018 National Health and Nutrition Examination Survey (NHANES). CDAI was calculated via 24-hour dietary recalls. Weighted multivariable linear regression and restricted cubic splines were used to analyze the association between CDAI and HOMA-IR, while mediation analysis assessed the potential role of obesity.

Results

A total of 2 568 participants were included in this study. After fully adjusting for confounding factors, weighted multivariable linear regression analysis revealed a negative association between CDAI and HOMA-IR levels (β=-0.05, 95% CI: -0.07~-0.02, P<0.001). Compared with the lowest quartile of CDAI, the highest quartile showed a reduction in HOMA-IR levels (β=-0.39, 95% CI:-0.67~-0.12, P=0.007). Mediation analysis indicated that obesity had no significant mediating effect on this association (P=0.28).

Conclusion

Higher CDAI levels are independently associated with lower HOMA-IR. The absence of a significant mediating effect of obesity suggests that the protective effect of CDAI may be achieved through direct biological pathways, such as reducing oxidative stress and improving insulin signaling, independent of body weight. Further longitudinal studies are warranted to verify causality.

, authors=Li ZHANG1, Yi-hua ZHANG2, Jun-kang ZHAO1, Qing-mei NIU1, 2, Xiu-mei WANG1, Qian ZHANG1, authorsList=Li ZHANG, Yi-hua ZHANG, Jun-kang ZHAO, Qing-mei NIU, Xiu-mei WANG, Qian ZHANG, authorCompany=null, correspAuthors=Qian ZHANG, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1324051058590352027, articleId=1324051055809528467, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=综合膳食抗氧化指数与胰岛素抵抗指数的关联及肥胖的中介作用——基于NHANES的横断面研究, columnId=1228016567632462653, journalTitle=现代预防医学, columnName=流行病与统计方法, runingTitle=null, highlight=null, articleAbstract=
目的

探讨综合膳食抗氧化指数（comprehensive dietary antioxidant index，CDAI）与稳态模型评估胰岛素抵抗指数（homeostatic model assessment of insulin resistance，HOMA-IR）的关联，并评估肥胖在上述关联中的中介效应。

方法

本研究基于美国国家健康与营养调查2005—2018年的数据，通过24 h膳食回顾法评估并计算CDAI。应用加权多变量线性回归模型及限制性立方样条分析CDAI与HOMA-IR的关联，并利用中介效应模型探讨肥胖在其中的潜在中介作用。

结果

本研究共纳入2 568名参与者。充分校正混杂因素后，加权多变量线性回归显示，CDAI与HOMA-IR水平呈负向关联（β=-0.05，95%CI：-0.07～-0.02，P<0.001）。与CDAI最低四分位组相比，最高四分位组的HOMA-IR水平降低（β=-0.39，95%CI：-0.67～-0.12，P=0.007）。中介分析结果表明，肥胖在二者关联中无显著中介效应（P=0.28）。

结论

较高的CDAI与较低的HOMA-IR水平独立相关。本研究中，未发现肥胖在此关联中具有显著的中介作用，提示CDAI的保护效应可能主要通过减轻氧化应激、改善胰岛素信号通路等独立于体重的直接生物学途径实现。未来需通过纵向研究进一步验证因果关联。

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张丽（1985—），女，硕士，主管医师，研究方向：流行病与卫生统计学

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张倩，E-mail：
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Asia Pacific Journal of Clinical Nutrition, 2025, 34(6): 941-951., articleTitle=Dietary antioxidant index and cardiometabolic risks in normal-weight individuals: Evidence from the National Health and Nutrition Examination Survey, refAbstract=null)], funds=[Fund(id=1324051064089084628, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051055809528467, awardId=2024YH21, language=CN, fundingSource=2024年度山西白求恩医院护理科研基金项目(2024YH21), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1324051058888147612, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051055809528467, xref=1., ext=[AuthorCompanyExt(id=1324051058896536221, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051055809528467, companyId=1324051058888147612, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Shanxi Bethune Hospital (Shanxi Academy of Medical Sciences), The Third Hospital of Shanxi Medical University; Tongji Shanxi Hospital, Taiyuan, Shanxi 030032, China), AuthorCompanyExt(id=1324051058904924830, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051055809528467, companyId=1324051058888147612, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.山西白求恩医院（山西医学科学院），山西医科大学第三医院，同济山西医院，山西 太原 030032)]), AuthorCompany(id=1324051058976227999, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051055809528467, xref=2., ext=[AuthorCompanyExt(id=1324051058984616608, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051055809528467, companyId=1324051058976227999, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.山西中医药大学)])], figs=[ArticleFig(id=1324051062902096584, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051055809528467, language=EN, label=Figure 1, caption=Flowchart of the study population screening process, figureFileSmall=LKA9qhQIzAjDmVobgRdEJQ==, figureFileBig=5q+Lp2K1YdNSHvzZPzL1VQ==, tableContent=null), ArticleFig(id=1324051062969205449, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051055809528467, language=CN, label=图1, caption=研究人群筛选流程图, figureFileSmall=LKA9qhQIzAjDmVobgRdEJQ==, figureFileBig=5q+Lp2K1YdNSHvzZPzL1VQ==, tableContent=null), ArticleFig(id=1324051063170532042, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051055809528467, language=EN, label=Figure 2, caption=The dose-response relationship between CDAI and HOMA-IR, figureFileSmall=GBXL0GcBG5vVqVui91m8AQ==, figureFileBig=YT4ocBfx/kHyObpUHEeQag==, tableContent=null), ArticleFig(id=1324051063246029515, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051055809528467, language=CN, label=图2, caption=CDAI与HOMA-IR的剂量-反应关系

注：所有分析均调整了年龄、性别、种族、婚姻状况、吸烟状况、饮酒状况、教育水平、收入状况、体力活动、BMI、每日热量摄入、睡眠情况。

, figureFileSmall=GBXL0GcBG5vVqVui91m8AQ==, figureFileBig=YT4ocBfx/kHyObpUHEeQag==, tableContent=null), ArticleFig(id=1324051063317332684, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051055809528467, language=EN, label=Table 1, caption=

Basic characteristics of participants

, figureFileSmall=null, figureFileBig=null, tableContent=
变量n (%)HOMA-IR[M (Q1, Q3)]Z/H值P值
性别-3.033*0.002
男1 230 (47.90)1.56 (1.04, 2.60)
女1 338 (52.10)1.47 (0.97, 2.17)
年龄（岁）2.9920.229
18～<401 713 (66.71)1.55 (1.02, 2.35)
40～60636 (24.77)1.42 (0.97, 2.28)
≥ 60219 (8.53)1.60 (1.08, 2.51)
种族53.673<0.001
墨西哥裔美国人390 (15.19)2.03 (1.29, 2.94)
非西班牙裔白人1 089 (42.41)1.43 (0.95, 2.20)
非西班牙裔黑人534 (20.79)1.67 (1.18, 2.62)
其他种族555 (21.61)1.50 (1.04, 2.41)
婚姻8.4530.017
已婚/与伴侣居住1 418 (55.22)1.45 (0.97, 2.28)
离婚或丧偶299 (11.64)1.54 (1.10, 2.25)
未婚851 (33.14)1.63 (1.06, 2.54)
BMI754.927<0.001
偏瘦102 (3.97)0.85 (0.58, 1.46)
正常1 246(48.52)1.20 (0.85, 1.73)
超重733 (28.54)1.72 (1.18, 2.46)
肥胖487 (18.96)2.84 (1.97, 4.21)
吸烟状态11.8930.004
从未吸烟1 607 (62.58)1.56 (1.05, 2.37)
曾经吸烟448 (17.45)1.51 (1.04, 2.41)
现在吸烟513 (19.98)1.36 (0.85, 2.25)
饮酒情况-2.799*0.005
从未饮酒702 (27.34)1.65 (1.09, 2.63)
现在饮酒1 866 (72.66)1.49 (0.98, 2.28)
教育水平8.3290.018
大学以上1 598 (62.23)1.48 (0.99, 2.22)
高中827 (32.20)1.62 (1.03, 2.58)
高中以下143 (5.57)1.71 (1.15, 2.60)
PIR7.8800.022
<1.5777 (30.26)1.59 (1.08, 2.50)
1.5～3.5958 (37.31)1.56 (1.06, 2.52)
>3.5833 (32.44)1.44 (0.95, 2.18)
CDAI 四分位23.561<0.001
Q1695 (27.06)1.66 (1.12, 2.58)
Q2632 (24.61)1.49 (0.99, 2.42)
Q3641 (24.96)1.54 (1.03, 2.36)
Q4600 (23.36)1.37 (0.90, 2.06)
睡眠时长（h/d）1.1570.562
<7855 (33.29)1.54 (1.02, 2.50)
7～91 602 (62.38)1.50 (1.01, 2.30)
>9109 (4.24)1.47 (1.00, 2.55)
Total2 568 (100)1.52 (1.01, 2.36)
), ArticleFig(id=1324051063405413069, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051055809528467, language=CN, label=表1, caption=

研究人员基本特征

, figureFileSmall=null, figureFileBig=null, tableContent=
变量n (%)HOMA-IR[M (Q1, Q3)]Z/H值P值
性别-3.033*0.002
男1 230 (47.90)1.56 (1.04, 2.60)
女1 338 (52.10)1.47 (0.97, 2.17)
年龄（岁）2.9920.229
18～<401 713 (66.71)1.55 (1.02, 2.35)
40～60636 (24.77)1.42 (0.97, 2.28)
≥ 60219 (8.53)1.60 (1.08, 2.51)
种族53.673<0.001
墨西哥裔美国人390 (15.19)2.03 (1.29, 2.94)
非西班牙裔白人1 089 (42.41)1.43 (0.95, 2.20)
非西班牙裔黑人534 (20.79)1.67 (1.18, 2.62)
其他种族555 (21.61)1.50 (1.04, 2.41)
婚姻8.4530.017
已婚/与伴侣居住1 418 (55.22)1.45 (0.97, 2.28)
离婚或丧偶299 (11.64)1.54 (1.10, 2.25)
未婚851 (33.14)1.63 (1.06, 2.54)
BMI754.927<0.001
偏瘦102 (3.97)0.85 (0.58, 1.46)
正常1 246(48.52)1.20 (0.85, 1.73)
超重733 (28.54)1.72 (1.18, 2.46)
肥胖487 (18.96)2.84 (1.97, 4.21)
吸烟状态11.8930.004
从未吸烟1 607 (62.58)1.56 (1.05, 2.37)
曾经吸烟448 (17.45)1.51 (1.04, 2.41)
现在吸烟513 (19.98)1.36 (0.85, 2.25)
饮酒情况-2.799*0.005
从未饮酒702 (27.34)1.65 (1.09, 2.63)
现在饮酒1 866 (72.66)1.49 (0.98, 2.28)
教育水平8.3290.018
大学以上1 598 (62.23)1.48 (0.99, 2.22)
高中827 (32.20)1.62 (1.03, 2.58)
高中以下143 (5.57)1.71 (1.15, 2.60)
PIR7.8800.022
<1.5777 (30.26)1.59 (1.08, 2.50)
1.5～3.5958 (37.31)1.56 (1.06, 2.52)
>3.5833 (32.44)1.44 (0.95, 2.18)
CDAI 四分位23.561<0.001
Q1695 (27.06)1.66 (1.12, 2.58)
Q2632 (24.61)1.49 (0.99, 2.42)
Q3641 (24.96)1.54 (1.03, 2.36)
Q4600 (23.36)1.37 (0.90, 2.06)
睡眠时长（h/d）1.1570.562
<7855 (33.29)1.54 (1.02, 2.50)
7～91 602 (62.38)1.50 (1.01, 2.30)
>9109 (4.24)1.47 (1.00, 2.55)
Total2 568 (100)1.52 (1.01, 2.36)
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Correlation between CDAI and HOMA-IR

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CDAI模型1模型2模型3
β (95%CI)P值β (95%CI)P值β (95%CI)P值
CDAI连续变量-0.04(-0.06～-0.02)<.001-0.06(-0.08～-0.03)<.001-0.05 (-0.07～-0.02)<0.001
CDAI四分位数
Q10.00 (参考组)0.00 (参考组)0.00 (参考组)
Q2-0.19 (-0.43～0.04)0.115-0.20 (-0.44～0.05)0.126-0.10 (-0.33～0.13)0.406
Q3-0.18 (-0.43～0.07)0.172-0.22 (-0.47～0.03)0.093-0.11 (-0.35～0.14)0.409
Q4-0.49 (-0.72～-0.25)<.001-0.58 (-0.84～-0.33)<.001-0.39 (-0.67～-0.12)0.007
), ArticleFig(id=1324051063623516879, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051055809528467, language=CN, label=表2, caption=

CDAI与HOMA-IR的相关性

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CDAI模型1模型2模型3
β (95%CI)P值β (95%CI)P值β (95%CI)P值
CDAI连续变量-0.04(-0.06～-0.02)<.001-0.06(-0.08～-0.03)<.001-0.05 (-0.07～-0.02)<0.001
CDAI四分位数
Q10.00 (参考组)0.00 (参考组)0.00 (参考组)
Q2-0.19 (-0.43～0.04)0.115-0.20 (-0.44～0.05)0.126-0.10 (-0.33～0.13)0.406
Q3-0.18 (-0.43～0.07)0.172-0.22 (-0.47～0.03)0.093-0.11 (-0.35～0.14)0.409
Q4-0.49 (-0.72～-0.25)<.001-0.58 (-0.84～-0.33)<.001-0.39 (-0.67～-0.12)0.007
), ArticleFig(id=1324051063707402960, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051055809528467, language=EN, label=Table 3, caption=

Association analysis of CDAI and the level of HOMA-IR in different population groups

, figureFileSmall=null, figureFileBig=null, tableContent=
变量n (%)β (95%CI)P值交互作用P值
研究对象2 568 (100.00)-0.05 (-0.07～-0.02)<0.001
性别0.016
男1 230 (47.90)-0.06 (-0.10～-0.03)<0.001
女1 338 (52.10)-0.02 (-0.05～0.01)0.146
年龄（岁）0.158
18～<401 713 (66.71)-0.04 (-0.07～-0.02)0.002
40～60636 (24.77)-0.06 (-0.12～-0.00)0.051
≥ 60219 (8.53)-0.05 (-0.09～-0.01)0.017
种族四分类0.431
墨西哥裔美国人390 (15.19)-0.04 (-0.13～0.05)0.421
非西班牙裔白人1 089 (42.41)-0.04 (-0.07～-0.01)0.012
非西班牙裔黑人534 (20.79)-0.04 (-0.08～-0.01)0.040
其他种族555 (21.61)-0.07 (-0.14～0.00)0.059
婚姻三分类0.523
已婚/与伴侣居住1 418 (55.22)-0.05 (-0.08～-0.01)0.009
离婚或丧偶299 (11.64)-0.05 (-0.10～0.00)0.058
未婚851 (33.14)-0.04 (-0.08～0.00)0.069
睡眠时长（h/d）0.658
< 7855 (33.32)-0.06 (-0.10～-0.03)0.002
7～91 602 (62.43)-0.05 (-0.08～-0.02)0.001
>9109 (4.25)0.23 (-0.16～0.63)0.064
BMI分组0.718
正常1 348 (52.49)-0.01 (-0.04～0.02)0.513
超重733 (28.54)-0.05 (-0.08～-0.02)0.003
肥胖487 (18.96)-0.15 (-0.25～-0.06)0.003
吸烟状态0.564
从未吸烟1 607 (62.58)-0.06 (-0.08～-0.03)<0.001
曾经吸烟448 (17.45)-0.06 (-0.10 ～-0.01)0.023
现在吸烟513 (19.98)0.01 (-0.07～0.09)0.792
饮酒情况0.130
从未饮酒702 (27.34)-0.10 (-0.15～-0.05)<0.001
现在饮酒1 866 (72.66)-0.03 (-0.06～-0.01)0.038
教育水平0.920
大学以上1 598 (62.23)-0.05 (-0.08～-0.02)<0.001
高中827 (32.20)-0.02 (-0.08～0.03)0.372
高中以下143 (5.57)-0.11 (-0.23～0.01)0.179
体力活动0.024
低体力活动644 (26.08)0.03 (-0.05～0.11)0.415
高体力活动1 825 (73.92)-0.06 (-0.09～-0.03)<0.001
PIR0.364
<1.5777 (30.26)-0.02 (-0.06～0.02)0.318
1.5～3.5958 (37.31)-0.07 (-0.13～-0.01)0.017
>3.5833 (32.44)-0.04 (-0.07～-0.02)0.003
), ArticleFig(id=1324051063782900433, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051055809528467, language=CN, label=表3, caption=

不同特征人群CDAI与HOMA-IR水平的关联分析

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变量n (%)β (95%CI)P值交互作用P值
研究对象2 568 (100.00)-0.05 (-0.07～-0.02)<0.001
性别0.016
男1 230 (47.90)-0.06 (-0.10～-0.03)<0.001
女1 338 (52.10)-0.02 (-0.05～0.01)0.146
年龄（岁）0.158
18～<401 713 (66.71)-0.04 (-0.07～-0.02)0.002
40～60636 (24.77)-0.06 (-0.12～-0.00)0.051
≥ 60219 (8.53)-0.05 (-0.09～-0.01)0.017
种族四分类0.431
墨西哥裔美国人390 (15.19)-0.04 (-0.13～0.05)0.421
非西班牙裔白人1 089 (42.41)-0.04 (-0.07～-0.01)0.012
非西班牙裔黑人534 (20.79)-0.04 (-0.08～-0.01)0.040
其他种族555 (21.61)-0.07 (-0.14～0.00)0.059
婚姻三分类0.523
已婚/与伴侣居住1 418 (55.22)-0.05 (-0.08～-0.01)0.009
离婚或丧偶299 (11.64)-0.05 (-0.10～0.00)0.058
未婚851 (33.14)-0.04 (-0.08～0.00)0.069
睡眠时长（h/d）0.658
< 7855 (33.32)-0.06 (-0.10～-0.03)0.002
7～91 602 (62.43)-0.05 (-0.08～-0.02)0.001
>9109 (4.25)0.23 (-0.16～0.63)0.064
BMI分组0.718
正常1 348 (52.49)-0.01 (-0.04～0.02)0.513
超重733 (28.54)-0.05 (-0.08～-0.02)0.003
肥胖487 (18.96)-0.15 (-0.25～-0.06)0.003
吸烟状态0.564
从未吸烟1 607 (62.58)-0.06 (-0.08～-0.03)<0.001
曾经吸烟448 (17.45)-0.06 (-0.10 ～-0.01)0.023
现在吸烟513 (19.98)0.01 (-0.07～0.09)0.792
饮酒情况0.130
从未饮酒702 (27.34)-0.10 (-0.15～-0.05)<0.001
现在饮酒1 866 (72.66)-0.03 (-0.06～-0.01)0.038
教育水平0.920
大学以上1 598 (62.23)-0.05 (-0.08～-0.02)<0.001
高中827 (32.20)-0.02 (-0.08～0.03)0.372
高中以下143 (5.57)-0.11 (-0.23～0.01)0.179
体力活动0.024
低体力活动644 (26.08)0.03 (-0.05～0.11)0.415
高体力活动1 825 (73.92)-0.06 (-0.09～-0.03)<0.001
PIR0.364
<1.5777 (30.26)-0.02 (-0.06～0.02)0.318
1.5～3.5958 (37.31)-0.07 (-0.13～-0.01)0.017
>3.5833 (32.44)-0.04 (-0.07～-0.02)0.003
), ArticleFig(id=1324051063900340946, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051055809528467, language=EN, label=Table 4, caption=

Mediating role of obesity in the CDAI and HOMA-IR association

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效应变量关系效应值（95%CI）P值
总效应CDAI→HOMA-IR-0.07（-0.11～-0.03）<0.001
直接效应CDAI→HOMA-IR-0.05 （-0.07～-0.02）<0.001
间接效应CDAI→肥胖→HOMA-IR-0.02（-0.06～0.02）0.280
), ArticleFig(id=1324051063984227027, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051055809528467, language=CN, label=表4, caption=

肥胖在CDAI与HOMA-IR关联中的中介效应分析

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效应变量关系效应值（95%CI）P值
总效应CDAI→HOMA-IR-0.07（-0.11～-0.03）<0.001
直接效应CDAI→HOMA-IR-0.05 （-0.07～-0.02）<0.001
间接效应CDAI→肥胖→HOMA-IR-0.02（-0.06～0.02）0.280
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综合膳食抗氧化指数与胰岛素抵抗指数的关联及肥胖的中介作用——基于NHANES的横断面研究
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张丽 1 , 张艺华 2 , 赵俊康 1 , 牛青梅 1, 2 , 王秀梅 1 , 张倩 1
现代预防医学 | 流行病与统计方法 2026,53(11): 1947-1953
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现代预防医学 |流行病与统计方法 2026 , 53 (11) : 1947 -1953
综合膳食抗氧化指数与胰岛素抵抗指数的关联及肥胖的中介作用——基于NHANES的横断面研究
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张丽1, 张艺华2, 赵俊康1, 牛青梅1, 2, 王秀梅1, 张倩1
作者信息
  • 1.山西白求恩医院（山西医学科学院），山西医科大学第三医院，同济山西医院，山西 太原 030032
  • 2.山西中医药大学
通讯作者:
张倩，E-mail：
作者简介:

张丽（1985—），女，硕士，主管医师，研究方向：流行病与卫生统计学

Association between comprehensive dietary antioxidant index and insulin resistance index: the mediating role of obesity—a cross-sectional study based on NHANES
Li ZHANG1, Yi-hua ZHANG2, Jun-kang ZHAO1, Qing-mei NIU1, 2, Xiu-mei WANG1, Qian ZHANG1
Affiliations
  • Shanxi Bethune Hospital (Shanxi Academy of Medical Sciences), The Third Hospital of Shanxi Medical University; Tongji Shanxi Hospital, Taiyuan, Shanxi 030032, China
出版时间: 2026-06-10 doi: 10.20043/j.cnki.MPM.202511079
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摘要
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目的

探讨综合膳食抗氧化指数（comprehensive dietary antioxidant index，CDAI）与稳态模型评估胰岛素抵抗指数（homeostatic model assessment of insulin resistance，HOMA-IR）的关联，并评估肥胖在上述关联中的中介效应。

方法

本研究基于美国国家健康与营养调查2005—2018年的数据，通过24 h膳食回顾法评估并计算CDAI。应用加权多变量线性回归模型及限制性立方样条分析CDAI与HOMA-IR的关联，并利用中介效应模型探讨肥胖在其中的潜在中介作用。

结果

本研究共纳入2 568名参与者。充分校正混杂因素后，加权多变量线性回归显示，CDAI与HOMA-IR水平呈负向关联（β=-0.05，95%CI：-0.07～-0.02，P<0.001）。与CDAI最低四分位组相比，最高四分位组的HOMA-IR水平降低（β=-0.39，95%CI：-0.67～-0.12，P=0.007）。中介分析结果表明，肥胖在二者关联中无显著中介效应（P=0.28）。

结论

较高的CDAI与较低的HOMA-IR水平独立相关。本研究中，未发现肥胖在此关联中具有显著的中介作用，提示CDAI的保护效应可能主要通过减轻氧化应激、改善胰岛素信号通路等独立于体重的直接生物学途径实现。未来需通过纵向研究进一步验证因果关联。

膳食抗氧化指数  /  肥胖  /  胰岛素抵抗指数  /  NHANES
Objective

To investigate the association between the comprehensive dietary antioxidant index (CDAI) and the homeostatic model assessment of insulin resistance (HOMA-IR), and to evaluate the mediating effect of obesity in this association.

Methods

Data were derived from the 2005—2018 National Health and Nutrition Examination Survey (NHANES). CDAI was calculated via 24-hour dietary recalls. Weighted multivariable linear regression and restricted cubic splines were used to analyze the association between CDAI and HOMA-IR, while mediation analysis assessed the potential role of obesity.

Results

A total of 2 568 participants were included in this study. After fully adjusting for confounding factors, weighted multivariable linear regression analysis revealed a negative association between CDAI and HOMA-IR levels (β=-0.05, 95% CI: -0.07~-0.02, P<0.001). Compared with the lowest quartile of CDAI, the highest quartile showed a reduction in HOMA-IR levels (β=-0.39, 95% CI:-0.67~-0.12, P=0.007). Mediation analysis indicated that obesity had no significant mediating effect on this association (P=0.28).

Conclusion

Higher CDAI levels are independently associated with lower HOMA-IR. The absence of a significant mediating effect of obesity suggests that the protective effect of CDAI may be achieved through direct biological pathways, such as reducing oxidative stress and improving insulin signaling, independent of body weight. Further longitudinal studies are warranted to verify causality.

CDAI  /  Obesity  /  HOMA-IR  /  NHANES
张丽, 张艺华, 赵俊康, 牛青梅, 王秀梅, 张倩. 综合膳食抗氧化指数与胰岛素抵抗指数的关联及肥胖的中介作用——基于NHANES的横断面研究. 现代预防医学, 2026 , 53 (11) : 1947 -1953 . DOI: 10.20043/j.cnki.MPM.202511079
Li ZHANG, Yi-hua ZHANG, Jun-kang ZHAO, Qing-mei NIU, Xiu-mei WANG, Qian ZHANG. Association between comprehensive dietary antioxidant index and insulin resistance index: the mediating role of obesity—a cross-sectional study based on NHANES[J]. Modern Preventive Medicine, 2026 , 53 (11) : 1947 -1953 . DOI: 10.20043/j.cnki.MPM.202511079
正文
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胰岛素是由胰岛β细胞分泌的关键激素，主要调节机体对葡萄糖的摄取、合成与储存[1]。胰岛素抵抗是胰岛素靶组织对胰岛素反应性降低的病理状态[2]，常伴随肥胖发生[3]，其病理特征表现为胰岛素靶组织对胰岛素生物效应的反应性降低，致使葡萄糖摄取与利用的效率显著下降[4]。在能量过剩状态下，机体通过降低胰岛素敏感性以适应代谢负荷，从而诱发胰岛素抵抗[5]。稳态模型评估的胰岛素抵抗指数（homeostasis model assessment of insulin resistance,HOMA-IR）基于空腹血糖与胰岛素水平计算，是反映肝脏胰岛素敏感性的常用指标[6]。Teresa Arrigo[7]等研究指出，膳食是调节氧化应激与肝脏疾病之间关系的关键环节。肝脏是活性氧产生和清除的关键场所，当体内脂质水平超过肝脏代谢能力时，会出现脂质积累和过量活性氧，诱发肝脏氧化应激，导致肝细胞损伤、炎症反应及胰岛素信号转导障碍，进而促进胰岛素抵抗的发生发展[7-8]。研究表明，膳食微量元素如硒、锌、铜等，参与调节抗氧化酶活性、葡萄糖代谢及胰岛素信号通路[9]。例如，硒依赖的谷胱甘肽过氧化物酶可通过抗氧化与抗炎作用，参与胰岛素合成与分泌的调节[10]。因此，充足的微量营养素摄入对于维持胰岛素敏感性至关重要[11]。鉴于氧化应激被认为是胰岛素抵抗的关键机制之一，提高膳食抗氧化物质摄入可能有助于改善胰岛素敏感性[12]。本研究选取HOMA-IR作为核心指标，旨在从肝脏胰岛素敏感性角度，探讨膳食抗氧化能力与胰岛素抵抗之间的潜在关联，为代谢性疾病的早期营养干预提供理论依据。
综合膳食抗氧化指数（composite dietary antioxidant index, CDAI）是基于膳食中维生素A、维生素C、维生素E、类胡萝卜素、硒和锌等六种抗氧化成分摄入量构建的综合指标，评分越高反映膳食抗氧化能力越强[13]。已有研究证实，较高的CDAI水平与较低的动脉粥样硬化、非酒精性脂肪肝及脑卒中等代谢性疾病风险相关[14-18]。现有证据主要集中于单一抗氧化营养素或特定人群（如儿童青少年）[11,19-23]。目前，在大规模、具有全国代表性的成年人群中，关于CDAI与HOMA-IR之间直接关联的流行病学证据仍较为缺乏。抗氧化剂可能通过减轻氧化应激与炎症直接影响胰岛素信号[5]，也可能通过改善代谢状况间接减轻肥胖[24]。尽管胰岛素抵抗与肥胖之间存在双向关联，但主流证据表明，肥胖是驱动胰岛素抵抗的关键因素[3,25-26]。其机制涉及肥胖相关的慢性炎症与氧化应激，可诱发脂肪组织功能紊乱，进而升高循环胰岛素与游离脂肪酸水平，促使胰岛β细胞损伤，加剧全身性胰岛素抵抗[27-28]。前期研究提示，CDAI与肥胖风险呈负相关[29-30]。基于上述证据，本研究提出核心假设：CDAI可能通过其抗氧化与抗炎作用，对胰岛素敏感性产生直接影响。为验证此假设，并填补现有研究空白，本研究旨在利用NHANES 2005—2018数据，重点探讨美国成年人群中CDAI与HOMA-IR的直接关联。同时，鉴于肥胖在其中的潜在复杂角色，本研究将探索肥胖在CDAI与HOMA-IR关联中的潜在中介作用，以期为从整体膳食模式角度制定胰岛素抵抗的预防策略提供新证据。
1　材料与方法
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1.1　数据来源
本研究采用美国国家健康与营养调查（National Health Nutrition Exmination Survey，NHANES）2005—2018年公开数据（www.cdc.gov/nchs/nhanes）[31]。该调查采用多阶段分层概率抽样，样本具有全国代表性。从101 316名初始参与者中，排除年龄<18岁，HOMA-IR、CDAI及关键协变量数据缺失者，最终纳入2 568名研究对象。见图1。
1.2　CDAI的定义及评估
本研究采用两次24 h膳食回顾数据计算CDAI。该数据由认证营养师通过标准化流程收集[32]，营养素摄入量依据美国膳食营养素数据库进行计算，并取两次回顾结果的平均值。CDAI旨在综合评估维生素A、C、E、锌、硒及类胡萝卜素这六种膳食抗氧化成分的总摄入水平[33]。该指标通过将每种成分的日均摄入量标准化为Z分数后加总得出。具体公式如下：
1.3　HOMA-IR的定义及评估
HOMA-IR由Matthews等人[34]提出，该模型基于葡萄糖与胰岛素在胰腺、肝脏及外周组织相互作用下的稳态反馈，用于评估胰岛素抵抗的程度。其计算公式为：HOMA-IR=［空腹血糖(mmol/L) ×空腹胰岛素（μU/ml）/22.5］。
1.4　肥胖的定义
本研究采用身体质量指数（body mass index, BMI）作为评估指标。根据分级标准，BMI≤18.5 kg/m2为偏瘦，BMI 在18.6～24.9 kg/m2为正常，BMI在 25.0～25.9 kg/m2之间为超重，BMI≥30.0 kg/m2为肥胖[1,6]。
1.5　相关因素
本研究纳入变量主要包括年龄（18～<40岁、40～60岁和≥ 60岁）、性别（男、女）、种族（非西班牙裔白人、非西班牙裔黑人、其他西班牙裔、墨西哥裔美国人及其他种族）、婚姻状况（未婚、离婚或丧偶、已婚或与伴侣同居）、教育水平（高中以下、高中及大学以上）、体力活动水平（低体力活动、高体力活动）、家庭收入贫困比（poverty income ratio，PIR）、吸烟情况、饮酒习惯、每日热量摄入、睡眠情况。
1.6　统计分析
本研究所有分析基于NHANES复杂抽样权重进行，使用R 4.4.0进行分析。符合正态分布的连续变量以（加权均值±标准差）表示，组间比较采用两独立样本t检验或方差分析；不符合正态分布的连续变量以中位数和四分位数间距表示，组间比较采用Wilcoxon 秩和检验或Kruskal-Wallis H检验。采用加权多元线性回归模型评估CDAI与HOMA-IR之间的关联，并构建三个层次的多变量回归模型以逐步控制混杂因素：模型1不纳入任何协变量；模型2调整社会人口学变量，包括性别、年龄、种族、婚姻状况；模型3在模型2的基础上进一步调整教育水平、家庭PIR、吸烟状况、饮酒状况、每日总能量摄入、体力活动水平、BMI及睡眠时长。为探索暴露与结局关系的潜在非线性特征及剂量反应趋势，本研究将CDAI按四分位数进行分层分析，并采用限制性立方样条(restrictive cubic spline,RCS)函数进行剂量反应关系拟合。
为进一步验证CDAI与HOMA-IR直接关联的稳健性，并探索肥胖状态在其中是否存在潜在的中间作用，本研究构建了以肥胖状态（是/否）为中介变量中介效应模型。采用广义线性模型，控制性别、年龄、种族、婚姻状况等混杂因素后，利用非参数bootstrap法估算总效应、直接效应及间接效应。检验水准α=0.05。
2　结果
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2.1　研究对象的基线特征
本研究共纳入2 568名研究对象，总体HOMA-IR的M (Q1, Q3)为1.52（1.01,2.36）。基线特征分析显示，研究对象性别比例基本平衡，男性占47.90%，女性占52.10%，但男性HOMA-IR水平显著高于女性。不同年龄、种族、BMI、吸烟状态、饮酒情况、教育水平、PIR、睡眠时长的人群中HOMA-IR水平差异有统计学意义。见表1。
2.2　CDAI与HOMA-IR水平的关系
本研究采用加权多变量线性回归模型分析CDAI与HOMA-IR的关联。表2显示，在完全校正混杂因素后，CDAI与HOMA-IR呈负相关（β=-0.05）。在未校正模型中，CDAI每增加1个单位，HOMA-IR降低0.04个单位（P<0.001），且该关联随校正因素增加而增强。四分位分析显示，与最低四分位（Q1）相比，最高四分位（Q4）的HOMA-IR水平显著降低（β=-0.39）。结果表明，较高的膳食抗氧化水平与较低的胰岛素抵抗水平相关，提示CDAI可能是胰岛素抵抗的保护因素。
采用 RCS分析CDAI与HOMA-IR水平的剂量-反应关系。结果显示，在完全调整混杂因素后，CDAI与HOMA-IR水平呈线性负相关联（非线性检验P=0.246；总体关联P<0.001），随着CDAI水平升高，HOMA-IR水平呈持续下降的趋势。见图2。
2.3　不同特征人群CDAI与HOMA-IR水平的关联分析
为评估不同人群差异，研究对年龄、性别等因素开展了分层分析。结果显示，CDAI的保护作用在男性、18～<40岁、≥60岁、非西班牙裔白人、非西班牙裔黑人、已婚、睡眠时长<9 h/d、超重、肥胖、高学历、从不吸烟、从不饮酒、高体力活动及高收入人群中更为显著。交互作用分析结果显示，性别、体力活动是CDAI与HOMA-IR发生之间的交互因素（P<0.05），其余协变量之间未表现出显著的交互作用，表明该关系在不同亚组中整体较为稳定，而性别、体力活动对该关联存在一定的调节作用。见表3。
2.4　中介分析
本研究将性别、年龄、种族、婚姻状况、教育水平、吸烟情况、饮酒情况、热量摄入、体力活动情况等作为控制变量进行中介分析。结果表明，肥胖在CDAI与胰岛素抵抗关联中的中介作用不具统计学意义（β=-0.02, 95% CI: -0.06～0.02, P=0.28）。见表4。
3　讨论
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本研究基于全国代表性数据表明，较高的CDAI与较低的HOMA-IR水平独立相关，且存在线性剂量-反应关系。亚组分析结果表明该关联在男性、高体力活动亚组中更为显著。
本研究结果与既往研究一致，支持膳食抗氧化剂在改善胰岛素敏感性中的作用[35-36]。近期研究探讨了CDAI与反映外周胰岛素抵抗的甘油三酯-葡萄糖（triglyceride-glucose，TyG）指数间的关系[37]。TyG指数作为评估胰岛素抵抗的稳定指标，更侧重反映与脂代谢相关的外周组织胰岛素敏感性[38]。与之相比，本研究选用主要反映肝脏胰岛素敏感性的HOMA-IR指标[39]，旨在从肝脏代谢角度探讨膳食抗氧化剂的潜在作用。从机制看，氧化应激是驱动胰岛素抵抗的核心环节，过量的活性氧不仅可直接损害胰岛β细胞功能，更能通过激活NF-κB等信号通路干扰胰岛素信号转导[40-41]，而胰岛素抵抗所致脂肪酸溢出又会加剧活性氧的生成，形成恶性循环[40]。膳食抗氧化剂可通过清除自由基、激活Nrf2通路缓解氧化损伤、改善胰岛素信号[42-43]。值得注意的是，本研究发现肥胖并未显著介导上述关联，提示其保护作用可能独立于体重变化，其潜在机制更可能涉及直接调控胰岛素信号通路[44]、减轻氧化应激[45]、抑制慢性炎症[46]等途径。即使在正常体重人群中，较高的CDAI亦被证明与较低的代谢异常风险相关，进一步支持其作用具有体重非依赖性[47]。病理上，胰岛素抵抗与氧化应激是代谢综合征的关键始动因素，其发生可先于或独立于肥胖[47]。例如，硒可直接参与胰岛素信号分子的调节，保护β细胞并减轻系统性炎症，从而独立改善葡萄糖稳态[10]。因此，CDAI可能主要通过直接调节胰岛素敏感性发挥保护作用，这为在不同体重状况（包括体重正常但存在代谢风险的个体）的人群中推广富含抗氧化剂的膳食模式提供了依据。
本研究的优势在于基于NHANES大样本多民族数据，调整了全面的社会经济及膳食混杂因素，为结果提供了可靠的流行病学证据。然而，研究亦存在局限性：一方面，横断面设计无法确定CDAI与HOMA-IR的时序关系，反向因果不能排除；其次，尽管采用两次24 h膳食回顾，但仍存在潜在的测量误差；另一方面，由于数据源于美国人群，其饮食结构与中国的差异可能限制结论的外推性，未来需在中国人群中开展本土化验证。
综上所述，本研究表明，较高的膳食抗氧化水平与较低的胰岛素抵抗独立相关，且该关联未发现由肥胖介导。本研究为通过膳食干预预防代谢性疾病提供了流行病学证据，未来需开展前瞻性队列与随机对照试验，以进一步明确其因果关系，并探索不同人群中的最佳膳食抗氧化摄入模式。
基金
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  • 2024年度山西白求恩医院护理科研基金项目(2024YH21)
文献
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2026年第53卷第11期
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doi: 10.20043/j.cnki.MPM.202511079
  • 接收时间：2025-11-07
  • 首发时间：2026-11-02
  • 出版时间：2026-06-10
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  • 收稿日期：2025-11-07
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2024年度山西白求恩医院护理科研基金项目(2024YH21)
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    1.山西白求恩医院（山西医学科学院），山西医科大学第三医院，同济山西医院，山西 太原 030032
    2.山西中医药大学

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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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