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中国人群研究:这种饮食模式将妊娠期糖尿病风险升高2倍!

2022-04-20 LILYMED MedSci原创

BMC Pregnancy Childbirth:同型半胱氨酸相关饮食模式与妊娠期糖尿病的相关性研究。

由于肥胖和高龄产妇的发病率增加,中国大陆地区妊娠期糖尿病(GDM)的发病率为14.8%,而华东、华中、华北地区的发病率较高。GDM的预后主要取决于早期预防和干预,其中饮食治疗是GDM一级预防的重要策略,也是所有糖尿病治疗的基础。饮食模式是对饮食作为一个整体的综合评价,能准确反映饮食对疾病的影响,在营养与健康的关系研究中具有重要意义。

研究发现高同型半胱氨酸水平(高同型半胱氨酸血症,hHcy)是GDM的危险因素,饮食模式影响血清同型半胱氨酸(Hcy)水平;例如,地中海饮食可以显著降低血清Hcy水平。然而,饮食模式是否通过Hcy水平的变化影响GDM的发生及其相关机制尚未明确

有三种类型的饮食模式提取方法,根据研究目的使用不同的方法。

  • 首先是饮食指数(DI)的使用,包括饮食平衡指数(DBI),饮食质量指数(DQI),健康饮食指数(HEI)。它主要用于评估群体和个人的饮食营养状况。
  • 二是聚类分析,包括主成分分析(PCA)、聚类分析(CA)和因子分析(FA)。聚类分析是一种根据个体或变量的特征对个体或变量进行分类的统计方法。在整体类别分类不明确的情况下,聚类分析可用于探索个体或变量的分类。
  • 第三种是第一类和第二类方法的组合,包括简化秩回归(RRR)和偏最小二乘回归(PLS)。RRR方法可以最大程度地解释反应变量,例如与疾病结果和营养素相关的变量,有助于分析饮食模式与疾病之间的关系,并分析其可能的机制。

因此,本研究旨在利用RRR方法提取hHcy相关的饮食模式,并分析其与GDM发生率的关系,以探讨饮食模式在Hcy水平和GDM中的可能作用。

本研究共纳入2019年1月-2020年12月期间在我院进行常规产科检查的24-28周孕妇512例。最后,488例纳入分析。与正常组相比,GDM组在教育背景和孕期体重增加方面没有差异P>0.01)而GDM组患者年龄较大,经产妇女较高,孕前BMI和能量摄入水平较高P<0.01)GDM组叶酸摄入量低于正常组,但两组B12和B6摄入量无显著差异P>0.01)GDM组血清Hcy水平高于正常组,但FA和B12水平低于正常组P <0.01)

本研究确定了三种饮食模式(表2)。

  • 对于模式1,相关指数>0.20,主要来与禽肉和牲畜肉;绿叶蔬菜、深色蔬菜、大豆和虾的< − 0.20,这解释了食物中29.14%的变化和响应变量的24.26%的变化。
  • 对于模式2,相关指数>0.20,主要针对熟小麦食品、牲畜肉和蛋;<− 0.20 主要用于粗粮、绿叶蔬菜、干真菌和藻类、牛奶组和坚果,这解释了食物中65.23%的变化和响应变量的56.38%的变化。
  • 模式3因素的相关指数>0.20,主要针对牲畜肉类;大豆<− 0.20,这解释了食物中5.63%的变化和响应变量的19.35%的变化。由于方式3的解释变化相对较小,因此被排除在外。

与模式1的最低四分位数组相比,模式1最高四分位数组中的受试者具有更高的能量摄入,更高的血清Hcy,更高的血清FA和B12,且均呈线性趋势。与模式2的最低四分位数组相比,最高四分位数组中的受试者年龄较大,孕前BMI较高,血清HCY较高,血清FA和B12较低,呈线性趋势,但在孕期能量摄入和体重增加方面没有差异(表3)。

Logistic回归分析显示多种混杂因素调整后, 模式2的评分与GDM的发生率呈显著正相关(P <0.01),GDM的风险相对于最低的四分位阵列和第四个四分位数阵列显著增加(OR = 2.963,95% CI:0.939–9.356)。而模式1得分与GDM发生率无显著相关性P >0.05)在得分的最低和最高四分位发生GDM的风险OR = 0.480 (95% CI: 0.137-1.684)(表4)。

综上所述,hHcy相关饮食模式评分与GDM风险呈显著正相关,表明可以调整饮食模式以增加富含单碳单位代谢相关维生素的食物的摄入量,从而影响Hcy水平可能有助于GDM的干预和预防。

 

原文来源:

Liu YH, Lu LP, Yi MH, et al. Study on the correlation between homocysteine-related dietary patterns and gestational diabetes mellitus:a reduced-rank regression analysis study. BMC Pregnancy Childbirth. 2022;22(1):306. Published 2022 Apr 10. doi:10.1186/s12884-022-04656-5.

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    2022-04-23 屋顶瞄爱赏月

    学习了

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    2022-04-23 ms5000000501335043

    学习了!

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同型半胱氨酸是一种由营养蛋氨酸去甲基化形成的氨基酸,它参与多种代谢过程,包括甲基化和硫化反应。

JAHA:同型半胱氨酸和尿酸联合识别亚临床房颤高危患者

同型半胱氨酸和UA生物标志物与SCAF密切相关。通过添加选定的生物标志物,欧洲心脏病学会模型对SCAF的预测性能得到了改善。

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