每日叶酸摄入量与美国患有糖尿病、糖尿病前期或胰岛素抵抗的成年人全因和心血管疾病死亡率降低有关。

Daily folate consumption is associated with reduced all-cause and cardiovascular disease mortality among US adults with diabetes, prediabetes, or insulin resistance.

机构信息

Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China.

Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, Edmonton, Alberta T6G 2P5, Canada.

出版信息

Nutr Res. 2023 Jun;114:71-80. doi: 10.1016/j.nutres.2023.04.007. Epub 2023 Apr 26.

DOI:10.1016/j.nutres.2023.04.007

PMID:37209506

Abstract

We hypothesized that daily folate consumption may have a beneficial effect on mortality among adults with dysglycemia. This prospective cohort study was conducted on 9266, 12,601, and 16,025 US adults with diabetes, prediabetes, and insulin resistance (IR; homeostasis model assessment of IR >2.6), respectively, from the National Health and Nutrition Examination Survey Ⅲ and 1999-2018. Daily folate consumption was obtained from dietary recall. All-cause, cardiovascular disease (CVD), and cancer mortality were obtained by linking to the National Death Index Mortality Data. During 117,746.00, 158,129.30, and 210,896.80 person-years of follow-up, 3356 (1053 CVD and 672 cancer), 3796 (1117 CVD and 854 cancer), and 4340 (1286 CVD and 928 cancer) deaths occurred among participants with diabetes, prediabetes, and IR, respectively. After multivariate adjustment, each 1-unit increase in ln-transformed daily folate consumption was linearly associated with 7.1% (hazard ratio [HR], 0.929; 95% confidence interval [CI], 0.914-0.945), 12.4% (HR, 0.886; 95% CI, 0.860-0.912), and 6.4% (HR, 0.936; 95% CI, 0.903-0.972) decreases in risk of all-cause, CVD, and cancer mortality, respectively, among participants with diabetes. Among participants with prediabetes, each 1-unit increase in ln-transformed daily folate consumption was linearly associated with 3.6% (HR, 0.964; 95% CI, 0.949-0.980), 7.8% (HR, 0.922; 95% CI, 0.895-0.949), and 3.6% (HR, 0.964; 95% CI, 0.932-0.997) decreases in risk of all-cause, CVD, and cancer mortality, respectively. Among participants with IR, each 1-unit increase in ln-transformed daily folate consumption was linearly associated with 5.7% (HR, 0.943; 95% CI, 0.929-0.956) and 9.0% (HR, 0.910; 95% CI, 0.885-0.933) decreases in risk of all-cause and CVD mortality, respectively. Increased daily folate consumption may be beneficial in reducing all-cause and CVD mortality of adults with dysglycemia. More research is needed to explore the underlying mechanisms.

摘要

我们假设，日常叶酸摄入可能对血糖异常的成年人的死亡率有有益影响。这项前瞻性队列研究针对分别患有糖尿病、糖尿病前期和胰岛素抵抗（IR；IR 的稳态模型评估>2.6）的 9266、12601 和 16025 名美国成年人进行，数据来自国家健康和营养检查调查 III 和 1999-2018 年。每日叶酸摄入量从膳食回忆中获得。通过与国家死亡指数死亡数据链接，获得全因、心血管疾病 (CVD) 和癌症死亡率。在 117746.00、158129.30 和 210896.80 人年的随访期间，参与者中分别有 3356 人（1053 例 CVD 和 672 例癌症）、3796 人（1117 例 CVD 和 854 例癌症）和 4340 人（1286 例 CVD 和 928 例癌症）死亡患有糖尿病、糖尿病前期和 IR。在多变量调整后，ln 转化的每日叶酸摄入量每增加 1 个单位，与全因死亡率风险降低 7.1%（风险比 [HR]，0.929；95%置信区间 [CI]，0.914-0.945）、CVD 死亡率风险降低 12.4%（HR，0.886；95%CI，0.860-0.912）和癌症死亡率风险降低 6.4%（HR，0.936；95%CI，0.903-0.972）分别相关。在糖尿病前期参与者中，ln 转化的每日叶酸摄入量每增加 1 个单位，与全因死亡率风险降低 3.6%（HR，0.964；95%CI，0.949-0.980）、CVD 死亡率风险降低 7.8%（HR，0.922；95%CI，0.895-0.949）和癌症死亡率风险降低 3.6%（HR，0.964；95%CI，0.932-0.997）分别相关。在 IR 参与者中，ln 转化的每日叶酸摄入量每增加 1 个单位，与全因死亡率风险降低 5.7%（HR，0.943；95%CI，0.929-0.956）和 CVD 死亡率风险降低 9.0%（HR，0.910；95%CI，0.885-0.933）分别相关。增加每日叶酸摄入可能有益于降低血糖异常成年人的全因和 CVD 死亡率。需要进一步研究来探索潜在的机制。