巴西成年人中，乳制品摄入量与血糖和胰岛素血症的关联，独立于肥胖因素：巴西成人健康纵向研究（ELSA-Brasil）

Associations of dairy intake with glycemia and insulinemia, independent of obesity, in Brazilian adults: the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

作者信息

Drehmer Michele, Pereira Mark A, Schmidt Maria Inês, Del Carmen B Molina Maria, Alvim Sheila, Lotufo Paulo A, Duncan Bruce B

机构信息

From the Department of Social Medicine, School of Medicine, Postgraduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (MD, MIS, and BBD); the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN (MAP); the Health Sciences Center, Federal University of Espirito Santo, Vitoria, Brazil (MDCBM); the Institute of Collective Health, Federal University of Bahia, Salvador, Brazil (SA); and the Center for Clinical and Epidemiologic Research, University of Sao Paulo, Sao Paulo, Brazil (PAL).

出版信息

Am J Clin Nutr. 2015 Apr;101(4):775-82. doi: 10.3945/ajcn.114.102152. Epub 2015 Jan 21.

DOI:10.3945/ajcn.114.102152

PMID:25833975

Abstract

BACKGROUND

Inverse associations between dairy intake and the risk of type 2 diabetes have been shown, but more studies are needed, especially from low- and middle-income countries.

OBJECTIVE

The objective was to describe the association between dairy products and direct measures of glycemic status in adults without known diabetes.

DESIGN

The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) includes 15,105 adults, aged 35-74 y, enrolled from universities and research institutions in 6 Brazilian capital cities. We excluded participants with a known diabetes diagnosis, cardiovascular diseases, and cancer. Dairy consumption was assessed by a food-frequency questionnaire, and we computed servings per day for total and subgroups of dairy. Associations with fasting blood glucose (FG) and fasting insulin, 2-h postload glucose (PG), 2-h postload insulin (PI), glycated hemoglobin (Hb A1c), and homeostasis model assessment of insulin resistance (HOMA-IR) were assessed through multivariable linear regression analysis with adjustment for demographic characteristics, behavioral risk factors, other dietary factors, and anthropometric measurements.

RESULTS

The sample size after exclusions was 10,010. The intake of total dairy was inversely associated with FG (linear β for dairy servings/d = -0.46 ± 0.2 mg/dL), PG (-1.25 ± 0.5 mg/dL), PI (-1.52 ± 0.6 mg/dL), Hb A1c (-0.02 ± 0.0%), and HOMA-IR (-0.04 ± 0.0) after adjustment for all covariates (P < 0.05 for all). The findings were consistent across categories of sex, race, obesity status, and dairy fat amount (reduced-fat vs. full-fat dairy). Fermented dairy products showed particularly strong inverse associations with the outcomes, with adjusted differences for a 1-serving/d increment of -0.24 (95% CI: -0.46, -0.02) mg/dL for FG, -0.86 (-1.42, -0.30) mg/dL for PG, and -0.01% (-0.02%, 0.00%) for Hb A1c. Myristic acid was the only nutrient that appeared to mediate the association between dairy intake and glycemia.

CONCLUSION

Dairy intake, especially fermented dairy, was inversely associated with measures of glycemia and insulinemia in Brazilian adults without diagnosed diabetes. This trial was registered at clinicaltrials.com as NCT02320461.

摘要

背景

已有研究表明乳制品摄入量与2型糖尿病风险呈负相关，但仍需更多研究，尤其是来自低收入和中等收入国家的研究。

目的

旨在描述乳制品与未患糖尿病成年人血糖状态直接指标之间的关联。

设计

巴西成人健康纵向研究（ELSA - Brasil）纳入了15105名年龄在35 - 74岁的成年人，他们来自巴西6个首都城市的大学和研究机构。我们排除了已知患有糖尿病、心血管疾病和癌症的参与者。通过食物频率问卷评估乳制品消费情况，并计算每日各类乳制品及其亚组的摄入量。通过多变量线性回归分析评估与空腹血糖（FG）、空腹胰岛素、餐后2小时血糖（PG）、餐后2小时胰岛素（PI）、糖化血红蛋白（Hb A1c）以及胰岛素抵抗稳态模型评估（HOMA - IR）的关联，并对人口统计学特征、行为危险因素、其他饮食因素和人体测量指标进行了调整。

结果

排除后样本量为10010。在对所有协变量进行调整后，总乳制品摄入量与FG（每增加一份乳制品，线性β = -0.46 ± 0.2mg/dL）、PG（-1.25 ± 0.5mg/dL）、PI（-1.52 ± 0.6mg/dL）、Hb A1c（-0.02 ± 0.0%）和HOMA - IR（-0.04 ± 0.0）呈负相关（所有P < 0.05）。在性别、种族、肥胖状态和乳制品脂肪含量类别（减脂乳制品与全脂乳制品）中，研究结果一致。发酵乳制品与这些指标呈现出特别强的负相关，每增加一份/天，调整后的差异为：FG为-0.24（95%CI：-0.46，-0.02）mg/dL，PG为-0.86（-1.42，-0.30）mg/dL，Hb A1c为-0.01%（-0.02%，0.00%）。肉豆蔻酸是唯一似乎介导乳制品摄入量与血糖之间关联的营养素。