Department of Clinical Nutrition, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, 710061, Xi'an, China.
Department of Clinical Laboratory, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, 710061, Xi'an, China.
BMC Public Health. 2024 Mar 4;24(1):696. doi: 10.1186/s12889-024-18191-9.
Multimorbidity is becoming an increasingly serious public health challenge in the aging population. The impact of nutrients on multimorbidity remains to be determined and was explored using data from a UK cohort study.
Our research analysis is mainly based on the data collected by the United Kingdom Women's Cohort Study (UKWCS), which recruited 35,372 women aged 35-69 years at baseline (1995 to 1998), aiming to explore potential associations between diet and chronic diseases. Daily intakes of energy and nutrients were estimated using a validated 217-item food frequency questionnaire at recruitment. Multimorbidity was assessed using the Charlson comorbidity index (CCI) through electronic linkages to Hospital Episode Statistics up to March 2019. Cox's proportional hazards models were used to estimate associations between daily intakes of nutrients and risk of multimorbidity. Those associations were also analyzed in multinomial logistic regression as a sensitivity analysis. In addition, a stratified analysis was conducted with age 60 as the cutoff point.
Among the 25,389 participants, 7,799 subjects (30.7%) were confirmed with multimorbidity over a median follow-up of 22 years. Compared with the lowest quintile, the highest quintile of daily intakes of energy and protein were associated with 8% and 12% increased risk of multimorbidity respectively (HR 1.08 (95% CI 1.01, 1.16), p-linearity = 0.022 for energy; 1.12 (1.04, 1.21), p-linearity = 0.003 for protein). Higher quintiles of daily intakes of vitamin C and iron had a slightly lowered risk of multimorbidity, compared to the lowest quintile. A significantly higher risk of multimorbidity was found to be linearly associated with higher intake quintiles of vitamin B12 and vitamin D (p-linearity = 0.001 and 0.002, respectively) in Cox models, which became insignificant in multinomial logistic regression. There was some evidence of effect modification by age in intakes of iron and vitamin B1 associated with the risk of multimorbidity (p-interaction = 0.006 and 0.025, respectively).
Our findings highlight a link between nutrient intake and multimorbidity risk. However, there is uncertainty in our results, and more research is needed before definite conclusions can be reached.
在人口老龄化的背景下，多种疾病的发生已成为日益严峻的公共健康挑战。目前，有关营养素对多种疾病影响的研究仍不明确，本研究使用英国队列研究的数据对此进行了探索。
本研究主要基于英国女性队列研究（UKWCS）的数据进行分析。该研究于 1995 年至 1998 年招募了 35372 名年龄在 35 至 69 岁的女性，旨在探索饮食与慢性疾病之间的潜在关联。在招募时，通过经过验证的 217 项食物频率问卷来估计每日能量和营养素的摄入量。通过与截至 2019 年 3 月的医院入院统计数据的电子链接，使用 Charlson 合并症指数（CCI）评估多种疾病的发生情况。使用 Cox 比例风险模型估计营养素的每日摄入量与多种疾病发生风险之间的关联。作为敏感性分析，还使用多项逻辑回归对这些关联进行了分析。此外，还进行了分层分析，以 60 岁为截断点。
在 25389 名参与者中，22 年的中位随访期间，7799 名（30.7%）参与者被确诊患有多种疾病。与最低五分位数相比，最高五分位数的每日能量和蛋白质摄入量分别与 8%和 12%的多种疾病发生风险增加相关（HR 1.08（95%CI 1.01，1.16），p 线性=0.022；1.12（1.04，1.21），p 线性=0.003）。与最低五分位数相比，每日摄入更多的维生素 C 和铁与多种疾病发生风险略有降低相关。在 Cox 模型中，较高的维生素 B12 和维生素 D 摄入量五分位数与较高的多种疾病发生风险呈线性相关（p 线性=0.001 和 0.002），但在多项逻辑回归中不显著。在铁和维生素 B1 摄入量与多种疾病发生风险的关联中，存在年龄的交互作用（p 交互=0.006 和 0.025）。
本研究结果提示营养素摄入与多种疾病发生风险之间存在关联。但是，我们的研究结果存在不确定性，需要进一步的研究来得出明确的结论。
