Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Aletta Jacobs School of Public Health, Groningen, the Netherlands; National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
Clin Nutr. 2021 Jul;40(7):4712-4719. doi: 10.1016/j.clnu.2021.04.046. Epub 2021 May 11.
BACKGROUND & AIMS: Blood lipids play a critical role in the pathogenesis of type 2 diabetes, and they are closely related to dietary factors. However, the associations between blood lipids-related dietary patterns and risk of type 2 diabetes are controversial and not fully clear. In this study, we aimed to derive dietary patterns that explained variation in blood lipids and to investigate their associations with incident type 2 diabetes.
The analysis was based on 39,000 women and 25,777 men participating in the Lifelines cohort study (aged 18-65 years, mean 43.2 years for women and 43.5 years for men). Dietary intake was measured using a 110-item semi-quantitative food frequency questionnaire. Reduced rank regression was used to derive dietary patterns with blood lipids (HDL-cholesterol, LDL-cholesterol, triglycerides, total cholesterol, and total cholesterol:HDL-cholesterol ratio) as response variables for women and men separately. The first dietary pattern identified for each sex was selected because they explained the largest variance in blood lipids. The associations between the identified dietary patterns and incident type 2 diabetes were subsequently investigated using multivariate logistic regression models. All analyses were performed separately for women and men.
During an average follow-up of 43 months, 479 new cases (incidence 0.74%) of type 2 diabetes were identified. Using reduced rank regression, we identified two sex-specific blood lipids-associated dietary patterns characterized by high intake of sugary beverages, added sugar, and low intake of vegetables, fruits, tea, and nuts/seeds. These two sex-specific dietary patterns were similar in food groups but differed in factor loadings. High dietary pattern scores were associated with increased risk of type 2 diabetes after adjustment for age, total energy intake, body mass index, waist-hip ratio, and blood pressure (ORs for the fifth quintile [Q5] using the first quintile [Q1] as reference, 1.87 [95% CI 1.23, 2.83] for women [P-trend < 0.001], and 1.72 [95% CI 1.11, 2.66] for men [P-trend = 0.018]). The associations were attenuated but remained significant after further adjustment for lifestyle and socio-economic factors.
Dietary patterns associated with adverse blood lipids are associated with incidence of type 2 diabetes. The present study provides new insights in optimizing blood lipids for the prevention of type 2 diabetes through dietary approaches.
血脂在 2 型糖尿病的发病机制中起着关键作用，并且与饮食因素密切相关。然而，与血脂相关的饮食模式与 2 型糖尿病风险之间的关联仍存在争议，且尚未完全阐明。本研究旨在得出能够解释血脂变化的饮食模式，并探讨其与 2 型糖尿病发病风险的关系。
该分析基于参加 Lifelines 队列研究的 39000 名女性和 25777 名男性（年龄 18-65 岁，女性平均年龄为 43.2 岁，男性平均年龄为 43.5 岁）。饮食摄入量通过 110 项半定量食物频率问卷进行测量。对于女性和男性，分别使用降秩回归来推导与血液脂质（高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、甘油三酯、总胆固醇和总胆固醇：高密度脂蛋白胆固醇比值）相关的饮食模式。选择每一种性别中被识别的第一个饮食模式，因为它们可以解释血脂变化的最大差异。随后使用多元逻辑回归模型调查这些确定的饮食模式与 2 型糖尿病发病之间的关联。所有分析均分别在女性和男性中进行。
在平均 43 个月的随访期间，共发现 479 例（发病率为 0.74%）新的 2 型糖尿病病例。使用降秩回归，我们确定了两个性别特异性的与血液脂质相关的饮食模式，其特点是高糖饮料、添加糖的摄入量高，而蔬菜、水果、茶和坚果/种子的摄入量低。这两种性别特异性的饮食模式在食物组上相似，但因子负荷不同。调整年龄、总能量摄入、体重指数、腰围臀围比和血压后，高饮食模式评分与 2 型糖尿病发病风险增加相关（第五五分位[Q5]与第一五分位[Q1]相比，女性的比值比[OR]为 1.87[95%置信区间 1.23，2.83]，[P-trend<0.001]，男性为 1.72[95%置信区间 1.11，2.66]，[P-trend=0.018]）。进一步调整生活方式和社会经济因素后，关联仍然存在，但有所减弱。
与不良血脂相关的饮食模式与 2 型糖尿病的发病有关。本研究通过饮食方法为优化血脂以预防 2 型糖尿病提供了新的见解。
