种族差异对感染负担的影响及其与心血管疾病代谢风险因素的关联：一项横断面分析。
Ethnic differences in infectious burden and the association with metabolic risk factors for cardiovascular disease: a cross-sectional analysis.
机构信息
Department of Public Health, Academic Medical Centre, University of Amsterdam, Meibergdreef 15, 1105 AZ, J2-209, Amsterdam, The Netherlands.
Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands.
出版信息
BMC Public Health. 2018 Feb 22;18(1):276. doi: 10.1186/s12889-018-5162-x.
BACKGROUND
The burden of metabolic risk factors for cardiovascular disease (CVD), such as type 2 diabetes, elevated cholesterol and hypertension, is unequally distributed across ethnic groups. Recent findings suggest an association of infectious burden (IB) and metabolic risk factors, but data from ethnic groups are scarce. Therefore, we investigated ethnic differences in IB and its association with metabolic risk factors.
METHODS
We included 440 Dutch, 320 Turkish and 272 Moroccan participants, 18-70 years, of the 2004 general health survey in Amsterdam, the Netherlands. IB was defined by seropositivity to the sum of 6 infections: Herpes Simplex Virus 1 and 2; Hepatitis A, B and C; and Helicobacter pylori. Associations between IB categories 4-6 (high), 3 (intermediate) and 0-2 (low) infections and metabolic risk factors were assessed by logistic regression. Finally, we determined the contribution of IB to the association between ethnicity and the metabolic risk factors by comparing adjusted logistic regression models with and without IB categories.
RESULTS
A high IB was more frequently observed among the Turkish and Moroccans than among the Dutch. After adjustment for age, sex, ethnicity, educational level, physical activity and body mass index, high IB was associated with type 2 diabetes (odds ratio high vs low IB (OR) =2.14, 95%-confidence interval (CI) 1.05-4.36). The association was weaker and not statistically significant, for elevated cholesterol (OR = 1.39, 95%-CI 0.82-2.34) and hypertension (OR = 1.49, 95%-CI 0.88-2.51). IB attenuated ethnic differences particularly for type 2 diabetes.
CONCLUSIONS
Our study showed that Turkish and Moroccan adults in Amsterdam have a higher IB than Dutch adults, which was associated with the differences in type 2 diabetes. Due to the cross-sectional nature of the study, we cannot draw a conclusions with regards to the time-sequence of cause and effect. Nevertheless, the findings ask for further research into the nature of association of IB with metabolic risk factors in a longitudinal setting.
背景
心血管疾病（CVD）的代谢风险因素（如 2 型糖尿病、胆固醇升高和高血压）负担在不同种族群体中分布不均。最近的研究结果表明，感染负担（IB）与代谢风险因素之间存在关联，但来自不同种族群体的数据却很少。因此，我们研究了 IB 在不同种族群体中的差异及其与代谢风险因素的关联。
方法
我们纳入了 2004 年荷兰阿姆斯特丹一般健康调查中的 440 名荷兰人、320 名土耳其人和 272 名摩洛哥人，年龄在 18-70 岁之间。IB 定义为对 6 种感染的血清阳性：单纯疱疹病毒 1 和 2；甲型、乙型和丙型肝炎；以及幽门螺杆菌。通过 logistic 回归评估 IB 类别 4-6（高）、3（中）和 0-2（低）感染与代谢风险因素之间的关联。最后，我们通过比较包含和不包含 IB 类别的调整后的 logistic 回归模型，来确定 IB 对种族与代谢风险因素之间关联的贡献。
结果
土耳其人和摩洛哥人的高 IB 发生率高于荷兰人。在校正年龄、性别、种族、教育水平、身体活动和体重指数后，高 IB 与 2 型糖尿病相关（高 vs 低 IB 的比值比（OR）=2.14，95%-置信区间（CI）为 1.05-4.36）。对于胆固醇升高（OR=1.39，95%-CI 为 0.82-2.34）和高血压（OR=1.49，95%-CI 为 0.88-2.51），这种关联较弱且无统计学意义。IB 减弱了种族差异，特别是对 2 型糖尿病的影响。
结论
我们的研究表明，阿姆斯特丹的土耳其和摩洛哥成年人的 IB 高于荷兰成年人，这与 2 型糖尿病的差异有关。由于研究的横断面性质，我们不能得出关于因果关系时间顺序的结论。尽管如此，这些发现还是要求在纵向研究中进一步研究 IB 与代谢风险因素之间的关联性质。
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