指尖血的 δ13C 值是一种有效的、可靠的、敏感的儿童和青少年含糖饮料摄入量的生物标志物。
The δ13C Value of Fingerstick Blood Is a Valid, Reliable, and Sensitive Biomarker of Sugar-Sweetened Beverage Intake in Children and Adolescents.
机构信息
Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA.
Biology Institute, University of Oslo, Norway.
出版信息
J Nutr. 2018 Jan 1;148(1):147-152. doi: 10.1093/jn/nxx017.
BACKGROUND
Reliance on self-reported dietary intake methods is a commonly cited research limitation, and dietary misreporting is a particular problem in children and adolescents. Objective indicators of dietary intake, such as dietary biomarkers, are needed to overcome this research limitation. The added sugar (AS) biomarker δ13C, which measures the relative abundance of 13C to 12C, has demonstrated preliminary validity in adults.
OBJECTIVE
The purpose of this investigation was to determine the comparative validity, test-retest reliability, and sensitivity of the δ13C biomarker to detect AS and sugar-sweetened beverage (SSB) intake using fingerstick blood samples in children and adolescents.
METHODS
Children (aged 6-11 y, n = 126, 56% male, mean ± SD age: 9 ± 2 y) and adolescents (aged 12-18 y, n = 200, 44% male, mean ± SD age: 15 ± 2 y) completed 4 testing sessions within a 3-wk period. Participants' height, weight, demographic characteristics, and health history were determined at the first session; 24-h recalls were obtained at each visit and fingerstick blood samples were collected at visits 1 and 3. Samples were analyzed for δ13C value using natural abundance stable isotope mass spectrometry. δ13C value was compared with dietary outcomes in the full sample, and in child and adolescent subgroups. t Tests and correlational analyses were used to assess biomarker validity and reliability, whereas logistic regression and area under the receiver-operator characteristic curve (AUC) were used to evaluate sensitivity.
RESULTS
Reported mean ± SD AS consumption was 82.2 ± 35.8 g/d and 329 ± 143 kcal/d, and SSB consumption was 222 ± 243 mL/d and 98 ± 103 kcal/d. Mean δ13C value was -19.65 ± 0.69‰, and was lower in children than in adolescents (-19.80 ± 0.67‰ compared with -19.56 ± 0.67‰, P = 0.002). δ13C values were similar across sessions (visit 1: -19.66 ± 0.68‰; visit 3: -19.64 ± 0.68‰; r = 0.99, P < 0.001) and were associated (P < 0.001) with intake of total AS (grams, kilocalories: r = 0.29) and SSB (milliliters, kilocalories: r = 0.35). The biomarker was able to better discriminate between high and low SSB consumers than high and low AS consumers, as demonstrated by the AUC (0.75 and 0.62, respectively).
CONCLUSIONS
The δ13C biomarker is a promising, minimally invasive, objective biomarker of SSB intake in children and adolescents. Further evaluation using controlled feeding designs is warranted. Registered at clinicaltrials.gov as NCT02455388.
背景
依赖自我报告的饮食摄入方法是一个常见的研究局限性，而饮食报告错误在儿童和青少年中是一个特别的问题。需要使用饮食生物标志物等客观指标来克服这一研究局限性。δ13C 是一种衡量 13C 与 12C 相对丰度的添加糖（AS）生物标志物，在成年人中已初步证明其有效性。
目的
本研究旨在通过指尖采血检测儿童和青少年的 AS 和含糖饮料（SSB）摄入量，确定 δ13C 生物标志物的比较有效性、重测信度和敏感性。
方法
6-11 岁的儿童（n=126，56%为男性，平均年龄±标准差：9±2 岁）和 12-18 岁的青少年（n=200，44%为男性，平均年龄±标准差：15±2 岁）在 3 周内完成 4 次测试。第一次测试时，确定参与者的身高、体重、人口统计学特征和健康史；每次访问时都进行 24 小时回顾，并在第 1 次和第 3 次访问时采集指尖血样。使用自然丰度稳定同位素质谱法分析 δ13C 值。将 δ13C 值与全样本的饮食结果进行比较，并在儿童和青少年亚组中进行比较。采用 t 检验和相关分析评估生物标志物的有效性和可靠性，采用逻辑回归和接收者操作特征曲线下面积（AUC）评估敏感性。
结果
报告的平均±标准差 AS 摄入量为 82.2±35.8 g/d 和 329±143 kcal/d，SSB 摄入量为 222±243 mL/d 和 98±103 kcal/d。平均 δ13C 值为-19.65±0.69‰，儿童的 δ13C 值低于青少年（-19.80±0.67‰与-19.56±0.67‰，P=0.002）。δ13C 值在各次测试中相似（第 1 次测试：-19.66±0.68‰；第 3 次测试：-19.64±0.68‰；r=0.99，P<0.001），与总 AS（克、千卡：r=0.29）和 SSB（毫升、千卡：r=0.35）的摄入量相关（P<0.001）。该生物标志物在区分高 SSB 消费者和低 SSB 消费者方面优于区分高 AS 消费者和低 AS 消费者，AUC 也证实了这一点（分别为 0.75 和 0.62）。
结论
δ13C 生物标志物是一种有前途的、微创的、儿童和青少年 SSB 摄入量的客观生物标志物。需要使用对照喂养设计进行进一步评估。在 clinicaltrials.gov 上注册为 NCT02455388。
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