卫生研究

目的 调查全国老年人群膳食纤维摄入状况，并分析膳食纤维与糖代谢异常的相关性。方法 数据来源于2015年中国成人慢性病与营养状况监测老年人群。利用标准化问卷和测量方法收集调查对象的一般情况和体格状况，采用3天24小时膳食回顾法收集调查对象的食物摄入。采集空腹静脉血测定空腹血糖、糖化血红蛋白及相关生化指标，将研究对象分成正常血糖(NG,normal glucose)、糖尿病前期(Pre-DM,pre-diabetes mellitus)和糖尿病(type 2 diabetes mellitus,T2DM)三组。应用Logistic回归模型探讨膳食纤维摄入与Pre-DM和T2DM的关系。结果 共纳入20 996例60岁及以上老年人，其中男性10 773例(51.3%),年龄(68.21±6.26)岁；女性10 223例(48.7%),年龄(67.67±6.26)岁。共检出Pre-DM 6526例，总检出率为31.1%,其中男性3274例，检出率为30.4%;女性3252例，检出率为31.8%。T2DM共检出1572例，总检出率为7.5%,其中男性784例，检出率为7.3%;女性788例，检出率为7.7%。不同膳食纤维摄入量组间老年人的平均年龄、体质指数、腰围、收缩压、舒张压、胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、糖化血红蛋白水平差异存在统计学意义(P<0.005)。随膳食纤维摄入量增加，超重及肥胖、中心性肥胖、血脂异常比例呈上升趋势(P<0.05),高血压患病比例随膳食纤维摄入量的增加呈下降趋势(P<0.0001)。调整混杂因素后，与极低摄入量组相比，低摄入量组、较低摄入量组和较高摄入量组均与Pre-DM负相关，其OR值及95%CI分别为0.913 (0.838～0.994)、0.861(0.790～0.938)和0.911(0.835～0.993),膳食纤维较高摄入量组与T2DM负相关，为0.848(0.726～0.991)。结论 老年人膳食纤维摄入与糖尿病及糖尿病前期相关，随着膳食纤维摄入量的增加，糖代谢异常的发生风险降低。

OBJECTIVE To investigate the dietary fiber intake status and analyze the relationship between dietary fiber and glucose metabolic disorder of the elderly in China.METHODS Data were collected from the participants of Chinese adult chronic diseases and nutrition surveillance in 2015.General information were collected by standardized questionnaires, anthropometric index and blood pressure of respondents were measured according to standard method. Food intake was collected by three consecutive day 24 h dietary recalls, dietary fiber was calculated through China food composition. Fasting venous blood were collected to measure glucose, HbA1C, and other related biochemical index. Subjects were divided into three groups: normal glucose(NG, normal glucose), pre-diabetes(Pre-DM, pre-diabetes mellitus) and diabetes(T2DM, type 2 diabetes mellitus).Multiple logistic regression model was used to analyze the relationship between dietary fiber intake and Pre-DM as well as T2DM.RESULTS A total of 20 996 elderly people aged 60 years and above were included. There 10 773 cases were males(51.3%) and 10 223 cases were females(48.7%), the age of both gender were(68.21±6.26) years and(67.67±6.26) years. A total of 6526 cases of pre-diabetes were detected in 20 996 elderly participants with detection rate of 31.1%.There 3274 cases were male and 3252 cases were female, the detection rates of both genders were 30.4% and 31.8%, respectively. While 1572 participants were detected as T2DM(784 of males and 788 of females), the detection rate of T2DM was 7.5%, 7.3% for males and 7.7% for females. There were significant differences in mean age, BMI, waist circumference, systolic blood pressure, diastolic blood pressure, TC, TG, HDL-C, LDL-C,HbA1c level among different dietary intake groups(P<0.005).With the increase of dietary fiber intake, the proportion of overweight and obesity, central obesity and dyslipidemia showed an increasing trend(P<0.05), and the proportion of hypertension showed a decreasing trend(P<0.000 1).After adjusting for potential confounding factors, compared to participants with lowest fiber intake, participants in subgroups of lower, minor lower, and higher fiber intake were associated with decreased risk of pre-diabetes, the OR and 95%CI were(OR=0.911,95%CI 0.835-0.993),(OR= 0.861,95%CI 0.790-0.938) and(OR= 0.913,95%CI 0.838-0.994), respectively. However, there was only a statistically significant negative association between the higher intake of dietary fiber and T2DM(OR = 0.848, 95%CI 0.726-0.991).CONCLUSION Dietary fiber intake was negatively related with diabetes and pre-diabetes mellitus. The risk of glucose metabolic disorder was decreased with the increase of dietary fiber intake.