代谢因素在水果或蔬菜摄入量与心血管疾病关联中的中介作用：韩国国民健康与营养检查调查

Mediating effects of metabolic factors on the association between fruit or vegetable intake and cardiovascular disease: the Korean National Health and Nutrition Examination Survey.

作者信息

Lee Hye Ah, Lim Dohee, Oh Kyungwon, Kim Eun Jung, Park Hyesook

机构信息

Clinical Trial Center, Mokdong Hospital, Ewha Womans University, Seoul, South Korea.

Division of Health and Nutrition Survey, Korea Centers for Disease Control and Prevention, Cheongwon-gun, South Korea.

出版信息

BMJ Open. 2018 Feb 28;8(2):e019620. doi: 10.1136/bmjopen-2017-019620.

DOI:10.1136/bmjopen-2017-019620

PMID:29490964

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5855238/

Abstract

OBJECTIVE

We assessed the mediating effects of metabolic components on the relationship between fruit or vegetable intake and cardiovascular disease (CVD).

DESIGN

Cross-sectional study.

SETTING

This study was conducted using data from the 2013-2015 Korean National Health and Nutrition Examination Survey, which is a national representative cross-sectional survey to assess health and nutritional status in the Korean population.

METHOD AND ANALYSIS

A total of 9040 subjects (3555 males and 5485 females) aged ≥25 years were included in the study. Physician-diagnosed CVD via self-report was used as the outcome. Fruit or vegetable intake was measured via a dish-based semiquantitative food frequency questionnaire and grouped into categories (<1 time/day, 1 time/day, 2 times/day and ≥3 times/day). Systolic blood pressure (SBP), cholesterol and fasting glucose were considered metabolic mediators, and the bootstrap method was used to assess mediating effect.

RESULTS

About 1.8% of adults aged 25-64 years had CVD. According to the result of 'process' macro, the confounder-adjusted risk for CVD decreased by 14% (OR=0.86, 95% CI 0.74 to 0.98) as fruit, but not vegetable, intake was increased by one unit per day. After additional adjustment for three metabolic factors simultaneously, the OR was attenuated to 0.89 (95% CI 0.77 to 1.03). This result indicates that the indirect effect of three metabolic factors accounted for 21.4% of the relationship between fruit intake and CVD. SBP was a more important metabolic mediator than the other factors. The indirect effect by metabolic factors accounted for 30.0% when body mass index was additionally controlled as a mediator, and SBP still had an independent effect compared with the other mediators.

CONCLUSIONS

Our results indicate that controlling SBP may lessen the CVD risk, and a diet rich in fruits can regulate SBP which, in turn, reduces CVD risk.

摘要

目的

我们评估了代谢成分在水果或蔬菜摄入量与心血管疾病（CVD）之间关系中的中介作用。

设计

横断面研究。

背景

本研究使用了2013 - 2015年韩国国民健康与营养检查调查的数据，这是一项全国代表性的横断面调查，旨在评估韩国人群的健康和营养状况。

方法与分析

共有9040名年龄≥25岁的受试者（3555名男性和5485名女性）纳入研究。通过自我报告由医生诊断的CVD作为结局。水果或蔬菜摄入量通过基于菜肴的半定量食物频率问卷进行测量，并分为几类（<1次/天、1次/天、2次/天和≥3次/天）。收缩压（SBP）、胆固醇和空腹血糖被视为代谢中介因素，采用Bootstrap方法评估中介作用。

结果

25 - 64岁的成年人中约1.8%患有CVD。根据“过程”宏的结果，随着水果摄入量而非蔬菜摄入量每天增加一个单位，经混杂因素调整后的CVD风险降低了14%（OR = 0.86，95%CI 0.74至0.98）。在同时对三个代谢因素进行额外调整后，OR值减弱至0.89（95%CI 0.77至1.03）。该结果表明，三个代谢因素的间接作用占水果摄入量与CVD之间关系的21.4%。SBP是比其他因素更重要的代谢中介因素。当将体重指数作为中介因素进行额外控制时，代谢因素的间接作用占30.0%，并且与其他中介因素相比，SBP仍具有独立作用。