健康人群中膳食营养素摄入与血糖及胰岛素抵抗相关性分析

doi:10.3969/j.issn.1004-583X.2023.02.005

摘要/Abstract

摘要：

目的探讨人群中不同膳食营养素摄入与血糖及胰岛素抵抗之间的相关性。方法基于中国健康与营养调查数据,通过ID匹配基本人口学资料与血清学检测结果,纳入1 376名健康人群数据,分析不同营养素摄入组间空腹血糖差异及与胰岛素抵抗指标相关性。结果糖尿病前期与糖尿病组总胆固醇、甘油三酯、低密度脂蛋白胆固醇(LDL-C)及血尿酸明显升高,糖尿病组升高更为显著,差异具有统计学意义(均P<0.05)。脂肪摄入量最高四分位组较摄入最低四分位组的空腹血糖显著升高(5.38±1.34 vs 5.06±1.10 mmol/L, P=0.017);空腹血糖与脂肪摄入量呈显著正相关(r=0.1122, P<0.01),而与碳水化合物和蛋白摄入量之间无相关性(均P>0.05)。此外,脂肪摄入还与胰岛素抵抗指标HOMA-IR正相关(r=0.0525, P=0.051),而与胰岛素敏感性指标HOMA-IS及β细胞功能指标HOMA-β负相关(r=-0.0520, P=0.053; r=-0.0681, P=0.011)。结论健康人群膳食中脂肪摄入与血糖升高及机体胰岛素抵抗的发生相关,具体机制有待进一步探究。

关键词: 糖尿病, 空腹血糖受损, 膳食营养素, 胰岛素抵抗, 脂肪摄入

Abstract:

Objective To explore the correlation between the intake of different dietary nutrients with fasting blood glucose (FBG) and insulin resistance (IR). Methods Based on the data of the China Health and Nutrition Survey(CHNS), the data of 1 376 samples were included by matching the basic demographic data and serological test results with ID. The differences in fasting blood glucose of people with different nutrient intake groups, and their correlation with IR indexes were analyzed. Results Serum total cholesterol, triglyceride, LDL-C and serum uric acid in prediabetes group and diabetic group significantly increased, especially in the latter group (P<0.05). FBG was significantly higher in the highest quartile of fat intake group than that in the lowest quartile of fat intake group (5.38±1.34 vs 5.06±1.10 mmol/L, P=0.017). It was positively correlated with fat intake (r=0.1122, P<0.01), but not correlated with carbohydrate and protein intake (both P>0.05). In addition, fat intake was correlated with Homeostatic model assessment of insulin resistance(HOMA-IR) (r=0.0525, P =0.051), and negatively correlated with the Homeostatic model assessment of insulin sensitivity (HOMA-IS) (r=-0.0520, P=0.053) and Homeostasis model assessment for beta-cell function (HOMA-β) (r=-0.0681, P=0.011). Conclusion Fat intake is closely correlated with the increased FBG and IR in healthy population, although the specific mechanism needs to be further explored.

Key words: diabetes mellitus, impaired fasting glucose, dietary nutrients, insulin resistance, fat intake

中图分类号:

R589.2

韩拓, 王丽霞, 王怡雯, 李盈, 巩红, 张春艳, 张岩, 李永勤, 王聪霞. 健康人群中膳食营养素摄入与血糖及胰岛素抵抗相关性分析[J]. 临床荟萃, 2023, 38(2): 126-131.

Han Tuo, Wang Lixia, Wang Yiwen, Li Ying, Gong Hong, Zhang Chunyan, Zhang Yan, Li Yongqin, Wang Congxia. Correlation analysis between dietary nutrient intake with blood glucose and insulin resistance in healthy population[J]. Clinical Focus, 2023, 38(2): 126-131.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.02.005

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I2/126

图/表 5

表1 3组临床资料比较

Tab. 1 Comparison of clinical characteristics between groups

项目	健康对照组( $n$ =906)	糖尿病前期组( $n$ =373)	糖尿病组( $n$ =97)	$F$ /χ²值	$P$ 值
性别(女)[例(%)]	537(59.3)	218(58.4)	48(49.5)	3.455	0.178
年龄(岁)	35.8±17.3	46.5±18.3^*	55.1±15.0^*#	89.226	<0.01
红细胞计数(×10¹²/L)	4.71±0.65	4.76±0.64	4.81±0.66	1.523	0.218
血红蛋白(g/L)	138.42±19.12	139.74±19.96	142.95±20.55^*	2.643	0.072
谷丙转氨酶(U/L)	19.41±16.91	23.27±18.93^*	29.72±27.74^*#	16.992	<0.01
白蛋白(g/L)	47.41±3.75	47.28±3.36	47.06±3.28	0.525	0.592
血肌酐(μmol/L)	81.19±17.04	83.86±17.69^*	89.29±21.24^*#	10.836	<0.01
尿素氮(mmol/L)	4.89±1.43	5.31±1.62^*	5.80±1.76^*#	22.763	<0.01
血尿酸(mg/dL)	291.24±95.53	304.09±102.37	370.41±242.55^*#	21.459	<0.01
总胆固醇(mmol/L)	4.56±.97	4.96±1.09*	5.47±1.11^*#	47.512	<0.01
三酰甘油(mmol/L)	1.41±1.16	1.65±.34^*	3.49±3.49^*#	85.621	<0.01
HDL-C(mmol/L)	1.45±0.42	1.39±0.35	1.36±1.50	2.553	0.078
LDL-C(mmol/L)	2.74±0.96	3.10±1.00^*	3.05±1.18^*	19.698	<0.01
FBG(mmol/L)	4.85±0.53	5.29±0.67^*	8.45±3.07^*#	47.512	<0.01
空腹胰岛素(mU/L)	12.83±20.48	15.87±13.72^*	25.51±41.95^*#	16.622	<0.01
HbA₁c(%)	5.19±0.33	5.86±0.29^*	7.53±1.83^*#	797.385	<0.01
总能量摄入(kCal/d)	1977.98±604.32	2006.72±596.79	2137.04±1069.13^*	2.715	0.067
碳水化合物(g/d)	272.27±96.45	274.80±96.71	270.04±106.80	0.131	0.877
脂肪摄入(g/d)	69.67±33.08	70.80±34.27	86.80±96.64^*#	7.614	0.001
蛋白摄入(g/d)	63.56±22.96	65.57±21.23	67.31±24.10	1.927	0.146

表1 3组临床资料比较

Tab. 1 Comparison of clinical characteristics between groups

项目	健康对照组( $n$ =906)	糖尿病前期组( $n$ =373)	糖尿病组( $n$ =97)	$F$ /χ²值	$P$ 值
性别(女)[例(%)]	537(59.3)	218(58.4)	48(49.5)	3.455	0.178
年龄(岁)	35.8±17.3	46.5±18.3^*	55.1±15.0^*#	89.226	<0.01
红细胞计数(×10¹²/L)	4.71±0.65	4.76±0.64	4.81±0.66	1.523	0.218
血红蛋白(g/L)	138.42±19.12	139.74±19.96	142.95±20.55^*	2.643	0.072
谷丙转氨酶(U/L)	19.41±16.91	23.27±18.93^*	29.72±27.74^*#	16.992	<0.01
白蛋白(g/L)	47.41±3.75	47.28±3.36	47.06±3.28	0.525	0.592
血肌酐(μmol/L)	81.19±17.04	83.86±17.69^*	89.29±21.24^*#	10.836	<0.01
尿素氮(mmol/L)	4.89±1.43	5.31±1.62^*	5.80±1.76^*#	22.763	<0.01
血尿酸(mg/dL)	291.24±95.53	304.09±102.37	370.41±242.55^*#	21.459	<0.01
总胆固醇(mmol/L)	4.56±.97	4.96±1.09*	5.47±1.11^*#	47.512	<0.01
三酰甘油(mmol/L)	1.41±1.16	1.65±.34^*	3.49±3.49^*#	85.621	<0.01
HDL-C(mmol/L)	1.45±0.42	1.39±0.35	1.36±1.50	2.553	0.078
LDL-C(mmol/L)	2.74±0.96	3.10±1.00^*	3.05±1.18^*	19.698	<0.01
FBG(mmol/L)	4.85±0.53	5.29±0.67^*	8.45±3.07^*#	47.512	<0.01
空腹胰岛素(mU/L)	12.83±20.48	15.87±13.72^*	25.51±41.95^*#	16.622	<0.01
HbA₁c(%)	5.19±0.33	5.86±0.29^*	7.53±1.83^*#	797.385	<0.01
总能量摄入(kCal/d)	1977.98±604.32	2006.72±596.79	2137.04±1069.13^*	2.715	0.067
碳水化合物(g/d)	272.27±96.45	274.80±96.71	270.04±106.80	0.131	0.877
脂肪摄入(g/d)	69.67±33.08	70.80±34.27	86.80±96.64^*#	7.614	0.001
蛋白摄入(g/d)	63.56±22.96	65.57±21.23	67.31±24.10	1.927	0.146

图1 不同膳食营养素组间空腹血糖比较及相关性

Fig. 1 Comparison and correlation analysis of FBG between dietary nutrient groups

图2 性别亚组中不同营养素组间空腹血糖比较与相关性分析

Fig. 2 Comparison and correlation analysis of FBG in gender subgroups

图3 不同营养素与胰岛素抵抗指标相关性分析

Fig. 3 Correlation analysis between different nutrients uptake and insulin resistance indexes

图4 同营养素与胰岛素之间相关性分析

Fig. 4 Correlation analysis between the same nutrients and insulin levels

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