膳食与代谢综合征和抑郁症的人群关联分析及干预研究
文献类型：学位论文
| 作者 | 张赓 |
| 学位类别 | 博士 |
| 答辩日期 | 2012-05 |
| 授予单位 | 中国科学院上海生命科学研究院营养科学研究所 |
| 授予地点 | 中国科学院上海生命科学研究院 |
| 导师 | 林旭 |
| 关键词 | 糙米 代谢综合征 硫胺素 n-3脂肪酸 抑郁症 |
| 其他题名 | Population Association and Intervention Studies of Diet, Metabolic Syndrome and Depression |
| 学位专业 | 生物化学与分子生物学 |
| 中文摘要 | 研究背景： 随着我国经济建设的迅猛发展以及居民生活方式的巨大变迁，肥胖及其相关慢性代谢性疾病和心理障碍已成为威胁我国人民健康的主要因素，给家庭和社会都造成了沉重的负担。已有相当多的研究表明，膳食在代谢性以及心理疾病的发生发展过程中起着重要的作用。但是，过往的研究大多采用食物频率问卷的方式收集膳食摄入信息，其准确性常常受制于研究对象回忆的可信度、食物成分表的完整性以及营养素含量的地区差异等因素。营养素的生物标记物相比前者能更客观地反映研究对象的膳食摄入水平，继而可以更好地探讨营养素状况与疾病的关系。而我国在相关领域的研究还很缺乏。另外，前瞻性研究发现过高的精白米摄入能够增加2型糖尿病的罹患风险，而糙米摄入则能够降低2型糖尿病的发病风险。但是该结论从未在随机化对照临床干预中进行过验证。 研究目的： 1） 论证在中国开展糙米对2型糖尿病风险的营养干预研究的可行性，并评估糙米对2型糖尿病患者及其高危人群的多项代谢指标的影响； 2） 分析红细胞硫胺素浓度与抑郁症的相关性； 3） 探讨红细胞膜n-3脂肪酸组成与代谢综合征及其组分的关联关系。 研究方法： 1） 我们招募了32名上海市成年居民，围绕公众对糙米的了解和接受程度以及对糙米营养干预的看法进行了问卷调查和焦点小组讨论。随后的糙米对2型糖尿病患者及其高危人群的营养干预是一项随机化对照临床研究，并采用平行设计方案，干预周期为16周。我们把招募到的202名志愿者随机分配至白米组或糙米组。在干预阶段的开始和结束时，分别进行一次基本生活方式信息（如饮食、体力活动等）收集、体格检查（包括体重、腰围、血压等指标）、和空腹血液的采集。血糖、血脂和糖化血红蛋白采用自动生化分析仪检测，胰岛素采用ELISA方法检测； 2） 我们运用高效液相色谱的方法检测了1587名50~70岁来自北京和上海的城乡居民的红细胞中游离硫胺素、硫胺素单磷酸酯和硫胺素焦磷酸酯的浓度。抑郁症的诊断采用流行病学抑郁量表评分的标准； 3） 我们利用高效液相色谱-质谱联用系统检测了2754名50~70岁来自北京和上海的城乡居民的红细胞膜脂肪酸构成比例。代谢综合征的诊断采用美国国家胆固醇教育计划成人治疗组第三次报告针对亚裔人群修订的标准。 研究结果： 1） 大多数项目参加者（30/32）每天都食用精白米。只有8人曾经尝试过糙米。在食用糙米之前，大多数人认为糙米在口感和品质方面不如精白米。然而，在品尝和了解糙米的营养价值后，大多数人表达了今后愿意食用糙米的想法。参加者认为阻碍糙米推广的主要因素包括口感粗糙、口味较差和价格过高。所有参加者都建议加大宣传力度以扭转公众对于糙米的固有印象。此外，绝大多数参加者（27/32）表达了参加今后长期糙米干预的意愿。营养干预16周后，绝大多数代谢风险指标（体质指数、腰围、血压、糖化血红蛋白、血脂、血糖、胰岛素）的前后变化在两组间都没有显著差异。只有低密度脂蛋白胆固醇的降低程度在白米组中更大（P = 0.02），而且这一现象只局限于糖尿病人群中（n = 47）。此外，我们还计算了基线时符合但是接受干预16周后不再符合代谢综合征及其组分标准的参加者的比例，并把他们定义为逆转的代谢综合征及其组分。其中高密度脂蛋白胆固醇偏低的逆转率在糙米组（14.9%）和白米组（6.9%）之间的差异呈现边缘性显著（P = 0.07）。而在糖尿病患者中，我们还观察到糙米相对于白米能够降低舒张压（P = 0.02）； 2） 红细胞中游离硫胺素、硫胺素单磷酸酯和硫胺素焦磷酸酯的平均浓度分别为4.71、3.91和174.87 nmol/L。抑郁症的患病率为11.3%。在控制了社会人口统计学、生活方式和膳食因素以及体质指数后，与游离硫胺素、硫胺素单磷酸酯和硫胺素焦磷酸酯最高的四分位数组相比，最低组的比值比分别为2.97（95% CI: 1.87~4.72; 趋势P值< 0.001）、3.46（95% CI: 1.99~6.02; 趋势P值< 0.001）和1.98（95% CI: 1.22~3.21; 趋势P值= 0.002）； 3） 四种n-3脂肪酸——二十二碳六烯酸、二十二碳五烯酸、二十碳五烯酸和α-亚麻酸占红细胞膜脂肪酸的比例中位数值分别为4.40%，1.72%，0.42%和0.25%。在调整了多个混杂因素（年龄、性别、地域、生活方式、膳食、体质指数、炎性因子等）后，二十二碳六烯酸与代谢综合征[比值比（95%置信区间）：0.75 (0.55, 1.01), 趋势P值= 0.04]以及其中的两个组分——血压偏高[比值比（95%置信区间）：0.70 (0.53, 0.92), 趋势P值= 0.01]和甘油三酯偏高[比值比（95%置信区间）：0.64 (0.48, 0.87), 趋势P值= 0.005]负相关。相反的是，α-亚麻酸则与代谢综合征正相关[比值比（95%置信区间）：4.06 (2.85, 5.80), 趋势P值< 0.001]。 结论： 1） 首次探究了公众对糙米的了解和接受程度，为今后糙米营养干预的项目设计以及强化对糙米健康作用的认识提供了重要的理论依据。此外，16周的糙米干预并不能显著改善多种代谢风险因子。今后还需要样本量更大、周期更长的干预研究对不同品种的糙米在2型糖尿病防治中的作用进行详尽细致的考查； 2） 首次在较大规模的一般人群中发现，相对较差的红细胞硫胺素营养状况与较高的抑郁症患病率显著且独立相关； 3） 在中国中老年人群中红细胞膜二十二碳六烯酸含量越高，代谢综合征的比值比越低；而α-亚麻酸含量则与代谢综合征正相关。 |
| 索取号 | D2012-025 |
| 英文摘要 | Background Paralleling the rapid economic development and dramatic lifestyle transition, obesity and its related chronic metabolic diseases as well as mental disorder have become major health challenges and resulted in serious burdens for China. A series of studies have showed that diet plays an important role in the development of metabolic and mental diseases. However, the most previous studies utilized self-reported food frequency questionnaires to evaluate dietary intake, which might be affected by measurement error due to inaccurate recall, an incomplete food composition database, and likely regional variation in nutrient contents. On the other hand, nutrient biomarkers can objectively reflect nutrient intake, especially for those human body cannot synthesize de novo, and thus can be used to better investigate the relationship between nutrition status and disease. However, the related researches are scarce in China. In addition, prospective studies have indicated that higher white rice (WR) consumption is associated with increased risk of type 2 diabetes, while brown rice (BR) has been suggested to be associated with a lower risk. However, the effect of brown rice on metabolic risk factors for diabetes has not been tested in a randomized controlled trial. Objectives 1) To assess the awareness and acceptability of BR in Chinese adults, examine the feasibility of introducing BR into the diet via a large, long-term randomized clinical trial to lower risk of type 2 diabetes, and determine the effects of substituting BR for WR on blood markers for diabetes risk in middle-aged Chinese men and women; 2) To investigate associations between erythrocyte thiamine concentrations and depressive symptoms among middle-aged and older Chinese men and women; 3) To evaluate associations between erythrocyte n-3 fatty acids and metabolic syndrome (MetS) as well as its components among middle-aged and older Chinese men and women. Methods 1) Thirty-two Chinese adults residing in Shanghai participated in this quantitative and qualitative study using questionnaires and focus group discussions. A total of 202 middle-aged adults with diabetes or a high risk for diabetes were randomly assigned to a WR (n = 101) or BR group (n = 101) and consumed the rice ad libitum for 16 wk. Metabolic risk markers, including body mass index (BMI), waist circumference, blood pressure, glycated hemoglobin, and serum lipid, glucose, and insulin concentrations were measured before and after the intervention; 2) Concentrations of free thiamine and its phosphate esters (thiamine monophosphate [TMP] and thiamine diphosphate [TDP]) in erythrocytes were measured by high-performance liquid chromatography among 1587 Chinese men and women aged 50 to 70 yr. Depressive symptoms were defined as a Center for Epidemiological Studies of Depression Scale (CES-D) score of 16 or higher; 3) Erythrocyte levels of docosahexaenoic acid (DHA), docosapentaenoic acid (DPA), eicosapentaenoic acid (EPA), and α-linolenic acid (ALA) were measured by gas chromatography among 2754 participants aged 50 to 70 yr living in Beijing and Shanghai. MetS was defined using the updated National Cholesterol Education Program Adult Treatment Panel III criteria for Asian-Americans. Results 1) Most participants (30 out of 32) consumed WR daily and only a few (n=8) had previously tried BR. Prior to tasting, most participants considered BR inferior to WR in terms of taste and quality. However, after tasting BR and learning about its nutritional value, the majority indicated greater willingness to consume BR. Main barriers to acceptance were the perception of rough texture and unpalatable taste as well as higher price. All participants suggested that large-scale promotion was needed to change societal attitudes towards BR. In addition, most participants (27 out of 32) expressed willingness to participate in a future long-term BR intervention study. Over the course of the intervention, no between-group differences were found for any markers except the serum LDL cholesterol concentration, which decreased more in the WR group compared to the BR group (P = 0.02). However, this effect was only observed among participants with diabetes (n = 47). The reversion rate of reduced serum HDL cholesterol was marginally higher in the BR group (14.9%) than the WR group (6.9%) (P = 0.07). Among participants with diabetes, a greater reduction in diastolic blood pressure was observed in the BR group compared to the WR group (P = 0.02); 2) The mean erythrocyte concentrations of free thiamine, TMP, and TDP were 4.71, 3.91 and 174.87 nmol/L, respectively. The prevalence of depressive symptoms was 11.3% in the study population. After adjustment for socio-demographic, lifestyle and diet factors, and BMI, the odds ratios (ORs) for depressive symptoms were 2.97 (95% confidence interval [CI] = 1.87 to 4.72; P for trend < 0.001) for free thiamine, 3.46 (95% CI = 1.99 to 6.02; P for trend < 0.001) for TMP, and 1.98 (95% CI = 1.22 to 3.21; P for trend = 0.002) for TDP comparing the lowest with the highest quartiles; 3) DHA, DPA, EPA and ALA accounted for 4.40, 1.72, 0.42 and 0.25 percentages of total fatty acids in erythrocytes, respectively. After multivariable adjustment, higher levels of DHA, but neither EPA nor DPA, were associated with lower odds of MetS, as well as elevated blood pressure and triglycerides. Comparing extreme quartiles of DHA, ORs (95% CI) were 0.75 (0.55, 1.01; P for trend = 0.04) for MetS, 0.70 (0.53, 0.92; P for trend = 0.01) for elevated blood pressure, and 0.64 (0.48, 0.87; P for trend = 0.005) for elevated triglycerides. In contrast, ALA concentrations were positively associated with MetS odds (OR: 4.06; 95% CI: 2.85, 5.80; P for trend < 0.001). Conclusions 1) These results provide valuable information for the design of the future BR intervention trial and highlight the importance of increasing awareness about the nutritional value of BR. Incorporating BR into the daily diet for 16 wk did not substantially improve metabolic risk factors. Further studies with larger sample sizes, longer durations of follow-up, and different varieties of rice are needed to carefully examine the role of BR in the prevention and management of diabetes; 2) Poor erythrocyte thiamine status was significantly and independently associated with a higher prevalence of depressive symptoms in middle-aged and elderly Chinese population. Further prospective or intervention studies are warranted to establish their roles in the development of depressive symptoms; 3) Higher concentrations of erythrocyte DHA were associated with lower odds of MetS, whereas higher concentrations of ALA were associated with increased odds among middle-aged and older Chinese. These findings warrant replication in other populations. |
| 语种 | 中文 |
| 公开日期 | 2015-12-24 |
| 源URL | [http://202.127.25.144/handle/331004/264]  |
| 专题 | 中国科学院上海生命科学研究院营养科学研究所_人类营养与疾病研究组 |
| 推荐引用方式 GB/T 7714 | 张赓. 膳食与代谢综合征和抑郁症的人群关联分析及干预研究[D]. 中国科学院上海生命科学研究院. 中国科学院上海生命科学研究院营养科学研究所. 2012. |
入库方式： OAI收割
来源：上海营养与健康研究所
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