Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
J Nutr. 2023 Nov;153(11):3247-3258. doi: 10.1016/j.tjnut.2023.08.031. Epub 2023 Sep 3.
Evidence regarding the potential health effects of dietary amino acids glutamine and glutamate among individuals with type 2 diabetes (T2D) is limited.
The aim was to examine dietary glutamine and glutamate in relation to subsequent risk of cardiovascular disease (CVD) and mortality among individuals with T2D.
We prospectively followed 15,040 men and women with T2D at baseline or diagnosed during follow-up (Nurses' Health Study: 1980-2014 and Health Professionals Follow-Up Study: 1986-2018). Diet was repeatedly assessed using validated food frequency questionnaires every 2-4 y. Associations of energy-adjusted glutamine and glutamate intake, as well as their ratio, with CVD risk and mortality, were assessed using Cox proportional-hazards models with adjustments for demographics, dietary and lifestyle factors, and medical history.
During 196,955 and 225,371 person-years of follow-up in participants with T2D, there were 2927 incident CVD cases and 4898 deaths, respectively. Higher intake of glutamine was associated with lower risk of CVD incidence, CVD mortality, and total mortality: comparing extreme quintiles, the hazard ratios (HRs) (95% confidence intervals [CIs]) were 0.88 (0.77, 0.99), 0.78 (0.65, 0.92), and 0.84 (0.76, 0.92), respectively (all P-trend < 0.05). In contrast, higher intake of glutamate was associated with a higher risk of CVD incidence, CVD mortality, and total mortality; the HRs were 1.30 (1.15, 1.46), 1.46 (1.24, 1.72), and 1.20 (1.09, 1.32), respectively (all P-trend < 0.05). Furthermore, comparing extreme quintiles, a higher dietary glutamine-to-glutamate ratio was associated with a lower risk of CVD incidence (0.84 [0.75, 0.95]), CVD mortality (0.66 [0.57, 0.77]), and total mortality (0.82 [0.75, 0.90]). In addition, compared with participants with stable or decreased consumption of glutamine-to-glutamate ratio from prediabetes to postdiabetes diagnosis, those who increased the ratio had a 17% (5%, 27%) lower CVD mortality.
In adults with T2D, dietary glutamine was associated with a lower risk of CVD incidence and mortality, whereas the opposite was observed for glutamate intake.
关于 2 型糖尿病（T2D）个体饮食中氨基酸谷氨酰胺和谷氨酸潜在健康影响的证据有限。
本研究旨在探讨 T2D 患者饮食中谷氨酰胺和谷氨酸与随后发生心血管疾病（CVD）和死亡的风险之间的关系。
我们前瞻性地随访了 15040 名基线或随访期间诊断为 T2D 的男性和女性（护士健康研究：1980-2014 年；健康专业人员随访研究：1986-2018 年）。每 2-4 年使用经过验证的食物频率问卷反复评估饮食。使用 Cox 比例风险模型评估能量调整后的谷氨酰胺和谷氨酸摄入量及其比值与 CVD 风险和死亡率的关系，并进行了人口统计学、饮食和生活方式因素以及病史的调整。
在 T2D 患者 196955 和 225371 人年的随访中，分别发生了 2927 例 CVD 事件和 4898 例死亡。较高的谷氨酰胺摄入量与较低的 CVD 发病风险、CVD 死亡率和总死亡率相关：比较极端五分位数，风险比（HR）（95%置信区间[CI]）分别为 0.88（0.77，0.99）、0.78（0.65，0.92）和 0.84（0.76，0.92）（所有 P-趋势 < 0.05）。相比之下，较高的谷氨酸摄入量与 CVD 发病风险、CVD 死亡率和总死亡率较高相关；HR 分别为 1.30（1.15，1.46）、1.46（1.24，1.72）和 1.20（1.09，1.32）（所有 P-趋势 < 0.05）。此外，与极端五分位数相比，较高的饮食谷氨酰胺与谷氨酸比值与 CVD 发病风险降低相关（0.84 [0.75，0.95]）、CVD 死亡率（0.66 [0.57，0.77]）和总死亡率（0.82 [0.75，0.90]）。此外，与从糖尿病前期到糖尿病诊断期间谷氨酰胺与谷氨酸比值稳定或下降的参与者相比，比值增加的参与者 CVD 死亡率降低 17%（5%，27%）。
在 T2D 成年人中，饮食谷氨酰胺与 CVD 发病和死亡率降低相关，而谷氨酸摄入量则相反。
