鱼油、血浆n-3多不饱和脂肪酸与2型糖尿病患者发生大血管和微血管并发症的风险
Fish Oil, Plasma n-3 PUFAs, and Risk of Macro- and Microvascular Complications Among Individuals With Type 2 Diabetes.
作者信息
Tian Shufan, Guo Tianyu, Qian Frank, Qiu Zixin, Lu Qi, Li Rui, Zhu Kai, Li Lin, Yu Hancheng, Li Ruyi, Ou Yunjing, Pan An, Liu Gang
机构信息
Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
Section of Cardiovascular Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA.
出版信息
J Clin Endocrinol Metab. 2025 Apr 22;110(5):e1687-e1696. doi: 10.1210/clinem/dgae482.
OBJECTIVE
To evaluate associations of fish oil supplementation and plasma omega 3 polyunsaturated fatty acids (n-3 PUFAs) with risks of macrovascular and microvascular complications among people with type 2 diabetes and to further explore the potential mediating role of metabolism-related biomarkers.
RESEARCH DESIGN AND METHODS
This study included 20 338 participants with type 2 diabetes from the UK Biobank. Diabetic complications were identified through hospital inpatient records.
RESULTS
During 13.2 years of follow-up, 5396 people developed macrovascular complications, and 4868 people developed microvascular complications. After multivariable adjustment, hazard ratios (HRs) and 95% confidence intervals (CIs) for patients with fish oil were 0.90 (0.85, 0.97) for composite macrovascular complications, 0.91 (0.84, 0.98) for coronary heart disease (CHD), 0.72 (0.61, 0.83) for peripheral artery disease and 0.89 (0.83, 0.95) for composite microvascular complications, 0.87 (0.79, 0.95) for diabetic kidney disease, and 0.88 (0.80, 0.97) for diabetic retinopathy. In addition, higher n-3 PUFA levels, especially docosahexaenoic acid (DHA), were associated with lower risks of macrovascular and microvascular complications. Comparing extreme quartiles of plasma DHA, the HRs (95% CIs) were 0.68 (0.57, 0.81) for composite macrovascular complications, 0.63 (0.51, 0.77) for CHD, and 0.59 (0.38, 0.91) for diabetic neuropathy. Moreover, biomarkers including lipid profile and inflammatory markers collectively explained 54.4% and 63.1% of associations of plasma DHA with risks of composite macrovascular complications and CHD.
CONCLUSION
Habitual use of fish oil supplementation and higher plasma n-3 PUFA levels, especially DHA, were associated with lower risks of macrovascular and microvascular complications among individuals with type 2 diabetes, and the favorable associations were partially mediated through improving biomarkers of lipid profile and inflammation.
目的
评估补充鱼油和血浆ω-3多不饱和脂肪酸（n-3 PUFAs）与2型糖尿病患者大血管和微血管并发症风险之间的关联，并进一步探讨代谢相关生物标志物的潜在中介作用。
研究设计与方法
本研究纳入了英国生物银行的20338名2型糖尿病患者。通过医院住院记录确定糖尿病并发症。
结果
在13.2年的随访期间，5396人发生了大血管并发症，4868人发生了微血管并发症。多变量调整后，服用鱼油患者发生复合大血管并发症的风险比（HRs）及95%置信区间（CIs）为0.90（0.85，0.97），冠心病（CHD）为0.91（0.84，0.98），外周动脉疾病为0.72（0.61，0.83），复合微血管并发症为0.89（0.83，0.95），糖尿病肾病为0.87（0.79，0.95），糖尿病视网膜病变为0.88（0.80，0.97）。此外，较高的n-3 PUFA水平，尤其是二十二碳六烯酸（DHA），与较低的大血管和微血管并发症风险相关。比较血浆DHA的极端四分位数，复合大血管并发症的HRs（95% CIs）为0.68（0.57，0.81），冠心病为0.63（0.51，0.77），糖尿病神经病变为0.59（0.38，0.91）。此外，包括血脂谱和炎症标志物在内的生物标志物共同解释了血浆DHA与复合大血管并发症和冠心病风险之间关联的54.4%和63.1%。
结论
习惯性补充鱼油和较高的血浆n-3 PUFA水平，尤其是DHA，与2型糖尿病患者较低的大血管和微血管并发症风险相关，且这种有利关联部分是通过改善血脂谱和炎症生物标志物介导的。
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