【作者】 王茜； 黄嘉欣； 孙长颢；

【Author】 Wang Qian;Huang Jiaxin;Sun Changhao;Department of Nutrition and Food Hygiene,College of Public Health,Harbin Medical University;

【机构】 哈尔滨医科大学公共卫生学院营养与食品卫生学教研室；

【摘要】 目的探讨人群膳食中不同的三大供能物质比例模式下,矿物质(Ca、P、K、Na、Mg、Fe、Zn、Se、Cu、Mn、I)整体营养状态对肥胖的影响。方法选取2012年哈尔滨市膳食、营养与非传染性慢性疾病横断面(采用分层随机抽样方法)人群监测数据(共9734例,年龄20～74岁),经过培训的专业人员进行调查问卷、24小时膳食回顾法进行膳食调查;采用统一标准测量方法测量身高、体重、腰围。计算碳水化合物、脂肪和蛋白质的供能比并进行三分位分层构建三大供能物质不同的比例模式,采用Logistic回归分析频数最高的三种比例模式与肥胖之间的风险关系;采用能量密度法对Ca、P、K、Na、Mg、Fe、Zn、Se、Cu、Mn和I进行能量校正,以Se为参照,构建矿物质平衡指数,采用Logistic回归分析矿物质平衡指数与肥胖之间的风险关系;分析三大供能物质三种比例模式和矿物质平衡指数的交互作用与肥胖之间的风险关系。结果碳水化合物、脂肪以及蛋白质的供能比进行三分位分层构建出27种组合,分别代表着人群膳食模式中三大供能物质的不同比例状态,其中频率最高三大供能物质比例结构为高碳水化合物、低脂肪、低蛋白摄食比例(称为高碳水化合物膳食结构)1583例,占16. 3%;其次为低碳水化合物、高脂肪、高蛋白比例(称为低碳水化合物膳食结构) 1580例,占16. 2%;第三位为碳水化合物、脂肪、蛋白质相对均衡比例(称为均衡膳食结构) 1122例,占11. 5%。与均衡膳食结构组相比,高碳水化合物膳食组和低碳水化合物膳食组均增加肥胖的患病风险且差异有统计学意义(P=0. 028),OR值与95%置信区间分别为1. 251(1. 017～1. 538)、1. 311(1. 069～1. 608)。矿物质平衡指数越小表示人群矿物质摄入量越接近推荐摄入量(参照2013年中国营养学会矿物质膳食推荐量),矿物质平衡指数越大表示人群矿物质摄入量与推荐摄入量偏差越大;将矿物质平衡指数绝对值四分位分组,与第一分位组相比,第二、三、四分位组均能增加肥胖的患病风险,OR值与95%置信区间分别为1. 221(1. 038～1. 435)、1. 233(1. 048～1. 450)、1. 179(1. 003～1. 388),P值为0. 050。矿物质平衡参数为正表示矿物质摄入量大于膳食推荐摄入量,矿物质平衡参数为负表示矿物质摄入量小于膳食推荐摄入量,筛选出每种矿物质参数均为正值的人群,将矿物质正平衡指数四分位分组,与第一分位组相比,第三、四分位组均能增加肥胖的患病风险,OR值与95%置信区间分别为1. 221(1. 038～1. 435)、1. 233(1. 048～1. 450)、1. 179 (1. 003～1. 388),P值为0. 050。碳水化合物、蛋白质和脂肪的三种比例膳食结构与矿物质平衡指数的交互作用也会影响肥胖的患病风险,与均衡膳食合并矿物质平衡指数第一分位组相比,高碳水化合物膳食结构合并矿物质平衡指数第四分位组、低碳水化合物膳食结构合并矿物质平衡指数第二、三分位组均能增加肥胖的患病风险,OR值与95%置信区间分别为1. 352(1. 083～1. 687)、1. 319(1. 000～1. 742)、1. 540 (1. 143～2. 076),P值为0. 037。结论人群膳食中存在三大供能物质不同的比例状态,其摄入不均衡显著增加肥胖的患病风险;矿物质摄入不均衡的营养状态同样会显著增加肥胖的患病风险。值得注意的是,即使是在矿物质均充足的情况下,其不均衡的比例也会增加肥胖的患病风险;与三大供能物质及矿物质摄入比例相对均衡组相比,其摄入不均衡会进一步增加肥胖的风险。矿物质作为整体在对肥胖产生影响的同时,受三大供能物质膳食结构的影响。更多还原

【Abstract】 OBJECTIVE To explore the effect of the overall nutritional status of minerals( Ca,P,K,Na,Mg,Fe,Zn,Se,Cu,Mn,I) on obesity under the different proportions of three energy-supplying substances in the diet of the population. METHODS Population monitoring data( a total of 9734 cases aged 20-74 years old) from the crosssection of diet,nutrition and non-communicable chronic diseases in Harbin in 2012( stratified random sampling method was adopted) were selected. Questionnaire and 24-hour dietary information were conducted by trained professionals. Height,weight and waist circumference were measured by uniform standard measurement method; The energy supply ratio of carbohydrate,fat and protein was calculated and a three-point stratification was carried out to construct different proportion patterns of the three energy-supplying nutrients. Logistic regression was used to analyze the risk relationship between the proportion patterns with the top 3 highest frequency and obesity. Energy density method was used for energy correction of Ca,P,K,Na,Mg,Fe,Zn,Se,Cu,Mn and I.Mineral equilibrium index was constructed with Se as reference,and Logistic regression was used to analyze the risk relationship between mineral equilibrium index and obesity.To analyze the relationship between the interaction of three proportions of three energy-supplying substances and the mineral balance index and the risk of obesity. RESULTS The energy supply ratio of carbohydrate,fat and protein was stratified in a third and 27 combinations were constructed,respectively representing the different proportions of the three energy-supplying substances in the dietary pattern of the population. The proportion of high carbohydrate,low fat and low protein( known as the dietary structure of low fat)was 1583 cases,accounting for 16. 3% of the total population.Secondly,the proportion of low-carbohydrate,high-fat and high-protein( called high-fat diet structure) was 1580 cases,accounting for 16. 2% of the total number. The third was the relative balanced proportion of carbohydrate,fat and protein( called balanced diet structure) in 1122 cases,accounting for 11. 5% of the total population. Compared with the balanced diet group,both the low fat diet group and the high fat diet group increased the risk of obesity and had statistical significance. OR value and 95% confidence interval were 1. 251( 1. 017-1. 538),1. 311( 1. 069-1. 608),respectively,the P value was 0. 028. The smaller the absolute value of mineral balance index was,the closer the population ’s mineral intake was to the recommended intake( refer to the recommended amount of mineral diet of China nutrition association in 2013). The larger the absolute value of mineral balance index was,the greater the deviation between the population ’ s mineral intake and the recommended intake was. When the absolute quartile of the mineral balance index was grouped,the risk of obesity was increased in the second,third and fourth quartile groups compared with the first quartile group. OR value and 95% confidence interval were 1. 221( 1. 038-1. 435),1. 233( 1. 048-1. 450),1. 179( 1. 003-1. 388),respectively,P value was 0. 050. A positive mineral balance index indicated that the mineral intake was greater than the recommended dietary intake,and a negative mineral balance index indicated that the mineral intake was less than the recommended dietary intake. The population with positive values of each mineral was screened and divided into four groups. Compared with the first group,the third and fourth groups could increase the risk of obesity. The OR value and 95% confidence interval were 1. 221( 1. 038-1. 435),1. 233( 1. 048-1. 450),1. 179( 1. 003-1. 388),respectively,P value was 0. 050.Carbohydrate, protein and fat dietary structure, the proportion of three kinds of interactions with mineral balance index also affected the risk of obesity,the first points of the minerals in combination with balanced diet balance index,compared to a set of low fat diet combined mineral balance index of 4 points a,with high fat diet and mineral balance index points 2 and 3 a group can increase the risk of obesity,the OR value and 95%confidence interval were 1. 352( 1. 083-1. 687),1. 319( 1. 000-1. 742),1. 540( 1. 143-2. 076),the P value was 0. 037. CONCLUSION There are different proportions of energy-supplying nutrients in the diet of the population,and the imbalance of intake significantly increases the risk of obesity. Mineral intake of unbalanced nutritional status will also significantly increase the risk of obesity. It is important to note that even when minerals are abundant,the imbalance increases the risk of obesity. An imbalance in intake of energy and minerals further increases the risk of obesity,compared with the three groups in which energy and mineral intake are relatively balanced. As a whole,minerals are affected by the dietary structure of three major energy-supplying substances while influencing obesity.更多还原