| 162 | 0 | 89 |
| 下载次数 | 被引频次 | 阅读次数 |
目的 研究中国5个省(自治区、直辖市)成人终止高血压膳食(dietary approaches to stop hypertension, DASH)与血尿酸水平及高尿酸血症的关联性，以及系统性炎症在此关联性中的中介作用。方法 中国居民营养与健康状况随访研究(2021)于2021年5月—2022年12月开展，基于中国居民营养与健康状况监测(2010—2012年)中5个省(自治区、直辖市)的部分研究对象及后续新增研究对象进行调查，选取6963名成人，对其社会经济、膳食、体格及血生化指标数据进行后续分析。使用DASH评分评估研究对象对该膳食的依从性，并以五分位法对研究对象进行分组(Q1～Q5)。采用逐步引入协变量进行校正的方法，使用广义线性回归和多重Logistic回归分析DASH膳食与血尿酸及高尿酸血症的关联性。并在测量高敏C-反应蛋白的2112名研究对象中，进一步分析系统性炎症对上述关联发挥的中介作用。结果 在6963名研究对象中，血尿酸浓度平均值为317.4μmol/L,高尿酸血症的患病率为21.18%。在高DASH膳食依从性者中，18～44岁、女性、超重/肥胖、城市居民、较高文化程度、已婚、较高家庭收入、目前不吸烟、身体活动水平高、未患高尿酸血症的研究对象中占比较高(P<0.05)。经调整了年龄、性别、体质指数、居住地区、文化程度、婚姻状况、家庭人均年收入、目前吸烟、过量饮酒、身体活动水平以及高血压、糖尿病和血脂异常的患病情况后，Q5组血尿酸水平(Q5 vs.Q1,相对浓度=0.93,95%CI0.91～0.94,P趋势<0.01)和高尿酸血症患病风险(Q5 vs. Q1 OR=0.59,95%CI 0.48～0.73,P趋势<0.01)均显著低于Q1组。中介分析结果提示，高敏C-反应蛋白分别介导了DASH评分与血尿酸17.69%(95%CI 10.22%～25.15%,P中介<0.01)的关联性以及与高尿酸血症患病风险26.00%(95%CI7.50%～44.49%,P中介<0.01)的关联性。结论 中国5个省(自治区、直辖市)成人DASH膳食依从性与血尿酸及高尿酸血症的患病风险呈负向关联，且系统性炎症在上述关联中起部分中介效应。
Abstract：OBJECTIVE To investigate the association between adherence to the dietary approaches to stop hypertension(DASH)diet and serum uric acid levels, the risk of hyperuricemia, and the mediation role of systematic inflammation, among Chinese adults from 5 provinces.METHODS China Nutrition and Health Follow-up Study(2021) was conducted based on a part of the participants in China Nutrition and Health Surveillance(2010-2012) and subsequently newly sampled participants. A total of 6963 Chinese adults were selected from and information on socioeconomic status, diet, body measurements, and laboratory examination were investigated. Using the DASH score to evaluate the adherence to the DASH diet, the participants were categorized into quintiles. Using multiple adjustment generalized linear regression and logistic regression analysis the association between DASH diet and serum uric acid level and the risk of hyperuricemia were explored. The mediation role of systematic inflammation on the above associations was evaluated among 2112 participants who were tested for serum high-sensitivity C-reactive protein(hs-CRP).RESULTS In 6963 participants, the average serum uric acid level was 317.4 μmol/L, and the prevalence of hyperuricemia was 21.18%. The result showed that participants who were 18-44 years, female, overweight or obese, urban residents, higher education level, married, higher household income, non-smokers, higher physical activity level, non-hyperuricemia had higher adherence to the DASH diet(P<0.05). After adjusting for potential confounders, including age, gender, body mass index, living area, education level, marital status, household income, current smoking, excessive drinking, physical activity level, and condition of hypertension, diabetes mellitus, and dyslipidemia, the adherence to DASH diet had a negative association with serum uric acid levels(Q5 vs. Q1, relative concentration =0.93,95%CI 0.91-0.94,Ptrend<0.01) and with the risk of hyperuricemia(Q5 vs. Q1, OR =0.59,95%CI 0.48-0.73,Ptrend<0.01). Mediation analysis revealed that hs-CRP significantly mediated 17.69%(95%CI 10.22%-25.15%,Pmediation<0.01)of the association between DASH diet and serum uric acid level and 26.00%(95%CI 7.50%-44.49%,Pmediation<0.01)of the association between DASH score and the risk of hyperuricemia, respectively.CONCLUSION Adhering to the DASH diet had negative associations with serum uric acid levels and the risk of hyperuricemia among Chinese adults from 5 provinces. Systematic inflammation may be an important biological mechanism partially mediating the association between the DASH diet on serum uric acid levels and hyperuricemia.
[1] GBD 2021 Gout Collaborators.Global,regional,and national burden of gout,1990-2020,and projections to 2050:a systematic analysis of the Global Burden of Disease Study 2021[J].Lancet Rheumatol,2024,6(8):e507-e517.
[2] RAI S K,FUNG T T,LU N,et al.The dietary approaches to stop hypertension (DASH) diet,western diet,and risk of gout in men:prospective cohort study[J].BMJ,2017,357:j1794.
[3] ZHU Y,PANDYA B J,CHOI H K.Comorbidities of gout and hyperuricemia in the US general population:NHANES 2007-2008[J].Am J Med,2012,125(7):679-687.
[4] HAN Y,CAO Y,HAN X,et al.Hyperuricemia and gout increased the risk of long-term mortality in patients with heart failure:insights from the national health and nutrition examination survey[J].J Transl Med,2023,21(1):463.
[5] ZHANG M,ZHU X,WU J,et al.Prevalence of hyperuricemia among chinese adults:findings from two nationally representative cross-sectional surveys in 2015-16 and 2018-19[J].Front Immunol,2021,12:791983.
[6] MENA-SANCHEZ G,BABIO N,BECERRA-TOMAS N,et al.Association between dairy product consumption and hyperuricemia in an elderly population with metabolic syndrome[J].Nutr Metab Cardiovasc Dis,2020,30(2):214-222.
[7] KAKUTANI-HATAYAMA M,KADOYA M,OKAZAKI H,et al.Nonpharmacological management of gout and hyperuricemia:hints for better lifestyle[J].Am J Lifestyle Med,2017,11(4):321-329.
[8] SACKS F M,CAMPOS H.Dietary therapy in hypertension[J].N Engl J Med,2010,362(22):2102-2112.
[9] ZHU Q,YU L,LI Y,et al.Association between dietary approaches to stop hypertension (DASH) diet and hyperuricemia among Chinese adults:findings from a nationwide representative study[J].Nutr J,2023,22(1):21.
[10] JURASCHEK S P,GELBER A C,CHOI H K,et al.Effects of the dietary approaches to stop hypertension (DASH) diet and sodium intake on serum uric acid[J].Arthritis Rheumatol,2016,68(12):3002-3009.
[11] MILLAR S R,NAVARRO P,HARRINGTON J M,et al.Dietary score associations with markers of chronic low-grade inflammation:a cross-sectional comparative analysis of a middle- to older-aged population[J].Eur J Nutr,2022,61(7):3377-3390.
[12] PU R,JIA S,ZHANG X,et al.Association between dietary patterns and sarcopenia among community-dwelling older adults in five provinces of China:a cross-sectional study[J].Front Public Health,2025,13:1556033.
[13] YU D M,ZHAO L Y,ZHANG J,et al.China nutrition and health surveys (1982-2017)[J].China CDC Wkly,2021,3(9):193-195.
[14] YANG Y X,YU D M,PIAO W,et al.Nutrient-derived beneficial for blood pressure dietary pattern associated with hypertension prevention and control:based on China nutrition and health surveillance 2015-2017[J].Nutrients,2022,14(15):3108.
[15] DAI H X,ZHAO Z Y,XIA Y,et al.Higher levels of high-sensitivity C-reactive protein is positively associated with the incidence of hyperuricemia in Chinese population:a report from the China health and retirement longitudinal study[J].Mediators Inflamm,2020,2020:3854982.
[16] ZHAO W H,HUANG Z P,ZHANG X,et al.Reproducibility and validity of a chinese food frequency questionnaire[J].Biomed Environ Sci,2010,23:1-38.
[17] 杨月欣.中国食物成分表(标准版)[M].北京：北京大学医学出版社，2018.
[18] 中国高血压防治指南修订委员会，高血压联盟(中国),中华医学会心血管病学分会，等.中国高血压防治指南(2018年修订版)[J].中国心血管杂志，2019,24(1):24-56.
[19] 中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017年版)[J].中国实用内科杂志，2018,38(4):292-344.
[20] 诸骏仁，高润霖，赵水平，等.中国成人血脂异常防治指南(2016年修订版)[J].中国循环杂志，2016,31(10):937-953.
[21] YANG Y X,PIAO W,HUANG K,et al.Dietary pattern associated with the risk of hyperuricemia in chinese elderly:result from China nutrition and health surveillance 2015-2017[J].Nutrients,2022,14(4):844.
[22] 杨宇祥，于冬梅，朴玮，等.中国中老年人习惯性饮茶与10年内心血管疾病风险的相关性[J].卫生研究，2024,53(2):180-188.
[23] 中国营养学会.中国居民膳食指南(2022)[M].北京：人民卫生出版社，2022.
[24] STAMATAKIS E,GALE J,BAUMAN A,et al.Sitting time,physical activity,and risk of mortality in adults[J].J Am Coll Cardiol,2019,73(16):2062-2072.
[25] TABUNG F K,STECK S E,ZHANG J,et al.Construct validation of the dietary inflammatory index among postmenopausal women[J].Ann Epidemiol,2015,25(6):398-405.
[26] GE L,SADEGHIRAD B,BALL G D C,et al.Comparison of dietary macronutrient patterns of 14 popular named dietary programmes for weight and cardiovascular risk factor reduction in adults:systematic review and network meta-analysis of randomised trials[J].BMJ,2020,369:m696.
[27] GOHARI S,GHOBADI S,JAFARI A,et al.The effect of dietary approaches to stop hypertension and ketogenic diets intervention on serum uric acid concentration:a systematic review and meta-analysis of randomized controlled trials[J].Sci Rep,2023,13(1):10492.
[28] ZHOU M,HUANG X,LI R,et al.Association of dietary patterns with blood uric acid concentration and hyperuricemia in northern Chinese adults[J].Nutr J,2022,21(1):42.
[29] YI K,CUI S,TANG M,et al.Adherence to DASH dietary pattern and its association with incident hyperuricemia risk:a prospective study in chinese community residents[J].Nutrients,2022,14(22):4853.
[30] GAO Y,CUI L F,SUN Y Y,et al.Adherence to the dietary approaches to stop hypertension diet and hyperuricemia:a cross-sectional study[J].Arthritis Care Res,2021,73(4):603-611.
[31] SOLTANI S,CHITSAZI M J,SALEHI-ABARGOUEI A.The effect of dietary approaches to stop hypertension (DASH) on serum inflammatory markers:a systematic review and meta-analysis of randomized trials[J].Clin Nutr,2018,37(2):542-550.
[32] HORNERO-RAMIREZ H,AUBIN A,MICHALSKI M C,et al.Multifunctional dietary interventions,low-grade inflammation and cardiometabolic profile:a scoping review[J].Front Immunol,2024,15:1304686.
[33] PHILLIPS C M,HARRINGTON J M,PERRY I J.Relationship between dietary quality,determined by DASH score,and cardiometabolic health biomarkers:a cross-sectional analysis in adults[J].Clin Nutr,2019,38(4):1620-1628.
[34] BARBARESKO J,KOCH M,SCHULZE M B,et al.Dietary pattern analysis and biomarkers of low-grade inflammation:a systematic literature review[J].Nutr Rev,2013,71(8):511-527.
[35] RYU S,CHANG Y,ZHANG Y,et al.A cohort study of hyperuricemia in middle-aged South Korean men[J].Am J Epidemiol,2012,175(2):133-143.
[36] ZADE R M,TELKABADI M H,BAHMANI F,et al.The effects of DASH diet on weight loss and metabolic status in adults with non-alcoholic fatty liver disease:a randomized clinical trial[J].Liver Int,2016,36(4):563-571.
[37] LIU Y,DING X,YU L,et al.Associations of polycyclic aromatic hydrocarbons exposure with serum uric acid and hyperuricemia in US adults:the role of systemic inflammation[J].J Environ Sci,2025,150:412-421.
[38] LI Q,HUANG Z,LIU D,et al.Effect of berberine on hyperuricemia and kidney injury:a network pharmacology analysis and experimental validation in a mouse model[J].Drug Des Devel Ther,2021,15:3241-3254.
[39] LIU L,JIANG S,LIU X,et al.Inflammatory response and oxidative stress as mechanism of reducing hyperuricemia of gardenia jasminoides-poria cocos with network pharmacology[J].Oxid Med Cell Longev,2021,2021:8031319.
基本信息:
DOI：10.19813/j.cnki.weishengyanjiu.2025.04.003
中图分类号:R544.1;R589.7
引用信息:
[1]杨宇祥,蔡姝雅,Tamas Szili-Torok等.终止高血压膳食依从性与成人血尿酸水平和高尿酸血症的关系——系统性炎症的中介作用[J].卫生研究,2025,54(04):540-548.DOI:10.19813/j.cnki.weishengyanjiu.2025.04.003.
基金信息:
国家财政项目(No.102393220020070000012); 达能膳食营养研究与宣教基金项目(No.DIC2023-03); 国家建设高水平大学公派研究生项目(No.202408110159)