Islam Mohammad Redwanul, Rahman Syed Moshfiqur, Selling Katarina, Näsänen-Gilmore Pieta, Kippler Maria, Kajantie Eero, Rahman Anisur, Pervin Jesmin, Ekström Eva-Charlotte
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Front Nutr. 2023 Jan 25;10:1058965. doi: 10.3389/fnut.2023.1058965. eCollection 2023.
Diet being a modifiable factor, its relationship with cardiometabolic risk is of public health interest. The vast majority of studies on associations of dietary patterns with cardiometabolic risk indicators among adolescents are from high-income countries and urban settings. We sought to describe dietary patterns and examine their associations with selected cardiometabolic risk indicators-waist circumference (WC), systolic blood pressure, fasting lipid profile and insulin resistance-along with its gender stratification among adolescents in a low-income, rural setting.
This cross-sectional study utilized data from the 15-year follow-up of the Maternal and Infant Nutrition Interventions in Matlab (MINIMat) cohort in southeast Bangladesh. The children who were born as singletons to the mothers randomized in the MINIMat trial and had valid birth anthropometrics were eligible for the follow-up. We employed a single, qualitative 24-hour recall to assess diet. Dietary patterns were derived from simple -means cluster analysis, and calculation of dietary diversity score (DDS) using a validated instrument. Anthropometric parameters and systolic blood pressure were recorded. Fasting plasma triglyceride, total cholesterol, low- and high-density lipoproteins, insulin and glucose levels were measured. We calculated insulin resistance using the Homeostasis Model Assessment equation (HOMA-IR). Three right-skewed outcome variables were natural log (Ln) transformed: WC, triglyceride and HOMA-IR. Omnibus and gender-specific multiple linear regression models were fitted.
Among 2,253 adolescents (52.1% girls, 7.1% overweight/obese), we identified four diet clusters: Traditional, Fish-dominant, Meat-dominant, and High-variety. No significant associations were found between the clusters and indicators. On gender-stratification, triglyceride levels were lower among boys in the Fish-dominant (Ln-triglyceride β: -0.09; 95% confidence interval (CI): -0.15, -0.02) and Meat-dominant (Ln-triglyceride β: -0.08; 95% CI: -0.15, -0.004) clusters than among boys in the Traditional cluster. Compared to boys in the bottom quartile of DDS, boys in the top quartile had 2.1 mm of Hg (95% CI: 0.5, 3.6) higher systolic blood pressure and 1.9% (95% CI: 0.01-3.8%) higher WC.
While statistically significant, the gender-specific differences in triglyceride, systolic blood pressure, and waist circumference across dietary patterns were small. Associations between dietary patterns and cardiometabolic risk indicators may require a time lag beyond mid-adolescence to manifest in a rural setting. Prospective studies are warranted to delineate the magnitude and direction of those associations.
饮食是一个可改变的因素，其与心血管代谢风险的关系具有公共卫生意义。关于青少年饮食模式与心血管代谢风险指标之间关联的绝大多数研究来自高收入国家和城市地区。我们试图描述低收入农村地区青少年的饮食模式，并研究它们与选定的心血管代谢风险指标（腰围、收缩压、空腹血脂谱和胰岛素抵抗）及其性别分层之间的关联。
这项横断面研究利用了孟加拉国东南部Matlab母婴营养干预（MINIMat）队列15年随访的数据。在MINIMat试验中随机分组的母亲所生的单胎儿童，且出生时人体测量数据有效的，有资格进行随访。我们采用单一的定性24小时回忆法来评估饮食。饮食模式通过简单均值聚类分析得出，并使用经过验证的工具计算饮食多样性得分（DDS）。记录人体测量参数和收缩压。测量空腹血浆甘油三酯、总胆固醇、低密度和高密度脂蛋白、胰岛素和血糖水平。我们使用稳态模型评估方程（HOMA-IR）计算胰岛素抵抗。对三个右偏态结局变量进行自然对数（Ln）转换：腰围、甘油三酯和HOMA-IR。拟合了综合和性别特异性多元线性回归模型。
在2253名青少年（52.1%为女孩，7.1%超重/肥胖）中，我们确定了四种饮食聚类：传统型、以鱼类为主型、以肉类为主型和多样化型。聚类与指标之间未发现显著关联。在按性别分层方面，以鱼类为主型（Ln-甘油三酯β：-0.09；95%置信区间（CI）：-0.15，-0.02）和以肉类为主型（Ln-甘油三酯β：-0.08；95%CI：-0.15，-0.004）聚类中的男孩甘油三酯水平低于传统聚类中的男孩。与DDS处于四分位间距底部的男孩相比，处于四分位间距顶部的男孩收缩压高2.1mmHg（95%CI：0.5，3.6），腰围高1.9%（95%CI：0.01 - 3.8%）。
虽然具有统计学意义，但不同饮食模式下甘油三酯、收缩压和腰围的性别特异性差异较小。饮食模式与心血管代谢风险指标之间的关联可能需要在青春期中期之后有一段时间滞后才会在农村地区显现出来。有必要进行前瞻性研究来明确这些关联的程度和方向。
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