个体生命历程和邻里社会经济地位对非裔美国人饮食摄入的影响：杰克逊心脏研究
Influence of individual life course and neighbourhood socioeconomic position on dietary intake in African Americans: the Jackson Heart Study.
作者信息
Gao Yan, Hickson DeMarc A, Talegawkar Sameera, Norwood Arnita Ford, Tucker Katherine L, Sims Mario, Diez Roux Ana V, Griswold Michael
机构信息
Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi, USA.
My Brother's Keeper, Inc., Ridgeland, Mississippi, USA.
出版信息
BMJ Open. 2019 Mar 12;9(3):e025237. doi: 10.1136/bmjopen-2018-025237.
OBJECTIVE
African Americans, especially those in the Southeastern USA, have different dietary behaviours from the general US population, and have the highest prevalence, incidence and mortality of diet-related disease outcomes, such as cardiovascular disease. However, there are scant data regarding factors such as socioeconomic position (SEP) across the life course that influence dietary behaviours in this high-risk population. Our aim was to examine the impact of life course and neighbourhood SEPs on dietary intake among African Americans.
PARTICIPANTS AND SETTING
Data for this cross-sectional analysis came from the community-based Jackson Heart Study (JHS). We analysed a total of 3948 JHS participants (mean age: 55.4±12.5; 63.9% women), who had complete dietary intake and covariate information.
METHODS
We examined the associations of childhood SEP (CSEP), adulthood SEP (ASEP) and neighbourhood SEP (NSEP) with 10 selected dietary intake measures, using multilevel log-gamma generalised linear regression models.
OUTCOME MEASURES
Dietary intake measures include daily saturated fat, sodium, protein, fibre, fruits and vegetables, whole grains, sugar-sweetened beverage, nuts, fish and processed meat.
RESULTS
In age, sex and total energy intake adjusted models, most dietary intakes were associated with these three SEP measures. After additional adjustment for other SEP measures, most of the significant associations with CSEP and NSEP were attenuated, except for the associations of fibre with CSEP (relative rate [RR] [95% CI] 1.05 [1.00-1.10]) and whole grains with NSEP (RR [95% CI] 1.28 [1.02-1.61]). The associations (shown as RR [95% CI]) between ASEP and sugar-sweetened beverage: 0.70 (0.59-0.83), processed meat: 0.75 (0.63-0.90), sodium: 0.99 (0.94-1.00), fibre: 1.10 (1.03-1.16), protein: 1.05 (1.01-1.09), fruits and vegetables: 1.21 (1.11-1.32), nuts: 2.13 (1.59-2.87), and fish: 1.57 (1.27-1.95) generally persisted after additional adjustment for both CSEP and NSEP. However, the association between ASEP and whole grains was attenuated.
CONCLUSIONS
High ASEP may have a more beneficial influence on dietary practices in African Americans than CSEP or NSEP.
目的
非裔美国人，尤其是美国东南部的非裔美国人，其饮食行为与美国普通人群不同，并且在与饮食相关的疾病结局（如心血管疾病）方面，患病率、发病率和死亡率最高。然而，关于整个生命历程中的社会经济地位（SEP）等因素对这一高危人群饮食行为的影响，数据却很少。我们的目的是研究生命历程和邻里SEP对非裔美国人饮食摄入的影响。
参与者与研究背景
这项横断面分析的数据来自基于社区的杰克逊心脏研究（JHS）。我们分析了总共3948名JHS参与者（平均年龄：55.4±12.5岁；63.9%为女性），他们拥有完整的饮食摄入和协变量信息。
方法
我们使用多水平对数伽马广义线性回归模型，研究儿童期SEP（CSEP）、成年期SEP（ASEP）和邻里SEP（NSEP）与10项选定的饮食摄入指标之间的关联。
结局指标
饮食摄入指标包括每日饱和脂肪、钠、蛋白质、纤维、水果和蔬菜、全谷物、含糖饮料、坚果、鱼类和加工肉类。
结果
在调整了年龄、性别和总能量摄入的模型中，大多数饮食摄入与这三种SEP指标相关。在进一步调整其他SEP指标后，与CSEP和NSEP的大多数显著关联减弱，但纤维与CSEP的关联（相对率[RR][95%置信区间]1.05[1.00 - 1.10]）以及全谷物与NSEP的关联（RR[95%置信区间]1.28[1.02 - 1.61]）除外。在进一步调整CSEP和NSEP后，ASEP与含糖饮料的关联（以RR[95%置信区间]表示）为：0.70（0.59 - 0.83），与加工肉类的关联为：0.75（0.63 - 0.90），与钠的关联为：0.99（0.94 - 1.00），与纤维的关联为：1.10（1.03 - 1.16），与蛋白质的关联为：1.05（1.01 - 1.09），与水果和蔬菜的关联为：1.21（1.11 - 1.32），与坚果的关联为：2.13（1.59 - 2.87），与鱼类的关联为：1.57（1.27 - 1.95），这些关联通常仍然存在。然而，ASEP与全谷物的关联减弱。
结论
较高的ASEP对非裔美国人饮食习惯的影响可能比CSEP或NSEP更有益。
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